[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8200 Introduced in House (IH)]
<DOC>
116th CONGRESS
2d Session
H. R. 8200
To improve the health of minority individuals during the COVID-19
pandemic, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 11, 2020
Ms. Kelly of Illinois (for herself, Ms. Bass, Mr. Castro of Texas, Ms.
Judy Chu of California, Mr. Garcia of Illinois, Ms. Haaland, Ms. Lee of
California, Mr. Soto, Ms. Sewell of Alabama, Mr. Butterfield, Mr.
Sablan, Ms. Barragan, Ms. Clarke of New York, Mr. Cardenas, Mr.
Sarbanes, Ms. Pressley, Mr. Thompson of Mississippi, Ms. Escobar, Mr.
Brendan F. Boyle of Pennsylvania, Mr. Carson of Indiana, Mr. Clay, Mrs.
Beatty, Mr. Khanna, Ms. Garcia of Texas, Mr. San Nicolas, Mr.
Espaillat, Ms. Jayapal, Mrs. Demings, Mr. Hastings, Mrs. Watson
Coleman, Ms. Johnson of Texas, Mr. Grijalva, Ms. Bonamici, and Mr.
Lynch) introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Ways and Means, the Judiciary, Transportation and Infrastructure,
Education and Labor, Agriculture, Natural Resources, House
Administration, Oversight and Reform, the Budget, and Small Business,
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 during the COVID-19
pandemic, 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 ``Ending Health Disparities During
COVID-19 Act of 2020'' or the ``EHDC Act of 2020''.
SEC. 2. TABLE OF CONTENTS.
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I--RACIAL AND ETHNICITY DATA COLLECTION
Subtitle A--Collection and Reporting
Sec. 101. Equitable data collection and disclosure on COVID-19 Act.
Sec. 102. COVID-19 reporting portal.
Sec. 103. Regular CDC reporting on demographic data.
Sec. 104. Amendment to the Public Health Service Act.
Sec. 105. Elimination of prerequisite of direct appropriations for data
collection and analysis.
Sec. 106. Collection of data for the Medicare program.
Sec. 107. Revision of HIPAA claims standards.
Sec. 108. Disparities data collected by the Federal Government.
Sec. 109. Standards for measuring sexual orientation, gender identity,
and socioeconomic status in collection of
health data.
Sec. 110. Improving health data regarding Native Hawaiians and other
Pacific Islanders.
Subtitle B--Improvements and Modernization
Sec. 121. Federal modernization for health inequities data.
Sec. 122. Modernization of State and local health inequities data.
Sec. 123. Additional reporting to Congress on the race and ethnicity
rates of COVID-19 testing,
hospitalizations, and mortalities.
TITLE II--EQUITABLE TESTING AND TRACING
Subtitle A--Free Testing for Patients
Sec. 201. Sooner coverage of testing for COVID-19.
Subtitle B--National Testing Strategy
Sec. 211. COVID-19 testing strategy.
Sec. 212. Coronavirus immigrant families protection.
Sec. 213. ICE detention.
Subtitle C--Contact Tracing
Sec. 221. COVID-19 Testing, reaching, and contacting everyone.
Sec. 222. National system for COVID-19 testing, contact tracing,
surveillance, containment, and mitigation.
Sec. 223. Grants.
Sec. 224. Grants to State and Tribal workforce agencies.
TITLE III--FREE TREATMENT FOR ALL AMERICANS
Sec. 301. Coverage at no cost sharing of COVID-19 vaccine and
treatment.
Sec. 302. Optional coverage at no cost sharing of COVID-19 treatment
and vaccines under Medicaid for uninsured
individuals.
Sec. 303. Coverage of treatments for COVID-19 at no cost sharing under
the Medicare Advantage program.
Sec. 304. Requiring coverage under Medicare PDPS and MA-PD plans,
without the imposition of cost sharing or
utilization management requirements, of
drugs intended to treat COVID-19 during
certain emergencies.
Sec. 305. Coverage of COVID-19 related treatment at no cost sharing.
Sec. 306. Reimbursement for additional health services relating to
coronavirus.
TITLE IV--FEDERAL HEALTH EQUITY OVERSIGHT
Sec. 401. COVID-19 Racial and Ethnic Disparities Task Force Act of
2020.
Sec. 402. Protection of the HHS Offices of Minority Health.
Sec. 403. Establish an interagency counsel and grant programs on social
determinants of health.
Sec. 404. Accountability and transparency within the Department of
Health and Human Services.
TITLE V--EXPANDED INSURANCE ACCESS
Sec. 501. Medicare special enrollment period for individuals residing
in COVID-19 emergency areas.
Sec. 502. Special enrollment period through exchanges; Federal exchange
outreach and educational activities.
Sec. 503. MOMMA's Act.
Sec. 504. Allowing for medical assistance under Medicaid for inmates
during 30-day period preceding release.
Sec. 505. Providing for immediate Medicaid eligibility for former
foster youth.
Sec. 506. Expanded coverage for former foster youth.
Sec. 507. Removing citizenship and immigration barriers to access to
affordable health care under ACA.
Sec. 508. Medicaid in the territories.
Sec. 509. Removing Medicare barrier to health care.
Sec. 510. Removing barriers to health care and nutrition assistance for
children, pregnant persons, and lawfully
present individuals.
Sec. 511. Repeal of requirement for documentation evidencing
citizenship or nationality under the
Medicaid program.
TITLE VI--COMMUNITY BASED GRANTS
Sec. 601. Grants for racial and ethnic approaches to community health.
Sec. 602. Grants to promote health for underserved communities.
Sec. 603. Addressing COVID-19 health inequities and improving health
equity.
Sec. 604. Improving social determinants of health.
Sec. 605. Funding to States, localities, and community-based
organizations for emergency aid and
services.
Sec. 606. Supplemental nutrition assistance program.
TITLE VII--CULTURALLY AND LINGUISTICALLY COMPETENT CARE
Sec. 701. Ensuring standards for culturally and linguistically
appropriate services in health care.
Sec. 702. Culturally and linguistically appropriate health care in the
Public Health Service Act.
Sec. 703. Training tomorrow's doctors for culturally and linguistically
appropriate care: graduate medical
education.
Sec. 704. Federal reimbursement for culturally and linguistically
appropriate services under the Medicare,
Medicaid, and State Children's Health
Insurance Programs.
Sec. 705. Requirements for health programs or activities receiving
Federal funds.
Sec. 706. Report on Federal efforts to provide culturally and
linguistically appropriate health care
services.
Sec. 707. Health professions competencies to address racial and ethnic
mental health disparities.
Sec. 708. Study on the uninsured.
TITLE VIII--AID TO PROVIDERS SERVING MINORITY COMMUNITIES
Sec. 801. Temporary increase in Medicaid DSH allotments.
Sec. 802. COVID-19-related temporary increase of Medicaid FMAP.
Sec. 803. Appropriation for primary health care.
Sec. 804. Amendment to the Public Health Service Act.
Sec. 805. Pandemic premium pay for essential workers.
Sec. 806. COVID-19 Heroes Fund grants.
Sec. 807. Enforcement and outreach.
TITLE IX--HEALTH IT AND BRIDGING THE DIGITAL DIVIDE IN HEALTH CARE
Sec. 901. HRSA assistance to health centers for promotion of Health IT.
Sec. 902. Assessment of impact of Health IT on racial and ethnic
minority communities; outreach and adoption
of Health IT in such communities.
Sec. 903. Extending funding to strengthen the Health IT infrastructure
in racial and ethnic minority communities.
Sec. 904. 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. 905. Authorization of appropriations.
Sec. 906. Data collection and assessments conducted in coordination
with minority-serving institutions.
Sec. 907. Study of health information technology in medically
underserved communities.
Sec. 908. Study on the effects of changes to telehealth under the
Medicare and Medicaid programs during the
COVID-19 emergency.
Sec. 909. COVID-19 designation of immediate special authority of
spectrum for Tribes' emergency response in
Indian Country.
Sec. 910. Facilitating the provision of telehealth services across
State lines.
TITLE X--PUBLIC AWARENESS
Sec. 1001. Awareness campaigns.
Sec. 1002. Increasing understanding of and improving health literacy.
Sec. 1003. English for speakers of other languages.
Sec. 1004. Influenza, COVID-19, and pneumonia vaccination campaign.
TITLE XI--RESEARCH
Sec. 1101. Research and development.
Sec. 1102. CDC field studies pertaining to specific health inequities.
Sec. 1103. Expanding capacity for health outcomes.
Sec. 1104. Data collection and analysis grants to minority-serving
institutions.
Sec. 1105. Safety and effectiveness of drugs with respect to racial and
ethnic background.
Sec. 1106. GAO and NIH reports.
Sec. 1107. Health impact assessments.
Sec. 1108. Tribal funding to research health inequities including
COVID-19.
Sec. 1109. Research endowments at both current and former centers of
excellence.
TITLE XII--EDUCATION
Sec. 1201. Grants for schools of medicine in diverse and underserved
areas.
Sec. 1202. Amendment to the Public Health Service Act.
Sec. 1203. 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. 1204. Loan repayment program of Centers for Disease Control and
Prevention.
Sec. 1205. Study and report on strategies for increasing diversity.
Sec. 1206. Amendments to the Pandemic EBT Act.
TITLE XIII--PUBLIC HEALTH ASSISTANCE TO TRIBES
Sec. 1301. Appropriations for the Indian Health Service.
Sec. 1302. Improving State, local, and Tribal public health security.
Sec. 1303. Provision of items to Indian programs and facilities.
Sec. 1304. Health care access for urban native veterans.
Sec. 1305. Proper and reimbursed care for native veterans.
TITLE I--RACIAL AND ETHNICITY DATA COLLECTION
Subtitle A--Collection and Reporting
SEC. 101. EQUITABLE DATA COLLECTION AND DISCLOSURE ON COVID-19 ACT.
(a) Findings.--Congress makes the following findings:
(1) The World Health Organization (WHO) declared COVID-19 a
``Public Health Emergency of International Concern'' on January
30, 2020. By late March 2020, there have been over 470,000
confirmed cases of, and 20,000 deaths associated with, COVID-19
worldwide.
(2) In the United States, cases of COVID-19 have quickly
surpassed those across the world, and as of April 12, 2020,
over 500,000 cases and 20,000 deaths have been reported in the
United States alone.
(3) Early reporting on racial inequities in COVID-19
testing and treatment have renewed calls for the Centers for
Disease Control and Prevention and other relevant subagencies
within the Department of Health and Human Services to publicly
release racial and demographic information to better inform the
pandemic response, specifically in communities of color and in
Limited English Proficient (LEP) communities.
(4) The burden of morbidity and mortality in the United
States has historically fallen disproportionately on
marginalized communities (those who suffer the most from great
public health needs and are the most medically underserved).
(5) Historically, structures and systems, such as racism,
ableism and class oppression, have rendered affected
individuals more vulnerable to inequities and have prevented
people from achieving their optimal health even when there is
not a crisis of pandemic proportions.
(6) Significant differences in access to health care,
specifically to primary health care providers, health care
information, and greater perceived discrimination in health
care place communities of color, individuals with disabilities,
and LEP individuals at greater risk of receiving delayed, and
perhaps poorer, health care.
(7) Stark racial inequities across the United States,
including unequal access to stable housing, quality education,
and decent employment significantly impact the ability of
individuals to take care of their most basic health needs.
Communities of color are more likely to experience homelessness
and struggle with low-paying jobs or unemployment. To date,
experts have cited that 2 in 5 Latino residents in New York
City, the current epicenter of the COVID-19 pandemic, are
recently unemployed as a direct consequence of COVID-19. And at
a time when sheltering in place will save lives, less than 1 in
5 Black workers and roughly 1 in 6 Latino workers are able to
work from home.
(8) Communities of color experience higher rates of chronic
disease and disabilities, such as diabetes, hypertension, and
asthma, than non-Hispanic White communities, which predisposes
them to greater risk of complications and mortality should they
contract COVID-19.
(9) Such communities are made even more vulnerable to the
uncertainty of the preparation, response, and events
surrounding the pandemic public health crisis, COVID-19. For
instance, in the recent past, multiple epidemiologic studies
and reviews have reported higher rates of hospitalization due
to the 2009 H1N1 pandemic among the poor, individuals with
disabilities and preexisting conditions, those living in
impoverished neighborhoods, and individuals of color and ethnic
backgrounds in the United States. These findings highlight the
urgency to adapt the COVID-19 response to monitor and act on
these inequities via data collection and research by race and
ethnicity.
(10) Research experts recognize that there are underlying
differences in illness and death when each of these factors are
examined through socioeconomic and racial or ethnic lenses.
These socially determinant factors of health accelerate disease
and degradation.
(11) Language barriers are highly correlated with
medication noncompliance and inconsistent engagement with
health systems. Without language accessibility data and
research around COVID-19, these communities are less likely to
receive critical testing and preventive health services. Yet,
to date, the Centers for Disease Control and Prevention do not
disseminate COVID-19 messaging in critical languages, including
Mandarin Chinese, Spanish, and Korean within the same timeframe
as information in English despite requirements to ensure
limited English proficient populations are not discriminated
against under title VI of the Civil Rights Act of 1964 and
subsequent laws and Federal policies.
(12) Further, it is critical to disaggregate data further
by ancestry to address disparities among Asian American, Native
Hawaiian, and Pacific Islander groups. According to the
National Equity Atlas, while 13 percent of the Asian population
overall lived in poverty in 2015, 39 percent of Burmese people,
29 percent of Hmong people, and 21 percent of Pacific Islanders
lived in poverty.
(13) Utilizing disaggregation of enrollment in Affordable
Care Act-sponsored health insurance, the Asian and Pacific
Islander American Health Forum found that prior to the passage
of the Patient Protection and Affordable Care Act (Public Law
111-148), Korean Americans had a high uninsured rate of 23
percent, compared to just 12 percent for all Asian Americans.
Developing targeted outreach efforts assisted 1,000,000 people
and resulted in a 56-percent decrease in the uninsured among
the Asian, Native Hawaiian, and Pacific Islander population.
Such efforts show that disaggregated data is essential to
public health mobilizations efforts.
(14) Without clear understanding of how COVID-19 impacts
marginalized racial and ethnic communities, there will be
exacerbated risk of endangering the most historically
vulnerable of our Nation.
(15) The consequences of misunderstanding the racial and
ethnic impact of COVID-19 expound beyond communities of color
such that it would impact all.
(16) Race and ethnicity are valuable research and practice
variables when used and interpreted appropriately. Health data
collected on patients by race and ethnicity will boost and more
efficiently direct critical resources and inform risk
communication development in languages and at appropriate
health literacy levels, which resonate with historically
vulnerable communities of color.
(17) To date, there is no public standardized and
comprehensive race and ethnicity data repository of COVID-19
testing, hospitalizations, or mortality. The inconsistency of
data collection by Federal, State, and local health
authorities, and the inability to access data by public
research institutions and academic organizations, poses a
threat to analysis and synthesis of the pandemic impact on
communities of color. However, research and medical experts of
Historically Black Colleges and Universities, academic health
care institutions which are historically and geographically
embedded in minoritized and marginalized communities, generally
also possess rapport with the communities they serve. They are
well-positioned, as trusted thought leaders and health care
service providers, to collect data and conduct research toward
creating holistic solutions to remedy the inequitable impact of
this and future public health crises.
(18) Well-designed, ethically sound research aligns with
the goals of medicine, addresses questions relevant to the
population among whom the study will be carried out, balances
the potential for benefit against the potential for harm,
employs study designs that will yield scientifically valid and
significant data, and generates useful knowledge.
(19) The dearth of racially and ethnically disaggregated
data reflecting the health of communities of color underlies
the challenges of a fully informed public health response.
(20) Without collecting race and ethnicity data associated
with COVID-19 testing, hospitalizations, morbidities, and
mortalities, as well as publicly disclosing it, communities of
color will remain at greater risk of disease and death.
(b) Emergency Funding for Federal Data Collection on the Racial,
Ethnic, and Other Demographic Disparities of COVID-19.--To conduct or
support data collection on the racial, ethnic, and other demographic
implications of COVID-19 in the United States and its territories,
including support to assist in the capacity building for State and
local public health departments to collect and transmit racial, ethnic,
and other demographic data to the relevant Department of Health and
Human Services agencies, there is authorized to be appropriated--
(1) to the Centers for Disease Control and Prevention,
$12,000,000;
(2) to State, territorial, and Tribal public health
agencies, distributed proportionally based on the total
population of their residents who are enrolled in Medicaid or
who have no health insurance, $15,000,000;
(3) to the Indian Health Service, Indian Tribes and Tribal
organizations (as defined in section 4 of the Indian Self-
Determination and Education Assistance Act), and urban Indian
organizations (as defined in section 4 of the Indian Health
Care Improvement Act), $3,000,000;
(4) to the Centers for Medicare & Medicaid Services,
$5,000,000;
(5) to the Food and Drug Administration, $5,000,000;
(6) to the Agency for Healthcare Research and Quality,
$5,000,000; and
(7) to the Office of the National Coordinator for Health
Information Technology, $5,000,000.
(c) COVID-19 Data Collection and Disclosure.--
(1) Data collection.--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 and the Administrator of the Centers for
Medicare & Medicaid Services, shall make publicly available on
the website of the Centers for Disease Control and Prevention
data collected across all surveillance systems relating to
COVID-19, disaggregated by race, ethnicity, sex, age, primary
language, socioeconomic status, disability status, and county,
including the following:
(A) Data related to all COVID-19 testing, including
the number of individuals tested and the number of
tests that were positive.
(B) Data related to treatment for COVID-19,
including hospitalizations and intensive care unit
admissions.
(C) Data related to COVID-19 outcomes, including
total fatalities and case fatality rates (expressed as
the proportion of individuals who were infected with
COVID-19 and died from the virus).
(2) Application of standards.--To the extent practicable,
data collection under this subsection shall follow standards
developed by the Department of Health and Human Services Office
of Minority Health and be collected, analyzed, and reported in
accordance with the standards promulgated by the Assistant
Secretary for Planning and Evaluation under title XXXI of the
Public Health Service Act (42 U.S.C. 300kk et seq.).
(3) Timeline.--The data made available under this
subsection shall be updated on a daily basis throughout the
public health emergency.
(4) Privacy.--In publishing data under this subsection, the
Secretary shall take all necessary steps to protect the privacy
of individuals whose information is included in such data,
including--
(A) complying with privacy protections provided
under the regulations promulgated under section 264(c)
of the Health Insurance Portability and Accountability
Act of 1996; and
(B) protections from all inappropriate internal use
by an 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 inappropriate uses.
(5) Consultation with tribes.--The Indian Health Service
shall consult with Indian Tribes and confer with urban Indian
organizations on data collection and reporting.
(6) Report.--Not later than 60 days after the date on which
the Secretary certifies that the public health emergency
related to COVID-19 has ended, the Secretary shall make
publicly available a summary of the final statistics related to
COVID-19.
(7) Report.--Not later than 60 days after the date on which
the Secretary certifies that the public health emergency
related to COVID-19 has ended, the Department of Health and
Human Services shall compile and submit 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 a preliminary report--
(A) describing the testing, hospitalization,
mortality rates, and preferred language of patients
associated with COVID-19 by race and ethnicity; and
(B) proposing evidenced-based response strategies
to safeguard the health of these communities in future
pandemics.
(d) Commission on Ensuring Health Equity During the COVID-19 Public
Health Emergency.--
(1) In general.--Not later than 30 days after the date of
enactment of this Act, the Secretary shall establish a
commission, to be known as the ``Commission on Ensuring Health
Equity During the COVID-19 Public Health Emergency'' (referred
to in this subsection as the ``Commission'') to provide clear
and robust guidance on how to improve the collection, analysis,
and use of demographic data in responding to future waves of
the coronavirus.
(2) Membership and chairperson.--
(A) Membership.--The Commission shall be composed
of--
(i) the Director of the Centers for Disease
Control and Prevention;
(ii) the Director of the National
Institutes of Health;
(iii) the Commissioner of Food and Drugs;
(iv) the Administrator of the Federal
Emergency Management Agency;
(v) the Director of the National Institute
on Minority Health and Health Disparities;
(vi) the Director of the Indian Health
Service;
(vii) the Administrator of the Centers for
Medicare & Medicaid Services;
(viii) the Director of the Agency for
Healthcare Research and Quality;
(ix) the Surgeon General;
(x) the Administrator of the Health
Resources and Services Administration;
(xi) the Director of the Office of Minority
Health;
(xii) the Director of the Office of Women's
Health;
(xiii) the Chairperson of the National
Council on Disability;
(xiv) at least 4 State, local, territorial,
and Tribal public health officials representing
departments of public health, who shall
represent jurisdictions from different regions
of the United States with relatively high
concentrations of historically marginalized
populations, to be appointed by the Secretary;
and
(xv) racially and ethnically diverse
representation from at least 3 independent
experts with knowledge or field experience with
racial and ethnic disparities in public health
appointed by the Secretary.
(B) Chairperson.--The President of the National
Academies of Sciences, Engineering, and Medicine, or
designee, shall serve as the chairperson of the
Commission.
(3) Duties.--The Commission shall--
(A) examine barriers to collecting, analyzing, and
using demographic data;
(B) determine how to best use such data to promote
health equity across the United States and reduce
racial, Tribal, and other demographic disparities in
COVID-19 prevalence and outcomes;
(C) gather available data related to COVID-19
treatment of individuals with disabilities, including
denial of treatment for pre-existing conditions,
removal or denial of disability related equipment
(including ventilators and CPAP), and data on
completion of DNR orders, and identify barriers to
obtaining accurate and timely data related to COVID-19
treatment of such individuals;
(D) solicit input from public health officials,
community-connected organizations, health care
providers, State and local agency officials, and other
experts on barriers to, and best practices for,
collecting demographic data; and
(E) recommend policy changes that the data
indicates are necessary to reduce disparities.
(4) Report.--Not later than 60 days after the date of
enactment of this Act, and every 180 days thereafter until the
Secretary certifies that the public health emergency related to
COVID-19 has ended, the Commission shall submit a written
report of its findings and recommendations to Congress and post
such report on a website of the Department of Health and Human
Services. Such reports shall contain information concerning--
(A) how to enhance State, local, territorial, and
Tribal capacity to conduct public health research on
COVID-19, with a focus on expanded capacity to analyze
data on disparities correlated with race, ethnicity,
income, sex, age, disability status, specific
geographic areas, and other relevant demographic
characteristics, and an analysis of what demographic
data is currently being collected about COVID-19, the
accuracy of that data and any gaps, how this data is
currently being used to inform efforts to combat COVID-
19, and what resources are needed to supplement
existing public health data collection;
(B) how to collect, process, and disclose to the
public the data described in subparagraph (A) in a way
that maintains individual privacy while helping direct
the State and local response to the virus;
(C) how to improve demographic data collection
related to COVID-19 in the short- and long-term,
including how to continue to grow and value the Tribal
sovereignty of data and information concerning Tribal
communities;
(D) to the extent possible, a preliminary analysis
of racial and other demographic disparities in COVID-19
mortality, including an analysis of comorbidities and
case fatality rates;
(E) to the extent possible, a preliminary analysis
of sex, gender, sexual orientation, and gender identity
disparities in COVID-19 treatment and mortality;
(F) an analysis of COVID-19 treatment of
individuals with disabilities, including equity of
access to treatment and equipment and intersections of
disability status with other demographic factors,
including race, and recommendations for how to improve
transparency and equity of treatment for such
individuals during the COVID-19 public health emergency
and future emergencies;
(G) how to support State, local, and Tribal
capacity to eliminate barriers to COVID-19 testing and
treatment; and
(H) to the extent possible, a preliminary analysis
of Federal Government policies that disparately
exacerbate the COVID-19 impact, and recommendations to
improve racial and other demographic disparities in
health outcomes.
(5) Authorization of appropriations.--There is authorized
to be appropriated such sums as may be necessary to carry out
this subsection.
SEC. 102. COVID-19 REPORTING PORTAL.
(a) In General.--Not later than 15 days after the date of enactment
of this Act, the Secretary of Health and Human Services (referred to in
this section as the ``Secretary'') shall establish and maintain an
online portal for use by eligible health care entities to track and
transmit data regarding their personal protective equipment and medical
supply inventory and capacity related to COVID-19.
(b) Eligible Health Care Entities.--In this section, the term
``eligible health care entity'' means a licensed acute care hospital,
hospital system, or long-term care facility with confirmed cases of
COVID-19.
(c) Submission.--An eligible health care entity shall report using
the portal under this section on a biweekly basis in order to assist
the Secretary in tracking usage and need of COVID-related supplies and
personnel in a regular and real-time manner.
(d) Included Information.--The Secretary shall design the portal
under this section to include information on personal protective
equipment and medical supply inventory and capacity related to COVID-
19, including with respect to the following:
(1) Personal protective equipment.--Total personal
protective equipment inventory, including, in units, the
numbers of N95 masks and authorized equivalent respirator
masks, surgical masks, exam gloves, face shields, isolation
gowns, and coveralls.
(2) Medical supply.--
(A) Total ventilator inventory, including, in
units, the number of universal, adult, pediatric, and
infant ventilators.
(B) Total diagnostic and serological test
inventory, including, in units, the number of test
platforms, tests, test kits, reagents, transport media,
swabs, and other materials or supplies determined
necessary by the Secretary.
(3) Capacity.--
(A) Case count measurements, including confirmed
positive cases and persons under investigation.
(B) Total number of staffed beds, including medical
surgical beds, intensive care beds, and critical care
beds.
(C) Available beds, including medical surgical
beds, intensive care beds, and critical care beds.
(D) Total number of COVID-19 patients currently
utilizing a ventilator.
(E) Average number of days a COVID-19 patient is
utilizing a ventilator.
(F) Total number of additionally needed
professionals in each of the following categories:
intensivists, critical care physicians, respiratory
therapists, registered nurses, certified registered
nurse anesthetists, and laboratory personnel.
(G) Total number of hospital personnel currently
not working due to self-isolation following a known or
presumed COVID-19 exposure.
(e) Access to Information Related to Inventory and Capacity.--The
Secretary shall ensure that relevant agencies and officials, including
the Centers for Disease Control and Prevention, the Assistant Secretary
for Preparedness and Response, and the Federal Emergency Management
Agency, have access to information related to inventory and capacity
submitted under this section.
(f) Weekly Report to Congress.--On a weekly basis, the Secretary
shall transmit information related to inventory and capacity submitted
under this section to the appropriate committees of the House and
Senate.
SEC. 103. REGULAR CDC REPORTING ON DEMOGRAPHIC DATA.
Not later than 14 days after the date of enactment of this Act, the
Secretary of Health and Human Services, in coordination with the
Director of the Centers for Disease Control and Prevention, shall amend
the reporting under the heading ``Department of Health and Human
Services--Office of the Secretary--Public Health and Social Service
Emergency Fund'' in title I of division B of the Paycheck Protection
Program and Health Care Enhancement Act (Public Law 116-139; 134 Stat.
620, 626) on the demographic characteristics, including race, ethnicity
(including breakdowns of major ethnic groups and Tribal affiliations
within minority populations), age, sex, gender, geographic region,
primary written and spoken language, disability status, sexual
orientation, socioeconomic status, occupation, and other relevant
factors of individuals tested for or diagnosed with COVID-19, to
include--
(1) providing technical assistance to State, local, Tribal,
and territorial health departments to improve the collection
and reporting of such demographic data;
(2) if such data is not so collected or reported, the
reason why the State, local, Tribal, or territorial department
of health has not been able to collect or provide such
information; and
(3) making a copy of such report available publicly on the
website of the Centers for Disease Control and Prevention.
SEC. 104. 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.--The Public Health Service Act is amended by adding
at the end the following:
``TITLE XXXIV--STRENGTHENING DATA COLLECTION, IMPROVING DATA ANALYSIS,
AND EXPANDING DATA REPORTING
``SEC. 3400. 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. 3401. 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. 3402. 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 Native Americans,
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. 105. 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. 106. 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 and Medicaid
Services.
``(7) Analysis and reporting of data.--With respect to data
transmitted under paragraph (5), the Administrator of the
Centers for Medicare and 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. 107. 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. 108. 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. 109. 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. 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 Ending Health
Disparities During COVID-19 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 Ending Health Disparities During COVID-19 Act
of 2020.
``(d) Progress Report.--Not later than 2 years after the date of
enactment of the Ending Health Disparities During COVID-19 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 Ending Health Disparities During
COVID-19 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.''.
Subtitle B--Improvements and Modernization
SEC. 121. FEDERAL MODERNIZATION FOR HEALTH INEQUITIES DATA.
(a) In General.--The Secretary of Health and Human Services shall
work with covered agencies to support the modernization of data
collection methods and infrastructure at such agencies for the purpose
of increasing data collection related to health inequities, such as
racial, ethnic (including breakdowns of major ethnic groups and Tribal
affiliations within minority populations), socioeconomic, sex, gender,
age, geographic region, primary written and spoken language, sexual
orientation, occupation, and disability status disparities.
(b) Covered Agency Defined.--In this section, the term ``covered
agency'' means each of the following Federal agencies:
(1) The Agency for Healthcare Research and Quality.
(2) The Centers for Disease Control and Prevention.
(3) The Centers for Medicare & Medicaid Services.
(4) The Food and Drug Administration.
(5) The Office of the National Coordinator for Health
Information Technology.
(6) The National Institutes of Health.
(c) Authorization of Appropriations.--There is authorized to be
appropriated to each covered agency to carry out this section
$4,000,000, to remain available until expended.
SEC. 122. MODERNIZATION OF STATE AND LOCAL HEALTH INEQUITIES DATA.
(a) In General.--Not later than 6 months after the date of
enactment of this Act, 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, shall award
grants to State, local, Tribal, and territorial health departments in
order to support the modernization of data collection methods and
infrastructure for the purposes of increasing data related to health
inequities, such as racial, ethnic (including breakdowns of major
ethnic groups and Tribal affiliations within minority populations),
socioeconomic, sex, gender, age, geographic region, primary written and
spoken language, sexual orientation, occupation, and disability status
disparities. The Secretary shall--
(1) provide guidance, technical assistance, and information
to grantees under this section on best practices regarding
culturally competent, accurate, and increased data collection
and transmission; and
(2) track performance of grantees under this section to
help improve their health inequities data collection by
identifying gaps and taking effective steps to support States,
localities, and territories in addressing the gaps.
(b) Report.--Not later than 1 year after the date on which the
first grant is awarded under this section, the Secretary shall submit
to the Committee on Energy and Commerce of the House of Representatives
and the Committee on Health, Education, Labor, and Pensions of the
Senate an initial report detailing--
(1) nationwide best practices for ensuring States and
localities collect and transmit health inequities data;
(2) nationwide trends which hinder the collection and
transmission of health inequities data;
(3) Federal best practices for working with States and
localities to ensure culturally competent, accurate, and
increased data collection and transmission; and
(4) any recommended changes to legislative or regulatory
authority to help improve and increase health inequities data
collection.
(c) Final Report.--Not later than December 31, 2023, the Secretary
shall--
(1) update and finalize the initial report under subsection
(b); and
(2) submit such final report to the committees specified in
such subsection.
(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $100,000,000, to remain
available until expended.
SEC. 123. ADDITIONAL REPORTING TO CONGRESS ON THE RACE AND ETHNICITY
RATES OF COVID-19 TESTING, HOSPITALIZATIONS, AND
MORTALITIES.
(a) In General.--Not later than August 1, 2020, the Secretary of
Health and Human Services (referred to in this section as the
``Secretary'') shall submit to the Committee on Appropriations and the
Committee on Energy and Commerce of the House of Representatives and
the Committee on Appropriations and the Committee on Health, Education,
Labor, and Pensions of the Senate an initial report--
(1) describing the testing, positive diagnoses,
hospitalization, intensive care admissions, and mortality rates
associated with COVID-19, disaggregated by race, ethnicity
(including breakdowns of major ethnic groups and Tribal
affiliations within minority populations), age, sex, gender,
geographic region, primary written and spoken language,
disability status, sexual orientation, socioeconomic status,
occupation, and other relevant factors as determined by the
Secretary;
(2) including an analysis of any variances of testing,
positive diagnoses, hospitalizations, and deaths by demographic
characteristics; and
(3) including proposals for evidenced-based response
strategies to reduce disparities related to COVID-19.
(b) Final Report.--Not later than December 31, 2024, the Secretary
shall--
(1) update and finalize the initial report under subsection
(a); and
(2) submit such final report to the committees specified in
such subsection.
(c) Coordination.--In preparing the report submitted under this
section, the Secretary shall take into account and otherwise coordinate
such report with reporting required under section 103 and under the
heading ``Department of Health and Human Services--Office of the
Secretary--Public Health and Social Service Emergency Fund'' in title I
of division B of the Paycheck Protection Program and Health Care
Enhancement Act (Public Law 116-139; 134 Stat. 620, 626).
TITLE II--EQUITABLE TESTING AND TRACING
Subtitle A--Free Testing for Patients
SEC. 201. SOONER COVERAGE OF TESTING FOR COVID-19.
Section 6001(a) of division F of the Families First Coronavirus
Response Act (42 U.S.C. 1320b-5 note) is amended by striking
``beginning on or after'' and inserting ``beginning before, on, or
after''.
Subtitle B--National Testing Strategy
SEC. 211. COVID-19 TESTING STRATEGY.
(a) Strategy.--Not later than June 15, 2020, the Secretary of
Health and Human Services (referred to in this section as the
``Secretary'') shall update the COVID-19 strategic testing plan under
the heading ``Department of Health and Human Services--Office of the
Secretary--Public Health and Social Service Emergency Fund'' in title I
of division B of the Paycheck Protection Program and Health Care
Enhancement Act (Public Law 116-139, 134 Stat. 620, 626-627) and submit
to the appropriate congressional committees such updated national plan
identifying--
(1) what level of, types of, and approaches to testing
(including predicted numbers of tests, populations to be
tested, and frequency of testing and the appropriate setting
whether a health care setting (such as hospital-based, high-
complexity laboratory, point-of-care, mobile testing units,
pharmacies or community health centers) or non-health care
setting (such as workplaces, schools, or child care centers))
are necessary--
(A) to sufficiently monitor and contribute to the
control of the transmission of SARS-CoV-2 in the United
States;
(B) to ensure that any reduction in social
distancing efforts, when determined appropriate by
public health officials, can be undertaken in a manner
that optimizes the health and safety of the people of
the United States, and reduces disparities (including
disparities related to race, ethnicity, sex, age,
disability status, socioeconomic status, primary
written and spoken language, occupation, and geographic
location) in the prevalence of, incidence of, and
health outcomes with respect to, COVID-19; and
(C) to provide for ongoing surveillance sufficient
to support contact tracing, case identification,
quarantine, and isolation to prevent future outbreaks
of COVID-19;
(2) specific plans and benchmarks, each with clear
timelines, to ensure--
(A) such level of, types of, and approaches to
testing as are described in paragraph (1), with respect
to optimizing health and safety;
(B) sufficient availability of all necessary
testing materials and supplies, including extraction
and testing kits, reagents, transport media, swabs,
instruments, analysis equipment, personal protective
equipment if necessary for testing (including point-of-
care testing), and other equipment;
(C) allocation of testing materials and supplies in
a manner that optimizes public health, including by
considering the variable impact of SARS-CoV-2 on
specific States, territories, Indian Tribes, Tribal
organizations, urban Indian organizations, communities,
industries, and professions;
(D) sufficient evidence of validation for tests
that are deployed as a part of such strategy;
(E) sufficient laboratory and analytical capacity,
including target turnaround time for test results;
(F) sufficient personnel, including personnel to
collect testing samples, conduct and analyze results,
and conduct testing follow-up, including contact
tracing, as appropriate; and
(G) enforcement of the Families First Coronavirus
Response Act (Public Law 116-127) to ensure patients
who are tested are not subject to cost sharing;
(3) specific plans to ensure adequate testing in rural
areas, frontier areas, health professional shortage areas, and
medically underserved areas (as defined in section 330I(a) of
the Public Health Service Act (42 U.S.C. 254c-14(a))), and for
underserved populations, Native Americans (including Indian
Tribes, Tribal organizations, and urban Indian organizations),
and populations at increased risk related to COVID-19;
(4) specific plans to ensure accessibility of testing to
people with disabilities, older individuals, individuals with
limited English proficiency, and individuals with underlying
health conditions or weakened immune systems; and
(5) specific plans for broadly developing and implementing
testing for potential immunity in the United States, as
appropriate, in a manner sufficient--
(A) to monitor and contribute to the control of
SARS-CoV-2 in the United States;
(B) to ensure that any reduction in social
distancing efforts, when determined appropriate by
public health officials, can be undertaken in a manner
that optimizes the health and safety of the people of
the United States; and
(C) to reduce disparities (including disparities
related to race, ethnicity, sex, age, disability
status, socioeconomic status, primary written and
spoken language, occupation, and geographic location)
in the prevalence of, incidence of, and health outcomes
with respect to, COVID-19.
(b) Coordination.--The Secretary shall carry out this section--
(1) in coordination with the Administrator of the Federal
Emergency Management Agency;
(2) in collaboration with other agencies and departments,
as appropriate; and
(3) taking into consideration the State plans for COVID-19
testing prepared as required under the heading ``Department of
Health and Human Services--Office of the Secretary--Public
Health and Social Service Emergency Fund'' in title I of
division B of the Paycheck Protection Program and Health Care
Enhancement Act (Public Law 116-139; 134 Stat. 620, 624).
(c) Updates.--
(1) Frequency.--The updated national plan under subsection
(a) shall be updated every 30 days until the end of the public
health emergency first declared by the Secretary under section
319 of the Public Health Service Act (42 U.S.C. 247d) on
January 31, 2020, with respect to COVID-19.
(2) Relation to other law.--Paragraph (1) applies in lieu
of the requirement (for updates every 90 days until funds are
expended) in the second to last proviso under the heading
``Department of Health and Human Services--Office of the
Secretary--Public Health and Social Service Emergency Fund'' in
title I of division B of the Paycheck Protection Program and
Health Care Enhancement Act (Public Law 116-139; 134 Stat. 620,
627).
(d) Appropriate Congressional Committees.--In this section, the
term ``appropriate congressional committees'' means--
(1) the Committee on Appropriations and the Committee on
Energy and Commerce of the House of Representatives; and
(2) the Committee on Appropriations and the Committee on
Health, Education, Labor, and Pensions of the Senate.
SEC. 212. CORONAVIRUS IMMIGRANT FAMILIES PROTECTION.
(a) Definitions.--In this section:
(1) Coronavirus public health emergency.--The term
``coronavirus public health emergency'' means--
(A) an emergency involving Federal primary
responsibility determined to exist by the President
under section 501(b) of the Robert T. Stafford Disaster
Relief and Emergency Assistance Act (42 U.S.C. 5191(b))
with respect to COVID-19 or any other coronavirus with
pandemic potential;
(B) an emergency declared by a Federal official
with respect to coronavirus (as defined in section 506
of the Coronavirus Preparedness and Response
Supplemental Appropriations Act, 2020 (Public Law 116-
123));
(C) a national emergency declared by the President
under the National Emergencies Act (50 U.S.C. 1601 et
seq.) with respect to COVID-19 or any other coronavirus
with pandemic potential; and
(D) a public health emergency declared by the
Secretary of Health and Human Services pursuant to
section 319 of the Public Health Service Act (42 U.S.C.
247(d)) with respect to COVID-19 or any other
coronavirus with pandemic potential.
(2) Coronavirus response law.--The term ``coronavirus
response law'' means--
(A) the Coronavirus Preparedness and Response
Supplemental Appropriations Act, 2020 (Public Law 116-
123);
(B) the Families First Coronavirus Response Act
(Public Law 116-127);
(C) the Coronavirus Aid, Relief, and Economic
Security Act (Public Law 116-136); and
(D) any subsequent law enacted as a response to a
coronavirus public health emergency.
(3) COVID-19.--The term ``COVID-19'' means the Coronavirus
Disease 2019.
(4) Enforcement action.--The term ``enforcement action''
means an apprehension, an arrest, a search, an interview, a
request for identification, or surveillance for the purposes of
immigration enforcement.
(5) Sensitive location.--The term ``sensitive location''
means all physical space located within 1,000 feet of--
(A) a medical treatment or health care facility,
including a hospital, an office of a health care
practitioner, an accredited health clinic, an alcohol
or drug treatment center, an emergent or urgent care
facility, and a community health center;
(B) a location at which emergency service providers
distribute food or provide shelter;
(C) an organization that provides--
(i) disaster or emergency social services
and assistance;
(ii) services for individuals experiencing
homelessness, including food banks and
shelters; or
(iii) assistance for children, pregnant
women, victims of crime or abuse, or
individuals with significant mental or physical
disabilities;
(D) a public assistance office, including any
Federal, State, or municipal location at which
individuals may apply for or receive unemployment
compensation or report violations of labor and
employment laws;
(E) a Federal, State, or local courthouse,
including the office of the legal counsel or
representative of an individual;
(F) a domestic violence shelter, rape crisis
center, supervised visitation center, family justice
center, or victim services provider;
(G) an office of the Social Security
Administration;
(H) a childcare facility or a school, including a
preschool, primary school, secondary school, post-
secondary school up to and including a college or
university, and any other institution of learning such
as a vocational or trade school;
(I) a church, synagogue, mosque or any other
institution of worship, such as a building rented for
the purpose of a religious service;
(J) the site of a funeral, wedding, or any other
public religious ceremony;
(K) in the case of a jurisdiction in which a
shelter-in-place order is in effect during a
coronavirus public health emergency, any business
location considered to provide an essential service,
such as a pharmacy or a grocery store; and
(L) any other location specified by the Secretary
of Homeland Security.
(b) Suspension of Adverse Immigration Actions That Deter Immigrant
Communities From Seeking Health Services in a Public Health
Emergency.--
(1) In general.--Beginning on the date on which a
coronavirus public health emergency is declared and ending on
the date that is 60 days after the date on which the
coronavirus public health emergency expires--
(A) the Secretary of Homeland Security, the
Secretary of State, and the Attorney General shall
not--
(i) implement the final rule of the
Department of Homeland Security entitled
``Inadmissibility on Public Charge Grounds''
(84 Fed. Reg. 41292 (August 14, 2019));
(ii) implement the interim final rule of
the Department of State entitled ``Visas:
Ineligibility Based on Public Charge Grounds''
(84 Fed. Reg. 54996 (October 11, 2019));
(iii) implement the proposed rule of the
Department of Justice entitled
``Inadmissibility on Public Charge Grounds''
published in the Fall 2018 Uniform Regulatory
Agenda;
(iv) conduct any enforcement action against
an individual at, or in transit to or from, a
sensitive location unless the enforcement
action is conducted pursuant to a valid
judicial warrant;
(v) detain or remove--
(I) a survivor of domestic
violence, sexual assault, or human
trafficking, or any other individual,
who has a pending application under
section 101(a)(15)(T), 101(a)(15)(U),
106, 240A(b)(2) of the Immigration and
Nationality Act (8 U.S.C.
1101(a)(15)(T), 1101(a)(15)(U), 1105a,
1229b(b)(2)) or section 244(a)(3) of
that Act (as in effect on March 31,
1997); or
(II) a VAWA self-petitioner
described in section 101(a)(51) of that
Act (8 U.S.C. 1101(a)(51)) who has a
pending application for relief under--
(aa) a provision referred
to in any of subparagraphs (A)
through (G) of that section; or
(bb) section 101(a)(27)(J)
of that Act (8 U.S.C.
1101(a)(27)(J)); and
(vi) require an individual subject to
supervision by U.S. Immigration and Customs
Enforcement to report in person.
(B) The Attorney General shall conduct fully
telephonic bond hearings and allow supporting documents
to be faxed and emailed to the appropriate clerk.
(C) The Secretary of Homeland Security, to the
extent practicable, shall stipulate to bond
determinations on written motions.
(2) Use of benefits funded by coronavirus response law.--
The Secretary of Homeland Security, the Secretary of State, and
the Attorney General shall not consider in any determination
affecting the current or future immigration status of any
individual the use of any benefit of any program or activity
funded in whole or in part by amounts made available under a
coronavirus response law.
(c) Access to COVID-19 Testing and Treatment for All Communities.--
(1) Clarification regarding emergency services for certain
individuals.--Section 1903(v)(2) of the Social Security Act (42
U.S.C. 1396b(v)(2)) is amended by adding at the end the
following flush sentence:
``For purposes of subparagraph (A), care and services described in
such subparagraph include any in vitro diagnostic product described in
section 1905(a)(3)(B) that is administered during any portion of the
emergency period described in such section beginning on or after the
date of the enactment of this sentence (and the administration of such
product), any COVID-19 vaccine that is administered during any such
portion (and the administration of such vaccine), any item or service
that is furnished during any such portion for the treatment of COVID-19
or a condition that may complicate the treatment of COVID-19, and any
services described in section 1916(a)(2)(G).''.
(2) Emergency medicaid for individuals with suspected
covid-19 infections.--Section 1903(v)(3) of the Social Security
Act (42 U.S.C. 1396b(v)(3)) is amended by striking ``means a''
and inserting ``means any concern that the individual may have
contracted COVID-19 or another.''.
(3) Treatment of assistance and services provided.--For any
period during which a coronavirus public health emergency is in
effect--
(A) the value of assistance or services provided to
any person under a program with respect to which a
coronavirus response law establishes or expands
eligibility or benefits shall not be considered income
or resources; and
(B)(i) any medical coverage or services shall be
considered treatment for an emergency medical condition
(as defined in section 1903(v)(3) of the Social
Security Act (42 U.S.C. 1396b(v)(3))) for any purpose
under any Federal, State, or local law, including law
relating to taxation, welfare, and public assistance
programs;
(ii) a participating State or political subdivision
of a State shall not decrease any assistance otherwise
provided to an individual because of the receipt of
benefits under the Social Security Act (42 U.S.C. 301
et seq.); and
(iii) assistance and services described in this
subparagraph shall be considered noncash disaster
assistance, notwithstanding the form in which the
assistance and services are provided, except that cash
received by an individual or a household may be treated
as income by any public benefit program under the rules
applicable before the date of the enactment of this
Act.
(4) Nondiscrimination.--No person shall be, on the basis of
actual or perceived immigration status, excluded from
participation in, denied the benefits of, or subject to
discrimination under, any program or activity funded in whole
or in part by amounts made available under a coronavirus
response law.
(d) Language Access and Public Outreach for Public Health.--
(1) Grants and cooperative agreements.--
(A) In general.--The Director of the Centers for
Disease Control and Prevention (referred to in this
subsection as the ``Director'') shall provide grants
to, or enter into cooperative agreements with,
community-based organizations for the purpose of
supporting culturally and linguistically appropriate
preparedness, response, and recovery activities, such
as the development of educational programs and
materials to promote screening, testing, treatment, and
public health practices.
(B) Definition of community-based organization.--In
this paragraph, the term ``community-based
organization'' means an entity that has established
relationships with hard-to-reach populations, including
racial and ethnic minorities, individuals with limited
English proficiency, and individuals with disabilities.
(2) Translation.--
(A) In general.--The Director shall provide for the
translation of materials on awareness, screening,
testing, and treatment for COVID-19 into the languages
described in the language access plan of the Federal
Emergency Management Agency dated October 1, 2016, as
the languages most frequently encountered.
(B) Public availability.--Not later than 7 days
after the date on which the materials described in
subparagraph (A) are made available to the public in
English, the Director shall ensure that the
translations required by that subparagraph are made
available to the public.
(3) Hotline.--The Director shall establish an informational
hotline line that provides, in the languages referred to in
paragraph (2)(A), information to the public directly on COVID-
19.
(4) Interagency coordination.--With respect to individuals
with limited English proficiency, the Director shall facilitate
interagency coordination among agencies activated through the
National Response Framework based on the language access
standards established under the language access plans of the
Federal Emergency Management Agency and the Department of
Health and Human Services.
(5) Authorization of appropriations.--
(A) In general.--There is authorized to be
appropriated to carry out this subsection $100,000,000
for fiscal year 2020, to be available until expended.
(B) Grants and cooperative agreements.--Of the
amount authorized to be appropriated under subparagraph
(A), not less than $50,000,000 shall be made available
to carry out paragraph (1).
(e) Access To Support Measures for Vulnerable Communities.--
(1) Disaster supplemental nutrition assistance program
benefits.--The Robert T. Stafford Disaster Relief and Emergency
Assistance Act (42 U.S.C. 5121 et seq.) is amended--
(A) in section 102(1) (42 U.S.C. 5122(1)), by
inserting ``or pandemic'' after ``catastrophe'';
(B) in section 301 (42 U.S.C. 5141), by inserting
``or an emergency due to a pandemic'' after ``major
disaster'' each place the term appears;
(C) in section 412 (42 U.S.C. 5179)--
(i) by inserting ``or an emergency due to a
pandemic'' after ``major disaster'' each place
the term appears;
(ii) in subsection (a), by inserting
``without regard to regular allotments'' before
``and to make surplus''; and
(iii) by adding at the end the following:
``(d) Assistance During a Pandemic.--In the case of an emergency
due to a pandemic, for purposes of providing benefits under this
section, the Secretary of Agriculture shall remove or delay the
requirement of an in-person interview, and if an interview occurs,
provide an alternative to the in-person interview requirement for all
applicants. Assistance shall be provided based on need and not lost
provisions.
``(e) Authorization of Appropriations.--There are authorized to be
appropriated such sums as are necessary to carry out this section, only
if such sums are designated by Congress as being for an emergency
requirement pursuant to section 251(b)(2)(A)(i) of the Balanced Budget
and Emergency Deficit Control Act of 1985 (2 U.S.C.
901(b)(2)(A)(i)).''; and
(D) in section 502(a) (42 U.S.C. 5192(a))--
(i) in paragraph (7), by striking ``and''
at the end;
(ii) in paragraph (8)(B), by striking the
period at the end and inserting a semicolon;
and
(iii) by adding at the end the following:
``(9) provide assistance in accordance with section 412.''.
(2) Access to benefits using individual taxpayer
identification number.--Subsection (g)(2)(A) of section 6428 of
the Internal Revenue Code of 1986, as added by section 2201 of
the Coronavirus Aid, Relief, and Economic Security Act (Public
Law 116-136), is amended by inserting before the period at the
end ``or a taxpayer identification number''.
(3) Extension of immigration status and employment
authorization.--
(A) In general.--Notwithstanding any other
provision of law, including the Immigration and
Nationality Act (8 U.S.C. 1101 et seq.), the Secretary
of Homeland Security shall automatically extend the
immigration status and employment authorization, as
applicable, of an alien described in subparagraph (B)
for the same period for which the status and employment
authorization was initially granted.
(B) Alien described.--An alien described in this
subparagraph is an alien (as defined in section 101(a)
of the Immigration and Nationality Act (8 U.S.C.
1101(a))) whose immigration status, including
permanent, temporary, and deferred status, or whose
employment authorization--
(i) expired during the 30-day period
preceding the date of the enactment of this
Act; or
(ii) will expire not later than--
(I) one year after such date of
enactment; or
(II) 90 days after the date on
which the national emergency declared
by the President under the National
Emergencies Act (50 U.S.C. 1601 et
seq.) with respect to the Coronavirus
Disease 2019 (COVID-19) is rescinded.
(4) Language access.--Any agency receiving funding under a
coronavirus response law shall ensure that all programs and
opportunities made available to the general public provide
translated materials describing the programs and opportunities
into the languages described in the language access plan of the
Federal Emergency Management Agency dated October 1, 2016, as
the languages most frequently encountered.
SEC. 213. ICE DETENTION.
(a) Reviewing ICE Detention.--During the public health emergency
declared by the Secretary of Health and Human Services under section
319 of the Public Health Service Act (42 U.S.C. 247d) with respect to
COVID-19, the Secretary of Homeland Security shall review the
immigration files of all individuals in the custody of U.S. Immigration
and Customs Enforcement to assess the need for continued detention. The
Secretary of Homeland Security shall prioritize for release on
recognizance or alternatives to detention individuals who are not
subject to mandatory detention laws, unless the individual is a threat
to public safety or national security.
(b) Access to Electronic Communications and Hygiene Products.--
During the period described in subsection (c), the Secretary of
Homeland Security shall ensure that--
(1) all individuals in the custody of U.S. Immigration and
Customs Enforcement--
(A) have access to telephonic or video
communication at no cost to the detained individual;
(B) have access to free, unmonitored telephone
calls, at any time, to contact attorneys or legal
service providers in a sufficiently private space to
protect confidentiality;
(C) are permitted to receive legal correspondence
by fax or email rather than postal mail; and
(D) are provided sufficient soap, hand sanitizer,
and other hygiene products; and
(2) nonprofit organizations providing legal orientation
programming or know-your-rights programming to individuals in
the custody of U.S. Immigration and Customs Enforcement are
permitted broad and flexible access to such individuals--
(A) to provide group presentations using remote
videoconferencing; and
(B) to schedule and provide individual orientations
using free telephone calls or remote videoconferencing.
(c) Period Described.--The period described in this subsection--
(1) begins on the first day of the public health emergency
declared by the Secretary of Health and Human Services under
section 319 of the Public Health Service Act (42 U.S.C. 247d)
with respect to COVID-19; and
(2) ends 90 days after the date on which such public health
emergency terminates.
Subtitle C--Contact Tracing
SEC. 221. COVID-19 TESTING, REACHING, AND CONTACTING EVERYONE.
(a) In General.--The Secretary of Health and Human Services, acting
through the Director of the Centers for Disease Control and Prevention,
may award grants to eligible entities to conduct diagnostic testing for
COVID-19, to trace and monitor the contacts of infected individuals,
and to support the quarantine of such contacts, through--
(1) mobile health units; and
(2) as necessary, testing individuals and providing
individuals with services related to testing and quarantine at
their residences.
(b) Permissible Uses of Funds.--A grant recipient under this
section may use the grant funds, in support of the activities described
in subsection (a)--
(1) to hire, train, compensate, and pay the expenses of
individuals; and
(2) to purchase personal protective equipment and other
supplies.
(c) Priority.--In selecting grant recipients under this section,
the Secretary shall give priority to--
(1) applicants proposing to conduct activities funded under
this section in hot spots and medically underserved
communities; and
(2) applicants that agree, in hiring individuals to carry
out activities funded under this section, to hire residents of
the area or community where the activities will primarily
occur, with higher priority among applicants described in this
paragraph given based on the percentage of individuals to be
hired from such area or community.
(d) Distribution.--In selecting grant recipients under this
section, the Secretary shall ensure that grants are distributed across
urban and rural areas.
(e) Federal Privacy Requirements.--Nothing in this section shall be
construed to supersede any Federal privacy or confidentiality
requirement, including the regulations promulgated under section 264(c)
of the Health Insurance Portability and Accountability Act of 1996
(Public Law 104-191; 110 Stat. 2033) and section 543 of the Public
Health Service Act (42 U.S.C. 290dd-2).
(f) Definitions.--In this section:
(1) The term ``eligible entity'' means--
(A) a Federally qualified health center (as defined
in section 1861(aa) of the Social Security Act (42
U.S.C. 1395x(aa)));
(B) a school-based health clinic;
(C) a disproportionate share hospital (as defined
under the applicable State plan under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.) pursuant
to section 1923(a)(1)(A) of such Act (42 U.S.C. 1396r-
4));
(D) an academic medical center;
(E) a nonprofit organization (including any such
faith-based organization);
(F) an institution of higher education (as defined
in section 101 of the Higher Education Act of 1965 (20
U.S.C. 1001));
(G) a high school (as defined in section 8101 of
the Elementary and Secondary Education Act of 1965 (20
U.S.C. 7801));
(H) any Tribal organization including the Indian
Health Service and Native American servicing
facilities; or
(I) any other type of entity that is determined by
the Secretary to be an eligible entity for purposes of
this section.
(2) The term ``emergency period'' has the meaning given to
that term in section 1135(g)(1)(B) of the Social Security Act
(42 U.S.C. 1320b-5(g)(1)(B)).
(3) The term ``hot spot'' means a geographic area where the
rate of infection with the virus that causes COVID-19 exceeds
the national average.
(4) The term ``medically underserved community'' has the
meaning given to that term in section 799B of the Public Health
Service Act (42 U.S.C. 295p).
(5) The term ``Secretary'' means the Secretary of Health
and Human Services.
(g) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated--
(1) $100,000,000,000 for fiscal year 2020; and
(2) such sums as may be necessary for each of fiscal year
2021 and any subsequent fiscal year during which the emergency
period continues.
SEC. 222. NATIONAL SYSTEM FOR COVID-19 TESTING, CONTACT TRACING,
SURVEILLANCE, CONTAINMENT, AND MITIGATION.
(a) In General.--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, and in
coordination with State, local, Tribal, and territorial health
departments, shall establish and implement a nationwide evidence-based
system for--
(1) testing, contact tracing, surveillance, containment,
and mitigation with respect to COVID-19;
(2) offering guidance on voluntary isolation and quarantine
of individuals infected with, or exposed to individuals
infected with, the virus that causes COVID-19; and
(3) public reporting on testing, contact tracing,
surveillance, and voluntary isolation and quarantine activities
with respect to COVID-19.
(b) Coordination; Technical Assistance.--In carrying out the
national system under this section, the Secretary shall--
(1) coordinate State, local, Tribal, and territorial
activities related to testing, contact tracing, surveillance,
containment, and mitigation with respect to COVID-19, as
appropriate; and
(2) provide technical assistance for such activities, as
appropriate.
(c) Consideration.--In establishing and implementing the national
system under this section, the Secretary shall take into
consideration--
(1) the State plans referred to in the heading ``Public
Health and Social Services Emergency Fund'' in title I of
division B of the Paycheck Protection Program and Health Care
Enhancement Act (Public Law 116-139); and
(2) the testing strategy submitted under section 211.
(d) Reporting.--The Secretary shall--
(1) not later than December 31, 2020, submit to the
Committee on Energy and Commerce of the House of
Representatives and the Committee on Health, Education, Labor,
and Pensions a preliminary report on the effectiveness of the
activities carried out pursuant to this subtitle; and
(2) not later than December 21, 2021, submit to such
committees a final report on such effectiveness.
SEC. 223. GRANTS.
(a) In General.--To implement the national system under section
222, 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, shall, subject to the
availability of appropriations, award grants to State, local, Tribal,
and territorial health departments that seek grants under this section
to carry out coordinated testing, contact tracing, surveillance,
containment, and mitigation with respect to COVID-19, including--
(1) diagnostic and surveillance testing and reporting;
(2) community-based contact tracing efforts; and
(3) policies related to voluntary isolation and quarantine
of individuals infected with, or exposed to individuals
infected with, the virus that causes COVID-19.
(b) Flexibility.--The Secretary shall ensure that--
(1) the grants under subsection (a) provide flexibility for
State, local, Tribal, and territorial health departments to
modify, establish, or maintain evidence-based systems; and
(2) local health departments receive funding from State
health departments or directly from the Centers for Disease
Control and Prevention to contribute to such systems, as
appropriate.
(c) Allocations.--
(1) Formula.--The Secretary, acting through the Director of
the Centers for Disease Control and Prevention, shall allocate
amounts made available pursuant to subsection (a) in accordance
with a formula to be established by the Secretary that provides
a minimum level of funding to each State, local, Tribal, and
territorial health department that seeks a grant under this
section and allocates additional funding based on the following
prioritization:
(A) The Secretary shall give highest priority to
applicants proposing to serve populations in one or
more geographic regions with a high burden of COVID-19
based on data provided by the Centers for Disease
Control and Prevention, or other sources as determined
by the Secretary.
(B) The Secretary shall give second highest
priority to applicants preparing for, or currently
working to mitigate, a COVID-19 surge in a geographic
region that does not yet have a high number of reported
cases of COVID-19 based on data provided by the Centers
for Disease Control and Prevention, or other sources as
determined by the Secretary.
(C) The Secretary shall give third highest priority
to applicants proposing to serve high numbers of low-
income and uninsured populations, including medically
underserved populations (as defined in section
330(b)(3) of the Public Health Service Act (42 U.S.C.
254b(b)(3))), health professional shortage areas (as
defined under section 332(a) of the Public Health
Service Act (42 U.S.C. 254e(a))), racial and ethnic
minorities, or geographically diverse areas, as
determined by the Secretary.
(2) Notification.--Not later than the date that is one week
before first awarding grants under this section, the Secretary
shall submit to the Committee on Energy and Commerce of the
House of Representatives and the Committee on Health,
Education, Labor, and Pensions of the Senate a notification
detailing the formula established under paragraph (1) for
allocating amounts made available pursuant to subsection (a).
(d) Use of Funds.--A State, local, Tribal, and territorial health
department receiving a grant under this section shall, to the extent
possible, use the grant funds for the following activities, or other
activities deemed appropriate by the Director of the Centers for
Disease Control and Prevention:
(1) Testing.--To implement a coordinated testing system
that--
(A) leverages or modernizes existing testing
infrastructure and capacity;
(B) is consistent with the updated testing strategy
required under section 211;
(C) is coordinated with the State plan for COVID-19
testing prepared as required under the heading
``Department of Health and Human Services--Office of
the Secretary--Public Health and Social Service
Emergency Fund'' in title I of division B of the
Paycheck Protection Program and Health Care Enhancement
Act (Public Law 116-139; 134 Stat. 620, 624);
(D) is informed by contact tracing and surveillance
activities under this subtitle;
(E) is informed by guidelines established by the
Centers for Disease Control and Prevention for which
populations should be tested;
(F) identifies how diagnostic and serological tests
in such system shall be validated prior to use;
(G) identifies how diagnostic and serological tests
and testing supplies will be distributed to implement
such system;
(H) identifies specific strategies for ensuring
testing capabilities and accessibility in medically
underserved populations (as defined in section
330(b)(3) of the Public Health Service Act (42 U.S.C.
254b(b)(3))), health professional shortage areas (as
defined under section 332(a) of the Public Health
Service Act (42 U.S.C. 254e(a))), racial and ethnic
minority populations, and geographically diverse areas,
as determined by the Secretary;
(I) identifies how testing may be used, and results
may be reported, in both health care settings (such as
hospitals, laboratories for moderate or high-complexity
testing, pharmacies, mobile testing units, and
community health centers) and non-health care settings
(such as workplaces, schools, childcare centers, or
drive-throughs);
(J) allows for testing in sentinel surveillance
programs, as appropriate; and
(K) supports the procurement and distribution of
diagnostic and serological tests and testing supplies
to meet the goals of the system.
(2) Contact tracing.--To implement a coordinated contact
tracing system that--
(A) leverages or modernizes existing contact
tracing systems and capabilities, including community
health workers, health departments, and Federally
qualified health centers;
(B) is able to investigate cases of COVID-19, and
help to identify other potential cases of COVID-19,
through tracing contacts of individuals with positive
diagnoses;
(C) establishes culturally competent and
multilingual strategies for contact tracing, which may
include consultation with and support for cultural or
civic organizations with established ties to the
community;
(D) provides individuals identified under the
contact tracing program with information and support
for containment or mitigation;
(E) enables State, local, Tribal, and territorial
health departments to work with a nongovernmental,
community partner or partners and State and local
workforce development systems (as defined in section
3(67) of Workforce Innovation and Opportunity Act (29
U.S.C. 3102(67))) receiving grants under section 224(b)
of this Act to hire and compensate a locally sourced
contact tracing workforce, if necessary, to supplement
the public health workforce, to--
(i) identify the number of contact tracers
needed for the respective State, locality,
territorial, or Tribal health department to
identify all cases of COVID-19 currently in the
jurisdiction and those anticipated to emerge
over the next 18 months in such jurisdiction;
(ii) outline qualifications necessary for
contact tracers;
(iii) train the existing and newly hired
public health workforce on best practices
related to tracing close contacts of
individuals diagnosed with COVID-19, including
the protection of individual privacy and
cybersecurity protection; and
(iv) equip the public health workforce with
tools and resources to enable a rapid response
to new cases;
(F) identifies the level of contact tracing needed
within the State, locality, territory, or Tribal area
to contain and mitigate the transmission of COVID-19;
(G) establishes statewide mechanisms to integrate
regular evaluation to the Centers for Disease Control
and Prevention regarding contact tracing efforts, makes
such evaluation publicly available, and to the extent
possible provides for such evaluation at the county
level; and
(H) identifies specific strategies for ensuring
contact tracing activities in medically underserved
populations (as defined in section 330(b)(3) of the
Public Health Service Act (42 U.S.C. 254b(b)(3))),
health professional shortage areas (as defined under
section 332(a) of the Public Health Service Act (42
U.S.C. 254e(a))), racial and ethnic minority
populations, and geographically diverse areas, as
determined by the Secretary.
(3) Surveillance.--To strengthen the existing public health
surveillance system that--
(A) leverages or modernizes existing surveillance
systems within the respective State, local, Tribal, or
territorial health department and national surveillance
systems;
(B) detects and identifies trends in COVID-19 at
the county level;
(C) evaluates State, local, Tribal, and territorial
health departments in achieving surveillance
capabilities with respect to COVID-19;
(D) integrates and improves disease surveillance
and immunization tracking; and
(E) identifies specific strategies for ensuring
disease surveillance in medically underserved
populations (as defined in section 330(b)(3) of the
Public Health Service Act (42 U.S.C. 254b(b)(3))),
health professional shortage areas (as defined under
section 332(a) of the Public Health Service Act (42
U.S.C. 254e(a))), racial and ethnic minority
populations, and geographically diverse areas, as
determined by the Secretary.
(4) Containment and mitigation.--To implement a coordinated
containment and mitigation system that--
(A) leverages or modernizes existing containment
and mitigation strategies within the respective State,
local, Tribal, or territorial governments and national
containment and mitigation strategies;
(B) may provide for, connect to, and leverage
existing social services and support for individuals
who have been infected with or exposed to COVID-19 and
who are isolated or quarantined in their homes, such as
through--
(i) food assistance programs;
(ii) guidance for household infection
control;
(iii) information and assistance with
childcare services; and
(iv) information and assistance pertaining
to support available under the CARES Act
(Public Law 116-136) and this Act;
(C) provides guidance on the establishment of safe,
high-quality, facilities for the voluntary isolation of
individuals infected with, or quarantine of the
contacts of individuals exposed to COVID-19, where
hospitalization is not required, which facilities
should--
(i) be prohibited from making inquiries
relating to the citizenship status of an
individual isolated or quarantined; and
(ii) be operated by a non-Federal,
community partner or partners that--
(I) have previously established
relationships in localities;
(II) work with local places of
worship, community centers, medical
facilities, and schools to recruit
local staff for such facilities; and
(III) are fully integrated into
State, local, Tribal, or territorial
containment and mitigation efforts; and
(D) identifies specific strategies for ensuring
containment and mitigation activities in medically
underserved populations (as defined in section
330(b)(3) of the Public Health Service Act (42 U.S.C.
254b(b)(3))), health professional shortage areas (as
defined under section 332(a) of the Public Health
Service Act (42 U.S.C. 254e(a))), racial and ethnic
minority populations, and geographically diverse areas,
as determined by the Secretary.
(e) Reporting.--The Secretary shall facilitate mechanisms for
timely, standardized reporting by grantees under this section regarding
implementation of the systems established under this section and
coordinated processes with the reporting as required and under the
heading ``Department of Health and Human Services--Office of the
Secretary--Public Health and Social Service Emergency Fund'' in title I
of division B of the Paycheck Protection Program and Health Care
Enhancement Act (Public Law 116-139, 134 Stat. 620), including--
(1) a summary of county or local health department level
information from the States receiving funding, and information
from directly funded localities, territories, and Tribal
entities, about the activities that will be undertaken using
funding awarded under this section, including subgrants;
(2) any anticipated shortages of required materials for
testing for COVID-19 under subsection (a); and
(3) other barriers in the prevention, mitigation, or
treatment of COVID-19 under this section.
(f) Public Listing of Awards.--The Secretary shall--
(1) not later than 7 days after first awarding grants under
this section, post in a searchable, electronic format a list of
all awards made by the Secretary under this section, including
the recipients and amounts of such awards; and
(2) update such list not less than every 7 days until all
funds made available to carry out this section are expended.
SEC. 224. GRANTS TO STATE AND TRIBAL WORKFORCE AGENCIES.
(a) Definitions.--In this section:
(1) In general.--Except as otherwise provided, the terms in
this section have the meanings given the terms in section 3 of
the Workforce Innovation and Opportunity Act (29 U.S.C. 3102).
(2) Apprenticeship; apprenticeship program.--The term
``apprenticeship'' or ``apprenticeship program'' means an
apprenticeship program registered under the Act of August 16,
1937 (commonly known as the ``National Apprenticeship Act'')
(50 Stat. 664, chapter 663; 29 U.S.C. 50 et seq.), including
any requirement, standard, or rule promulgated under such Act,
as such requirement, standard, or rule was in effect on
December 30, 2019.
(3) Contact tracing and related positions.--The term
``contact tracing and related positions'' means employment
related to contact tracing, surveillance, containment, and
mitigation activities as described in paragraphs (2), (3), and
(4) of section 223(d).
(4) Eligible entity.--The term ``eligible entity'' means--
(A) a State or territory, including the District of
Columbia and Puerto Rico;
(B) an Indian Tribe, Tribal organization, Alaska
Native entity, Indian-controlled organizations serving
Indians, or Native Hawaiian organizations;
(C) an outlying area; or
(D) a local board, if an eligible entity under
subparagraphs (A) through (C) has not applied with
respect to the area over which the local board has
jurisdiction as of the date on which the local board
submits an application under subsection (c).
(5) Eligible individual.--Notwithstanding section 170(b)(2)
of the Workforce Innovation and Opportunity Act (29 U.S.C.
3225(b)(2)), the term ``eligible individual'' means an
individual seeking or securing employment in contact tracing
and related positions and served by an eligible entity or
community-based organization receiving funding under this
section.
(6) Secretary.--The term ``Secretary'' means the Secretary
of Labor.
(b) Grants.--
(1) In general.--Subject to the availability of
appropriations under subsection (g), the Secretary shall award
national dislocated worker grants under section 170(b)(1)(B) of
the Workforce Innovation and Opportunity Act (29 U.S.C.
3225(b)(1)(B)) to each eligible entity that seeks a grant to
assist local boards and community-based organizations in
carrying out activities under subsections (f) and (d),
respectively, for the following purposes:
(A) To support the recruitment, placement, and
training, as applicable, of eligible individuals
seeking employment in contact tracing and related
positions in accordance with the national system for
COVID-19 testing, contact tracing, surveillance,
containment, and mitigation established under section
222.
(B) To assist with the employment transition to new
employment or education and training of individuals
employed under this section in preparation for and upon
termination of such employment.
(2) Timeline.--The Secretary of Labor shall--
(A) issue application requirements under subsection
(c) not later than 10 days after the date of enactment
of this section; and
(B) award grants to an eligible entity under
paragraph (1) not later than 10 days after the date on
which the Secretary receives an application from such
entity.
(c) Grant Application.--An eligible entity applying for a grant
under this section shall submit an application to the Secretary, at
such time and in such form and manner as the Secretary may reasonably
require, which shall include a description of--
(1) how the eligible entity will support the recruitment,
placement, and training, as applicable, of eligible individuals
seeking employment in contact tracing and related positions by
partnering with--
(A) a State, local, Tribal, or territorial health
department; or
(B) one or more nonprofit or community-based
organizations partnering with such health departments;
(2) how the activities described in paragraph (1) will
support State efforts to address the demand for contact tracing
and related positions with respect to--
(A) the State plans referred to in the heading
``Public Health and Social Services Emergency Fund'' in
title I of division B of the Paycheck Protection
Program and Health Care Enhancement Act (Public Law
116-139);
(B) the testing strategy submitted under section
211; and
(C) the number of eligible individuals that the
State plans to recruit and train under the plans and
strategies described in subparagraphs (A) and (B);
(3) the specific strategies for recruiting and placement of
eligible individuals from or residing within the communities in
which they will work, including--
(A) plans for the recruitment of eligible
individuals to serve as contact tracers and related
positions, including dislocated workers, individuals
with barriers to employment, veterans, new entrants in
the workforce, or underemployed or furloughed workers,
who are from or reside in or near the local area in
which they will serve, and who, to the extent
practicable--
(i) have experience or a background in
industry-sectors and occupations such as public
health, social services, customer service, case
management, or occupations that require related
qualifications, skills, or competencies, such
as strong interpersonal and communication
skills, needed for contact tracing and related
positions, as described in section
223(d)(2)(E)(ii); or
(ii) seek to transition to public health
and public health related occupations upon the
conclusion of employment in contact tracing and
related positions; and
(B) how such strategies will take into account the
diversity of such community, including racial, ethnic,
socioeconomic, linguistic, or geographic diversity;
(4) the amount, timing, and mechanisms for distribution of
funds provided to local boards or through subgrants as
described in subsection (d);
(5) for eligible entities described in subparagraphs (A)
through (C) of subsection (a)(4), a description of how the
eligible entity will ensure the equitable distribution of funds
with respect to--
(A) geography (such as urban and rural
distribution);
(B) medically underserved populations (as defined
in section 33(b)(3) of the Public Health Service Act
(42 U.S.C. 254b(b)));
(C) health professional shortage areas (as defined
under section 332(a) of the Public Health Service Act
(42 U.S.C. 254e(a))); and
(D) the racial and ethnic diversity of the area;
and
(6) for eligible entities who are local boards, a
description of how a grant to such eligible entity would serve
the equitable distribution of funds as described in paragraph
(5).
(d) Subgrant Authorization and Application Process.--
(1) In general.--An eligible entity may award a subgrant to
one or more community-based organizations for the purposes of
partnering with a State or local board to conduct outreach and
education activities to inform potentially eligible individuals
about employment opportunities in contact tracing and related
positions.
(2) Application.--A community-based organization shall
submit an application at such time and in such manner as the
eligible entity may reasonably require, including--
(A) a demonstration of the community-based
organization's established expertise and effectiveness
in community outreach in the local area that such
organization plans to serve;
(B) a demonstration of the community-based
organization's expertise in providing employment or
public health information to the local areas in which
such organization plans to serve; and
(C) a description of the expertise of the
community-based organization in utilizing culturally
competent and multilingual strategies in the provision
of services.
(e) Grant Distribution.--
(1) Federal distribution.--
(A) Use of funds.-- The Secretary of Labor shall
use the funds appropriated to carry out this section as
follows:
(i) Subject to clause (ii), the Secretary
shall distribute funds among eligible entities
in accordance with a formula to be established
by the Secretary that provides a minimum level
of funding to each eligible entity that seeks a
grant under this section and allocates
additional funding as follows:
(I) The formula shall give first
priority based on the number and
proportion of contact tracing and
related positions that the State plans
to recruit, place, and train
individuals as a part of the State
strategy described in subsection
(c)(2)(A).
(II) Subject to subclause (I), the
formula shall give priority in
accordance with section 223(c).
(ii) Not more than 2 percent of the funding
for administration of the grants and for
providing technical assistance to recipients of
funds under this section.
(B) Equitable distribution.--If the geographic
region served by one or more eligible entities
overlaps, the Secretary shall distribute funds among
such entities in such a manner that ensures equitable
distribution with respect to the factors under
subsection (c)(5).
(2) Eligible entity use of funds.--An eligible entity
described in subparagraphs (A) through (C) of subsection
(a)(4)--
(A) shall, not later than 30 days after the date on
which the entity receives grant funds under this
section, provide not less than 70 percent of grant
funds to local boards for the purpose of carrying out
activities in subsection (f);
(B) may use up to 20 percent of such funds to make
subgrants to community-based organizations in the
service area to conduct outreach, to potential eligible
individuals, as described in subsection (d);
(C) in providing funds to local boards and awarding
subgrants under this subsection shall ensure the
equitable distribution with respect to the factors
described in subsection (c)(5); and
(D) may use not more than 10 percent of the funds
awarded under this section for the administrative costs
of carrying out the grant and for providing technical
assistance to local boards and community-based
organizations.
(3) Local board use of funds.--A local board, or an
eligible entity that is a local board, shall use--
(A) not less than 60 percent of the funds for
recruitment and training for COVID-19 testing, contact
tracing, surveillance, containment, and mitigation
established under section 222;
(B) not less than 30 percent of the funds to
support the transition of individuals hired as contact
tracers and related positions into an education or
training program, or unsubsidized employment upon
completion of such positions; and
(C) not more than 10 percent of the funds for
administrative costs.
(f) Eligible Activities.--The State or local boards shall use funds
awarded under this section to support the recruitment and placement of
eligible individuals, training and employment transition as related to
contact tracing and related positions, and for the following
activities:
(1) Establishing or expanding partnerships with--
(A) State, local, Tribal, and territorial public
health departments;
(B) community-based health providers, including
community health centers and rural health clinics;
(C) labor organizations or joint labor management
organizations;
(D) two-year and four-year institutions of higher
education (as defined in section 101 of the Higher
Education Act of 1965 (20 U.S.C. 1001)), including
institutions eligible to receive funds under section
371(a) of the Higher Education Act of 1965 (20 U.S.C.
1067q(a)); and
(E) community action agencies or other community-
based organizations serving local areas in which there
is a demand for contact tracing and related positions.
(2) Providing training for contact tracing and related
positions in coordination with State, local, Tribal, or
territorial health departments that is consistent with the
State or territorial testing and contact tracing strategy, and
ensuring that eligible individuals receive compensation while
participating in such training.
(3) Providing eligible individuals with--
(A) adequate and safe equipment, environments, and
facilities for training and supervision, as applicable;
(B) information regarding the wages and benefits
related to contact tracing and related positions, as
compared to State, local, and national averages;
(C) supplies and equipment needed by the eligible
individuals to support placement of an individual in
contact tracing and related positions, as applicable;
(D) an individualized employment plan for each
eligible individual, as applicable--
(i) in coordination with the entity
employing the eligible individual in a contact
tracing and related positions; and
(ii) which shall include providing a case
manager to work with each eligible individual
to develop the plan, which may include--
(I) identifying employment and
career goals, and setting appropriate
achievement objectives to attain such
goals; and
(II) exploring career pathways that
lead to in-demand industries and
sectors, including in public health and
related occupations; and
(E) services for the period during which the
eligible individual is employed in a contact tracing
and related position to ensure job retention, which may
include--
(i) supportive services throughout the term
of employment;
(ii) a continuation of skills training as
related to employment in contact tracing and
related positions, that is conducted in
collaboration with the employers of such
individuals;
(iii) mentorship services and job retention
support for eligible individuals; or
(iv) targeted training for managers and
workers working with eligible individuals (such
as mentors), and human resource
representatives.
(4) Supporting the transition and placement in unsubsidized
employment for eligible individuals serving in contact tracing
and related positions after such positions are no longer
necessary in the State or local area, including--
(A) any additional training and employment
activities as described in section 170(d)(4) of the
Workforce Innovation and Opportunity Act (29 U.S.C.
3225(d)(4));
(B) developing the appropriate combination of
services to enable the eligible individual to achieve
the employment and career goals identified under
paragraph (3)(D)(ii)(I); and
(C) services to assist eligible individuals in
maintaining employment for not less than 12 months
after the completion of employment in contact tracing
and related positions, as appropriate.
(5) Any other activities as described in subsections (a)(3)
and (b) of section 134 of the Workforce Innovation and
Opportunity Act (29 U.S.C. 3174).
(g) Limitation.--Notwithstanding section 170(d)(3)(A) of the
Workforce Innovation and Opportunity Act (29 U.S.C. 3225(d)(3)(A)), a
person may be employed in a contact tracing and related positions using
funds under this section for a period not greater than 2 years.
(h) Reporting by the Department of Labor.--
(1) In general.--Not later than 120 days of the enactment
of this Act, and once grant funds have been expended under this
section, the Secretary shall report to the Committee on
Education and Labor of the House of Representatives and the
Committee on Health, Education, Labor, and Pensions of the
Senate, and make publicly available a report containing a
description of--
(A) the number of eligible individuals recruited,
hired, and trained in contact tracing and related
positions;
(B) the number of individuals successfully
transitioned to unsubsidized employment or training at
the completion of employment in contact tracing and
related positions using funds under this subtitle;
(C) the number of such individuals who were
unemployed prior to being hired, trained, or deployed
as described in paragraph (1);
(D) the performance of each program supported by
funds under this subtitle with respect to the
indicators of performance under section 116 of the
Workforce Innovation and Opportunity Act (29 U.S.C.
3141), as applicable;
(E) the number of individuals in unsubsidized
employment within six months and 1 year, respectively,
of the conclusion of employment in contact tracing and
related positions and, of those, the number of
individuals within a State, territorial, or local
public health department in an occupation related to
public health;
(F) any information on how eligible entities, local
boards, or community-based organizations that received
funding under this subsection were able to support the
goals of the national system for COVID-19 testing,
contact tracing, surveillance, containment, and
mitigation established under section 222 of this Act;
and
(G) best practices for improving and increasing the
transition of individuals employed in contract tracing
and related positions to unsubsidized employment.
(2) Disaggregation.--All data reported under paragraph (1)
shall be disaggregated by race, ethnicity, sex, age, and, with
respect to individuals with barriers to employment,
subpopulation of such individuals, except for when the number
of participants in a category is insufficient to yield
statistically reliable information or when the results would
reveal personally identifiable information about an individual
participant.
(i) Special Rule.--Any funds used for programs under this section
that are used to fund an apprenticeship or apprenticeship program shall
only be used for, or provided to, an apprenticeship or apprenticeship
program that meets the definition of such term subsection (a) of this
section, including any funds awarded for the purposes of grants,
contracts, or cooperative agreements, or the development,
implementation, or administration, of an apprenticeship or an
apprenticeship program.
(j) Information Sharing Requirement for HHS.--The Secretary of
Health and Human Services, acting through the Director of the Centers
for Disease Control and Prevention, shall provide the Secretary of
Labor, acting through the Assistant Secretary of the Employment and
Training Administration, with information on grants under section 223,
including--
(1) the formula used to award such grants to State, local,
Tribal, and territorial health departments;
(2) the dollar amounts of and scope of the work funded
under such grants;
(3) the geographic areas served by eligible entities that
receive such grants; and
(4) the number of contact tracers and related positions to
be hired using such grants.
(k) Authorization of Appropriations.--Of the amounts appropriated
to carry out this subtitle, $500,000,000 shall be used by the Secretary
of Labor to carry out subsections (a) through (h) of this section.
TITLE III--FREE TREATMENT FOR ALL AMERICANS
SEC. 301. COVERAGE AT NO COST SHARING OF COVID-19 VACCINE AND
TREATMENT.
(a) Medicaid.--
(1) In general.--Section 1905(a)(4) of the Social Security
Act (42 U.S.C. 1396d(a)(4)) is amended--
(A) by striking ``and (D)'' and inserting ``(D)'';
and
(B) by striking the semicolon at the end and
inserting ``; (E) during the portion of the emergency
period described in paragraph (1)(B) of section 1135(g)
beginning on the date of the enactment of The Heroes
Act, a COVID-19 vaccine licensed under section 351 of
the Public Health Service Act, or approved or
authorized under sections 505 or 564 of the Federal
Food, Drug, and Cosmetic Act, and administration of the
vaccine; and (F) during such portion of the emergency
period described in paragraph (1)(B) of section
1135(g), items or services for the prevention or
treatment of COVID-19, including drugs approved or
authorized under such section 505 or such section 564
or, without regard to the requirements of section
1902(a)(10)(B) (relating to comparability), in the case
of an individual who is diagnosed with or presumed to
have COVID-19, during such portion of such emergency
period during which such individual is infected (or
presumed infected) with COVID-19, the treatment of a
condition that may complicate the treatment of COVID-
19;''.
(2) Prohibition of cost sharing.--
(A) In general.--Subsections (a)(2) and (b)(2) of
section 1916 of the Social Security Act (42 U.S.C.
1396o) are each amended--
(i) in subparagraph (F), by striking ``or''
at the end;
(ii) in subparagraph (G), by striking ``;
and'' and inserting ``;''; and
(iii) by adding at the end the following
subparagraphs:
``(H) during the portion of the emergency period
described in paragraph (1)(B) of section 1135(g)
beginning on the date of the enactment of this
subparagraph, a COVID-19 vaccine licensed under section
351 of the Public Health Service Act, or approved or
authorized under section 505 or 564 of the Federal
Food, Drug, and Cosmetic Act, and the administration of
such vaccine; or
``(I) during such portion of the emergency period
described in paragraph (1)(B) of section 1135(g), any
item or service furnished for the treatment of COVID-
19, including drugs approved or authorized under such
section 505 or such section 564 or, in the case of an
individual who is diagnosed with or presumed to have
COVID-19, during the portion of such emergency period
during which such individual is infected (or presumed
infected) with COVID-19, the treatment of a condition
that may complicate the treatment of COVID-19; and''.
(B) Application to alternative cost sharing.--
Section 1916A(b)(3)(B) of the Social Security Act (42
U.S.C. 1396o-1(b)(3)(B)) is amended--
(i) in clause (xi), by striking ``any
visit'' and inserting ``any service''; and
(ii) by adding at the end the following
clauses:
``(xii) During the portion of the emergency
period described in paragraph (1)(B) of section
1135(g) beginning on the date of the enactment
of this clause, a COVID-19 vaccine licensed
under section 351 of the Public Health Service
Act, or approved or authorized under section
505 or 564 of the Federal Food, Drug, and
Cosmetic Act, and the administration of such
vaccine.
``(xiii) During such portion of the
emergency period described in paragraph (1)(B)
of section 1135(g), an item or service
furnished for the treatment of COVID-19,
including drugs approved or authorized under
such section 505 or such section 564 or, in the
case of an individual who is diagnosed with or
presumed to have COVID-19, during such portion
of such emergency period during which such
individual is infected (or presumed infected)
with COVID-19, the treatment of a condition
that may complicate the treatment of COVID-
19.''.
(C) Clarification.--The amendments made by this
subsection shall apply with respect to a State plan of
a territory in the same manner as a State plan of one
of the 50 States.
(b) State Pediatric Vaccine Distribution Program.--Section 1928 of
the Social Security Act (42 U.S.C. 1396s) is amended--
(1) in subsection (a)(1)--
(A) in subparagraph (A), by striking ``; and'' and
inserting a semicolon;
(B) in subparagraph (B), by striking the period and
inserting ``; and''; and
(C) by adding at the end the following
subparagraph:
``(C) during the portion of the emergency period
described in paragraph (1)(B) of section 1135(g)
beginning on the date of the enactment of this
subparagraph, each vaccine-eligible child (as defined
in subsection (b)) is entitled to receive a COVID-19
vaccine from a program-registered provider (as defined
in subsection (h)(7)) without charge for--
``(i) the cost of such vaccine; or
``(ii) the administration of such
vaccine.'';
(2) in subsection (c)(2)--
(A) in subparagraph (C)(ii), by inserting ``, but,
during the portion of the emergency period described in
paragraph (1)(B) of section 1135(g) beginning on the
date of the enactment of The Heroes Act, may not impose
a fee for the administration of a COVID-19 vaccine''
before the period; and
(B) by adding at the end the following
subparagraph:
``(D) The provider will provide and administer an
approved COVID-19 vaccine to a vaccine-eligible child
in accordance with the same requirements as apply under
the preceding subparagraphs to the provision and
administration of a qualified pediatric vaccine to such
a child.''; and
(3) in subsection (d)(1), in the first sentence, by
inserting ``, including, during the portion of the emergency
period described in paragraph (1)(B) of section 1135(g)
beginning on the date of the enactment of The Heroes Act, with
respect to a COVID-19 vaccine licensed under section 351 of the
Public Health Service Act, or approved or authorized under
section 505 or 564 of the Federal Food, Drug, and Cosmetic
Act'' before the period.
(c) CHIP.--
(1) In general.--Section 2103(c) of the Social Security Act
(42 U.S.C. 1397cc(c)) is amended by adding at the end the
following paragraph:
``(11) Coverage of covid-19 vaccines and treatment.--
Regardless of the type of coverage elected by a State under
subsection (a), child health assistance provided under such
coverage for targeted low-income children and, in the case that
the State elects to provide pregnancy-related assistance under
such coverage pursuant to section 2112, such pregnancy-related
assistance for targeted low-income pregnant women (as defined
in section 2112(d)) shall include coverage, during the portion
of the emergency period described in paragraph (1)(B) of
section 1135(g) beginning on the date of the enactment of this
paragraph, of--
``(A) a COVID-19 vaccine licensed under section 351
of the Public Health Service Act, or approved or
authorized under section 505 or 564 of the Federal
Food, Drug, and Cosmetic Act, and the administration of
such vaccine; and
``(B) any item or service furnished for the
treatment of COVID-19, including drugs approved or
authorized under such section 505 or such section 564,
or, in the case of an individual who is diagnosed with
or presumed to have COVID-19, during the portion of
such emergency period during which such individual is
infected (or presumed infected) with COVID-19, the
treatment of a condition that may complicate the
treatment of COVID-19.''.
(2) Prohibition of cost sharing.--Section 2103(e)(2) of the
Social Security Act (42 U.S.C. 1397cc(e)(2)), as amended by
section 6004(b)(3) of the Families First Coronavirus Response
Act, is amended--
(A) in the paragraph header, by inserting ``a
covid-19 vaccine, covid-19 treatment,'' before ``or
pregnancy-related assistance''; and
(B) by striking ``visits described in section
1916(a)(2)(G), or'' and inserting ``services described
in section 1916(a)(2)(G), vaccines described in section
1916(a)(2)(H) administered during the portion of the
emergency period described in paragraph (1)(B) of
section 1135(g) beginning on the date of the enactment
of The Heroes Act, items or services described in
section 1916(a)(2)(I) furnished during such emergency
period, or''.
(d) Conforming Amendments.--Section 1937 of the Social Security Act
(42 U.S.C. 1396u-7) is amended--
(1) in subsection (a)(1)(B), by inserting ``, under
subclause (XXIII) of section 1902(a)(10)(A)(ii),'' after
``section 1902(a)(10)(A)(i)''; and
(2) in subsection (b)(5), by adding before the period the
following: ``, and, effective on the date of the enactment of
The Heroes Act, must comply with subparagraphs (F) through (I)
of subsections (a)(2) and (b)(2) of section 1916 and subsection
(b)(3)(B) of section 1916A''.
(e) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act and shall apply with
respect to a COVID-19 vaccine beginning on the date that such vaccine
is licensed under section 351 of the Public Health Service Act (42
U.S.C. 262), or approved or authorized under section 505 or 564 of the
Federal Food, Drug, and Cosmetic Act.
SEC. 302. OPTIONAL COVERAGE AT NO COST SHARING OF COVID-19 TREATMENT
AND VACCINES UNDER MEDICAID FOR UNINSURED INDIVIDUALS.
(a) In General.--Section 1902(a)(10) of the Social Security Act (42
U.S.C. 1396a(a)(10)) is amended, in the matter following subparagraph
(G), by striking ``and any visit described in section 1916(a)(2)(G)''
and inserting the following: ``, any COVID-19 vaccine that is
administered during any such portion (and the administration of such
vaccine), any item or service that is furnished during any such portion
for the treatment of COVID-19, including drugs approved or authorized
under section 505 or 564 of the Federal Food, Drug, and Cosmetic Act,
or, in the case of an individual who is diagnosed with or presumed to
have COVID-19, during the period such individual is infected (or
presumed infected) with COVID-19, the treatment of a condition that may
complicate the treatment of COVID-19, and any services described in
section 1916(a)(2)(G)''.
(b) Definition of Uninsured Individual.--
(1) In general.--Subsection (ss) of section 1902 of the
Social Security Act (42 U.S.C. 1396a) is amended to read as
follows:
``(ss) Uninsured Individual Defined.--For purposes of this section,
the term `uninsured individual' means, notwithstanding any other
provision of this title, any individual who is not covered by minimum
essential coverage (as defined in section 5000A(f)(1) of the Internal
Revenue Code of 1986).''.
(2) Effective date.--The amendment made by paragraph (1)
shall take effect and apply as if included in the enactment of
the Families First Coronavirus Response Act (Public Law 116-
127).
(c) Clarification Regarding Emergency Services for Certain
Individuals.--Section 1903(v)(2) of the Social Security Act (42 U.S.C.
1396b(v)(2)) is amended by adding at the end the following flush
sentence:
``For purposes of subparagraph (A), care and services described
in such subparagraph include any in vitro diagnostic product
described in section 1905(a)(3)(B) (and the administration of
such product), any COVID-19 vaccine (and the administration of
such vaccine), any item or service that is furnished for the
treatment of COVID-19, including drugs approved or authorized
under section 505 or 564 of the Federal Food, Drug, and
Cosmetic Act, or a condition that may complicate the treatment
of COVID-19, and any services described in section
1916(a)(2)(G).''.
(d) Inclusion of COVID-19 Concern as an Emergency Condition.--
Section 1903(v)(3) of the Social Security Act (42 U.S.C. 1396b(v)(3))
is amended by adding at the end the following flush sentence:
``Such term includes any indication that an alien described in
paragraph (1) may have contracted COVID-19.''.
SEC. 303. COVERAGE OF TREATMENTS FOR COVID-19 AT NO COST SHARING UNDER
THE MEDICARE ADVANTAGE PROGRAM.
(a) In General.--Section 1852(a)(1)(B) of the Social Security Act
(42 U.S.C. 1395w-22(a)(1)(B)) is amended by adding at the end the
following new clause:
``(vii) Special coverage rules for
specified covid-19 treatment services.--
Notwithstanding clause (i), in the case of a
specified COVID-19 treatment service (as
defined in section 30201(b) of The Heroes Act)
that is furnished during a plan year occurring
during any portion of the emergency period
defined in section 1135(g)(1)(B) beginning on
or after the date of the enactment of this
clause, a Medicare Advantage plan may not, with
respect to such service, impose--
``(I) any cost-sharing requirement
(including a deductible, copayment, or
coinsurance requirement); and
``(II) in the case such service is
a critical specified COVID-19 treatment
service (including ventilator services
and intensive care unit services), any
prior authorization or other
utilization management requirement.
A Medicare Advantage plan may not take the
application of this clause into account for
purposes of a bid amount submitted by such plan
under section 1854(a)(6).''.
(b) Implementation.--Notwithstanding any other provision of law,
the Secretary of Health and Human Services may implement the amendments
made by this section by program instruction or otherwise.
SEC. 304. REQUIRING COVERAGE UNDER MEDICARE PDPS AND MA-PD PLANS,
WITHOUT THE IMPOSITION OF COST SHARING OR UTILIZATION
MANAGEMENT REQUIREMENTS, OF DRUGS INTENDED TO TREAT
COVID-19 DURING CERTAIN EMERGENCIES.
(a) Coverage Requirement.--Section 1860D-4(b)(3) of the Social
Security Act (42 U.S.C. 1395w-104(b)(3)) is amended by adding at the
end the following new subparagraph:
``(I) Required inclusion of drugs intended to treat
covid-19.--
``(i) In general.--Notwithstanding any
other provision of law, a PDP sponsor offering
a prescription drug plan shall, with respect to
a plan year, any portion of which occurs during
the period described in clause (ii), be
required to--
``(I) include in any formulary--
``(aa) all covered part D
drugs with a medically accepted
indication (as defined in
section 1860D-2(e)(4)) to treat
COVID-19 that are marketed in
the United States; and
``(bb) all drugs authorized
under section 564 or 564A of
the Federal Food, Drug, and
Cosmetic Act to treat COVID-19;
and
``(II) not impose any prior
authorization or other utilization
management requirement with respect to
such drugs described in item (aa) or
(bb) of subclause (I) (other than such
a requirement that limits the quantity
of drugs due to safety).
``(ii) Period described.--For purposes of
clause (i), the period described in this clause
is the period during which there exists the
public health emergency declared by the
Secretary pursuant to section 319 of the Public
Health Service Act on January 31, 2020,
entitled `Determination that a Public Health
Emergency Exists Nationwide as the Result of
the 2019 Novel Coronavirus' (including any
renewal of such declaration pursuant to such
section).''.
(b) Elimination of Cost Sharing.--
(1) Elimination of cost sharing for drugs intended to treat
covid-19 under standard and alternative prescription drug
coverage.--Section 1860D-2 of the Social Security Act (42
U.S.C. 1395w-102) is amended--
(A) in subsection (b)--
(i) in paragraph (1)(A), by striking ``The
coverage'' and inserting ``Subject to paragraph
(8), the coverage'';
(ii) in paragraph (2)--
(I) in subparagraph (A), by
inserting after ``Subject to
subparagraphs (C) and (D)'' the
following: ``and paragraph (8)'';
(II) in subparagraph (C)(i), by
striking ``paragraph (4)'' and
inserting ``paragraphs (4) and (8)'';
and
(III) in subparagraph (D)(i), by
striking ``paragraph (4)'' and
inserting ``paragraphs (4) and (8)'';
(iii) in paragraph (4)(A)(i), by striking
``The coverage'' and inserting ``Subject to
paragraph (8), the coverage''; and
(iv) by adding at the end the following new
paragraph:
``(8) Elimination of cost sharing for drugs intended to
treat covid-19.--The coverage does not impose any deductible,
copayment, coinsurance, or other cost-sharing requirement for
drugs described in section 1860D-4(b)(3)(I)(i)(I) with respect
to a plan year, any portion of which occurs during the period
during which there exists the public health emergency declared
by the Secretary pursuant to section 319 of the Public Health
Service Act on January 31, 2020, entitled `Determination that a
Public Health Emergency Exists Nationwide as the Result of the
2019 Novel Coronavirus' (including any renewal of such
declaration pursuant to such section).''; and
(B) in subsection (c), by adding at the end the
following new paragraph:
``(4) Same elimination of cost sharing for drugs intended
to treat covid-19.--The coverage is in accordance with
subsection (b)(8).''.
(2) Elimination of cost sharing for drugs intended to treat
covid-19 dispensed to individuals who are subsidy eligible
individuals.--Section 1860D-14(a) of the Social Security Act
(42 U.S.C. 1395w-114(a)) is amended--
(A) in paragraph (1)--
(i) in subparagraph (D)--
(I) in clause (ii), by striking
``In the case of'' and inserting
``Subject to subparagraph (F), in the
case of''; and
(II) in clause (iii), by striking
``In the case of'' and inserting
``Subject to subparagraph (F), in the
case of''; and
(ii) by adding at the end the following new
subparagraph:
``(F) Elimination of cost sharing for drugs
intended to treat covid-19.--Coverage that is in
accordance with section 1860D-2(b)(8).''; and
(B) in paragraph (2)--
(i) in subparagraph (B), by striking ``A
reduction'' and inserting ``Subject to
subparagraph (F), a reduction'';
(ii) in subparagraph (D), by striking ``The
substitution'' and inserting ``Subject to
subparagraph (F), the substitution'';
(iii) in subparagraph (E), by inserting
after ``Subject to'' the following:
``subparagraph (F) and''; and
(iv) by adding at the end the following new
subparagraph:
``(F) Elimination of cost sharing for drugs
intended to treat covid-19.--Coverage that is in
accordance with section 1860D-2(b)(8).''.
(c) Implementation.--Notwithstanding any other provision of law,
the Secretary of Health and Human Services may implement the amendments
made by this section by program instruction or otherwise.
SEC. 305. COVERAGE OF COVID-19 RELATED TREATMENT AT NO COST SHARING.
(a) In General.--A group health plan and a health insurance issuer
offering group or individual health insurance coverage (including a
grandfathered health plan (as defined in section 1251(e) of the Patient
Protection and Affordable Care Act)) shall provide coverage, and shall
not impose any cost sharing (including deductibles, copayments, and
coinsurance) requirements, for the following items and services
furnished during any portion of the emergency period defined in
paragraph (1)(B) of section 1135(g) of the Social Security Act (42
U.S.C. 1320b-5(g)) beginning on or after the date of the enactment of
this Act:
(1) Medically necessary items and services (including in-
person or telehealth visits in which such items and services
are furnished) that are furnished to an individual who has been
diagnosed with (or after provision of the items and services is
diagnosed with) COVID-19 to treat or mitigate the effects of
COVID-19.
(2) Medically necessary items and services (including in-
person or telehealth visits in which such items and services
are furnished) that are furnished to an individual who is
presumed to have COVID-19 but is never diagnosed as such, if
the following conditions are met:
(A) Such items and services are furnished to the
individual to treat or mitigate the effects of COVID-19
or to mitigate the impact of COVID-19 on society.
(B) Health care providers have taken appropriate
steps under the circumstances to make a diagnosis, or
confirm whether a diagnosis was made, with respect to
such individual, for COVID-19, if possible.
(b) Items and Services Related to COVID-19.--For purposes of this
section--
(1) not later than one week after the date of the enactment
of this section, the Secretary of Health and Human Services,
Secretary of Labor, and Secretary of the Treasury shall jointly
issue guidance specifying applicable diagnoses and medically
necessary items and services related to COVID-19; and
(2) such items and services shall include all items or
services that are relevant to the treatment or mitigation of
COVID-19, regardless of whether such items or services are
ordinarily covered under the terms of a group health plan or
group or individual health insurance coverage offered by a
health insurance issuer.
(c) Enforcement.--
(1) Application with respect to phsa, erisa, and irc.--The
provisions of this section shall be applied by the Secretary of
Health and Human Services, Secretary of Labor, and Secretary of
the Treasury to group health plans and health insurance issuers
offering group or individual health insurance coverage as if
included in the provisions of part A of title XXVII of the
Public Health Service Act, part 7 of the Employee Retirement
Income Security Act of 1974, and subchapter B of chapter 100 of
the Internal Revenue Code of 1986, as applicable.
(2) Private right of action.--An individual with respect to
whom an action is taken by a group health plan or health
insurance issuer offering group or individual health insurance
coverage in violation of subsection (a) may commence a civil
action against the plan or issuer for appropriate relief. The
previous sentence shall not be construed as limiting any
enforcement mechanism otherwise applicable pursuant to
paragraph (1).
(d) Implementation.--The Secretary of Health and Human Services,
Secretary of Labor, and Secretary of the Treasury may implement the
provisions of this section through sub-regulatory guidance, program
instruction or otherwise.
(e) Terms.--The terms ``group health plan'', ``health insurance
issuer'', ``group health insurance coverage'', and ``individual health
insurance coverage'' have the meanings given such terms in section 2791
of the Public Health Service Act (42 U.S.C. 300gg-91), section 733 of
the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191b),
and section 9832 of the Internal Revenue Code of 1986, as applicable.
SEC. 306. REIMBURSEMENT FOR ADDITIONAL HEALTH SERVICES RELATING TO
CORONAVIRUS.
Title V of division A of the Families First Coronavirus Response
Act (Public Law 116-127) is amended under the heading ``Department of
Health and Human Services--Office of the Secretary--Public Health and
Social Services Emergency Fund'' by inserting ``, or treatment related
to SARS-CoV-2 or COVID-19 for uninsured individuals'' after ``or visits
described in paragraph (2) of such section for uninsured individuals''.
TITLE IV--FEDERAL HEALTH EQUITY OVERSIGHT
SEC. 401. COVID-19 RACIAL AND ETHNIC DISPARITIES TASK FORCE ACT OF
2020.
(a) In General.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary'') shall establish an
interagency task force, to be known as the ``COVID-19 Racial and Ethnic
Disparities Task Force'' (referred to in this section as the ``task
force''), to gather data about disproportionately affected communities
and provide recommendations to combat the racial and ethnic disparities
in the COVID-19 response throughout the United States and in response
to future public health crises.
(b) Membership.--The task force shall be composed of the following:
(1) The Secretary of Health and Human Services.
(2) The Assistant Secretary for Planning and Evaluation of
the Department of Health and Human Services.
(3) The Assistant Secretary for Preparedness and Response
of the Department of Health and Human Services.
(4) The Director of the Centers for Disease Control and
Prevention.
(5) The Director of the National Institutes of Health.
(6) The Commissioner of Food and Drugs.
(7) The Administrator of the Federal Emergency Management
Agency.
(8) The Director of the National Institute on Minority
Health and Health Disparities.
(9) The Director of the Indian Health Service.
(10) The Administrator of the Centers for Medicare &
Medicaid Services.
(11) The Director of the Agency for Healthcare Research and
Quality.
(12) The Surgeon General.
(13) The Administrator of the Health Resources and Services
Administration.
(14) The Director of the Office of Minority Health.
(15) The Secretary of Housing and Urban Development.
(16) The Secretary of Education.
(17) The Secretary of Labor.
(18) The Secretary of Defense.
(19) The Secretary of Transportation.
(20) The Secretary of the Treasury.
(21) The Administrator of the Small Business
Administration.
(22) The Administrator of the Environmental Protection
Agency.
(23) Five health care professionals with expertise in
addressing racial and ethnic disparities, with at least one
representative from a rural area, to be appointed by the
Secretary.
(24) Five policy experts specializing in addressing racial
and ethnic disparities in education or racial and ethnic
economic inequality to be appointed by the Secretary.
(25) Six representatives from community-based organizations
specializing in providing culturally competent care or services
and addressing racial and ethnic disparities, to be appointed
by the Secretary, with at least one representative from an
urban Indian organization and one representative from a
national organization that represents Tribal governments with
expertise in Tribal public health.
(26) Six State, local, territorial, or Tribal public health
officials representing departments of public health, who shall
represent jurisdictions from different regions of the United
States with relatively high concentrations of historically
marginalized populations, to be appointed by the Secretary,
with at least one territorial representative and one
representative of a Tribal public health department.
(c) Administrative Provisions.--
(1) Appointment of non-government members.--Notwithstanding
any other provision of law, the Secretary shall appoint all
non-government members of the task force within 30 days of the
date enactment of this section.
(2) Chairperson.--The Secretary shall serve as the
chairperson of the task force. The Director of the Office of
Minority Health shall serve as the vice chairperson.
(3) Staff.--The task force shall have 10 full-time staff
members.
(4) Meetings.--Not later than 45 days after the date of
enactment of this section, the full task force shall have its
first meeting. The task force shall convene at least once a
month thereafter.
(5) Subcommittees.--The chairperson and vice chairperson of
the task force are authorized to establish subcommittees to
consider specific issues related to the broader mission of
addressing racial and ethnic disparities.
(d) Federal Emergency Management Agency Resource Allocation
Reporting and Recommendations.--
(1) Weekly reports.--Not later than 7 days after the task
force first meets, and weekly thereafter, the task force shall
submit to Congress and the Federal Emergency Management Agency
a report that includes--
(A) a description of COVID-19 patient outcomes,
including cases, hospitalizations, patients on
ventilation, and mortality, disaggregated by race and
ethnicity (where such data is missing, the task force
shall utilize appropriate authorities to improve data
collection);
(B) the identification of communities that lack
resources to combat the COVID-19 pandemic, including
personal protective equipment, ventilators, hospital
beds, testing kits, testing supplies, vaccinations
(when available), resources to conduct surveillance and
contact tracing, funding, staffing, and other resources
the task force deems essential as needs arise;
(C) the identification of communities where racial
and ethnic disparities in COVID-19 infection,
hospitalization, and death rates are out of proportion
to the community's population by a certain threshold,
to be determined by the task force based on available
public health data;
(D) recommendations about how to best allocate
critical COVID-19 resources to--
(i) communities with disproportionately
high COVID-19 infection, hospitalization, and
death rates; and
(ii) communities identified in subparagraph
(C);
(E) with respect to communities that are able to
reduce racial and ethnic disparities effectively, a
description of best practices involved; and
(F) an update with respect to the response of the
Federal Emergency Management Agency to the task force's
previous weeks' recommendations under this section.
(2) General consultation.--In submitting weekly reports and
recommendations under this subsection, the task force shall
consult with and notify State, local, territorial, and Tribal
officials and community-based organizations from communities
identified as disproportionately impacted by COVID-19.
(3) Consultation with indian tribes.--In submitting weekly
reports and recommendations under this subsection, the Director
of Indian Health Service shall, in coordination with the task
force, consult with Indian Tribes and Tribal organizations that
are disproportionately affected by COVID-19 on a government to
government basis to identify specific needs and
recommendations.
(4) Dissemination.--Reports under this subsection shall be
disseminated to all relevant stakeholders, including State,
local, territorial, and Tribal officials, and public health
departments.
(5) Tribal data.--The task force, in consultation with
Indian Tribes and Tribal organizations, shall ensure that an
Indian Tribe consents to any public reporting of health data.
(e) COVID-19 Relief Oversight and Implementation Reports.--Not
later than 14 days after the task force first meets, and not later than
every 14 days thereafter, the task force shall submit to Congress and
the relevant Federal agencies a report that includes--
(1) an examination of funds distributed under COVID-19-
related relief and stimulus laws (enacted prior to and after
the date of enactment of this Act), including the Coronavirus
Preparedness and Response Emergency Supplemental Appropriations
Act, 2020 (Public Law 116-123), the Families First Coronavirus
Response Act (Public Law 116-127), the Coronavirus Aid, Relief,
and Economic Security Act (Public Law 116-136), and the
Paycheck Protection Program and Health Care Enhancement Act
(Public Law 116-139), and how that distribution impacted racial
and ethnic disparities with respect to the COVID-19 pandemic;
and
(2) recommendations to relevant Federal agencies about how
to disburse any undisbursed funding from COVID-19-related
relief and stimulus laws (enacted prior to and after the date
of enactment of this Act), including those laws described in
paragraph (1), to address racial and ethnic disparities with
respect to the COVID-19 pandemic, including recommendations
to--
(A) the Department of Health and Human Services
about disbursement of funds under the Public Health and
Social Service Emergency Fund;
(B) the Small Business Administration about
disbursement of funds under the Paycheck Protection
Program and the Economic Injury Disaster Loan Program;
and
(C) the Department of Education about disbursement
of funds under the Education Stabilization Fund.
(f) Final COVID-19 Reports.--Not later than 90 days after the date
on which the President declares the end of the COVID-19 public health
emergency first declared by the Secretary on January 31, 2020, the task
force shall submit to Congress a report that--
(1) describes inequities within the health care system,
implicit bias, structural racism, and social determinants of
health (including housing, nutrition, education, economic, and
environmental factors) that contributed to racial and ethnic
health disparities with respect to the COVID-19 pandemic and
how these factors contributed to such disparities;
(2) examines the initial Federal response to the COVID-19
pandemic and its impact on the racial and ethnic disparities in
COVID-19 infection, hospitalization, and death rates; and
(3) contains recommendations to combat racial and ethnic
disparities in future infectious disease responses, including
future COVID-19 outbreaks.
(g) Sunset and Successor Task Force.--
(1) Sunset.--The task force shall terminate on the date
that is 90 days after the date on which the President declares
the end of the COVID-19 public health emergency first declared
by the Secretary on January 31, 2020.
(2) Successor.--Upon the termination of the task force
under paragraph (1), the Secretary shall establish a permanent
Infectious Disease Racial and Ethnic Disparities Task Force
based on the membership, convening, and reporting requirements
recommended by the task force in reports submitted under this
section.
(h) Authorization of Appropriations.--There is authorized to be
appropriated, such sums as may be necessary to carry out this section.
SEC. 402. 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. 403. 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,
including health disparities associated with public
health emergencies, 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. 404. ACCOUNTABILITY AND TRANSPARENCY WITHIN THE DEPARTMENT OF
HEALTH AND HUMAN SERVICES.
Title XXXIV of the Public Health Service Act is 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.''.
TITLE V--EXPANDED INSURANCE ACCESS
SEC. 501. MEDICARE SPECIAL ENROLLMENT PERIOD FOR INDIVIDUALS RESIDING
IN COVID-19 EMERGENCY AREAS.
(a) In General.--Section 1837(i) of the Social Security Act (42
U.S.C. 1395p(i)) is amended by adding at the end the following new
paragraph:
``(5)(A) In the case of an individual who--
``(i) is eligible under section 1836 to enroll in
the medical insurance program established by this part,
``(ii) did not enroll (or elected not to be deemed
enrolled) under this section during an enrollment
period, and
``(iii) during the emergency period (as described
in section 1135(g)(1)(B)), resided in an emergency area
(as described in such section),
there shall be a special enrollment period described in
subparagraph (B).
``(B) The special enrollment period referred to in
subparagraph (A) is the period that begins not later
than July 1, 2020, and ends on the last day of the
month in which the emergency period (as described in
section 1135(g)(1)(B)) ends.''.
(b) Coverage Period for Individuals Transitioning From Other
Coverage.--Section 1838(e) of the Social Security Act (42 U.S.C.
1395q(e)) is amended--
(1) by striking ``pursuant to section 1837(i)(3) or
1837(i)(4)(B)--'' and inserting the following: ``pursuant to--
``(1) section 1837(i)(3) or 1837(i)(4)(B)--'';
(2) by redesignating paragraphs (1) and (2) as
subparagraphs (A) and (B), respectively, and moving the
indentation of each such subparagraph 2 ems to the right;
(3) by striking the period at the end of the subparagraph
(B), as so redesignated, and inserting ``; or''; and
(4) by adding at the end the following new paragraph:
``(2) section 1837(i)(5), the coverage period shall begin
on the first day of the month following the month in which the
individual so enrolls.''.
(c) Funding.--The Secretary of Health and Human Services shall
provide for the transfer from the Federal Hospital Insurance Trust Fund
(as described in section 1817 of the Social Security Act (42 U.S.C.
1395i)) and the Federal Supplementary Medical Insurance Trust Fund (as
described in section 1841 of such Act (42 U.S.C. 1395t)), in such
proportions as determined appropriate by the Secretary, to the Social
Security Administration, of $30,000,000, to remain available until
expended, for purposes of carrying out the amendments made by this
section.
(d) Implementation.--Notwithstanding any other provision of law,
the Secretary of Health and Human Services may implement the amendments
made by this section by program instruction or otherwise.
SEC. 502. SPECIAL ENROLLMENT PERIOD THROUGH EXCHANGES; FEDERAL EXCHANGE
OUTREACH AND EDUCATIONAL ACTIVITIES.
(a) Special Enrollment Period Through Exchanges.--Section 1311(c)
of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c))
is amended--
(1) in paragraph (6)--
(A) in subparagraph (C), by striking at the end
``and'';
(B) in subparagraph (D), by striking at the end the
period and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(E) subject to subparagraph (B) of paragraph (8),
the special enrollment period described in subparagraph
(A) of such paragraph.''; and
(2) by adding at the end the following new paragraph:
``(8) Special enrollment period for certain public health
emergency.--
``(A) In general.--The Secretary shall, subject to
subparagraph (B), require an Exchange to provide--
``(i) for a special enrollment period
during the emergency period described in
section 1135(g)(1)(B) of the Social Security
Act--
``(I) which shall begin on the date
that is one week after the date of the
enactment of this paragraph and which,
in the case of an Exchange established
or operated by the Secretary within a
State pursuant to section 1321(c),
shall be an 8-week period; and
``(II) during which any individual
who is otherwise eligible to enroll in
a qualified health plan through the
Exchange may enroll in such a qualified
health plan; and
``(ii) that, in the case of an individual
who enrolls in a qualified health plan through
the Exchange during such enrollment period, the
coverage period under such plan shall begin, at
the option of the individual, on April 1, 2020,
or on the first day of the month following the
day the individual selects a plan through such
special enrollment period.
``(B) Exception.--The requirement of subparagraph
(A) shall not apply to a State-operated or State-
established Exchange if such Exchange, prior to the
date of the enactment of this paragraph, established or
otherwise provided for a special enrollment period to
address access to coverage under qualified health plans
offered through such Exchange during the emergency
period described in section 1135(g)(1)(B) of the Social
Security Act.''.
(b) Federal Exchange Outreach and Educational Activities.--Section
1321(c) of the Patient Protection and Affordable Care Act (42 U.S.C.
18041(c)) is amended by adding at the end the following new paragraph:
``(3) Outreach and educational activities.--
``(A) In general.--In the case of an Exchange
established or operated by the Secretary within a State
pursuant to this subsection, the Secretary shall carry
out outreach and educational activities for purposes of
informing potential enrollees in qualified health plans
offered through the Exchange of the availability of
coverage under such plans and financial assistance for
coverage under such plans. Such outreach and
educational activities shall be provided in a manner
that is culturally and linguistically appropriate to
the needs of the populations being served by the
Exchange (including hard-to-reach populations, such as
racial and sexual minorities, limited English
proficient populations, and young adults).
``(B) Limitation on use of funds.--No funds
appropriated under this paragraph shall be used for
expenditures for promoting non-ACA compliant health
insurance coverage.
``(C) Non-ACA compliant health insurance
coverage.--For purposes of subparagraph (B):
``(i) The term `non-ACA compliant health
insurance coverage' means health insurance
coverage, or a group health plan, that is not a
qualified health plan.
``(ii) Such term includes the following:
``(I) An association health plan.
``(II) Short-term limited duration
insurance.
``(D) Funding.--There are appropriated, out of any
funds in the Treasury not otherwise appropriated,
$25,000,000, to remain available until expended--
``(i) to carry out this paragraph; and
``(ii) at the discretion of the Secretary,
to carry out section 1311(i), with respect to
an Exchange established or operated by the
Secretary within a State pursuant to this
subsection.''.
(c) Implementation.--The Secretary of Health and Human Services may
implement the provisions of (including amendments made by) this section
through subregulatory guidance, program instruction, or otherwise.
SEC. 503. 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 are 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. 504. ALLOWING FOR MEDICAL ASSISTANCE UNDER MEDICAID FOR INMATES
DURING 30-DAY PERIOD PRECEDING RELEASE.
(a) In General.--The subdivision (A) following paragraph (30) of
section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is
amended by inserting ``and except during the 30-day period preceding
the date of release of such individual from such public institution''
after ``medical institution''.
(b) Report.--Not later than June 30, 2022, the Medicaid and CHIP
Payment and Access Commission shall submit a report to Congress on the
Medicaid inmate exclusion under the subdivision (A) following paragraph
(30) of section 1905(a) of the Social Security Act (42 U.S.C.
1396d(a)). Such report may, to the extent practicable, include the
following information:
(1) The number of incarcerated individuals who would
otherwise be eligible to enroll for medical assistance under a
State plan approved under title XIX of the Social Security Act
(42 U.S.C. 1396 et seq.) (or a waiver of such a plan).
(2) Access to health care for incarcerated individuals,
including a description of medical services generally available
to incarcerated individuals.
(3) A description of current practices related to the
discharge of incarcerated individuals, including how prisons
interact with State Medicaid agencies to ensure that such
individuals who are eligible to enroll for medical assistance
under a State plan or waiver described in paragraph (1) are so
enrolled.
(4) If determined appropriate by the Commission,
recommendations for Congress, the Department of Health and
Human Services, or States regarding the Medicaid inmate
exclusion.
(5) Any other information that the Commission determines
would be useful to Congress.
SEC. 505. PROVIDING FOR IMMEDIATE MEDICAID ELIGIBILITY FOR FORMER
FOSTER YOUTH.
Section 1002(a)(2) of the SUPPORT for Patients and Communities Act
(Public Law 115-271) is amended by striking ``January 1, 2023'' and
inserting ``the date of enactment of the Ending Health Disparities
During COVID-19 Act of 2020''.
SEC. 506. EXPANDED COVERAGE FOR FORMER FOSTER YOUTH.
(a) Coverage Continuity for Former Foster Care Children up to Age
26.--
(1) In general.--Section 1002(a)(1)(B) of the SUPPORT for
Patients and Communities Act (Public Law 115-271) is amended by
striking all that follows after ``item (cc),'' and inserting
the following: ``by striking `responsibility of the State' and
all that follows through `475(8)(B)(iii); and' and inserting
`responsibility of a State on the date of attaining 18 years of
age (or such higher age as such State has elected under section
475(8)(B)(iii)), or who were in such care at any age but
subsequently left such care to enter into a legal guardianship
with a kinship caregiver (without regard to whether kinship
guardianship payments are being made on behalf of the child
under this part) or were emancipated from such care prior to
attaining age 18;'''.
(2) Amendments to social security act.--
(A) In general.--Section 1902(a)(10)(A)(i)(IX) of
the Social Security Act (42 U.S.C.
1396a(a)(10)(A)(i)(IX)), as amended by section 1002(a)
of the SUPPORT for Patients and Communities Act (Public
Law 115-271), is amended--
(i) in item (bb), by striking the semicolon
at the end and inserting ``; and''; and
(ii) by striking item (dd).
(B) Effective date.--The amendments made by this
paragraph shall take effect on January 1, 2023.
(b) Outreach Efforts for Enrollment of Former Foster Children.--
Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is
amended--
(1) in paragraph (85), by striking ``; and'' and inserting
a semicolon;
(2) in paragraph (86), by striking the period at the end
and inserting ``; and''; and
(3) by inserting after paragraph (86) the following new
paragraph:
``(87) not later than January 1, 2020, establish an
outreach and enrollment program, in coordination with the State
agency responsible for administering the State plan under part
E of title IV and any other appropriate or interested agencies,
designed to increase the enrollment of individuals who are
eligible for medical assistance under the State plan under
paragraph (10)(A)(i)(IX) in accordance with best practices
established by the Secretary.''.
SEC. 507. 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. 508. 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. 509. 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. 510. 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. 511. 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.
TITLE VI--COMMUNITY BASED GRANTS
SEC. 601. 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. 602. 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. 603. ADDRESSING COVID-19 HEALTH INEQUITIES AND IMPROVING HEALTH
EQUITY.
(a) In General.--Not later than 60 days after the date of enactment
of this Act, 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, shall award grants to
eligible entities to establish or expand programs to improve health
equity regarding COVID-19 and reduce or eliminate inequities, including
racial and ethnic inequities, in the incidence, prevalence, and health
outcomes of COVID-19.
(b) Eligibility.--To be eligible to receive a grant under
subsection (a), an entity shall--
(1) be a nongovernmental entity or consortium of entities
that works to improve health and health equity in populations
or communities disproportionately affected by adverse health
outcomes, including--
(A) racial and ethnic minority communities;
(B) Indian Tribes, Tribal organizations, and urban
Indian organizations;
(C) people with disabilities;
(D) English language learners;
(E) older adults;
(F) low-income communities;
(G) justice-involved communities;
(H) immigrant communities; and
(I) communities on the basis of their sexual
orientation or gender identity;
(2) have demonstrated experience in successfully working in
and partnering with such communities, and have an established
record of accomplishment in improving health outcomes or
preventing, reducing or eliminating health inequities,
including racial and ethnic inequities, in those communities;
(3) communicate with State, local, and Tribal health
departments to coordinate grant activities, as appropriate; 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.--An entity shall use amounts received under grant
under this section to establish, improve upon, or expand programs to
improve health equity regarding COVID-19 and reduce or eliminate
inequities, including racial and ethnic inequities, in the incidence,
prevalence, and health outcomes of COVID-19. Such uses may include--
(1) acquiring and distributing medical supplies, such as
personal protective equipment, to communities that are at an
increased risk of COVID-19;
(2) helping people enroll in a health insurance plan that
meets minimum essential coverage;
(3) increasing the availability of COVID-19 testing and any
future COVID-19 treatments or vaccines in communities that are
at an increased risk of COVID-19;
(4) aiding communities and individuals in following
guidelines and best practices in regards to COVID-19, including
physical distancing guidelines;
(5) helping communities and COVID-19 survivors recover and
cope with the long-term health impacts of COVID-19;
(6) addressing social determinants of health, such as
transportation, nutrition, housing, discrimination, health care
access, including mental health care and substance use disorder
prevention, treatment, and recovery, health literacy,
employment status, and working conditions, education, income,
and stress, that impact COVID-19 incidence, prevalence, and
health outcomes, and facilitating or providing access to needed
services;
(7) the provision of anti-racism and implicit and explicit
bias training for health care providers and other relevant
professionals;
(8) creating and disseminating culturally informed,
linguistically appropriate, accessible, and medically accurate
outreach and education regarding COVID-19;
(9) acquiring, retaining, and training a diverse workforce;
and
(10) improving the accessibility to health care, including
accessibility to health care providers, mental health care, and
COVID-19 testing for people with disabilities.
(d) Administration.--
(1) Priority.--In awarding grants under this section, the
Secretary shall give priority to eligible entities that are a
community-based organization or have an established history of
successfully working in and partnering with the community or
with populations which the entity intends to provide services
under the grant. The Secretary shall also utilize available
demographic data to give priority to eligible entities working
with populations or communities disproportionately affected by
COVID-19.
(2) Geographical diversity.--The Secretary shall seek to
ensure geographical diversity among grant recipients.
(3) Reduction of burdens.--In administering the grant
program under this section, the Secretary shall make every
effort to minimize unnecessary administrative burdens on
eligible entities receiving such grants.
(4) Technical assistance.--The Secretary shall provide
technical assistance to eligible entities on best practices for
applying grants under this section.
(e) Duration.--A grant awarded under this section shall be for a
period of 3 years.
(f) Reporting.--
(1) By grantee.--Not later than 180 days after the end of a
grant period under this section, the grantee shall submit to
the Secretary a report on the activities conducted under the
grant, including--
(A) a description of the impact of grant
activities, including on--
(i) outreach and education related to
COVID-19; and
(ii) improving public health activities
related to COVID-19, including physical
distancing;
(B) the number of individuals reached by the
activities under the grant and, to the extent known,
the disaggregated demographic data of such individuals,
such as by race, ethnicity, sex (including sexual
orientation and gender identity), income, disability
status, or primary language; and
(C) any other information the Secretary determines
is necessary.
(2) By secretary.--Not later than 1 year after the end of
the grant program under this section, the Secretary shall
submit to Congress a report on the grant program, including a
summary of the information gathered under paragraph (1).
(g) Supplement, Not Supplant.--Grants awarded under this Act shall
be used to supplement and not supplant any other Federal funds made
available to carry out the activities described in this Act.
(h) Funding.--Out of funds in the Treasury not otherwise
appropriated, there are appropriated to carry out this section,
$500,000,000 for each of fiscal years 2020 through 2022.
SEC. 604. IMPROVING SOCIAL DETERMINANTS OF HEALTH.
(a) Findings.--Congress finds the following:
(1) Healthy People 2020 defines social determinants of
health as conditions in the environments in which people live,
learn, work, play, worship, and age that affect a wide range of
health, functioning, and quality-of-life outcomes and risks.
(2) One of the overarching goals of Healthy People 2020 is
to ``create social and physical environments that promote good
health for all''.
(3) Healthy People 2020 developed a ``place-based''
organizing framework, reflecting five key areas of social
determinants of health namely--
(A) economic stability;
(B) education;
(C) social and community context;
(D) health and health care; and
(E) neighborhood and built environment.
(4) It is estimated that medical care accounts for only 10
to 20 percent of the modifiable contributors to healthy
outcomes for a population.
(5) The Centers for Medicare & Medicaid Services has
indicated the importance of the social determinants in its work
stating that, ``As we seek to foster innovation, rethink rural
health, find solutions to the opioid epidemic, and continue to
put patients first, we need to take into account social
determinants of health and recognize their importance.''.
(6) The Department of Health and Human Services' Public
Health 3.0 initiative recognizes the role of public health in
working across sectors on social determinants of health, as
well as the role of public health as chief health strategist in
communities.
(7) Through its Health Impact in 5 Years initiative, the
Centers for Disease Control and Prevention has highlighted
nonclinical, community-wide approaches that show positive
health impacts, results within five years, and cost
effectiveness or cost savings over the lifetime of the
population or earlier.
(8) Health departments and the Centers for Disease Control
and Prevention are not funded for such cross-cutting work.
(9) Providing grants to public health departments and other
eligible entities to coordinate cross-sector collaboration will
allow a community-wide, evidence-based approach to address
underlying social determinants of health.
(b) Social Determinants of Health Program.--
(1) Program.--To the extent and in the amounts made
available in advance in appropriations Acts, the Director of
the Centers for Disease Control and Prevention (in this section
referred to as the ``Director'') shall carry out a program, to
be known as the Social Determinants of Health Program (in this
section referred to as the ``Program''), to achieve the
following goals:
(A) Improve health outcomes and reduce health
inequities by coordinating social determinants of
health activities across the Centers for Disease
Control and Prevention.
(B) Improve the capacity of public health agencies
and community organizations to address social
determinants of health in communities.
(2) Activities.--To achieve the goals listed in paragraph
(1), the Director shall carry out activities including the
following:
(A) Coordinating across the Centers for Disease
Control and Prevention to ensure that relevant programs
consider and incorporate social determinants of health
in grant awards and other activities.
(B) Awarding grants under subsection (c) to State,
local, territorial, and Tribal health agencies and
organizations, and to other eligible entities, to
address social determinants of health in target
communities.
(C) Awarding grants under subsection (d) to
nonprofit organizations and public or other nonprofit
institutions of higher education--
(i) to conduct research on best practices
to improve social determinants of health;
(ii) to provide technical assistance,
training, and evaluation assistance to grantees
under subsection (c); and
(iii) to disseminate best practices to
grantees under subsection (c).
(D) Coordinating, supporting, and aligning
activities of the Centers for Disease Control and
Prevention related to social determinants of health
with activities of other Federal agencies related to
social determinants of health, including such
activities of agencies in the Department of Health and
Human Services such as the Centers for Medicare &
Medicaid Services.
(E) Collecting and analyzing data related to the
social determinants of health.
(c) Grants To Address Social Determinants of Health.--
(1) In general.--The Director, as part of the Program,
shall award grants to eligible entities to address social
determinants of health in their communities.
(2) Eligibility.--To be eligible to apply for a grant under
this subsection, an entity shall be--
(A) a State, local, territorial, or Tribal health
agency or organization;
(B) a qualified nongovernmental entity, as defined
by the Director; or
(C) a consortium of entities that includes a State,
local, territorial, or Tribal health agency or
organization.
(3) Use of funds.--
(A) In general.--A grant under this subsection
shall be used to address social determinants of health
in a target community by designing and implementing
innovative, evidence-based, cross-sector strategies.
(B) Target community.--For purposes of this
subsection, a target community shall be a State,
county, city, or other municipality.
(4) Priority.--In awarding grants under this subsection,
the Director shall prioritize applicants proposing to serve
target communities with significant unmet health and social
needs, as defined by the Director.
(5) Application.--To seek a grant under this subsection, an
eligible entity shall--
(A) submit an application at such time, in such
manner, and containing such information as the Director
may require;
(B) propose a set of activities to address social
determinants of health through evidence-based, cross-
sector strategies, which activities may include--
(i) collecting quantifiable data from
health care, social services, and other
entities regarding the most significant gaps in
health-promoting social, economic, and
environmental needs;
(ii) identifying evidence-based approaches
to meeting the nonmedical, social needs of
populations identified by data collection
described in clause (i), such as unstable
housing or inadequate food;
(iii) developing scalable methods to meet
patients' social needs identified in clinical
settings or other sites;
(iv) convening entities such as local and
State governmental and nongovernmental
organizations, health systems, payors, and
community-based organizations to review, plan,
and implement community-wide interventions and
strategies to advance health-promoting social
conditions;
(v) monitoring and evaluating the impact of
activities funded through the grant on the
health and well-being of the residents of the
target community and on the cost of health
care; and
(vi) such other activities as may be
specified by the Director;
(C) demonstrate how the eligible entity will
collaborate with--
(i) health systems;
(ii) payors, including, as appropriate,
medicaid managed care organizations (as defined
in section 1903(m)(1)(A) of the Social Security
Act (42 U.S.C. 1396b(m)(1)(A))), Medicare
Advantage plans under part C of title XVIII of
such Act (42 U.S.C. 1395w-21 et seq.), and
health insurance issuers and group health plans
(as such terms are defined in section 2791 of
the Public Health Service Act);
(iii) other relevant stakeholders and
initiatives in areas of need, such as the
Accountable Health Communities Model of the
Centers for Medicare & Medicaid Services,
health homes under the Medicaid program under
title XIX of the Social Security Act (42 U.S.C.
1396 et seq.), community-based organizations,
and human services organizations;
(iv) other non-health care sector
organizations, including organizations focusing
on transportation, housing, or food access; and
(v) local employers; and
(D) identify key health inequities in the target
community and demonstrate how the proposed efforts of
the eligible entity would address such inequities.
(6) Monitoring and evaluation.--As a condition of receipt
of a grant under this subsection, a grantee shall agree to
submit an annual report to the Director describing the
activities carried out through the grant and the outcomes of
such activities.
(7) Independent national evaluation.--
(A) In general.--Not later than 5 years after the
first grants are awarded under this subsection, the
Director shall provide for the commencement of an
independent national evaluation of the Program under
this subsection.
(B) Report to congress.--Not later than 60 days
after receiving the results of such independent
national evaluation, the Director shall report such
results to the Congress.
(d) Research and Training.--The Director, as part of the Program--
(1) shall award grants to nonprofit organizations and
public or other nonprofit institutions of higher education--
(A) to conduct research on best practices to
improve social determinants of health;
(B) to provide technical assistance, training, and
evaluation assistance to grantees under subsection (c);
and
(C) to disseminate best practices to grantees under
subsection (c); and
(2) may require a grantee under paragraph (1) to provide
technical assistance and capacity building to entities that are
eligible entities under subsection (c) but not receiving funds
through such subsection.
(e) Funding.--
(1) In general.--There is authorized to be appropriated to
carry out this section, $50,000,000 for each of fiscal years
2021 through 2026.
(2) Allocation.--Of the amount made available to carry out
this section for a fiscal year, not less than 75 percent shall
be used for grants under subsections (c) and (d).
SEC. 605. FUNDING TO STATES, LOCALITIES, AND COMMUNITY-BASED
ORGANIZATIONS FOR EMERGENCY AID AND SERVICES.
(a) Funding for States.--
(1) Increase in funding for social services block grant
program.--
(A) Appropriation.--Out of any money in the
Treasury of the United States not otherwise
appropriated, there are appropriated $9,600,000,000,
which shall be available for payments under section
2002 of the Social Security Act.
(B) Deadline for distribution of funds.--Within 45
days after the date of the enactment of this Act, the
Secretary of Health and Human Services shall distribute
the funds made available by this paragraph, which shall
be made available to States on an emergency basis for
immediate obligation and expenditure.
(C) Submission of revised pre-expenditure report.--
Within 90 days after a State receives funds made
available by this paragraph, the State shall submit to
the Secretary a revised pre-expenditure report pursuant
to title XX of the Social Security Act that describes
how the State plans to administer the funds.
(D) Obligation of funds by states.--A State to
which funds made available by this paragraph are
distributed shall obligate the funds not later than
December 31, 2020.
(E) Expenditure of funds by states.--A grantee to
which a State (or a subgrantee to which a grantee)
provides funds made available by this paragraph shall
expend the funds not later than December 31, 2021.
(2) Rules governing use of additional funds.--A State to
which funds made available by paragraph (1)(B) are distributed
shall use the funds in accordance with the following:
(A) Purpose.--
(i) In general.--The State shall use the
funds only to support the provision of
emergency services to disadvantaged children,
families, and households.
(ii) Disadvantaged defined.--In this
paragraph, the term ``disadvantaged'' means,
with respect to an entity, that the entity--
(I) is an individual, or is located
in a community, that is experiencing
material hardship;
(II) is a household in which there
is a child (as defined in section 12(d)
of the Richard B. Russell National
School Lunch Act) or a child served
under section 11(a)(1) of such Act,
who, if not for the closure of the
school attended by the child during a
public health emergency designation and
due to concerns about a COVID-19
outbreak, would receive free or reduced
price school meals pursuant to such
Act;
(III) is an individual, or is
located in a community, with barriers
to employment; or
(IV) is located in a community
that, as of the date of the enactment
of this Act, is not experiencing a 56-
day downward trajectory of--
(aa) influenza-like
illnesses;
(bb) COVID-like syndromic
cases;
(cc) documented COVID-19
cases; or
(dd) positive test results
as a percentage of total COVID-
19 tests.
(B) Pass-through to local entities.--
(i) In the case of a State in which a
county administers or contributes financially
to the non-Federal share of the amounts
expended in carrying out a State program funded
under title IV of the Social Security Act, the
State may pass funds so made available through
to--
(I) the chief elected official of
the city or urban county that
administers the program; or
(II) local government and
community-based organizations.
(ii) In the case of any other State, the
State shall--
(I) pass the funds through to--
(aa)(AA) local governments
that will expend or distribute
the funds in consultation with
community-based organizations
with experience serving
disadvantaged families or
individuals; or
(BB) community-based
organizations with experience
serving disadvantaged families
and individuals; and
(bb) sub-State areas in
proportions based on the
population of disadvantaged
individuals living in the
areas; and
(II) report to the Secretary on how
the State determined the amounts passed
through pursuant to this clause.
(C) Methods.--
(i) In general.--The State shall use the
funds only for--
(I) administering emergency
services;
(II) providing short-term cash,
non-cash, or in-kind emergency disaster
relief;
(III) providing services with
demonstrated need in accordance with
objective criteria that are made
available to the public;
(IV) operational costs directly
related to providing services described
in subclauses (I), (II), and (III);
(V) local government emergency
social service operations; and
(VI) providing emergency social
services to rural and frontier
communities that may not have access to
other emergency funding streams.
(ii) Administering emergency services
defined.--In clause (i), the term
``administering emergency services'' means--
(I) providing basic disaster
relief, economic, and well-being
necessities to ensure communities are
able to safely observe shelter-in-place
and social distancing orders;
(II) providing necessary supplies
such as masks, gloves, and soap, to
protect the public against infectious
disease; and
(III) connecting individuals,
children, and families to services or
payments for which they may already be
eligible.
(D) Prohibitions.--
(i) No individual eligibility
determinations by grantees or subgrantees.--
Neither a grantee to which the State provides
the funds nor any subgrantee of such a grantee
may exercise individual eligibility
determinations for the purpose of administering
short-term, non-cash, in-kind emergency
disaster relief to communities.
(ii) Applicability of certain social
services block grant funds use limitations.--
The State shall use the funds subject to the
limitations in section 2005 of the Social
Security Act, except that, for purposes of this
clause, section 2005(a)(2) and 2005(a)(8) of
such Act shall not apply.
(iii) No supplantation of certain state
funds.--The State may use the funds to
supplement, not supplant, State general revenue
funds for social services.
(iv) Ban on use for certain costs
reimbursable by fema.--The State may not use
the funds for costs that are reimbursable by
the Federal Emergency Management Agency, under
a contract for insurance, or by self-insurance.
(b) Funding for Federally Recognized Indian Tribes and Tribal
Organizations.--
(1) Grants.--
(A) In general.--Within 90 days after the date of
the enactment of this Act, the Secretary of Health and
Human Services shall make grants to federally
recognized Indian Tribes and Tribal organizations.
(B) Amount of grant.--The amount of the grant for
an Indian Tribe or Tribal organization shall bear the
same ratio to the amount appropriated by paragraph (3)
as the total amount of grants awarded to the Indian
Tribe or Tribal organization under the Low-Income Home
Energy Assistance Act of 1981 and the Community Service
Block Grant for fiscal year 2020 bears to the total
amount of grants awarded to all Indian Tribes and
Tribal organizations under such Act and such Grant for
the fiscal year.
(2) Rules governing use of funds.--An entity to which a
grant is made under paragraph (1) shall obligate the funds not
later than December 31, 2020, and the funds shall be expended
by grantees and subgrantees not later than December 31, 2021,
and used in accordance with the following:
(A) Purpose.--
(i) In general.--The grantee shall use the
funds only to support the provision of
emergency services to disadvantaged households.
(ii) Disadvantaged defined.--In clause (i),
the term ``disadvantaged'' means, with respect
to an entity, that the entity--
(I) is an individual, or is located
in a community, that is experiencing
material hardship;
(II) is a household in which there
is a child (as defined in section 12(d)
of the Richard B. Russell National
School Lunch Act) or a child served
under section 11(a)(1) of such Act,
who, if not for the closure of the
school attended by the child during a
public health emergency designation and
due to concerns about a COVID-19
outbreak, would receive free or reduced
price school meals pursuant to such
Act;
(III) is an individual, or is
located in a community, with barriers
to employment; or
(IV) is located in a community
that, as of the date of the enactment
of this Act, is not experiencing a 56-
day downward trajectory of--
(aa) influenza-like
illnesses;
(bb) COVID-like syndromic
cases;
(cc) documented COVID-19
cases; or
(dd) positive test results
as a percentage of total COVID-
19 tests.
(B) Methods.--
(i) In general.--The grantee shall use the
funds only for--
(I) administering emergency
services;
(II) providing short-term, non-
cash, in-kind emergency disaster
relief; and
(III) tribal emergency social
service operations.
(ii) Administering emergency services
defined.--In clause (i), the term
``administering emergency services'' means--
(I) providing basic economic and
well-being necessities to ensure
communities are able to safely observe
shelter-in-place and social distancing
orders;
(II) providing necessary supplies
such as masks, gloves, and soap, to
protect the public against infectious
disease; and
(III) connecting individuals,
children, and families to services or
payments for which they may already be
eligible.
(C) Prohibitions.--
(i) No individual eligibility
determinations by grantees or subgrantees.--
Neither the grantee nor any subgrantee may
exercise individual eligibility determinations
for the purpose of administering short-term,
non-cash, in-kind emergency disaster relief to
communities.
(ii) Ban on use for certain costs
reimbursable by fema.--The grantee may not use
the funds for costs that are reimbursable by
the Federal Emergency Management Agency, under
a contract for insurance, or by self-insurance.
(3) Appropriation.--Out of any money in the Treasury of the
United States not otherwise appropriated, there are
appropriated to the Secretary of Health and Human Services
$400,000,000 to carry out this subsection.
SEC. 606. SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM.
(a) Value of Benefits.--Notwithstanding any other provision of law,
beginning on June 1, 2020, and for each subsequent month through
September 30, 2021, the value of benefits determined under section 8(a)
of the Food and Nutrition Act of 2008 (7 U.S.C. 2017(a)), and
consolidated block grants for Puerto Rico and American Samoa determined
under section 19(a) of such Act (7 U.S.C. 2028(a)), shall be calculated
using 115 percent of the June 2019 value of the thrifty food plan (as
defined in section 3 of such Act (7 U.S.C. 2012)) if the value of the
benefits and block grants would be greater under that calculation than
in the absence of this subsection.
(b) Minimum Amount.--
(1) In general.--The minimum value of benefits determined
under section 8(a) of the Food and Nutrition Act of 2008 (7
U.S.C. 2017(a)) for a household of not more than 2 members
shall be $30.
(2) Effectiveness.--Paragraph (1) shall remain in effect
until the date on which 8 percent of the value of the thrifty
food plan for a household containing 1 member, rounded to the
nearest whole dollar increment, is equal to or greater than
$30.
(c) Requirements for the Secretary.--In carrying out this section,
the Secretary shall--
(1) consider the benefit increases described in each of
subsections (a) and (b) to be a ``mass change'';
(2) require a simple process for States to notify
households of the increase in benefits;
(3) consider section 16(c)(3)(A) of the Food and Nutrition
Act of 2008 (7 U.S.C. 2025(c)(3)(A)) to apply to any errors in
the implementation of this section, without regard to the 120-
day limit described in that section;
(4) disregard the additional amount of benefits that a
household receives as a result of this section in determining
the amount of overissuances under section 13 of the Food and
Nutrition Act of 2008 (7 U.S.C. 2022); and
(5) set the tolerance level for excluding small errors for
the purposes of section 16(c) of the Food and Nutrition Act of
2008 (7 U.S.C. 2025(c)) at $50 through September 30, 2021.
(d) Provisions for Impacted Workers.--Notwithstanding any other
provision of law, the requirements under subsections (d)(1)(A)(ii) and
(o) of section 6 of the Food and Nutrition Act of 2008 (7 U.S.C. 2015)
shall not be in effect during the period beginning on June 1, 2020, and
ending 2 years after the date of enactment of this Act.
(e) Administrative Expenses.--
(1) In general.--For the costs of State administrative
expenses associated with carrying out this section and
administering the supplemental nutrition assistance program
established under the Food and Nutrition Act of 2008 (7 U.S.C.
2011 et seq.), the Secretary shall make available $150,000,000
for fiscal year 2020 and $150,000,000 for fiscal year 2021.
(2) Timing for fiscal year 2020.--Not later than 60 days
after the date of the enactment of this Act, the Secretary
shall make available to States amounts for fiscal year 2020
under paragraph (1).
(3) Allocation of funds.--Funds described in paragraph (1)
shall be made available as grants to State agencies for each
fiscal year as follows:
(A) 75 percent of the amounts available for each
fiscal year shall be allocated to States based on the
share of each State of households that participate in
the supplemental nutrition assistance program as
reported to the Department of Agriculture for the most
recent 12-month period for which data are available,
adjusted by the Secretary (as of the date of the
enactment of this Act) for participation in disaster
programs under section 5(h) of the Food and Nutrition
Act of 2008 (7 U.S.C. 2014(h)); and
(B) 25 percent of the amounts available for each
fiscal year shall be allocated to States based on the
increase in the number of households that participate
in the supplemental nutrition assistance program as
reported to the Department of Agriculture over the most
recent 12-month period for which data are available,
adjusted by the Secretary (as of the date of the
enactment of this Act) for participation in disaster
programs under section 5(h) of the Food and Nutrition
Act of 2008 (7 U.S.C. 2014(h)).
(f) SNAP Rules.--No funds (including fees) made available under
this Act or any other Act for any fiscal year may be used to finalize,
implement, administer, enforce, carry out, or otherwise give effect
to--
(1) the final rule entitled ``Supplemental Nutrition
Assistance Program: Requirements for Able-Bodied Adults Without
Dependents'' published in the Federal Register on December 5,
2019 (84 Fed. Reg. 66782);
(2) the proposed rule entitled ``Revision of Categorical
Eligibility in the Supplemental Nutrition Assistance Program
(SNAP)'' published in the Federal Register on July 24, 2019 (84
Fed. Reg. 35570); or
(3) the proposed rule entitled ``Supplemental Nutrition
Assistance Program: Standardization of State Heating and
Cooling Standard Utility Allowances'' published in the Federal
Register on October 3, 2019 (84 Fed. Reg. 52809).
(g) Certain Exclusions From SNAP Income.--A Federal pandemic
unemployment compensation payment made to an individual under section
2104 of the CARES Act (Public Law 116-136) shall not be regarded as
income and shall not be regarded as a resource for the month of receipt
and the following 9 months, for the purpose of determining eligibility
for such individual or any other individual for benefits or assistance,
or the amount of benefits or assistance, under any programs authorized
under the Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.).
(h) Public Availability.--Not later than 10 days after the date of
the receipt or issuance of each document listed below, the Secretary
shall make publicly available on the website of the Department of
Agriculture the following documents:
(1) Any State agency request to participate in the
supplemental nutrition assistance program online program under
section 7(k).
(2) Any State agency request to waive, adjust, or modify
statutory or regulatory requirements under the Food and
Nutrition Act of 2008 related to the COVID-19 outbreak.
(3) The Secretary's approval or denial of each such request
under paragraphs (1) or (2).
(i) Funding.--There are hereby appropriated to the Secretary, out
of any money not otherwise appropriated, such sums as may be necessary
to carry out this section.
TITLE VII--CULTURALLY AND LINGUISTICALLY COMPETENT CARE
SEC. 701. 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. 702. CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE IN THE
PUBLIC HEALTH SERVICE ACT.
Title XXXIV of the Public Health Service Act, as amended by section
104, is further amended by adding at the end the following:
``Subtitle B--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE
``SEC. 3403. 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 on-site 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 on-site
appearance--
``(A) adheres to generally accepted interpreter
ethics principles, including client confidentiality;
``(B) has demonstrated proficiency in speaking and
understanding both spoken English and one or more other
spoken languages; and
``(C) is able to interpret effectively, accurately,
and impartially, both receptively and expressly, to and
from such languages and English, using any necessary
specialized vocabulary, terminology, and phraseology.
``(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).
``CHAPTER 1--RESOURCES AND INNOVATION FOR CULTURALLY AND LINGUISTICALLY
APPROPRIATE HEALTH CARE
``SEC. 3404. 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. 3405. 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. 3406. 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. 703. 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. 704. 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 Ending Health
Disparities During COVID-19 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 by--
(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
by--
(A) by striking ``or'' at the end of subparagraph
(D);
(B) by striking ``; and'' at the end of
subparagraph (E) and inserting ``, or''; and
(C) by adding at the end the following new
subparagraph:
``(F) language assistance services described in
section 1905(a)(29); and''.
(5) CHIP coverage requirements.--Section 2103 of the Social
Security Act (42 U.S.C. 1397cc) is amended--
(A) in subsection (a), in the matter before
paragraph (1), by striking ``and (7)'' and inserting
``(7), and (10)''; and
(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 subsections (a), (b), (c),
or (d) or by private health insurance.
(B) Eligible entity.--The term ``eligible entity''
means an entity that--
(i) is a Medicaid provider that is--
(I) a physician;
(II) a hospital with a low-income
utilization rate (as defined in section
1923(b)(3) of the Social Security Act
(42 U.S.C. 1396r-4(b)(3))) of greater
than 25 percent; or
(III) a Federally qualified health
center (as defined in section
1905(l)(2)(B) of the Social Security
Act (42 U.S.C. 1396d(l)(2)(B)));
(ii) not later than 6 months after the date
of the enactment of this Act, provides language
assistance services to not less than 8 percent
of the entity's total number of patients; and
(iii) prepares and submits an application
to the Secretary, at such time, in such manner,
and accompanied by such information as the
Secretary may require, to ascertain the
entity's eligibility for funding under this
subsection.
(C) English learner.--The term ``English learner''
has the meaning given such term in section 8101(20) of
the Elementary and Secondary Education Act of 1965 (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. 705. 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. 706. 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. 707. 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. 708. 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.
TITLE VIII--AID TO PROVIDERS SERVING MINORITY COMMUNITIES
SEC. 801. TEMPORARY INCREASE IN MEDICAID DSH ALLOTMENTS.
(a) In General.--Section 1923(f)(3) of the Social Security Act (42
U.S.C. 1396r-4(f)(3)) is amended--
(1) in subparagraph (A), by striking ``and subparagraph
(E)'' and inserting ``and subparagraphs (E) and (F)''; and
(2) by adding at the end the following new subparagraph:
``(F) Temporary increase in allotments during
certain public health emergency.--The DSH allotment for
any State for each of fiscal years 2020 and 2021 is
equal to 102.5 percent of the DSH allotment that would
be determined under this paragraph for the State for
each respective fiscal year without application of this
subparagraph, notwithstanding subparagraphs (B) and
(C). For each fiscal year after fiscal year 2021, the
DSH allotment for a State for such fiscal year is equal
to the DSH allotment that would have been determined
under this paragraph for such fiscal year if this
subparagraph had not been enacted.''.
(b) DSH Allotment Adjustment for Tennessee.--Section
1923(f)(6)(A)(vi) of the Social Security Act (42 U.S.C. 1396r-
4(f)(6)(A)(vi)) is amended--
(1) by striking ``Notwithstanding any other provision of
this subsection'' and inserting the following:
``(I) In general.--Notwithstanding
any other provision of this subsection
(except as provided in subclause (II)
of this clause)''; and
(2) by adding at the end the following:
``(II) Temporary increase in
allotments.--The DSH allotment for
Tennessee for each of fiscal years 2020
and 2021 shall be equal to
$54,427,500.''.
(c) Sense of Congress.--It is the sense of Congress that a State
should prioritize making payments under the State plan of the State
under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) (or
a waiver of such plan) to disproportionate share hospitals that have a
higher share of COVID-19 patients relative to other such hospitals in
the State.
SEC. 802. COVID-19-RELATED TEMPORARY INCREASE OF MEDICAID FMAP.
(a) In General.--Section 6008 of the Families First Coronavirus
Response Act (42 U.S.C. 1396d note) is amended--
(1) in subsection (a)--
(A) by inserting ``(or, if later, June 30, 2021)''
after ``last day of such emergency period occurs''; and
(B) by striking ``6.2 percentage points.'' and
inserting ``the percentage points specified in
subsection (e). In no case may the application of this
section result in the Federal medical assistance
percentage determined for a State being more than 95
percent.''; and
(2) by adding at the end the following new subsections:
``(e) Specified Percentage Points.--For purposes of subsection (a),
the percentage points specified in this subsection are--
``(1) for each calendar quarter occurring during the period
beginning on the first day of the emergency period described in
paragraph (1)(B) of section 1135(g) of the Social Security Act
(42 U.S.C. 1320b-5(g)) and ending on June 30, 2020, 6.2
percentage points;
``(2) for each calendar quarter occurring during the period
beginning on July 1, 2020, and ending on June 30, 2021, 14
percentage points; and
``(3) for each calendar quarter, if any, occurring during
the period beginning on July 1, 2021, and ending on the last
day of the calendar quarter in which the last day of such
emergency period occurs, 6.2 percentage points.
``(f) Clarifications.--
``(1) In the case of a State that treats an individual
described in subsection (b)(3) as eligible for the benefits
described in such subsection, for the period described in
subsection (a), expenditures for medical assistance and
administrative costs attributable to such individual that would
not otherwise be included as expenditures under section 1903 of
the Social Security Act shall be regarded as expenditures under
the State plan approved under title XIX of the Social Security
Act or for administration of such State plan.
``(2) The limitations on payment under subsections (f) and
(g) of section 1108 of the Social Security Act (42 U.S.C. 1308)
shall not apply to Federal payments made under section
1903(a)(1) of the Social Security Act (42 U.S.C. 1396b(a)(1))
attributable to the increase in the Federal medical assistance
percentage under this section.
``(3) Expenditures attributable to the increased Federal
medical assistance percentage under this section shall not be
counted for purposes of the limitations under section
2104(b)(4) of such Act (42 U.S.C. 1397dd(b)(4)).
``(4) Notwithstanding the first sentence of section 2105(b)
of the Social Security Act (42 U.S.C. 1397ee(b)), the
application of the increase under this section may result in
the enhanced FMAP of a State for a fiscal year under such
section exceeding 85 percent, but in no case may the
application of such increase before application of the second
sentence of such section result in the enhanced FMAP of the
State exceeding 95 percent.
``(g) Scope of Application.--An increase in the Federal medical
assistance percentage for a State under this section shall not be taken
into account for purposes of payments under part D of title IV of the
Social Security Act (42 U.S.C. 651 et seq.).''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect and apply as if included in the enactment of section 6008
of the Families First Coronavirus Response Act (Public Law 116-127).
SEC. 803. APPROPRIATION FOR PRIMARY HEALTH CARE.
For an additional amount for ``Department of Health and Human
Services--Health Resources and Services Administration--Primary Health
Care'', $7,600,000,000, to remain available until September 30, 2025,
for necessary expenses to prevent, prepare for, and respond to
coronavirus, for grants and cooperative agreements under the Health
Centers Program, as defined by section 330 of the Public Health Service
Act, and for grants to Federally qualified health centers, as defined
in section 1861(aa)(4)(B) of the Social Security Act, and for eligible
entities under the Native Hawaiian Health Care Improvement Act,
including maintenance or expansion of health center and system capacity
and staffing levels: Provided, That sections 330(r)(2)(B),
330(e)(6)(A)(iii), and 330(e)(6)(B)(iii) shall not apply to funds
provided under this heading in this section: Provided further, That
funds provided under this heading in this section may be used to (1)
purchase equipment and supplies to conduct mobile testing for SARS-CoV-
2 or COVID-19; (2) purchase and maintain mobile vehicles and equipment
to conduct such testing; and (3) hire and train laboratory personnel
and other staff to conduct such mobile testing: Provided further, That
such amount is designated by the Congress as being for an emergency
requirement pursuant to section 251(b)(2)(A)(i) of the Balanced Budget
and Emergency Deficit Control Act of 1985.
SEC. 804. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
Title XXXIV of the Public Health Service Act, as amended by
sections 104 and 702, is further amended by adding at the following:
``Subtitle C--Reconstruction and Improvement Grants for Public Health
Care Facilities Serving Pacific Islanders and the Insular Areas
``SEC. 3407. 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 decision making.
``(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. 3408. 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. 3409. 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. 805. PANDEMIC PREMIUM PAY FOR ESSENTIAL WORKERS.
(a) In General.-- Beginning 3 days after an essential work employer
receives a grant under section 806 from the Secretary of the Treasury,
the essential work employer shall--
(1) be required to comply with subsections (b) through (h);
and
(2) be subject to the enforcement requirements of section
807.
(b) Pandemic Premium Pay.--
(1) In general.--An essential work employer receiving a
grant under section 806 shall, in accordance with this
subsection, provide each essential worker of the essential work
employer with premium pay at a rate equal to $13 for each hour
of work performed by the essential worker for the employer from
January 27, 2020, until the date that is 60 days after the last
day of the COVID-19 Public Health Emergency.
(2) Maximum amounts.--The total amount of all premium pay
under this subsection that an essential work employer is
required to provide to an essential worker, including through
any retroactive payment under paragraph (3), shall not exceed--
(A) for an essential worker who is not a highly-
compensated essential worker, $10,000 reduced by
employer payroll taxes with respect to such premium
pay; or
(B) for a highly-compensated essential worker,
$5,000 reduced by employer payroll taxes with respect
to such premium pay.
(3) Retroactive payment.--For all work performed by an
essential worker during the period from January 27, 2020,
through the date on which the essential work employer of the
worker receives a grant under this title, the essential work
employer shall use a portion of the amount of such grant to
provide such worker with premium pay under this subsection for
such work at the rate provided under paragraph (1). Such amount
shall be provided to the essential worker as a lump sum in the
next paycheck (or other payment form) that immediately follows
the receipt of the grant by the essential work employer. In any
case where it is impossible for the employer to arrange for
payment of the amount due in such paycheck (or other payment
form), such amounts shall be paid as soon as practicable, but
in no event later than the second paycheck (or other payment
form) following the receipt of the grant by the essential work
employer.
(4) No employer discretion.--An essential work employer
receiving a grant under section 806 shall not have any
discretion to determine which portions of work performed by an
essential worker qualify for premium pay under this subsection,
but shall pay such premium pay for any increment of time worked
by the essential worker for the essential work employer up to
the maximum amount applicable to the essential worker under
paragraph (2).
(c) Prohibition on Reducing Compensation and Displacement.--
(1) In general.--Any payments made to an essential worker
as premium pay under subsection (b) shall be in addition to all
other compensation, including all wages, remuneration, or other
pay and benefits, that the essential worker otherwise receives
from the essential work employer.
(2) Reduction of compensation.--An essential work employer
receiving a grant under section 806 shall not, during the
period beginning on the date of enactment of this Act and
ending on the date that is 60 days after the last day of the
COVID-19 Public Health Emergency, reduce or in any other way
diminish, any other compensation, including the wages,
remuneration, or other pay or benefits, that the essential work
employer provided to the essential worker on the day before the
date of enactment of this Act.
(3) Displacement.--An essential work employer shall not
take any action to displace an essential worker (including
partial displacement such as a reduction in hours, wages, or
employment benefits) for purposes of hiring an individual for
an equivalent position at a rate of compensation that is less
than is required to be provided to an essential worker under
paragraph (2).
(d) Demarcation From Other Compensation.--The amount of any premium
pay paid under subsection (b) shall be clearly demarcated as a separate
line item in each paystub or other document provided to an essential
worker that details the remuneration the essential worker received from
the essential work employer for a particular period of time. If any
essential worker does not otherwise regularly receive any such paystub
or other document from the employer, the essential work employer shall
provide such paystub or other document to the essential worker for the
duration of the period in which the essential work employer provides
premium pay under subsection (b).
(e) Exclusion From Wage-Based Calculations.--Any premium pay under
subsection (b) paid to an essential worker under this section by an
essential work employer receiving a grant under section 806 shall be
excluded from the amount of remuneration for work paid to the essential
worker for purposes of--
(1) calculating the essential worker's eligibility for any
wage-based benefits offered by the essential work employer;
(2) computing the regular rate at which such essential
worker is employed under section 7 of the Fair Labor Standards
Act of 1938 (29 U.S.C. 207); and
(3) determining whether such essential worker is exempt
from application of such section 7 under section 13(a)(1) of
such Act (29 U.S.C. 213(a)(1)).
(f) Essential Worker Death.--
(1) In general.--In any case in which an essential worker
of an essential work employer receiving a grant under section
806 exhibits symptoms of COVID-19 and dies, the essential work
employer shall pay as a lump sum to the next of kin of the
essential worker for premium pay under subsection (b)--
(A) for an essential worker who is not a highly-
compensated essential worker, the amount determined
under subsection (b)(2)(A) minus the total amount of
any premium pay the worker received under subsection
(b) prior to the death; or
(B) for a highly-compensated essential worker, the
amount determined under subsection (b)(2)(B) minus the
amount of any premium pay the worker received under
subsection (b) prior to the death.
(2) Treatment of lump sum payments.--
(A) Treatment as premium pay.--For purposes of this
title, any payment made under this subsection shall be
treated as a premium pay under subsection (b).
(B) Treatment for purposes of internal revenue code
of 1986.--For purposes of the Internal Revenue Code of
1986, any payment made under this subsection shall be
treated as a payment for work performed by the
essential worker.
(g) Application to Self-Directed Care Workers Funded Through
Medicaid or the Veteran-Directed Care Program.--
(1) Medicaid.--In the case of an essential work employer
receiving a grant under section 806 that is a covered employer
described in paragraph (4) who, under a State Medicaid plan
under title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.) or under a waiver of such plan, has opted to receive
items or services using a self-directed service delivery model,
the preceding requirements of this section, including the
requirements to provide premium pay under subsection (b)
(including a lump sum payment in the event of an essential
worker death under subsection (f)) and the requirements of
sections 806 and 807, shall apply to the State Medicaid agency
responsible for the administration of such plan or waiver with
respect to self-directed care workers employed by that
employer. In administering payments made under this title to
such self-directed care workers on behalf of such employers, a
State Medicaid agency shall--
(A) exclude and disregard any payments made under
this title to such self-directed workers from the
individualized budget that applies to the items or
services furnished to the individual client employer
under the State Medicaid plan or waiver;
(B) to the extent practicable, administer and
provide payments under this title directly to such
self-directed workers through arrangements with
entities that provide financial management services in
connection with the self-directed service delivery
models used under the State Medicaid plan or waiver;
and
(C) ensure that individual client employers of such
self-directed workers are provided notice of, and
comply with, the prohibition under section
807(b)(1)(B).
(2) Veteran-directed care program.--In the case of an
essential work employer that is a covered employer described in
paragraph (4) who is a veteran participating in the Veteran
Directed Care program administered by the VA Office of
Geriatrics & Extended Care of the Veterans Health
Administration, the preceding requirements of this section and
sections 806 and 807, shall apply to such VA Office of
Geriatrics & Extended Care with respect to self-directed care
workers employed by that employer. Paragraph (1) of this
subsection shall apply to the administration by the VA Office
of Geriatrics & Extended Care of payments made under this title
to such self-directed care workers on behalf of such employers
in the same manner as such requirements apply to State Medicaid
agencies.
(3) Penalty enforcement.--The Secretary of Labor shall
consult with the Secretary of Health and Human Services and the
Secretary of Veterans Affairs regarding the enforcement of
penalties imposed under section 807(b)(2) with respect to
violations of subparagraph (A) or (B) of section 807(b)(1) that
involve self-directed workers for which the requirements of
this section and sections 806 and 807 are applied to a State
Medicaid agency under paragraph (1) or the VA Office of
Geriatrics & Extended Care under paragraph (2).
(4) Covered employer described.--For purposes of paragraphs
(1) and (2), a covered employer described in this paragraph
means--
(A) an entity or person that contracts directly
with a State, locality, Tribal government, or the
Federal Government, to provide care (which may include
items and services) through employees of such entity or
person to individuals under the Medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395
et seq.), under a State Medicaid plan under title XIX
of such Act (42 U.S.C. 1396 et seq.) or under a waiver
of such plan, or under any other program established or
administered by a State, locality, Tribal government,
or the Federal Government;
(B) a subcontractor of an entity or person
described in subparagraph (A);
(C) an individual client (or a representative on
behalf of an individual client), an entity, or a
person, that employs an individual to provide care
(which may include items and services) to the
individual client under a self-directed service
delivery model through a program established or
administered by a State, locality, Tribal government,
or the Federal Government; or
(D) an individual client (or a representative on
behalf of an individual client) that, on their own
accord, employs an individual to provide care (which
may include items and services) to the individual
client using the individual client's own finances.
(h) Interaction With Stafford Act.--Nothing in this section shall
nullify, supersede, or otherwise change a State's ability to seek
reimbursement under section 403 of the Robert T. Stafford Disaster
Relief and Emergency Assistance Act (42 U.S.C. 5170b) for the costs of
premium pay based on pre-disaster labor policies for eligible
employees.
(i) Calculation of Paid Leave Under FFCRA and FMLA.--
(1) Families first coronavirus response act.--Section
5110(5)(B) of the Families First Coronavirus Response Act (29
U.S.C. 2601 note) is amended by adding at the end the
following:
``(iii) Pandemic premium pay.--Compensation
received by an employee under section 807(b) of
the EHDC Act of 2020 shall be included as
remuneration for employment paid to the
employee for purposes of computing the regular
rate at which such employee is employed.''.
(2) Family and medical leave act of 1993.--Section
110(b)(2)(B) of the Family and Medical Leave Act of 1993 (29
U.S.C. 2620(b)(2)(B)) is amended by adding at the end the
following:
``(iii) Pandemic premium pay.--Compensation
received by an employee under section 807(b) of
the EHDC Act of 2020 shall be included as
remuneration for employment paid to the
employee for purposes of computing the regular
rate at which such employee is employed.''.
SEC. 806. COVID-19 HEROES FUND GRANTS.
(a) Grants.--
(1) For pandemic premium pay.--The Secretary of the
Treasury shall, subject to the availability of amounts provided
in this title, award a grant to each essential work employer
that applies for a grant, in accordance with this section, for
the purpose of providing premium pay to essential workers under
section 805(b), including amounts paid under section 805(f).
(2) Eligibility.--
(A) Eligible employers generally.--Any essential
work employer shall be eligible for a grant under
paragraph (1).
(B) Self-directed care workers.--A self-directed
care worker employed by an essential work employer
other than an essential work employer described in
section 805(g), shall be eligible to apply for a grant
under paragraph (1) in the same manner as an essential
work employer. Such a worker shall provide premium pay
to himself or herself in accordance with this section,
including the recordkeeping and refund requirements of
this section.
(b) Amount of Grants.--
(1) In general.--The maximum amount available for making a
grant under subsection (a)(1) to an essential work employer
shall be equal to the sum of--
(A) the amount obtained by multiplying $10,000 by
the number of essential workers the employer certifies,
in the application submitted under subsection (c)(1),
as employing, or providing remuneration to for services
or labor, who are paid wages or remuneration by the
employer at a rate that is less than the equivalent of
$200,000 per year; and
(B) the amount obtained by multiplying $5,000 by
the number of highly-compensated essential workers the
employer certifies, in the application submitted under
subsection (c)(1), as employing, or providing
remuneration to for services or labor, who are paid
wages or remuneration by the employer at a rate that is
equal to or greater than the equivalent of $200,000 per
year.
(2) No partial grants.--The Secretary of the Treasury shall
not award a grant under this section in an amount less than the
maximum described in paragraph (1).
(c) Grant Application and Disbursal.--
(1) Application.--Any essential work employer seeking a
grant under subsection (a)(1) shall submit an application to
the Secretary of the Treasury at such time, in such manner, and
complete with such information as the Secretary may require.
(2) Notice and certification.--
(A) In general.--The Secretary of the Treasury
shall, within 15 days after receiving a complete
application from an essential work employer eligible
for a grant under this section--
(i) notify the employer of the Secretary's
findings with respect to the requirements for
the grant; and
(ii)(I) if the Secretary finds that the
essential work employer meets the requirements
under this section for a grant under subsection
(a), provide a certification to the employer--
(aa) that the employer has met such
requirements;
(bb) of the amount of the grant
payment that the Secretary has
determined the employer shall receive
based on the requirements under this
section; or
(II) if the Secretary finds that the
essential work employer does not meet the
requirements under this section for a grant
under subsection (a), provide a notice of
denial stating the reasons for the denial and
provide an opportunity for administrative
review by not later than 10 days after the
denial.
(B) Transfer.--Not later than 7 days after making a
certification under subparagraph (A)(ii) with respect
to an essential work employer, the Secretary of the
Treasury shall make the appropriate transfer to the
employer of the amount of the grant.
(d) Use of Funds.--
(1) In general.--An essential work employer receiving a
grant under this section shall use the amount of the grant
solely for the following purposes:
(A) Providing premium pay under section 805(b) to
essential workers in accordance with the requirements
for such payments under such section, including
providing payments described in section 805(f) to the
next of kin of essential workers in accordance with the
requirements for such payments under such section.
(B) Paying employer payroll taxes with respect to
premium pay amounts described in subparagraph (A),
including such payments described in section 805(f).
Each dollar of a grant received by an essential work employer
under this title shall be used as provided in subparagraph (A)
or (B) or returned to the Secretary of the Treasury.
(2) No other uses authorized.--An essential work employer
who uses any amount of a grant for a purpose not required under
paragraph (1) shall be--
(A) considered to have misused funds in violation
of section 805; and
(B) subject to the enforcement and remedies
provided under section 807.
(3) Refund.--
(A) In general.--If an essential work employer
receives a grant under this section and, for any
reason, does not provide every dollar of such grant to
essential workers in accordance with the requirements
of this title, then the employer shall refund any such
dollars to the Secretary of the Treasury not later than
June 30, 2021. Any amounts returned to the Secretary
shall be deposited into the Fund and be available for
any additional grants under this section.
(B) Requirement for not reducing compensation.--An
essential work employer who is required to refund any
amount under this paragraph shall not reduce or
otherwise diminish an eligible worker's compensation or
benefits in response to or otherwise due to such
refund.
(e) Recordkeeping.--An essential work employer that receives a
grant under this section shall--
(1) maintain records, including payroll records,
demonstrating how each dollar of funds received through the
grant were provided to essential workers; and
(2) provide such records to the Secretary of the Treasury
or the Secretary of Labor upon the request of either such
Secretary.
(f) Recoupment.--In addition to all other enforcement and remedies
available under this title or any other law, the Secretary of the
Treasury shall establish a process under which the Secretary shall
recoup the amount of any grant awarded under subsection (a)(1) if the
Secretary determines that the essential work employer receiving the
grant--
(1) did not provide all of the dollars of such grant to the
essential workers of the employer;
(2) did not, in fact, have the number of essential workers
certified by the employer in accordance with subparagraphs (A)
and (B) of subsection (b)(1);
(3) did not pay the essential workers for the number of
hours the employer claimed to have paid; or
(4) otherwise misused funds or violated this title.
(g) Special Rule for Certain Employees of Tribal Employers.--
Essential workers of Tribal employers who receive funds under title II
shall not be eligible to receive funds from grants under this section.
(h) Tax Treatment.--
(1) Exclusion from income.--For purposes of the Internal
Revenue Code of 1986, any grant received by an essential work
employer under this section shall not be included in the gross
income of such essential work employer.
(2) Denial of double benefit.--
(A) In general.--In the case of an essential work
employer that receives a grant under this section--
(i) amounts paid under subsections (b) or
(f) of section 805 shall not be taken into
account as wages for purposes of sections 41,
45A, 51, or 1396 of the Internal Revenue Code
of 1986 or section 2301 of the CARES Act
(Public Law 116-136); and
(ii) any deduction otherwise allowable
under such Code for applicable payments during
any taxable year shall be reduced (but not
below zero) by the excess (if any) of--
(I) the aggregate amounts of grants
received under this section; over
(II) the sum of any amount refunded
under subsection (d) plus the aggregate
amount of applicable payments made for
all preceding taxable years.
(B) Applicable payments.--For purposes of this
paragraph, the term ``applicable payments'' means
amounts paid as premium pay under subsections (b) or
(f) of section 805 and amounts paid for employer
payroll taxes with respect to such amounts.
(C) Aggregation rule.--Rules similar to the rules
of subsections (a) and (b) of section 52 of the
Internal Revenue Code of 1986 shall apply for purposes
of this section.
(3) Information reporting.--The Secretary of the Treasury
shall submit to the Commissioner of Internal Revenue statements
containing--
(A) the name and tax identification number of each
essential work employer receiving a grant under this
section;
(B) the amount of such grant; and
(C) any amounts refunded under subsection (d)(3).
(i) Reports.--
(1) In general.--Not later than 30 days after obligating
the last dollar of the funds appropriated under this title, the
Secretary of the Treasury shall submit a report, to the
Committees of Congress described in paragraph (2), that--
(A) certifies that all funds appropriated under
this title have been obligated; and
(B) indicates the number of pending applications
for grants under this section that will be rejected due
to the lack of funds.
(2) Committees of congress.--The Committees of Congress
described in this paragraph are--
(A) the Committee on Ways and Means of the House of
Representatives;
(B) the Committee on Education and Labor of the
House of Representatives;
(C) the Committee on Finance of the Senate; and
(D) the Committee on Health, Education, Labor, and
Pensions of the Senate.
SEC. 807. ENFORCEMENT AND OUTREACH.
(a) Duties of Secretary of Labor.--The Secretary of Labor shall--
(1) have authority to enforce the requirements of section
805, in accordance with subsections (b) through (e);
(2) conduct outreach as described in subsection (f); and
(3) coordinate with the Secretary of the Treasury as needed
to carry out the Secretary of Labor's responsibilities under
this section.
(b) Prohibited Acts, Penalties, and Enforcement.--
(1) Prohibited acts.--It shall be unlawful for a person
to--
(A) violate any provision of section 805 applicable
to such person; or
(B) discharge or in any other manner discriminate
against any essential worker because such essential
worker has filed any complaint or instituted or caused
to be instituted any proceeding under or related to
this title, or has testified or is about to testify in
any such proceeding.
(2) Enforcement and penalties.--
(A) Premium pay violations.--A violation described
in paragraph (1)(A) shall be deemed a violation of
section 7 of the Fair Labor Standards Act of 1938 (29
U.S.C. 207) and unpaid amounts required under this
section shall be treated as unpaid overtime
compensation under such section 7 for the purposes of
sections 15 and 16 of such Act (29 U.S.C. 215 and 216).
(B) Discharge or discrimination.--A violation of
paragraph (1)(B) shall be deemed a violation of section
15(a)(3) of the Fair Labor Standards Act of 1938 (29
U.S.C. 215(a)(3)).
(c) Investigation.--
(1) In general.--To ensure compliance with the provisions
of section 805, including any regulation or order issued under
that section, the Secretary of Labor shall have the
investigative authority provided under section 11(a) of the
Fair Labor Standards Act of 1938 (29 U.S.C. 211(a)). For the
purposes of any investigation provided for in this subsection,
the Secretary of Labor shall have the subpoena authority
provided for under section 9 of such Act (29 U.S.C. 209).
(2) State agencies.--The Secretary of Labor may, for the
purpose of carrying out the functions and duties under this
section, utilize the services of State and local agencies in
accordance with section 11(b) of the Fair Labor Standards Act
of 1938 (29 U.S.C. 211(b)).
(d) Essential Worker Enforcement.--
(1) Right of action.--An action alleging a violation of
paragraph (1) or (2) of subsection (b) may be maintained
against an essential work employer receiving a grant under
section 806 in any Federal or State court of competent
jurisdiction by one or more essential workers or their
representative for and on behalf of the essential workers, or
the essential workers and others similarly situated, in the
same manner, and subject to the same remedies (including
attorney's fees and costs of the action), as an action brought
by an employee alleging a violation of section 7 or 15(a)(3),
respectively, of the Fair Labor Standards Act of 1938 (29
U.S.C. 207, 215(a)(3)).
(2) No waiver.--In an action alleging a violation of
paragraph (1) or (2) of subsection (b) brought by one or more
essential workers or their representative for and on behalf of
the persons as described in paragraph (1), to enforce the
rights in section 805, no court of competent jurisdiction may
grant the motion of an essential work employer receiving a
grant under section 806 to compel arbitration, under chapter 1
of title 9, United States Code, or any analogous State
arbitration statute, of the claims involved. An essential
worker's right to bring an action described in paragraph (1) or
subsection (b)(2)(A) on behalf of similarly situated essential
workers to enforce such rights may not be subject to any
private agreement that purports to require the essential
workers to pursue claims on an individual basis.
(e) Recordkeeping.--An essential work employer receiving a grant
under section 806 shall make, keep, and preserve records pertaining to
compliance with section 805 in accordance with section 11(c) of the
Fair Labor Standards Act of 1938 (29 U.S.C. 211(c)) and in accordance
with regulations prescribed by the Secretary of Labor.
(f) Outreach and Education.--Out of amounts appropriated to the
Secretary of the Treasury under section 805 for a fiscal year, the
Secretary of the Treasury shall transfer to the Secretary of Labor,
$3,000,000, of which the Secretary of Labor shall use--
(1) $2,500,000 for outreach to essential work employers and
essential workers regarding the premium pay under section 805;
and
(2) $500,000 to implement an advertising campaign
encouraging large essential work employers to provide the same
premium pay provided for by section 805 using the large
essential work employers' own funds and without utilizing
grants under this title.
(g) Clarification of Enforcing Official.--Nothing in the Government
Employee Rights Act of 1991 (42 U.S.C. 2000e-16a et seq.) or section
3(e)(2)(C) of the Fair Labor Standards Act of 1938 (29 U.S.C.
203(e)(2)(C)) shall be construed to prevent the Secretary of Labor from
carrying out the authority of the Secretary under this section in the
case of State employees described in section 304(a) of the Government
Employee Rights Act of 1991 (42 U.S.C. 2000e-16c(a)).
TITLE IX--HEALTH IT AND BRIDGING THE DIGITAL DIVIDE IN HEALTH CARE
SEC. 901. 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. 902. 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, socioeconomic
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 Ending Health
Disparities During COVID-19 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. 903. 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. 904. 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. 905. 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''.
SEC. 906. 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. 907. 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. 908. STUDY ON THE EFFECTS OF CHANGES TO TELEHEALTH UNDER THE
MEDICARE AND MEDICAID PROGRAMS DURING THE COVID-19
EMERGENCY.
(a) In General.--Not later than 1 year after the end of the
emergency period described in section 1135(g)(1)(B) of the Social
Security Act (42 U.S.C. 1320b-5(g)(1)(B)), the Secretary of Health and
Human Services (in this section referred to as the ``Secretary'') shall
conduct a study and submit to the Committee on Energy and Commerce and
the Committee on Ways and Means of the House of Representatives and the
Committee on Finance of the Senate an interim report on any changes
made to the provision or availability of telehealth services under part
A or B of title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) during such period. Such report shall include the following:
(1) A summary of utilization of all health care services
furnished under such part A or B during such period, including
the number of--
(A) in-person outpatient visits, inpatient
admissions, and in-person emergency department visits;
and
(B) telehealth visits, broken down by--
(i) the number of such visits furnished via
audio-visual technology compared to the number
of such visits furnished via audio-only
technology;
(ii) the number of such visits furnished by
each type of provider of services or supplier
(as defined in section 1861 of such Act (42
U.S.C. 1395x) and including a Federally
qualified health center or rural health clinic
(as so defined)), including a specification of
the specialty of each such provider or supplier
(if applicable); and
(iii) the type of service provided,
including level of service and diagnoses
associated with the telehealth visit.
(2) A description of any changes in utilization patterns
for the care settings described in paragraph (1) over the
course of such period compared to such patterns prior to such
period.
(3) An analysis of utilization of telehealth services under
such part A or B during such period, broken down by age, sex
(including sexual orientation and gender identity where
possible), race and ethnicity, disability status, primary
language, geographic region (including by rural health areas
(as defined by the Health Resources & Services Administration),
non-rural health areas, health professional shortage areas (as
defined in section 332(a)(1) of the Public Health Service Act
(42 U.S.C. 254e(a)(1))), medically underserved communities (as
defined in section 799B(6) of such Act (42 U.S.C. 295p(6))),
areas with medically underserved populations (as defined in
section 330(b)(3) of such Act (42 U.S.C. 254b(b)(3))), and by
State), and income level (as measured directly or indirectly,
such as by patient's zip code tabulation area median income as
publicly reported by the United States Census Bureau), and of
any trends in such utilization during such period, so broken
down. Such analysis shall include the number of telehealth
visits performed by providers of services or suppliers licensed
in a State different from the State where the individual
receiving such telehealth services is located at the time such
services are furnished. Such analysis may not include any
individually identifiable information or protected health
information.
(4) A description of expenditures and any savings under
such part A or B attributable to use of such telehealth
services during such period.
(5) A description of any instances of fraud identified by
the Secretary, acting through the Office of the Inspector
General or other relevant agencies and departments, with
respect to such telehealth services furnished under such part A
or B during such period and a comparison of the number of such
instances with the number of instances of fraud so identified
with respect to in-person services so furnished during such
period.
(6) A description of any privacy concerns with respect to
the furnishing of such telehealth services (such as
cybersecurity or ransomware concerns), including a description
of any actions taken by the Secretary, acting through the
Health Sector Cybersecurity Coordination Center or other
relevant agencies and departments, during such period to assist
health care providers secure telecommunications systems.
(7) An analysis of health care quality related to
telehealth (which may include patient health outcomes (such as
morbidity, mortality, healthcare utilization, and disease-
specific management metrics), safety metrics, quality measures,
health equity focused measures, patient satisfaction, provider
satisfaction, and other inputs and sources as determined by the
Secretary).
(8) An analysis of any other outcomes or metrics related to
telehealth, as determined appropriate by the Secretary.
(b) Input.--In conducting the study and submitting the report under
subsection (a), the Secretary--
(1)(A) consult with relevant stakeholders (such as
patients, caregivers, patient advocacy groups, minority or
tribal groups (including Urban Indian Organization (UIOs)),
health care professionals (including behavioral health
professionals), hospitals, State medical boards, State nursing
boards, the Federation of State Medical Boards, National
Council of State Boards of Nursing, medical professional
employers (such as hospitals, medical groups, staffing
companies), telehealth groups, health professional liability
providers, public and private payers, and State leaders); and
(B) solicit public comments on such report before the
submission of such report; and
(2) shall endeavor to include as many racially, ethnically,
geographically, linguistically, and professionally diverse
perspectives as possible.
(c) Final Report.--Not later than December 31, 2024, the Secretary
shall--
(1) update and finalize the interim report under subsection
(a); and
(2) submit such updated and finalized report to the
committees specified in such subsection.
(d) Grants for Medicaid Reports.--
(1) In general.--Not later than 2 years after the end of
the emergency period described in section 1135(g)(1)(B) of the
Social Security Act (42 U.S.C. 1320b-5(g)(1)(B)), the Secretary
shall award grants to States with a State plan (or waiver of
such plan) in effect under title XIX of the Social Security Act
(42 U.S.C. 1396r) that submit an application under this
subsection for purposes of enabling such States to study and
submit reports to the Secretary on any changes made to the
provision or availability of telehealth services under such
plans (or such waivers) during such period.
(2) Eligibility.--To be eligible to receive a grant under
paragraph (1), a State shall--
(A) provide benefits for telehealth services under
the State plan (or waiver of such plan) in effect under
title XIX of the Social Security Act (42 U.S.C. 1396r);
(B) be able to differentiate telehealth from in-
person visits within claims data submitted under such
plan (or such waiver) during such period; and
(C) submit to the Secretary an application at such
time, in such manner, and containing such information
(including the amount of the grant requested) as the
Secretary may require.
(3) Use of funds.--An State shall use amounts received
under a grant under this subsection to conduct a study and
report findings regarding the effects of changes to telehealth
services offered under the State plan (or waiver of such plan)
of such State under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) during such period in accordance with
paragraph (4).
(4) Reports.--
(A) Interim report.--Not later 1 year after the
date a State receives a grant under this subsection,
the State shall submit to the Secretary an interim
report that--
(i) details any changes made to the
provision or availability of telehealth
benefits (such as eligibility, coverage, or
payment changes) under the State plan (or
waiver of such plan) of the State under title
XIX of the Social Security Act (42 U.S.C. 1396
et seq.) during the emergency period described
in paragraph (1); and
(ii) contains--
(I) a summary and description of
the type described in paragraphs (1)
and (2), respectively, of subsection
(a); and
(II) to the extent practicable, an
analysis of the type described in
paragraph (3) of subsection (a),
except that any reference in such subsection to
``such part A or B'' shall, for purposes of
subclauses (I) and (II), be treated as a
reference to such State plan (or waiver).
(B) Final report.--Not later than 3 years after the
date a State receives a grant under this subsection,
the State shall update and finalize the interim report
and submit such final report to the Secretary.
(C) Report by secretary.--Not later than the
earlier of the date that is 1 year after the submission
of all final reports under subparagraph (B) and
December 31, 2028, the Secretary shall submit to
Congress a report on the grant program, including a
summary of the reports received from States under this
paragraph.
(5) Modification authority.--The Secretary may modify any
deadline described in paragraph (4) or any information required
to be included in a report made under this subsection to
provide flexibility for States to modify the scope of the study
and timeline for such reports.
(6) Technical assistance.--The Secretary shall provide such
technical assistance as may be necessary to a State receiving a
grant under this subsection in order to assist such state in
conducting studies and submitting reports under this
subsection.
(7) State.--For purposes of this subsection, the term
``State'' means each of the several States, the District of
Columbia, and each territory of the United States.
(e) Authorization of Appropriations.--
(1) Medicare.--For the purpose of carrying out subsections
(a) through (c), there are authorized to be appropriated such
sums as may be necessary for each of the fiscal years 2020
through 2024.
(2) Medicaid.--For the purpose of carrying out subsection
(d), there are authorized to be appropriated such sums as may
be necessary for each of the fiscal years 2022 through 2028.
SEC. 909. COVID-19 DESIGNATION OF IMMEDIATE SPECIAL AUTHORITY OF
SPECTRUM FOR TRIBES' EMERGENCY RESPONSE IN INDIAN
COUNTRY.
(a) Findings.--Congress finds the following:
(1) The immediate grant of emergency special temporary
authority of available spectrum that will efficiently support
temporary wireless broadband networks and allow Indian Tribes
to provide Tribal members with wireless broadband service over
Tribal lands or Hawaiian Home Lands during the COVID-19 crisis
due to the increased demand for telecommunications and
disproportionate impacts of the COVID-19 pandemic in Indian
Country is essential.
(2) Reservations are the most digitally disconnected areas
in the United States that lack basic access to broadband and
wireless services at rates comparable to, and in some cases
lower than, third-world countries.
(3) In 2018, the Government Accountability Office and the
Federal Communications Commission reported that only 65 percent
of American Indian and Alaska Natives (AI/ANs) living on Tribal
lands had access to fixed broadband services, and only 68
percent of AI/AN households on rural Tribal lands had telephone
services. This is a stark comparison to only 8 percent of the
national average that lacks access to fixed broadband services.
(4) Indian Tribes have previously encountered substantial
barriers to accessing broadband and other communications
services on Tribal lands to deploy telecommunication services
for the safety and well-being of Tribal members and to decrease
the alarming rates of unnecessary loss of lives that AI/ANs
disproportionately experience, especially through the lack of
access to health care services and emergency resources, as
demonstrated during the COVID-19 pandemic that continues to
disproportionately impact Indian Country.
(5) Indian Tribes' lack of access to broadband services on
Tribal lands and Hawaiian Home Lands during the COVID-19
pandemic further highlights the digital divide in Indian
Country.
(6) The Government Accountability Office found that health
information technology systems at the Indian Health Service
rank as the Federal Government's third-highest need for agency
system modernization, since 50 percent of Indian Health Service
facilities depend on outdated circuit connections based on one
or two TI circuit lines (3 Mbps), creating slower response
times than any other health facility system in the United
States.
(7) A 2018 Tribal health reform comment filed with the
Federal Communications Commission has further stated that
approximately 1.5 million people living on Tribal lands lack
access to broadband and, of the 75 percent of rural Indian
Health Service facilities, many still lack reliable broadband
networks for American Indians and Alaska Natives (AI/ANs) to
access telehealth or clinical health care services, which is a
critical need in the most geographically isolated areas of the
country with some of the highest poverty rates, and lack of
access to reliable transportation.
(8) The Bureau of Indian Education has stated that recent
estimates from 142 out of 174 schools have indicated that
approximately 15 to 95 percent of students do not have access
to internet services at home depending on Bureau school
location and limitations on data caps during the COVID-19
crisis.
(b) Deployment of Wireless Broadband Service on Tribal Lands and
Hawaiian Home Lands.--
(1) Funding of grants for immediate deployment of wireless
broadband service on tribal lands and hawaiian home lands.--In
addition to any other amounts made available, out of any money
in the Treasury of the United States not otherwise
appropriated, there are appropriated--
(A) $297,500,000 for grants under the community
facilities grant program under section 306(a)(19) of
the Consolidated Farm and Rural Development Act to
Indian Tribes, qualifying Tribal entities, and the
Director of the Department of Hawaiian Home Lands, for
the immediate deployment of wireless broadband service
on Tribal lands and Hawaiian Home Lands, respectively,
through the use of emergency special temporary
authority granted under paragraph (2) of this
subsection, including backhaul costs, repairs to
damaged infrastructure, the cost of the repairs to
which would be less expensive than the cost of new
infrastructure and would support the emergency special
temporary use, and the Federal share applicable to
grants from such amount shall be 100 percent, which
amount shall remain available for one year from the
enactment of this Act; and
(B) $3,000,000 for grants under the community
facilities technical assistance and training grant
program under section 306(a)(26) of such Act, without
regard to sections 306(a)(26)(B) and 306(a)(26)(C) of
such Act, to assist Indian Tribes, qualifying Tribal
entities, and the Director of the Department of
Hawaiian Home Lands in preparing applications for the
grants referred to in subparagraph (B) of this
paragraph, which amount shall remain available for one
year from the enactment of this Act.
Grants referred to under subparagraph (B) shall be available to
Indian Tribes, qualifying Tribal entities and shall also be
available to inter-Tribal government organizations,
universities, and colleges with Tribal serving institutions for
the purposes stated herein.
(2) Emergency special temporary authority to use available
and efficient spectrum on tribal lands and hawaiian home
lands.--
(A) Grant of authority.--Not later than 10 days
after receiving a request from an Indian Tribe, a
qualifying Tribal entity, or the Director of the
Department of Hawaiian Home Lands for emergency special
temporary authority to use electromagnetic spectrum
described in subparagraph (C) for the provision of
wireless broadband service over the Tribal lands over
which the Indian Tribe or qualifying Tribal entity has
jurisdiction or (in the case of a request from the
Director of the Department of Hawaiian Home Lands) over
the Hawaiian Home Lands, allowing unlicensed radio
transmitters to operate for such provision on such
spectrum at locations on such Tribal lands or Hawaiian
Home Lands where such spectrum is not being used, the
Commission shall grant such request on a secondary non-
interference basis.
(B) Duration.--A grant of emergency special
temporary authority under subparagraph (A) shall be for
a period of operation to begin not later than 6 months
after the date of the enactment of this Act and to
remain in operation for not longer than 6 months,
absent extensions granted by the Commission pursuant to
the procedures of the Commission relating to special
temporary authority.
(C) Electromagnetic spectrum described.--The
electromagnetic spectrum described in this subparagraph
for utilization on the temporary basis is any portion
of the electromagnetic spectrum--
(i) that is--
(I) between the frequencies of 2496
megahertz and 2690 megahertz,
inclusive;
(II) in the white spaces of the
television broadcast spectrum between
the frequencies of 470 megahertz and
790 megahertz, inclusive, excluding
those frequencies utilized for other
purposes under subpart H of part 15 of
title 47, Code of Federal Regulations;
(III) between the frequencies of
5925 megahertz and 7125 megahertz,
inclusive; or
(IV) between frequencies of 3550
megahertz and 3700 megahertz,
inclusive; and
(ii) with respect to the Tribal lands or
Hawaiian Home Lands over which authority to use
such spectrum is requested under subparagraph
(A), is not assigned to any licensee.
(3) Definitions.--In this subsection:
(A) Commission.--The term ``Commission'' means the
Federal Communications Commission.
(B) Hawaiian home lands.--The term ``Hawaiian Home
Lands'' means lands held in trust for Native Hawaiians
by Hawaii pursuant to the Hawaiian Homes Commission
Act, 1920.
(C) Indian tribe.--The term ``Indian Tribe'' means
the governing body of any individually identified and
federally recognized Indian or Alaska Native Tribe,
band, nation, pueblo, village, community, affiliated
tribal group, or component reservation in the list
published pursuant to section 104(a) of the Federally
Recognized Indian Tribe List Act of 1994 (25 U.S.C.
5131(a)).
(D) Qualifying tribal entity.--The term
``qualifying Tribal entity'' means an entity designated
by the Indian Tribe with jurisdiction over particular
Tribal lands for which the spectrum access is sought.
The following may be designated as a qualifying Tribal
entity:
(i) Indian Tribes.
(ii) Tribal consortia which consists of two
or more Indian Tribes, or an Indian Tribe and
an entity that is more than 50 percent owned
and controlled by one or more Indian Tribes.
(iii) Federally chartered Tribal
corporations created under section 17 of the
Indian Reorganization Act (25 U.S.C. 5124), and
created under section 4 of the Oklahoma Indian
Welfare Act (25 U.S.C. 5204).
(iv) Entities that are more than 50 percent
owned and controlled by an Indian Tribe or
Indian Tribes.
(E) Entity that is more than 50 percent owned and
controlled by one or more indian tribes.--The term
``entity that is more than 50 percent owned and
controlled by one or more Indian Tribes'' means an
entity over which one or more Indian Tribes have both
de facto and de jure control of the entity. De jure
control of the entity is evidenced by ownership of
greater than 50 percent of the voting stock of a
corporation, or in the case of a partnership, general
partnership interests. De facto control of an entity is
determined on a case-by-case basis. An Indian Tribe or
Indian Tribes must demonstrate indicia of control to
establish that such Indian Tribe or Indian Tribes
retain de facto control of the applicant seeking
eligibility as a ``qualifying Tribal entity'',
including the following:
(i) The Indian Tribe or Indian Tribes
constitute or appoint more than 50 percent of
the board of directors or management committee
of the entity.
(ii) The Indian Tribe or Indian Tribes have
authority to appoint, promote, demote, and fire
senior executives who control the day-to-day
activities of the entity.
(iii) The Indian Tribe or Indian Tribes
play an integral role in the management
decisions of the entity.
(iv) The Indian Tribe or Indian Tribes have
the authority to make decisions or otherwise
engage in practices or activities that
determine or significantly influence--
(I) the nature or types of services
offered by such an entity;
(II) the terms upon which such
services are offered; or
(III) the prices charged for such
services.
(F) Tribal lands.--The term ``Tribal lands'' has
the meaning given that term in section 73.7000 of title
47, Code of Federal Regulations, as of April 16, 2020,
and includes the definition ``Indian Country'' as
defined in section 1151 of title 18, United States
Code, and includes fee simple and restricted fee land
held by an Indian Tribe.
(G) Wireless broadband service.--The term
``wireless broadband service'' means wireless broadband
internet access service that is delivered--
(i) with a download speed of not less than
25 megabits per second and an upload speed of
not less than 3 megabits per second; and
(ii) through--
(I) mobile service;
(II) fixed point-to-point
multipoint service;
(III) fixed point-to-point service;
or
(IV) broadcast service.
SEC. 910. 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.).
TITLE X--PUBLIC AWARENESS
SEC. 1001. AWARENESS CAMPAIGNS.
The Secretary of Health and Human Services, acting through the
Director of the Centers for Disease Control and Prevention and in
coordination with other offices and agencies, as appropriate, shall
award competitive grants or contracts to one or more public or private
entities, including faith-based organizations, to carry out
multilingual and culturally appropriate awareness campaigns. Such
campaigns shall--
(1) be based on available scientific evidence;
(2) increase awareness and knowledge of COVID-19, including
countering stigma associated with COVID-19;
(3) improve information on the availability of COVID-19
diagnostic testing; and
(4) promote cooperation with contact tracing efforts.
SEC. 1002. 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. 1003. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES.
(a) Grants Authorized.--The Secretary of Education is authorized to
provide grants to eligible entities for the provision of English as a
second language (in this section referred to ``ESL'') instruction and
shall determine, after consultation with appropriate stakeholders, the
mechanism for administering and distributing such grants.
(b) Eligible Entity Defined.--In this section, the term ``eligible
entity'' means a State or community-based organization that employs and
serves minority populations.
(c) Application.--An eligible entity may apply for a grant under
this section by submitting such information as the Secretary of
Education may require and in such form and manner as the Secretary may
require.
(d) Use of Grant.--As a condition of receiving a grant under this
section, an eligible entity shall--
(1) develop and implement a plan for assuring the
availability of ESL instruction that effectively integrates
information about the nature of the United States health care
system, how to access care, and any special language skills
that may be required for individuals to access and regularly
negotiate the system effectively;
(2) develop a plan, including, where appropriate, public-
private partnerships, for making ESL instruction progressively
available to all individuals seeking instruction; and
(3) maintain current ESL instruction efforts by using funds
available under this section to supplement rather than supplant
any funds expended for ESL instruction in the State as of
January 1, 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. 1004. INFLUENZA, COVID-19, 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, pneumonia, and COVID-19; 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,
pneumonia, and COVID-19; 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.
TITLE XI--RESEARCH
SEC. 1101. RESEARCH AND DEVELOPMENT.
The Secretary of Health and Human Services, in coordination with
the Director of the Centers for Disease Control and Prevention and in
collaboration with the Director of the National Institutes of Health,
the Director of the Agency for Healthcare Research and Quality, the
Commissioner of Food and Drugs, and the Administrator of the Centers
for Medicare & Medicaid Services, shall support research and
development on more efficient and effective strategies--
(1) for the surveillance of SARS-CoV-2 and COVID-19;
(2) for the testing and identification of individuals
infected with COVID-19; and
(3) for the tracing of contacts of individuals infected
with COVID-19.
SEC. 1102. CDC FIELD STUDIES PERTAINING TO SPECIFIC HEALTH INEQUITIES.
(a) In General.--Not later than 90 days after the date of enactment
of this Act, the Secretary of Health and Human Services (referred to in
this section as the ``Secretary''), acting through the Centers for
Disease Control and Prevention, in collaboration with State, local,
Tribal, and territorial health departments, shall complete (by the
reporting deadline in subsection (b)) field studies to better
understand health inequities that are not currently tracked by the
Secretary. Such studies shall include an analysis of--
(1) the impact of socioeconomic status on health care
access and disease outcomes, including COVID-19 outcomes;
(2) the impact of disability status on health care access
and disease outcomes, including COVID-19 outcomes;
(3) the impact of language preference on health care access
and disease outcomes, including COVID-19 outcomes;
(4) factors contributing to disparities in health outcomes
for the COVID-19 pandemic; and
(5) other topics related to disparities in health outcomes
for the COVID-19 pandemic, as determined by the Secretary.
(b) Report.--Not later than December 31, 2021, the Secretary shall
submit to the Committee on Energy and Commerce of the House of
Representatives and the Committee on Health, Education, Labor, and
Pensions of the Senate an initial report on the results of the field
studies under this section.
(c) Final Report.--Not later than December 31, 2023, the Secretary
shall--
(1) update and finalize the initial report under subsection
(b); and
(2) submit such final report to the committees specified in
such subsection.
(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $25,000,000, to remain available
until expended.
SEC. 1103. EXPANDING CAPACITY FOR HEALTH OUTCOMES.
(a) In General.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary''), acting through the
Administrator of the Health Resources and Services Administration,
shall award grants to eligible entities to develop and expand the use
of technology-enabled collaborative learning and capacity building
models to respond to ongoing and real-time learning, health care
information sharing, and capacity building needs related to COVID-19.
(b) Eligible Entities.--To be eligible to receive a grant under
this section, an entity shall have experience providing technology-
enabled collaborative learning and capacity building health care
services--
(1) in rural areas, frontier areas, health professional
shortage areas, or medically underserved area; or
(2) to medically underserved populations or Indian Tribes.
(c) Use of Funds.--An eligible entity receiving a grant under this
section shall use funds received through the grant--
(1) to advance quality of care in response to COVID-19,
with particular emphasis on rural and underserved areas and
populations;
(2) to protect medical personnel and first responders
through sharing real-time learning through virtual communities
of practice;
(3) to improve patient outcomes for conditions affected or
exacerbated by COVID-19, including improvement of care for
patients with complex chronic conditions; and
(4) to support rapid uptake by health care professionals of
emerging best practices and treatment protocols around COVID-
19.
(d) Optional Additional Uses of Funds.--An eligible entity
receiving a grant under this section may use funds received through the
grant for--
(1) equipment to support the use and expansion of
technology-enabled collaborative learning and capacity building
models, including hardware and software that enables distance
learning, health care provider support, and the secure exchange
of electronic health information;
(2) the participation of multidisciplinary expert team
members to facilitate and lead technology-enabled collaborative
learning sessions, and professionals and staff assisting in the
development and execution of technology-enabled collaborative
learning;
(3) the development of instructional programming and the
training of health care providers and other professionals that
provide or assist in the provision of services through
technology-enabled collaborative learning and capacity building
models; and
(4) other activities consistent with achieving the
objectives of the grants awarded under this section.
(e) Technology-Enabled Collaborative Learning and Capacity Building
Model Defined.--In this section, the term ``technology-enabled
collaborative learning and capacity building model'' has the meaning
given that term in section 2(7) of the Expanding Capacity for Health
Outcomes Act (Public Law 114-270; 130 Stat. 1395).
(f) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $20,000,000, to remain available
until expended.
SEC. 1104. 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. 1105. 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 or other
demographic characteristics (such as age, sex, gender) as to the safety
or effectiveness of a drug or biological product or if such product
addresses a disease that disproportionately impacts certain racial or
ethnic groups or other demographic characteristics (such as age, sex,
gender), 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 or other
demographic characteristics (such as age, sex, gender) 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 or other demographic
characteristics (such as age, sex, gender) as to the safety or
effectiveness of the drug 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 (such as
age, sex, gender) 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 or other demographic
characteristics (such as age, sex, gender) 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 or other demographic
characteristics (such as age, sex, gender) 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 or other demographic
characteristics (such as age, sex, gender) in the way the drug
or biological product is metabolized;
``(3) other evidence as the Secretary may determine
appropriate; and
``(4) if such product addresses a disease/condition that
evidence shows disproportionately impacts certain racial or
ethnic groups or other demographic characteristics (such as
age, sex, gender).''.
(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. 1106. GAO AND NIH REPORTS.
(b) 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.
(c) GAO Report.--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 funding provided
pursuant to Coronavirus Preparedness and Response Supplemental
Appropriations Act (Public Law 116-123), Families First
Coronavirus Response Act (Public Law 116-127), Coronavirus Aid,
Relief, and Economic Security Act (Public Law 116-136), and
Paycheck Protection Program and Health Care Enhancement Act
(Public Law 116-139);
(2) the percentage of such organizations that were awarded
such funding; and
(3) the impact of such community-based organizations'
efforts on reducing health disparities within racial and ethnic
minority groups.
(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.
SEC. 1107. HEALTH IMPACT ASSESSMENTS.
(a) Findings.--Congress makes the following findings:
(1) Health Impact Assessment is a tool to help planners,
health officials, decision makers, 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
decisionmaking processes; and
(3) build stronger, healthier communities through the use
of Health Impact Assessment.
(c) Health Impact Assessments.--Part P of title III of the Public
Health Service Act (42 U.S.C. 280g et seq.), as amended by section
796A, is further amended by adding at the end the following:
``SEC. 399V-12. HEALTH IMPACT ASSESSMENTS.
``(a) Definitions.--In this section:
``(1) Administrator.--The term `Administrator' means the
Administrator of the Environmental Protection Agency.
``(2) 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 Ending Health Disparities during COVID-19 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 decisionmaking processes;
``(B) assess the effect on the health of
individuals and populations of proposed policies,
projects, or plans that result in modifications to the
built environment; and
``(C) assess the distribution of health effects
across various factors, such as race, income,
ethnicity, age, disability status, gender, and
geography.
``(5) Eligible activities.--
``(A) In general.--Eligible entities funded under
this subsection shall conduct an evaluation of any
proposed activity to determine whether it will have a
significant adverse or positive effect on the health of
the affected population in the jurisdiction of the
eligible entity, based on the criteria described in
subparagraph (B).
``(B) Criteria.--The criteria described in this
subparagraph include, as applicable to the proposed
activity, the following:
``(i) Any substantial adverse effect or
significant health benefit on health outcomes
or factors known to influence health, including
the following:
``(I) Physical activity.
``(II) Injury.
``(III) Mental health.
``(IV) Accessibility to health-
promoting goods and services.
``(V) Respiratory health.
``(VI) Chronic disease.
``(VII) Nutrition.
``(VIII) Land use changes that
promote local, sustainable food
sources.
``(IX) Infectious disease,
including COVID-19.
``(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, pandemic, or other
infectious or biochemical agent;
``(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
decision makers.
``(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 Ending Health Disparities During COVID-19 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;
``(10) ability to reduce the spread of infectious diseases
(such as COVID-19); and
``(11) 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. 1108. TRIBAL FUNDING TO RESEARCH HEALTH INEQUITIES INCLUDING
COVID-19.
(a) In General.--Not later than 6 months after the date of
enactment of this Act, the Director of the Indian Health Service, in
coordination with Tribal Epidemiology Centers and other Federal
agencies, as appropriate, shall conduct or support research and field
studies for the purposes of improved understanding of Tribal health
inequities among American Indians and Alaska Natives, including with
respect to--
(1) disparities related to COVID-19;
(2) public health surveillance and infrastructure regarding
unmet needs in Indian country and Urban Indian communities;
(3) population-based health disparities;
(4) barriers to health care services;
(5) the impact of socioeconomic status; and
(6) factors contributing to Tribal health inequities.
(b) Consultation, Confer, and Coordination.--In carrying out this
section, the Director of the Indian Health Service shall--
(1) consult with Indian Tribes and Tribal organizations;
(2) confer with Urban Indian organizations;
(3) coordinate with the Director of the Centers for Disease
Control and Prevention and the Director of the National
Institutes of Health.
(c) Process.--Not later than 60 days after the date of enactment of
this Act, the Director of the Indian Health Service shall establish a
nationally representative panel to establish processes and procedures
for the research and field studies conducted or supported under
subsection (a). The Director shall ensure that, at a minimum, the panel
consists of the following individuals:
(1) Elected Tribal leaders or their designees.
(2) Tribal public health practitioners and experts from the
national and regional levels.
(d) Duties.--The panel established under subsection (c) shall, at a
minimum--
(1) advise the Director of the Indian Health Service on the
processes and procedures regarding the design, implementation,
and evaluation of, and reporting on, research and field studies
conducted or supported under this section;
(2) develop and share resources on Tribal public health
data surveillance and reporting, including best practices; and
(3) carry out such other activities as may be appropriate
to establish processes and procedures for the research and
field studies conducted or supported under subsection (a).
(e) Report.--Not later than 1 year after expending all funds made
available to carry out this section, the Director of the Indian Health
Service, in coordination with the panel established under subsection
(c), shall submit an initial report on the results of the research and
field studies under this section to--
(1) the Committee on Energy and Commerce and the Committee
on Natural Resources of the House of Representatives; and
(2) the Committee on Indian Affairs and the Committee on
Health, Education, Labor, and Pensions of the Senate.
(f) Tribal Data Sovereignty.--The Director of the Indian Health
Service shall ensure that all research and field studies conducted or
supported under this section are tribally-directed and carried out in a
manner which ensures Tribal-direction of all data collected under this
section--
(1) according to Tribal best practices regarding research
design and implementation, including by ensuring the consent of
the Tribes involved to public reporting of Tribal data;
(2) according to all relevant and applicable Tribal,
professional, institutional, and Federal standards for
conducting research and governing research ethics;
(3) with the prior and informed consent of any Indian Tribe
participating in the research or sharing data for use under
this section; and
(4) in a manner that respects the inherent sovereignty of
Indian Tribes, including Tribal governance of data and
research.
(g) Final Report.--Not later than December 31, 2023, the Director
of the Indian Health Service shall--
(1) update and finalize the initial report under subsection
(e); and
(2) submit such final report to the committees specified in
such subsection.
(h) Definitions.--In this section:
(1) The terms ``Indian Tribe'' and ``Tribal organization''
have the meanings given to such terms in section 4 of the
Indian Self-Determination and Education Assistance Act (25
U.S.C. 5304).
(2) The term ``Urban Indian organization'' has the meaning
given to such term in section 4 of the Indian Health Care
Improvement Act (25 U.S.C. 1603).
(i) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $25,000,000, to remain available
until expended.
SEC. 1109. RESEARCH ENDOWMENTS AT BOTH CURRENT AND FORMER CENTERS OF
EXCELLENCE.
Paragraph (1) of section 464z-3(h) of the Public Health Service Act
(42 U.S.C. 285t(h)) is amended to read as follows:
``(1) In general.--The Director of the Institute may carry
out a program to facilitate minority health disparities
research and other health disparities research by providing for
research endowments--
``(A) at current or former centers of excellence
under section 736; and
``(B) at current or former centers of excellence
under section 464z-4.''.
TITLE XII--EDUCATION
SEC. 1201. GRANTS FOR SCHOOLS OF MEDICINE IN DIVERSE AND UNDERSERVED
AREAS.
Subpart II of part C of title VII of the Public Health Service Act
is amended by inserting after section 749B of such Act (42 U.S.C. 293m)
the following:
``SEC. 749C. SCHOOLS OF MEDICINE IN UNDERSERVED AREAS.
``(a) Grants.--The Secretary, acting through the Administrator of
the Health Resources and Services Administration, may award grants to
institutions of higher education (including multiple institutions of
higher education applying jointly) for the establishment, improvement,
and expansion of an allopathic or osteopathic school of medicine, or a
branch campus of an allopathic or osteopathic school of medicine.
``(b) Priority.--In selecting grant recipients under this section,
the Secretary shall give priority to institutions of higher education
that--
``(1) propose to use the grant for an allopathic or
osteopathic school of medicine, or a branch campus of an
allopathic or osteopathic school of medicine, in a combined
statistical area with fewer than 200 actively practicing
physicians per 100,000 residents according to the medical board
(or boards) of the State (or States) involved;
``(2) have a curriculum that emphasizes care for diverse
and underserved populations; or
``(3) are minority-serving institutions described in the
list in section 371(a) of the Higher Education Act of 1965.
``(c) Use of Funds.--The activities for which a grant under this
section may be used include--
``(1) planning and constructing--
``(A) a new allopathic or osteopathic school of
medicine in an area in which no other school is based;
or
``(B) a branch campus of an allopathic or
osteopathic school of medicine in an area in which no
such school is based;
``(2) accreditation and planning activities for an
allopathic or osteopathic school of medicine or branch campus;
``(3) hiring faculty and other staff to serve at an
allopathic or osteopathic school of medicine or branch campus;
``(4) recruitment and enrollment of students at an
allopathic or osteopathic school of medicine or branch campus;
``(5) supporting educational programs at an allopathic or
osteopathic school of medicine or branch campus;
``(6) modernizing infrastructure or curriculum at an
existing allopathic or osteopathic school of medicine or branch
campus thereof;
``(7) expanding infrastructure or curriculum at existing an
allopathic or osteopathic school of medicine or branch campus;
and
``(8) other activities that the Secretary determines
further the development, improvement, and expansion of an
allopathic or osteopathic school of medicine or branch campus
thereof.
``(d) Definitions.--In this section:
``(1) The term `branch campus' means a geographically
separate site at least 100 miles from the main campus of a
school of medicine where at least one student completes at
least 60 percent of the student's training leading to a degree
of doctor of medicine.
``(2) The term `institution of higher education' has the
meaning given to such term in section 101(a) of the Higher
Education Act of 1965.
``(e) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $1,000,000,000, to remain
available until expended.''.
SEC. 1202. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
Title XXXIV of the Public Health Service Act, as amended by as
amended by sections 104, 702, and 806, is amended by adding at the end
the following:
``Subtitle D--Diversifying the Health Care Workplace
``SEC. 3410. 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. 1203. 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.
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 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 colleges and university.--The term
`historically black college and university' has the meaning
given the term `part B institution' as defined in section 322
of the Higher Education Act of 1965.
``(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. 1204. 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. 1205. 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. 1206. AMENDMENTS TO THE PANDEMIC EBT ACT.
Section 1101 of the Families First Coronavirus Response Act (Public
Law 116-127) is amended--
(1) in subsection (a)--
(A) by striking ``fiscal year 2020'' and inserting
``fiscal years 2020 and 2021'';
(B) by striking ``during which the school would
otherwise be in session''; and
(C) by inserting ``until the school reopens'' after
``assistance'';
(2) in subsection (b)--
(A) by inserting ``and State agency plans for child
care covered children in accordance with subsection
(i)'' after ``with eligible children'';
(B) by inserting ``, a plan to enroll children who
become eligible children during a public health
emergency designation'' before ``, and issuances'';
(C) by striking ``in an amount not less than the
value of meals at the free rate over the course of 5
school days'' and inserting ``in accordance with
subsection (h)(1)''; and
(D) by inserting ``and for each child care covered
child in the household'' before the period at the end;
(3) in subsection (c), by inserting ``or child care
center'' after ``school'';
(4) by amending subsection (e) to read as follows:
``(e) Release of Information.--Notwithstanding any other provision
of law, the Secretary of Agriculture may authorize--
``(1) State educational agencies and school food
authorities administering a school lunch program under the
Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et
seq.) to release to appropriate officials administering the
supplemental nutrition assistance program such information as
may be necessary to carry out this section with respect to
eligible children; and
``(2) State agencies administering a child and adult care
food program under section 17 of the Richard B. Russell
National School Lunch Act (42 U.S.C. 1766) to release to
appropriate officials administering the supplemental nutrition
assistance program such information as may be necessary to
carry out this section with respect to child care covered
children.'';
(5) by amending subsection (g) to read as follows:
``(g) Availability of Commodities.--
``(1) In general.--Subject to paragraph (2), during fiscal
year 2020, the Secretary of Agriculture may purchase
commodities for emergency distribution in any area of the
United States during a public health emergency designation.
``(2) Purchases.--Funds made available to carry out this
subsection on or after the date of the enactment of the Child
Nutrition and Related Programs Recovery Act may only be used to
purchase commodities for emergency distribution--
``(A) under commodity distribution programs and
child nutrition programs that were established and
administered by the Food and Nutrition Service on or
before the day before the date of the enactment of the
Families First Coronavirus Response Act (Public Law
116-127);
``(B) to Tribal organizations (as defined in
section 3 of the Food and Nutrition Act of 2008 (7
U.S.C. 2012)), that are not administering the food
distribution program established under section 4(b) of
the Food and Nutrition Act of 2008 (7 U.S.C. 2013(b));
or
``(C) to emergency feeding organizations that are
eligible recipient agencies (as such terms are defined
in section 201A of the Emergency Food Assistance Act of
1983 (7 U.S.C. 7501)).'';
(6) by redesignating subsections (h) and (i) as subsections
(l) and (m);
(7) by inserting after subsection (g) the following:
``(h) Amount of Benefits.--
``(1) In general.--A household shall receive benefits under
this section in an amount equal to 1 breakfast and 1 lunch at
the free rate for each eligible child or child care covered
child in such household for each day.
``(2) Treatment of newly eligible children.--In the case of
a child who becomes an eligible child during a public health
emergency designation, the Secretary and State agency shall--
``(A) if such child becomes an eligible child
during school year 2019-2020, treat such child as if
such child was an eligible child as of the date the
school in which the child is enrolled closed; and
``(B) if such child becomes an eligible child after
school year 2019-2020, treat such child as an eligible
child as of the first day of the month in which such
child becomes so eligible.
``(i) Child Care Covered Child Assistance.--
``(1) In general.--During fiscal years 2020 and 2021, in
any case in which a child care center is closed for at least 5
consecutive days during a public health emergency designation,
each household containing at least 1 member who is a child care
covered child attending the child care center shall be eligible
until the schools in the State in which such child care center
is located reopen, as determined by the Secretary, to receive
assistance pursuant to--
``(A) a State agency plan approved under subsection
(b) that includes--
``(i) an application by the State agency
seeking to participate in the program under
this subsection; and
``(ii) a State agency plan for temporary
emergency standards of eligibility and levels
of benefits under the Food and Nutrition Act of
2008 (7 U.S.C. 2011 et seq.) for households
with child care covered children; or
``(B) an addendum application described in
paragraph (2).
``(2) Addendum application.--In the case of a State agency
that submits a plan to the Secretary of Agriculture under
subsection (b) that does not include an application or plan
described in clauses (i) and (ii) of paragraph (1)(A), such
State agency may apply to participate in the program under this
subsection by submitting to the Secretary of Agriculture an
addendum application for approval that includes a State agency
plan described in such clause (ii).
``(3) Requirements for participation.--A State agency may
not participate in the program under this subsection if--
``(A) the State agency plan submitted by such State
agency under subsection (b) with respect to eligible
children is not approved by the Secretary under such
subsection; or
``(B) the State agency plan submitted by such State
agency under subsection (b) or this subsection with
respect to child care covered children is not approved
by the Secretary under either such subsection.
``(4) Automatic enrollment.--
``(A) In general.--Subject to subparagraph (B), the
Secretary shall deem a child who is less than 6 years
of age to be a child care covered child eligible to
receive assistance under this subsection if--
``(i) the household with such child attests
that such child is a child care covered child;
``(ii) such child resides in a household
that includes an eligible child;
``(iii) such child receives cash assistance
benefits under the temporary assistance for
needy families program under part A of title IV
of the Social Security Act (42 U.S.C. 601 et
seq.);
``(iv) such child receives assistance under
the Child Care and Development Block Grant Act
of 1990 (42 U.S.C. 9857 et seq.);
``(v) such child is--
``(I) enrolled as a participant in
a Head Start program authorized under
the Head Start Act (42 U.S.C. 9831 et
seq.);
``(II) a foster child whose care
and placement is the responsibility of
an agency that administers a State plan
under part B or E of title IV of the
Social Security Act (42 U.S.C. 621 et
seq.);
``(III) a foster child who a court
has placed with a caretaker household;
or
``(IV) a homeless child or youth
(as defined in section 725(2) of the
McKinney-Vento Homeless Assistance Act
(42 U.S.C. 11434a(2)));
``(vi) such child participates in 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);
``(vii) through the use of information
obtained by the State agency for the purpose of
participating in the supplemental nutrition
assistance program under the Food and Nutrition
Act of 2008 (7 U.S.C. 2011 et seq.), the State
agency elects to treat as a child care covered
child each child less than 6 years of age who
is a member of a household that receives
supplemental nutrition assistance program
benefits under such Act; or
``(viii) the State in which such child
resides determines that such child is a child
care covered child, using State data approved
by the Secretary.
``(B) Acceptance of any form of automatic
enrollment.--
``(i) One category.--For purposes of
deeming a child to be a child care covered
child under subparagraph (A), a State agency
may not be required to show that a child meets
more than one requirement specified in clauses
(i) through (viii) of such subparagraph.
``(ii) Deeming requirement.--If a State
agency submits to the Secretary information
that a child meets any one of the requirements
specified in clauses (i) through (viii) of
subparagraph (A), the Secretary shall deem such
child a child care covered child under such
subparagraph.
``(j) Exclusions.--The provisions of section 16 of the Food and
Nutrition Act of 2008 (7 U.S.C. 2025) relating to quality control shall
not apply with respect to assistance provided under this section.
``(k) Feasibility Analysis.--
``(1) In general.--Not later than 30 days after the date of
the enactment of the Child Nutrition and Related Programs
Recovery Act, the Secretary shall submit to the Education and
Labor Committee and the Agriculture Committee of the House of
Representatives and the Committee on Agriculture, Nutrition,
and Forestry of the Senate a report on--
``(A) the feasibility of implementing the program
for eligible children under this section using an EBT
system in Puerto Rico, the Commonwealth of the Northern
Mariana Islands, and American Samoa similar to the
manner in which the supplemental nutrition assistance
program under the Food and Nutrition Act of 2008 is
operated in the States, including an analysis of--
``(i) the current nutrition assistance
program issuance infrastructure;
``(ii) the availability of--
``(I) an EBT system, including the
ability for authorized retailers to
accept EBT cards; and
``(II) EBT cards;
``(iii) the ability to limit purchases
using nutrition assistance program benefits to
food for home consumption; and
``(iv) the availability of reliable data
necessary for the implementation of such
program under this section for eligible
children and child care covered children,
including the names of such children and the
mailing addresses of their households; and
``(B) the feasibility of implementing the program
for child care covered children under subsection (i) in
Puerto Rico, the Commonwealth of the Northern Mariana
Islands, and American Samoa, including with respect to
such program each analysis specified in clauses (i)
through (iv) of subparagraph (A).
``(2) Contingent availability of participation.--Beginning
30 days after the date of the enactment of the Child Nutrition
and Related Programs Recovery Act, Puerto Rico, the
Commonwealth of the Northern Mariana Islands, and American
Samoa may each--
``(A) submit a plan under subsection (b), unless
the Secretary makes a finding, based on the analysis
provided under paragraph (1)(A), that the
implementation of the program for eligible children
under this section is not feasible in such territories;
and
``(B) submit a plan under subsection (i), unless
the Secretary makes a finding, based on the analysis
provided under paragraph (1)(B), that the
implementation of the program for child care covered
children under subsection (i) is not feasible in such
territories.
``(3) Treatment of plans submitted by territories.--
Notwithstanding any other provision of law, with respect to a
plan submitted pursuant to this subsection by Puerto Rico, the
Commonwealth of the Northern Mariana Islands, or American Samoa
under subsection (b) or subsection (i), the Secretary shall
treat such plan in the same manner as a plan submitted by a
State agency under such subsection, including with respect to
the terms of funding provided under subsection (m).'';
(8) in subsection (l), as redesigned by paragraph (7)--
(A) by redesignating paragraph (1) as paragraph
(3);
(B) by redesignating paragraphs (2) and (3) as
paragraphs (5) and (6), respectively;
(C) by inserting before paragraph (3) (as so
redesignated) the following:
``(1) The term `child care center' means an organization
described in subparagraph (A) or (B) of section 17(a)(2) of the
Richard B. Russell National School Lunch Act (42 U.S.C.
1766(a)(2)) and a family or group day care home.
``(2) The term `child care covered child' means a child
served under section 17 of the Richard B. Russell National
School Lunch Act (42 U.S.C. 1766) who, if not for the closure
of the child care center attended by the child during a public
health emergency designation and due to concerns about a COVID-
19 outbreak, would receive meals under such section at the
child care center.''; and
(D) by inserting after paragraph (3) (as so
redesignated) the following:
``(4) The term `free rate' means--
``(A) with respect to a breakfast, the rate of a
free breakfast under the school breakfast program under
section 4 of the Child Nutrition Act of 1966 (42 U.S.C.
1773); and
``(B) with respect to a lunch, the rate of a free
lunch under the school lunch program under the Richard
B. Russell National School Lunch Act (42 U.S.C. 1771 et
seq.).''; and
(9) in subsection (m), as redesignated by paragraph (7), by
inserting ``(including all administrative expenses)'' after
``this section''.
TITLE XIII--PUBLIC HEALTH ASSISTANCE TO TRIBES
SEC. 1301. APPROPRIATIONS FOR THE INDIAN HEALTH SERVICE.
HEROES Act Division A, Title V--Department of Health & Human
Services--Indian Health Service--The $2.1 billion in COVID-19 response
funding for the Indian Health Service.
SEC. 1302. IMPROVING STATE, LOCAL, AND TRIBAL PUBLIC HEALTH SECURITY.
Section 319C-1 of the Public Health Service Act (42 U.S.C. 247d-3a)
is amended--
(1) in the section heading, by striking ``and local'' and
inserting ``, local, and tribal'';
(2) in subsection (b)--
(A) in paragraph (1)--
(i) in subparagraph (B), by striking ``or''
at the end;
(ii) in subparagraph (C), by striking
``and'' at the end and inserting ``or''; and
(iii) by adding at the end the following:
``(D) be an Indian Tribe, Tribal organization, or a
consortium of Indian Tribes or Tribal organizations;
and''; and
(B) in paragraph (2)--
(i) in the matter preceding subparagraph
(A), by inserting ``, as applicable'' after
``including'';
(ii) in subparagraph (A)(viii)--
(I) by inserting ``and Tribal''
after ``with State'';
(II) by striking ``(as defined in
section 8101 of the Elementary and
Secondary Education Act of 1965)'' and
inserting ``and Tribal educational
agencies (as defined in sections 8101
and 6132, respectively, of the
Elementary and Secondary Education Act
of 1965)''; and
(III) by inserting ``and Tribal''
after ``and State'';
(iii) in subparagraph (G), by striking
``and tribal'' and inserting ``Tribal, and
urban Indian organization''; and
(iv) in subparagraph (H), by inserting ``,
Indian Tribes, and urban Indian organizations''
after ``public health'';
(3) in subsection (e), by inserting ``Indian Tribes, Tribal
organizations, urban Indian organizations,'' after ``local
emergency plans,'';
(4) in subsection (g)(1), by striking ``tribal officials''
and inserting ``Tribal officials'';
(5) in subsection (h)--
(A) in paragraph (1)(A)--
(i) by striking ``through 2023'' and
inserting ``and 2020''; and
(ii) by inserting before the period ``; and
$690,000,000 for each of fiscal years 2021
through 2023 for awards pursuant to paragraph
(3) (subject to the authority of the Secretary
to make awards pursuant to paragraphs (4) and
(5)) and paragraph (8), of which not less than
$5,000,000 shall be reserved each fiscal year
for awards under paragraph (8)'';
(B) in subsection (h)(2)(B), by striking ``tribal
public'' and inserting ``Tribal public'';
(C) in the heading of paragraph (3), by inserting
``for states'' after ``amount''; and
(D) by adding at the end the following:
``(8) Tribal eligible entities.--
``(A) Determination of funding amount.--
``(i) In general.--The Secretary shall
award at least 10 cooperative agreements under
this section, in amounts not less than the
minimum amount determined under clause (ii), to
eligible entities described in subsection
(b)(1)(D) that submits to the Secretary an
application that meets the criteria of the
Secretary for the receipt of such an award and
that meets other reasonable implementation
conditions established by the Secretary, in
consultation with Indian Tribes, for such
awards. If the Secretary receives more than 10
applications under this section from eligible
entities described in subsection (b)(1)(D) that
meet the criteria and conditions described in
the previous sentence, the Secretary, in
consultation with Indian Tribes, may make
additional awards under this section to such
entities.
``(ii) Minimum amount.--In determining the
minimum amount of an award pursuant to clause
(i), the Secretary, in consultation with Indian
Tribes, shall first determine an amount the
Secretary considers appropriate for the
eligible entity.
``(B) Available until expended.--Amounts provided
to a Tribal eligible entity under a cooperative
agreement under this section for a fiscal year and
remaining unobligated at the end of such year shall
remain available to such entity during the entirety of
the performance period, for the purposes for which said
funds were provided.
``(C) No matching requirement.--Subparagraphs (B),
(C), and (D) of paragraph (1) shall not apply with
respect to cooperative agreements awarded under this
section to eligible entities described in subsection
(b)(1)(D).''; and
(6) by adding at the end the following:
``(l) Special Rules Related to Tribal Eligible Entities.--
``(1) Modifications.--After consultation with Indian
Tribes, the Secretary may make necessary and appropriate
modifications to the program under this section to facilitate
the use of the cooperative agreement program by eligible
entities described in subsection (b)(1)(D).
``(2) Waivers.--
``(A) In general.--Except as provided in
subparagraph (B), the Secretary may waive or specify
alternative requirements for any provision of this
section (including regulations) that the Secretary
administers in connection with this section if the
Secretary finds that the waiver or alternative
requirement is necessary for the effective delivery and
administration of this program with respect to eligible
entities described in subsection (b)(1)(D).
``(B) Exception.--The Secretary may not waive or
specify alternative requirements under subparagraph (A)
relating to labor standards or the environment.
``(3) Consultation.--The Secretary shall consult with
Indian Tribes and Tribal organizations on the design of this
program with respect to such Tribes and organizations to ensure
the effectiveness of the program in enhancing the security of
Indian Tribes with respect to public health emergencies.
``(4) Reporting.--
``(A) In general.--Not later than 2 years after the
date of enactment of this subsection, and as an
addendum to the biennial evaluations required under
subsection (k), the Secretary, in coordination with the
Director of the Indian Health Service, shall--
``(i) conduct a review of the
implementation of this section with respect to
eligible entities described in subsection
(b)(1)(D), including any factors that may have
limited its success; and
``(ii) submit a report describing the
results of the review described in clause (i)
to--
``(I) the Committee on Indian
Affairs, the Committee on Health,
Education, Labor, and Pensions, and the
Committee on Appropriations of the
Senate; and
``(II) the Subcommittee for
Indigenous Peoples of the United States
of the Committee on Natural Resources,
the Committee on Energy and Commerce,
and the Committee on Appropriations of
the House of Representatives.
``(B) Analysis of tribal public health emergency
infrastructure limitation.--The Secretary shall include
in the initial report submitted under subparagraph (A)
a description of any public health emergency
infrastructure limitation encountered by eligible
entities described in subsection (b)(1)(D).''.
SEC. 1303. PROVISION OF ITEMS TO INDIAN PROGRAMS AND FACILITIES.
(a) Strategic National Stockpile.--Section 319F-2(a)(3)(G) of the
Public Health Service Act (42 U.S.C. 247d-6b(a)(3)(G)) is amended by
inserting ``, and, in the case that the Secretary deploys the stockpile
under this subparagraph, ensure, in coordination with the applicable
States and programs and facilities, that appropriate drugs, vaccines
and other biological products, medical devices, and other supplies are
deployed by the Secretary directly to health programs or facilities
operated by the Indian Health Service, an Indian Tribe, a Tribal
organization (as those terms are defined in section 4 of the Indian
Self-Determination and Education Assistance Act (25 U.S.C. 5304)), or
an inter-Tribal consortium (as defined in section 501 of the Indian
Self-Determination and Education Assistance Act (25 U.S.C. 5381)) or
through an urban Indian organization (as defined in section 4 of the
Indian Health Care Improvement Act), while avoiding duplicative
distributions to such programs or facilities'' before the semicolon.
(b) Distribution of Qualified Pandemic or Epidemic Products to IHS
Facilities.--Title III of the Public Health Service Act (42 U.S.C. 241
et seq.) is amended by inserting after section 319F-4 the following:
``SEC. 319F-5. DISTRIBUTION OF QUALIFIED PANDEMIC OR EPIDEMIC PRODUCTS
TO INDIAN PROGRAMS AND FACILITIES.
``In the case that the Secretary distributes qualified pandemic or
epidemic products (as defined in section 319F-3(i)(7)) to States or
other entities, the Secretary shall ensure, in coordination with the
applicable States and programs and facilities, that, as appropriate,
such products are distributed directly to health programs or facilities
operated by the Indian Health Service, an Indian Tribe, a Tribal
organization (as those terms are defined in section 4 of the Indian
Self-Determination and Education Assistance Act (25 U.S.C. 5304)), or
an inter-Tribal consortium (as defined in section 501 of the Indian
Self-Determination and Education Assistance Act (25 U.S.C. 5381)) or
through an urban Indian organization (as defined in section 4 of the
Indian Health Care Improvement Act), while avoiding duplicative
distributions to such programs or facilities.''.
SEC. 1304. HEALTH CARE ACCESS FOR URBAN NATIVE VETERANS.
Section 405 of the Indian Health Care Improvement Act (25 U.S.C.
1645) is amended--
(1) in subsection (a)(1), by inserting ``urban Indian
organizations,'' before ``and tribal organizations''; and
(2) in subsection (c)--
(A) by inserting ``urban Indian organization,''
before ``or tribal organization''; and
(B) by inserting ``an urban Indian organization,''
before ``or a tribal organization''.
SEC. 1305. PROPER AND REIMBURSED CARE FOR NATIVE VETERANS.
Section 405(c) of the Indian Health Care Improvement Act (25 U.S.C.
1645(c)) is amended by inserting before the period at the end the
following: ``, regardless of whether such services are provided
directly by the Service, an Indian tribe, or tribal organization,
through contract health services, or through a contract for travel
described in section 213(b)''.
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