    [Congressional Bills 117th Congress]
    [From the U.S. Government Publishing Office]
    [H.R. 7585 Introduced in House (IH)]

    <DOC>

    117th CONGRESS
      2d Session
                                    H. R. 7585

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

    _______________________________________________________________________

                        IN THE HOUSE OF REPRESENTATIVES

                                 April 26, 2022

        Ms. Kelly of Illinois (for herself, Ms. Adams, Ms. Norton, Mr.
     Butterfield, Ms. Wilson of Florida, Mr. Payne, Mr. Brown of Maryland,
        Ms. Schakowsky, Mr. Kahele, Mr. Danny K. Davis of Illinois, Ms.
     Underwood, Mr. Takano, Ms. Meng, Mr. Gomez, Mrs. Hayes, Mr. Carter of
    Louisiana, Mr. Horsford, Ms. Lee of California, Ms. Moore of Wisconsin,
      Mr. Lawson of Florida, Ms. Jayapal, Mrs. Watson Coleman, Ms. Titus,
      Mrs. Lawrence, Ms. Chu, Mr. Johnson of Georgia, Ms. Velazquez, Mr.
     Evans, Mr. Lowenthal, Ms. Brown of Ohio, Ms. Pressley, Mr. Rush, Mrs.
     Beatty, Mr. Carbajal, Mr. Carson, Ms. Barragan, Ms. Blunt Rochester,
      Ms. Bonamici, Mr. Cardenas, Mrs. Cherfilus-McCormick, Mr. Castro of
    Texas, Mrs. Napolitano, Mr. Schiff, Ms. Johnson of Texas, Ms. Sanchez,
     Ms. Strickland, Mr. Lieu, Mr. Green of Texas, Mr. McEachin, Mr. Smith
    of Washington, Mr. Gallego, Ms. Clark of Massachusetts, Mr. Sires, Mr.
       San Nicolas, Ms. Clarke of New York, Mr. Grijalva, Mr. Ruiz, Ms.
       Plaskett, and Mr. Meeks) introduced the following bill; which was
     referred to the Committee on Energy and Commerce, and in addition to
     the Committees on Agriculture, Oversight and Reform, Ways and Means,
      Education and Labor, the Judiciary, the Budget, Veterans' Affairs,
        Natural Resources, Armed Services, Homeland Security, Financial
      Services, and Transportation and Infrastructure, for a period to be
    subsequently determined by the Speaker, in each case for consideration
      of such provisions as fall within the jurisdiction of the committee
                                   concerned

    _______________________________________________________________________

                                     A BILL

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

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

    SECTION 1. SHORT TITLE.

        This Act may be cited as the ``Health Equity and Accountability Act
    of 2022''.

    SEC. 2. TABLE OF CONTENTS.

        The table of contents of this Act is as follows:

    Sec. 1. Short title.
    Sec. 2. Table of contents.
    Sec. 3. Findings.
                     TITLE I--DATA COLLECTION AND REPORTING

    Sec. 1001. Strengthening data collection, improving data analysis, and
                                expanding data reporting.
    Sec. 1002. Elimination of prerequisite of direct appropriations for
                                data collection and analysis.
    Sec. 1003. Collection of data for the Medicare program.
    Sec. 1004. Revision of HIPAA claims standards.
    Sec. 1005. National Center for Health Statistics.
    Sec. 1006. Disparities data collected by the Federal Government.
    Sec. 1007. Data collection and analysis grants to minority-serving
                                institutions.
    Sec. 1008. Safety and effectiveness of drugs with respect to racial and
                                ethnic background.
    Sec. 1009. Improving health data regarding Native Hawaiians and Pacific
                                Islanders.
    Sec. 1010. Clarification of simplified administrative reporting
                                requirement.
    Sec. 1011. Data collection regarding pandemic preparedness, testing,
                                infections, and deaths.
    Sec. 1012. Commission on Ensuring Data for Health Equity.
    Sec. 1013. Task Force on Preventing Bias in AI and Algorithms.
     TITLE II--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH AND HEALTH
                                      CARE

    Sec. 2001. Definitions; findings.
    Sec. 2002. Improving access to services for individuals with limited
                                English proficiency.
    Sec. 2003. Ensuring standards for culturally and linguistically
                                appropriate services in health care.
    Sec. 2004. Culturally and linguistically appropriate health care in the
                                Public Health Service Act.
    Sec. 2005. Pilot program for improvement and development of State
                                medical interpreting services.
    Sec. 2006. Training tomorrow's doctors for culturally and
                                linguistically appropriate care: graduate
                                medical education.
    Sec. 2007. Federal reimbursement for culturally and linguistically
                                appropriate services under the Medicare,
                                Medicaid, and State Children's Health
                                Insurance Programs.
    Sec. 2008. Increasing understanding of and improving health literacy.
    Sec. 2009. Requirements for health programs or activities receiving
                                Federal funds.
    Sec. 2010. Report on Federal efforts to provide culturally and
                                linguistically appropriate health care
                                services.
    Sec. 2011. English instruction for individuals with limited English
                                proficiency.
    Sec. 2012. Implementation.
    Sec. 2013. Language access services.
    Sec. 2014. Medically underserved populations.
                     TITLE III--HEALTH WORKFORCE DIVERSITY

    Sec. 3001. Amendment to the Public Health Service Act.
    Sec. 3002. Hispanic-serving institutions, historically Black colleges
                                and universities, historically Black
                                professional or graduate institutions,
                                Asian American and Native American Pacific
                                Islander-serving institutions, Tribal
                                Colleges, regional community-based
                                organizations, and national minority
                                medical associations.
    Sec. 3003. Loan repayment program of Centers for Disease Control and
                                Prevention.
    Sec. 3004. Allied health workforce diversity.
    Sec. 3005. Cooperative agreements for online degree programs at schools
                                of public health and schools of allied
                                health.
    Sec. 3006. National Health Care Workforce Commission.
    Sec. 3007. Scholarship and fellowship programs.
    Sec. 3008. McNair Postbaccalaureate Achievement Program.
    Sec. 3009. Rules for determination of full-time equivalent residents
                                for cost-reporting periods.
    Sec. 3010. Developing and implementing strategies for local health
                                equity.
    Sec. 3011. Health Professions Workforce Fund.
    Sec. 3012. Future advancement of academic nursing.
    Sec. 3013. Findings; sense of Congress relating to graduate medical
                                education.
    Sec. 3014. Career support for skilled, internationally educated health
                                professionals.
    Sec. 3015. Study and report on strategies for increasing diversity.
    Sec. 3016. Conrad State 30 program; physician retention.
    Sec. 3017. National Hispanic Nurses Day.
    Sec. 3018. Expanding medical education.
               TITLE IV--IMPROVING HEALTH CARE ACCESS AND QUALITY

    Sec. 4000. Definition.
                Subtitle A--Reducing Barriers to Accessing Care

    Sec. 4001. Protecting protected areas.
    Sec. 4002. Repeal of requirement for documentation evidencing
                                citizenship or nationality under the
                                Medicaid program.
    Sec. 4003. Availability of basic assistance to lawfully present
                                noncitizens.
    Sec. 4004. Improve affordability and reduce premium costs of health
                                insurance for consumers.
    Sec. 4005. Removing citizenship and immigration barriers to access to
                                affordable health care under the ACA.
    Sec. 4006. Removing barriers to access to affordable health care for
                                lawfully residing immigrants under Medicaid
                                and CHIP.
    Sec. 4007. Consistency in health insurance coverage for individuals
                                with federally authorized presence,
                                including deferred action.
    Sec. 4008. Study on the uninsured.
    Sec. 4009. Medicaid fallback coverage program for low-income adults in
                                non-expansion States.
    Sec. 4010. Increase and extension of temporary enhanced FMAP for States
                                which begin to expend amounts for certain
                                mandatory individuals.
                      Subtitle B--Improvement of Coverage

    Sec. 4101. Medicaid in the territories.
    Sec. 4102. Extension of the supplemental security income program to
                                Puerto Rico, the United States Virgin
                                Islands, Guam, and American Samoa.
    Sec. 4103. Extension of Medicare secondary payer.
    Sec. 4104. Indian defined in title I of the Patient Protection and
                                Affordable Care Act.
    Sec. 4105. Removing Medicare barrier to health care.
    Sec. 4106. Lowering Medicare premiums and prescription drug costs.
    Sec. 4107. Reducing cost-sharing, aligning income and resource
                                eligibility tests, simplifying enrollment,
                                and other program improvements for low-
                                income beneficiaries.
    Sec. 4108. 100 percent FMAP for medical assistance provided by urban
                                Indian organizations.
    Sec. 4109. 100 percent FMAP for medical assistance provided to a Native
                                Hawaiian through a federally qualified
                                health center or a Native Hawaiian health
                                care system under the Medicaid program.
    Sec. 4110. Repeal of requirement for estate recovery under the Medicaid
                                program.
    Sec. 4111. Allow for suspension of Medicare benefits and premium
                                liability for individuals who are
                                incarcerated and provide a special
                                enrollment period around the date of
                                release.
    Sec. 4112. Federal Employee Health Benefit Plans.
    Sec. 4113. Continuation of Medicaid income eligibility standard for
                                pregnant individuals and infants.
                        Subtitle C--Expansion of Access

                           Part 1--General Provisions

    Sec. 4201. Amendment to the Public Health Service Act.
    Sec. 4202. Border health grants.
    Sec. 4203. Critical access hospital improvements.
    Sec. 4204. Medicare remote monitoring pilot projects.
    Sec. 4205. Community health center collaborative access expansion.
    Sec. 4206. Facilitating the provision of telehealth services across
                                State lines.
    Sec. 4207. Scoring of preventive health savings.
    Sec. 4208. Sense of Congress on Maintenance of Effort Provisions
                                Regarding Children's Health.
    Sec. 4209. Protection of the HHS Offices of Minority Health.
    Sec. 4210. Office of Minority Health in Veterans Health Administration
                                of Department of Veterans Affairs.
    Sec. 4211. Study of DSH payments to ensure hospital access for low-
                                income patients.
    Sec. 4212. Reauthorization of the Native Hawaiian Health Care
                                Improvement Act.
                                 Part 2--Rural

    Sec. 4221. Establishment of Rural Community Hospital (RCH) Program.
    Sec. 4222. Rural Health Quality Advisory Commission and demonstration
                                projects.
    Sec. 4223. Rural health care services.
                           Part 3--Indian Communities

    Sec. 4231. Assistant Secretary of the Indian Health Service.
    Sec. 4232. Extension of full Federal medical assistance percentage to
                                Indian health care providers.
    Sec. 4233. Conferring with urban Indian organizations.
                               Part 4--Providers

    Sec. 4241. Availability of non-English language speaking providers.
    Sec. 4242. Access to essential community providers.
    Sec. 4243. Provider network adequacy in communities of color.
                                 Part 5--Dental

    Sec. 4251. Improving access to dental care.
    Sec. 4252. Oral health literacy and awareness campaign.
    Subtitle D--Advancing Health Equity Through Payment and Delivery Reform

    Sec. 4301. Sense of Congress.
    Sec. 4302. Centers for Medicare & Medicaid Services reporting and
                                value-based programs.
    Sec. 4303. Development and testing of disparity reducing delivery and
                                payment models.
    Sec. 4304. Diversity in Centers for Medicare and Medicaid consultation.
    Sec. 4305. Supporting safety net and community-based providers to
                                compete in value-based payment systems.
                      Subtitle E--Health Empowerment Zones

    Sec. 4401. Designation of health empowerment zones.
    Sec. 4402. Assistance to those seeking designation.
    Sec. 4403. Benefits of designation.
    Sec. 4404. Definition of Secretary.
    Sec. 4405. Authorization of appropriations.
                   Subtitle F--Equitable Health Care For All

    Sec. 4501. Findings.
    Sec. 4502. Data collection and reporting.
    Sec. 4503. Requiring equitable health care in the hospital value-based
                                purchasing program.
    Sec. 4504. Provision of inequitable health care as a basis for
                                permissive exclusion from medicare and
                                State health care programs.
    Sec. 4505. Office for Civil Rights and Health Equity of the Department
                                of Health and Human Services.
    Sec. 4506. Prohibiting discrimination in health care.
    Sec. 4507. Federal Health Equity Commission.
    Sec. 4508. Grants for hospitals to promote equitable health care and
                                outcomes.
                        Subtitle G--Investing in Equity

    Sec. 4601. Definitions.
    Sec. 4602. Strategy to incentivize health equity.
    Sec. 4603. Pay for Equity Advisory Council.
      TITLE V--IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES

                             Subtitle A--In General

    Sec. 5001. Grants to promote health for underserved communities.
                        Subtitle B--Pregnancy Screening

    Sec. 5101. Pregnancy intention screening initiative demonstration
                                program.
    Sec. 5102. Birth defects prevention, risk reduction, and awareness.
                       Subtitle C--Pregnancy-Related Care

    Sec. 5201. Mothers and Offspring Mortality and Morbidity Awareness.
    Sec. 5202. MOMMIES.
    Sec. 5203. Justice for Incarcerated Moms.
    Sec. 5204. IMPACT to Save Moms Act.
    Sec. 5205. Protecting moms and babies against climate change.
    Sec. 5206. Tech to Save Moms.
    Sec. 5207. Social Determinants for Moms.
    Sec. 5208. Data to Save Moms.
    Sec. 5209. Kira Johnson Act.
    Sec. 5210. Moms Matter.
    Sec. 5211. Taskforce Recommending Improvements for Unaddressed Mental
                                Perinatal & Postpartum Health (TRIUMPH) for
                                New Moms.
    Sec. 5212. Protect Moms from Domestic Violence.
    Sec. 5213. Perinatal workforce.
    Sec. 5214. Midwives schools and programs expansion.
    Sec. 5215. Gestational diabetes.
    Sec. 5216. Consumer education campaign.
    Sec. 5217. Bibliographic database of systematic reviews for care of
                                childbearing individuals and newborns.
    Sec. 5218. Development of interprofessional maternity care educational
                                models and tools.
    Sec. 5219. Dissemination of the quality family planning guidelines.
           Subtitle D--Federal Agency Coordination on Maternal Health

    Sec. 5301. Interagency Coordinating Committee on the Promotion of
                                Optimal Maternity Outcomes.
    Sec. 5302. Expansion of CDC Prevention Research Centers Program to
                                include Centers on Optimal Maternity
                                Outcomes.
    Sec. 5303. Expanding models to be tested by Center for Medicare and
                                Medicaid Innovation to explicitly include
                                maternity care and children's health
                                models.
    Sec. 5304. Interagency update to the quality family planning
                                guidelines.
                   Subtitle E--Reproductive and Sexual Health

    Sec. 5401. Findings; sense of Congress on urgent barriers to abortion
                                access and vital solutions.
    Sec. 5402. Emergency contraception education and information programs.
    Sec. 5403. Access to birth control duties of pharmacies to ensure
                                provision of FDA-approved contraception.
    Sec. 5404. Real Education and Access for Healthy Youth.
    Sec. 5405. Compassionate assistance for rape emergencies.
    Sec. 5406. Menstrual Equity For All Act of 2021.
    Sec. 5407. Additional focus area for the Office on Women's Health.
    Sec. 5408. Including services furnished by certain students, interns,
                                and residents supervised by certified nurse
                                midwives or certified midwives within
                                inpatient hospital services under Medicare.
    Sec. 5409. Grants to professional organizations and minority-serving
                                institutions to increase diversity in
                                maternal, reproductive, and sexual health
                                professionals.
                         Subtitle F--Children's Health

    Sec. 5501. CARING for Kids Act.
    Sec. 5502. End Diaper Need Act of 2021.
    Sec. 5503. Decreasing the risk factors for sudden unexpected infant
                                death and sudden unexplained death in
                                childhood.
              Subtitle G--Nutrition for Women, Children, Families

    Sec. 5601. Removing barriers to health care and nutrition assistance
                                for children, pregnant persons, and
                                lawfully present individuals.
    Sec. 5602. Closing the meal gap.
    Sec. 5603. Repeal of denial of Supplemental Nutrition Assistance
                                Program benefits.
                   Subtitle H--Universal School Meals Program

    Sec. 5701. Short title.
    Sec. 5702. Effective date.
    Sec. 5703. Free school breakfast program.
    Sec. 5704. Apportionment to States.
    Sec. 5705. Nutritional and other program requirements.
    Sec. 5706. Special assistance program.
    Sec. 5707. Price for a paid lunch.
    Sec. 5708. Summer food service program for children.
    Sec. 5709. Summer Electronic Benefit Transfer for Children Program.
    Sec. 5710. Child and adult care food program.
    Sec. 5711. Meals and supplements for children in afterschool care.
    Sec. 5712. Access to local foods: farm to school program.
    Sec. 5713. Fresh fruit and vegetable program.
    Sec. 5714. Training, technical assistance, and Food Service Management
                                Institute.
    Sec. 5715. Reimbursement of school meal delinquent debt program.
    Sec. 5716. Conforming amendments.
    Sec. 5717. Measure of poverty.
    Sec. 5718. Supplemental nutrition assistance program.
    Sec. 5719. Higher Education Act of 1965.
    Sec. 5720. Elementary and Secondary Education Act of 1965.
    Sec. 5721. America COMPETES Act.
    Sec. 5722. Workforce Innovation and Opportunity Act.
    Sec. 5723. National Science Foundation Authorization Act of 2002.
    Sec. 5724. Child care and development block grant.
    Sec. 5725. Children's Health Act of 2000.
    Sec. 5726. Juvenile justice and delinquency prevention.
                             Subtitle I--Elder Care

    Sec. 5801. Expenses for household and elder care services necessary for
                                gainful employment.
                      Subtitle J--Miscellaneous Provisions

    Sec. 5901. Clarification supporting permissible use of funds for
                                stillbirth prevention activities.
              TITLE VI--MENTAL HEALTH AND SUBSTANCE USE DISORDERS

    Sec. 6001. Mental health findings.
    Sec. 6002. Sense of Congress.
                 Subtitle A--Access to Care and Funding Streams

    Sec. 6011. Coverage of marriage and family therapist services, mental
                                health counselor services, substance abuse
                                counselor services, and peer support
                                specialist services under part B of the
                                Medicare program.
    Sec. 6012. Reauthorization of Minority Fellowship Program.
    Sec. 6013. Additional funds for National Institutes of Health.
    Sec. 6014. Additional funds for National Institute on Minority Health
                                and Health Disparities.
    Sec. 6015. Grants for increasing racial and ethnic minority access to
                                high-quality trauma support services and
                                mental health care.
    Sec. 6016. Grants for unarmed 9-1-1 response programs.
                       Subtitle B--Interprofessional Care

    Sec. 6021. Health professions competencies to address racial and ethnic
                                mental health inequities.
    Sec. 6022. Interprofessional health care teams for behavioral health
                                care.
    Sec. 6023. Integrated Health Care Demonstration Program.
                       Subtitle C--Workforce Development

    Sec. 6031. Building an effective workforce in mental health.
    Sec. 6032. Pilot program to increase language access at Federally
                                qualified health centers.
    Sec. 6033. Health professions competencies to address racial and ethnic
                                minority mental health disparities.
                      Subtitle D--Children's Mental Health

    Sec. 6041. Pediatric behavioral health care.
    Sec. 6042. Mental health in schools.
    Sec. 6043. Additional support for youth and young adult mental health
                                service provision.
    Sec. 6044. Early intervention and prevention programs for transition-
                                age youth.
    Sec. 6045. Strategies to increase access to telehealth under Medicaid
                                and Children's Health Insurance Program.
    Sec. 6046. Youth and young adult mental health promotion, prevention,
                                intervention, and treatment.
    Sec. 6047. Study on the Effects of Smartphone and Social Media Use on
                                Adolescents.
                        Subtitle E--Community-Based Care

    Sec. 6051. Mental health at the border.
    Sec. 6052. Asian American, African American, Native Hawaiian, Pacific
                                Islander, Indigenous, Middle Eastern and
                                North African, and Hispanic and Latino
                                behavioral and mental health outreach and
                                education strategy.
                              Subtitle F--Reports

    Sec. 6061. Addressing racial and ethnic mental health inequities
                                research gaps.
    Sec. 6062. Research on adverse health effects associated with
                                interactions with law enforcement.
    Sec. 6063. Geoaccess study.
    Sec. 6064. Cooccurring conditions.
    Sec. 6065. Technical correction.
                      Subtitle G--Miscellaneous Provisions

    Sec. 6071. Children's Mental Health Infrastructure Act.
    Sec. 6072. Mental Health for Latinos.
    Sec. 6073. Strengthening Mental Health Supports for BIPOC Communities.
    Sec. 6074. STRONG Support for Children.
    Sec. 6075. Improving access to mental health.
    Sec. 6076. Mental Health in Schools Excellence Program.
    Sec. 6077. School Social Workers Improving Student Success.
    Sec. 6078. Opioid grants to support caregivers, kinship care families,
                                and kinship caregivers.
    Sec. 6079. Advancing Student Services In Schools Today Act (ASSIST
                                Act).
              TITLE VII--ADDRESSING HIGH IMPACT MINORITY DISEASES

                               Subtitle A--Cancer

    Sec. 7001. Lung cancer mortality reduction.
    Sec. 7002. Expanding prostate cancer research, outreach, screening,
                                testing, access, and treatment
                                effectiveness.
    Sec. 7003. Prostate Research, Imaging, and Men's Education (PRIME).
    Sec. 7004. Prostate cancer detection research and education.
    Sec. 7005. National Prostate Cancer Council.
    Sec. 7006. Improved Medicaid coverage for certain breast and cervical
                                cancer patients in the territories.
    Sec. 7007. Cancer prevention and treatment demonstration for ethnic and
                                racial minorities.
    Sec. 7008. Reducing cancer disparities within Medicare.
      Subtitle B--Viral Hepatitis and Liver Cancer Control and Prevention

    Sec. 7051. Viral hepatitis and liver cancer control and prevention.
    Sec. 7052. Liver cancer and disease prevention, awareness, and patient
                                tracking grants.
               Subtitle C--Acquired Bone Marrow Failure Diseases

    Sec. 7101. Acquired bone marrow failure diseases.
    Subtitle D--Cardiovascular Disease, Chronic Disease, Obesity, and Other
                                 Disease Issues

    Sec. 7151. Guidelines for disease screening for minority patients.
    Sec. 7152. CDC Wisewoman Screening Program.
    Sec. 7153. Report on cardiovascular care for women and minorities.
    Sec. 7154. Coverage of comprehensive tobacco cessation services in
                                Medicaid, CHIP, and private health
                                insurance.
    Sec. 7155. Clinical research funding for oral health.
    Sec. 7156. Guide on evidence-based strategies for public health
                                department obesity prevention programs.
    Sec. 7157. Stephanie Tubbs Jones Uterine Fibroid Research and Education
                                Act.
                              Subtitle E--HIV/AIDS

    Sec. 7201. Statement of policy.
    Sec. 7202. Findings.
    Sec. 7203. Additional funding for AIDS drug assistance program
                                treatments.
    Sec. 7204. Enhancing the national HIV surveillance system.
    Sec. 7205. Evidence-based strategies for improving linkage to, and
                                retention in, appropriate care.
    Sec. 7206. Improving entry into, and retention in, care and
                                antiretroviral adherence for persons with
                                HIV.
    Sec. 7207. Services to reduce HIV/AIDS in racial and ethnic minority
                                communities.
    Sec. 7208. Minority AIDS initiative.
    Sec. 7209. Health care professionals treating individuals with HIV.
    Sec. 7210. HIV/AIDS provider loan repayment program.
    Sec. 7211. Dental education loan repayment program.
    Sec. 7212. Reducing new HIV infections among injecting drug users.
    Sec. 7213. Report on impact of HIV/AIDS in vulnerable populations.
    Sec. 7214. National HIV/AIDS observance days.
    Sec. 7215. Review of all Federal and State laws, policies, and
                                regulations regarding the criminal
                                prosecution of individuals for HIV-related
                                offenses.
    Sec. 7216. Expanding support for condoms in prisons.
    Sec. 7217. Automatic reinstatement or enrollment in Medicaid for people
                                who test positive for HIV before reentering
                                communities.
    Sec. 7218. Stop HIV in prison.
    Sec. 7219. Transfer of funds for implementation of Ending the HIV
                                Epidemic: A Plan for America.
    Sec. 7220. PrEP access and coverage.
                              Subtitle F--Diabetes

    Sec. 7251. Research, treatment, and education.
    Sec. 7252. Research, education, and other activities.
    Sec. 7253. Programs to educate health providers on the causes and
                                effects of diabetes in minority
                                populations.
    Sec. 7254. Research, education, and other activities regarding diabetes
                                in American Indian populations.
    Sec. 7255. Updated report on health disparities.
                            Subtitle G--Lung Disease

    Sec. 7301. National asthma burden.
    Sec. 7302. Asthma-related activities of the Centers for Disease Control
                                and Prevention.
    Sec. 7303. Influenza and pneumonia vaccination campaign.
    Sec. 7304. Chronic obstructive pulmonary disease.
                            Subtitle H--Tuberculosis

    Sec. 7351. Elimination of all forms of tuberculosis.
    Sec. 7352. Additional funding for States in combating and eliminating
                                tuberculosis.
    Sec. 7353. Strengthening clinical research funding for tuberculosis.
            Subtitle I--Osteoarthritis and Musculoskeletal Diseases

    Sec. 7401. Findings.
    Sec. 7402. Osteoarthritis and other musculoskeletal health-related
                                activities of the Centers for Disease
                                Control and Prevention.
    Sec. 7403. Grants for comprehensive osteoarthritis and musculoskeletal
                                disease health education within health
                                professions schools.
                Subtitle J--Sleep and Circadian Rhythm Disorders

    Sec. 7451. Short title; findings.
    Sec. 7452. Sleep and circadian rhythm disorders research activities of
                                the National Institutes of Health.
    Sec. 7453. Sleep and circadian rhythm health disparities-related
                                activities of the Centers for Disease
                                Control and Prevention.
    Sec. 7454. Grants for comprehensive sleep and circadian health
                                education within health professions
                                schools.
    Sec. 7455. Report on impact of sleep and circadian health disorders in
                                vulnerable and racial/ethnic populations.
      Subtitle K--Kidney Disease Research, Surveillance, Prevention, and
                                   Treatment

    Sec. 7501. Kidney disease, research, surveillance, prevention, and
                                treatment.
    Sec. 7502. Kidney disease research in minority populations.
    Sec. 7503. Kidney disease action plan.
    Sec. 7504. Home dialysis and increasing end-stage renal disease
                                treatment modalities in minority
                                communities action plan.
    Sec. 7505. Increasing kidney transplants in minority populations.
    Sec. 7506. Environmental and occupational health programs.
    Sec. 7507. Understanding the treatment patterns associated with
                                providing care and treatment of kidney
                                failure in minority populations.
    Sec. 7508. Improving access in underserved areas.
    Sec. 7509. The Jack Reynolds Memorial Medigap Expansion Act; Medigap
                                coverage for beneficiaries with end-stage
                                renal disease.
                    Subtitle L--Diversity in Clinical Trials

    Sec. 7551. FDA review of clinical trial best practices.
    Sec. 7552. Diversifying Investigations Via Equitable Research Studies
                                for Everyone Trials Act.
    Sec. 7553. Clinical trial diversity.
    Sec. 7554. Patient experience data.
       Subtitle M--Additional Provisions Addressing High Impact Minority
                                    Diseases

    Sec. 7601. Medicare coverage of multi-cancer early detection screening
                                tests.
    Sec. 7602. Amputation Reduction and Compassion Act.
    Sec. 7603. Eliminating the coinsurance requirement for certain
                                colorectal cancer screening tests furnished
                                under the Medicare program.
    Sec. 7604. Expanding the availability of medical nutrition therapy
                                services under the Medicare program.
    Sec. 7605. Encouraging the development and use of DISARM antimicrobial
                                drugs.
    Sec. 7606. Treat and Reduce Obesity Act.
    Sec. 7607. Incentives, improvements, and outreach to increase diversity
                                in Alzheimer's disease research.
                   TITLE VIII--HEALTH INFORMATION TECHNOLOGY

    Sec. 8001. Definitions.
           Subtitle A--Reducing Health Disparities Through Health IT

    Sec. 8101. HRSA assistance to health centers for promotion of Health
                                IT.
    Sec. 8102. Assessment of impact of Health IT on racial and ethnic
                                minority communities; outreach and adoption
                                of Health IT in such communities.
    Sec. 8103. Nondiscrimination and health equity in health information
                                technology.
    Sec. 8104. Language access in health information technology.
        Subtitle B--Modifications To Achieve Parity in Existing Programs

    Sec. 8201. Extending funding to strengthen the Health IT infrastructure
                                in racial and ethnic minority communities.
    Sec. 8202. 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. 8203. Authorization of appropriations.
                  Subtitle C--Additional Research and Studies

    Sec. 8301. Data collection and assessments conducted in coordination
                                with minority-serving institutions.
    Sec. 8302. Study of health information technology in medically
                                underserved communities.
    Sec. 8303. Assessment of use and misuse of de-identified health data.
          Subtitle D--Closing Gaps in Funding To Adopt Certified EHRs

    Sec. 8401. Extending Medicaid EHR incentive payments to rehabilitation
                                facilities, long-term care facilities, and
                                home health agencies.
    Sec. 8402. Extending physician assistant eligibility for Medicaid
                                electronic health record incentive
                                payments.
              Subtitle E--Expanding Access to Telehealth Services

    Sec. 8501. Removing geographic requirements for telehealth services.
    Sec. 8502. Expanding originating sites.
                    TITLE IX--ACCOUNTABILITY AND EVALUATION

    Sec. 9001. Prohibition on discrimination in Federal assisted health
                                care services and research on the basis of
                                sex (including sexual orientation, gender
                                identity, and pregnancy, including
                                termination of pregnancy), race, color,
                                national origin, marital status, familial
                                status, or disability status.
    Sec. 9002. Treatment of Medicare payments under title VI of the Civil
                                Rights Act of 1964.
    Sec. 9003. Accountability and transparency within the Department of
                                Health and Human Services.
    Sec. 9004. United States Commission on Civil Rights.
    Sec. 9005. Sense of Congress concerning full funding of activities to
                                eliminate racial and ethnic health
                                disparities.
    Sec. 9006. GAO and NIH reports.
    Sec. 9007. Investigative and enforcement actions.
    Sec. 9008. Federal Health Equity Commission.
      TITLE X--ADDRESSING SOCIAL DETERMINANTS AND IMPROVING ENVIRONMENTAL
                                    JUSTICE

                             Subtitle A--In General

    Sec. 10001. Definitions.
    Sec. 10002. Findings.
    Sec. 10003. Health impact assessments.
    Sec. 10004. Grant program to conduct environmental health improvement
                                activities and to improve social
                                determinants of health.
    Sec. 10005. Additional research on the relationship between the built
                                environment and the health of community
                                residents.
    Sec. 10006. Environment and public health restoration.
    Sec. 10007. GAO report on health effects of Deepwater Horizon oil rig
                                explosion in the Gulf Coast.
    Sec. 10008. Establish an interagency counsel and grant programs on
                                social determinants of health.
    Sec. 10009. Correcting Hurtful and Alienating Names in Government
                                Expression (CHANGE).
    Sec. 10010. Andrew Kearse Accountability for Denial of Medical Care.
    Sec. 10011. Investing in community healing.
    Sec. 10012. Environmental justice mapping and data collection.
    Sec. 10013. Antiracism in public health.
    Sec. 10014. LGBTQ essential data.
    Sec. 10015. Social determinants accelerator.
    Sec. 10016. Improving social determinants of health.
                            Subtitle B--Gun Violence

    Sec. 10101. Reaffirming research authority of the Centers for Disease
                                Control and Prevention.
    Sec. 10102. National Violent Death Reporting System.
    Sec. 10103. Report on effects of gun violence on public health.
    Sec. 10104. Report on effects of gun violence on mental health in
                                minority communities.

    SEC. 3. FINDINGS.

        The Congress finds as follows:
                (1) The population of racial and ethnic minorities is
            expected to increase over the next few decades, yet racial and
            ethnic minorities have the poorest health status and face
            substantial cultural, social, and economic barriers to
            obtaining high-quality health care.
                (2) Health disparities are a function of not only access to
            health care, but also the social determinants of health--
            including the environment, the physical structure of
            communities, nutrition and food options, educational
            attainment, employment, race, ethnicity, sex, geography,
            language preference, immigrant or citizenship status, sexual
            orientation, gender identity, socioeconomic status, or
            disability status--that directly and indirectly affect the
            health, health care, and wellness of individuals and
            communities.
                (3) Over the next few decades, the United States will face
            a shortage of health care providers and allied health workers.
                (4) All efforts to reduce health disparities and barriers
            to high-quality health services require better and more
            consistent data, and better and more consistent collection of
            and access to data.
                (5) A full range of culturally and linguistically
            appropriate health care and public health services must be
            available and accessible in every community.
                (6) Racial and ethnic minorities and underserved
            populations must be included early and equitably in health
            reform innovations.
                (7) Efforts to improve minority health have been limited by
            inadequate resources in funding, staffing, stewardship, and
            accountability. Targeted investments that are focused on
            disparities elimination must be made in providing care and
            services that are community-based, including prevention and
            policies addressing social determinants of health.
                (8) In 2011, the Department of Health and Human Services
            developed the HHS Action Plan to Reduce Racial and Ethnic
            Health Disparities and the National Stakeholder Strategy for
            Achieving Health Equity, which are 2 strategic plans that
            represent the first coordinated roadmap in the United States to
            reducing health disparities. These comprehensive plans, along
            with the National Prevention Strategy issued by the National
            Prevention Council of the Department of Health and Human
            Services, Healthy People 2030, and the National Quality
            Strategy of the Agency for Healthcare Research and Quality, as
            well as critical resources such as the 2012 National Healthcare
            Quality and Disparities Reports, will work to increase the
            number of people in the United States who are healthy at every
            stage of life.
                (9) The Secretary of Health and Human Services has also
            reviewed and advanced updated clinical guidelines and developed
            other strategic planning documents to combat health disparities
            with a high impact on minority populations and to provide high-
            quality family planning services. Such guidelines and documents
            include the National HIV/AIDS Strategy, the Action Plan for the
            Prevention, Care, and Treatment of Viral Hepatitis, and
            recommendations of the Centers for Disease Control and
            Prevention and the Office of Population Affairs.
                (10) The Patient Protection and Affordable Care Act (Public
            Law 111-148), as amended by the Health Care and Education
            Reconciliation Act (Public Law 111-152), represents the biggest
            advancement for minority health in the 40 years immediately
            preceding the enactment of this Act.
                (11) The Health Information Technology for Educational and
            Clinical Health Act of 2009, part of the American Recovery and
            Reinvestment Act of 2009 (Public Law 111-5), provides that the
            nationwide health information exchange infrastructure be
            developed and used to reduce health disparities, among other
            purposes.

                     TITLE I--DATA COLLECTION AND REPORTING

    SEC. 1001. STRENGTHENING DATA COLLECTION, IMPROVING DATA ANALYSIS, AND
                  EXPANDING DATA REPORTING.

        (a) Amendments to the Public Health Service Act.--
                (1) Purpose.--The purpose of the amendments made by this
            subsection is to promote culturally and linguistically
            appropriate data collection, analysis, and reporting by race,
            ethnicity, sex, primary language, sexual orientation,
            disability status, gender identity, age, and socioeconomic
            status in federally supported health programs.
                (2) AHRQ general authorities.--Section 902(a) of the Public
            Health Service Act (42 U.S.C. 299a(a)) is amended--
                        (A) in paragraph (8), by striking ``and'' at the
                    end;
                        (B) in paragraph (9), by striking the period at the
                    end and inserting ``; and''; and
                        (C) by adding at the end the following:
                ``(10) cultural and linguistic competence of health care
            services and of data collection activities described under
            section 3101.''.
                (3) Office of minority health.--Section 1707(g)(1) of the
            Public Health Service Act (42 U.S.C. 300u-6(g)(1)) is amended
            by inserting ``Middle Easterners and North Africans;'' after
            ``Blacks;''.
                (4) Office of the national coordinator for health
            information technology.--Section 3001 of the Public Health
            Service Act (42 U.S.C. 300jj-11) is amended--
                        (A) in subsection (b)--
                                (i) in paragraph (10), by striking ``and''
                            at the end;
                                (ii) in paragraph (11), by striking the
                            period at the end and inserting ``; and''; and
                                (iii) by adding at the end the following:
                ``(12) ensures the interoperability of health information
            systems among federally conducted or supported health care or
            public health programs, State health agencies, and social
            service agencies.''; and
                        (B) by amending clause (vii) in subsection
                    (c)(3)(A) to read as follows:
                                ``(vii) Strategies to enhance the use of
                            health information technology in improving the
                            quality of health care; reducing medical
                            errors; reducing health disparities and
                            ensuring the provision of equitable health
                            services; improving public health; increasing
                            prevention and coordination with community
                            resources; ensuring interoperability among
                            federally conducted or supported health care or
                            public health programs, State health agencies,
                            and social service agencies; and improving the
                            continuity of care among health care
                            settings.''.
                (5) Data collection, analysis, and quality.--Section 3101
            of the Public Health Service Act (42 U.S.C. 300kk) is amended--
                        (A) in subsections (a)(1)(A), (a)(1)(C), (a)(2)(B),
                    and (a)(2)(E), by inserting ``sexual orientation,
                    gender identity, age,'' before ``and disability
                    status'';
                        (B) in subsection (a)(1), by amending subparagraph
                    (D) to read as follows:
                        ``(D) data for additional population groups if such
                    groups can be aggregated into the data collection
                    standards described under paragraph (2).'';
                        (C) in subsection (a)(2)--
                                (i) in subparagraph (C)--
                                        (I) in clause (i), by striking
                                    ``and'' at the end;
                                        (II) in clause (ii)--
                                                (aa) by striking ``is a
                                            minor or legally
                                            incapacitated'' and inserting
                                            ``is a minor, requires
                                            assistance with communication
                                            in speech or writing, or is
                                            legally incapacitated''; and
                                                (bb) by striking the
                                            semicolon at the end and
                                            inserting ``; and''; and
                                        (III) by adding at the end the
                                    following:
                                ``(iii) collects data in a manner that is
                            culturally and linguistically appropriate;'';
                                (ii) in subparagraph (D)(iii), by striking
                            ``and'' at the end;
                                (iii) in subparagraph (E), by striking the
                            period at the end and inserting ``; and''; and
                                (iv) by adding at the end the following:
                        ``(F) use, 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 titled `Race,
                    Ethnicity, and Language Data: Standardization for
                    Health Care Quality Improvement'.''; and
                        (D) in subsection (a)(3), by amending subparagraph
                    (B) to read as follows:
                        ``(B) develop interoperability and security systems
                    for data management among federally conducted and
                    supported health care and public health programs, State
                    health agencies, and social service agencies.''.
        (b) Corollary Provisions.--
                (1) Recommendations by the data council.--The Data Council
            of the Department of Health and Human Services, in consultation
            with the Director of the National Center for Health Statistics,
            the Deputy Assistant Secretary for Minority Health, the Deputy
            Assistant Secretary for Women's Health, the Administrator of
            the Centers for Medicare & Medicaid, the head of the Office of
            the National Coordinator for Health Information Technology, and
            other appropriate public and private entities and officials,
            shall make recommendations to the Secretary of Health and Human
            Services concerning how to--
                        (A) implement the amendments made by this section,
                    while minimizing the cost and administrative burdens of
                    data collection and reporting on all parties, including
                    patients and providers;
                        (B) expand awareness 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
                    ensure equity and nondiscrimination in the quality of
                    health care services;
                        (C) ensure that future patient record systems
                    follow Federal standards promulgated under the HITECH
                    Act (42 U.S.C. 201 note) 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;
                        (D) improve health and health care data collection
                    and analysis for more population groups if such groups
                    can be aggregated into 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;
                        (E) provide researchers with greater access to
                    racial, ethnic, primary language, sex, sexual
                    orientation, gender identity, age, socioeconomic
                    status, and disability status data, subject to all
                    applicable privacy and confidentiality requirements,
                    including HIPAA privacy and security law as defined in
                    section 3009 of the Public Health Service Act (42
                    U.S.C. 300jj-19);
                        (F) ensure the cultural and linguistic competence
                    of entities that receive Federal support to collect and
                    report data pursuant to the amendments made by
                    subsection (a); and
                        (G) safeguard and prevent the misuse of data
                    collected under section 3101 of the Public Health
                    Service Act (42 U.S.C. 300kk), as amended by subsection
                    (a)(5).
                (2) Rules of construction.--Nothing in this section shall
            be construed to--
                        (A) permit the use of information collected under
                    this section or any provision amended by this section
                    in a manner that would adversely affect any individual
                    providing any such information; or
                        (B) diminish any requirements on health care
                    providers to collect data, including such requirements
                    in effect on or after the date of enactment of this
                    Act.
                (3) Technical assistance for the analysis of health
            disparity data.--The Secretary of Health and Human Services,
            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, the Director of the
            National Institutes of Health, and the head of the Office of
            the National Coordinator for Health Information Technology,
            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--
                        (A) identifying appropriate quality assurance
                    mechanisms to monitor for health disparities;
                        (B) specifying the clinical, diagnostic, or
                    therapeutic measures which should be monitored;
                        (C) developing new quality measures relating to
                    racial and ethnic disparities and their overlap with
                    other disparity factors in health and health care;
                        (D) identifying the level at which data analysis
                    should be conducted;
                        (E) sharing data with external organizations for
                    research and quality improvement purposes; and
                        (F) identifying and addressing issues relating to
                    the interoperability of Federal- and State-level health
                    information systems which undermine the ability of
                    health-related programs collecting data under this
                    section to achieve the purpose described in subsection
                    (a)(1).
                (4) References.--Except as otherwise specified, any
            reference to the term ``racial and ethnic minority group'' in
            any Federal regulation, guidance, order, or document for
            establishment or implementation of any federally conducted or
            supported health care or public health program, activity, or
            survey shall be treated as having the definition given to such
            term in section 1707(g) of the Public Health Service Act (42
            U.S.C. 300u-6(g)).
                (5) Authorization of appropriations.--To carry out this
            subsection, subsection (a), and the amendments made by
            subsection (a), there are authorized to be appropriated such
            sums as may be necessary for each of fiscal years 2023 through
            2027.
        (c) Additions to the Public Health Service Act.--Title XXXIV of the
    Public Health Service Act, as added by titles II and III of this Act,
    is further amended by inserting after subtitle B the following:

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

    ``SEC. 3431. 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, the head of the Office of the National Coordinator for
    Health Information Technology, 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 3101 of the Public
    Health Service Act.
        ``(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;
                ``(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;
            and
                ``(5) develop educational programs to train health
            providers, health care organizations, health plans, health-
            related agencies, and frontline health care workers on how to
            collect and report disaggregated data in a culturally and
            linguistically appropriate manner.
        ``(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 3101.
        ``(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 2023 through 2027.

    ``SEC. 3432. 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, and
            other officials within the Department of Health and Human
            Services as the Secretary determines appropriate, shall develop
            and implement a 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 Middle Easterners
            and North Africans, 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, the 2016
                    Behavioral Risk Factor Survey of Health Risk Behaviors
                    Among Arab Adults Within the State of Michigan, 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
    enactment of this section, the Secretary shall submit to the Congress a
    progress report, which shall include the national strategy required by
    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 2023 through 2027.''.

    SEC. 1002. ELIMINATION OF PREREQUISITE OF DIRECT APPROPRIATIONS FOR
                  DATA COLLECTION AND ANALYSIS.

        Section 3101 of the Public Health Service Act (42 U.S.C. 300kk), as
    amended by section 1001(a), is further amended--
                (1) by striking subsection (h); and
                (2) by redesignating subsection (i) as subsection (h).

    SEC. 1003. 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. 1150D.
        ``(a) Requirement.--
                ``(1) In general.--The Commissioner of Social Security, in
            consultation with the Administrator of the Centers for Medicare
            & Medicaid Services, shall collect data on the race, ethnicity,
            sex, primary language, sexual orientation, gender identity,
            socioeconomic status, and disability status of all applicants
            for Social Security benefits under title II or Medicare
            benefits under title XVIII.
                ``(2) Data collection standards.--In collecting data under
            paragraph (1), the Commissioner of Social Security shall at
            least use the standards for data collection developed under
            section 3101 of the Public Health Service Act or the standards
            developed by the Office of Management and Budget, whichever is
            more disaggregated. In the event there are no standards for the
            demographic groups listed under paragraph (1), the Commissioner
            shall consult with stakeholder groups representing the various
            identities as well as with the Office of Minority Health within
            the Centers for Medicare & Medicaid Services to develop
            appropriate standards.
                ``(3) Data for additional population groups.--Where
            practicable, the information collected by the Commissioner of
            Social Security under paragraph (1) shall include data for
            additional population groups if such groups can be aggregated
            into the race and ethnicity categories outlined by the data
            collection standards described in paragraph (2).
                ``(4) Collection of data for minors and legally
            incapacitated individuals.--With respect to the collection of
            the data described in paragraph (1) of applicants who are under
            18 years of age or otherwise legally incapacitated, the
            Commissioner of Social Security shall require that--
                        ``(A) such data be collected from the parent or
                    legal guardian of such an applicant; and
                        ``(B) the primary language of the parent or legal
                    guardian of such an applicant or recipient be used in
                    collecting the data.
                ``(5) Quality of data.--The Commissioner of Social Security
            shall periodically review the quality and completeness of the
            data collected under paragraph (1) and make adjustments as
            necessary to improve both.
                ``(6) Transmission of data.--Upon enrollment in Medicare
            benefits under title XVIII, the Commissioner of Social Security
            shall transmit an individual's demographic data as collected
            under paragraph (1) to the Centers for Medicare & Medicaid
            Services.
                ``(7) Analysis and reporting of data.--With respect to data
            transmitted under paragraph (5), the Administrator of the
            Centers for Medicare & Medicaid Services, in consultation with
            the Commissioner of Social Security shall--
                        ``(A) require that such data be uniformly analyzed
                    and that such analysis be reported at least annually to
                    Congress;
                        ``(B) incorporate such data in other analysis and
                    reporting on health disparities and the provision of
                    inequitable health care services by a health care
                    provider, 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 of Health and Human
    Services 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 2022 and $100
    million for each fiscal year thereafter.''.

    SEC. 1004. 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. 1005. NATIONAL CENTER FOR HEALTH STATISTICS.

        Section 306(n) of the Public Health Service Act (42 U.S.C. 242k(n))
    is amended--
                (1) in paragraph (1), by striking ``2003'' and inserting
            ``2024'';
                (2) in paragraph (2), in the first sentence, by striking
            ``2003'' and inserting ``2024''; and
                (3) in paragraph (3), by striking ``2002'' and inserting
            ``2024''.

    SEC. 1006. DISPARITIES DATA COLLECTED BY THE FEDERAL GOVERNMENT.

        (a) Repository of Government Data.--The Secretary of Health and
    Human Services, in coordination with the officials referenced 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 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, the
            provision of equitable health services, 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. 1007. 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 2023 through 2027.

    SEC. 1008. 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 inserting after section 505G
    (21 U.S.C. 355h) the following:

    ``SEC. 505H. SAFETY AND EFFECTIVENESS OF DRUGS WITH RESPECT TO RACIAL
                  AND ETHNIC BACKGROUND.

        ``(a) Preapproval Studies.--If there is evidence of a racial or
    ethnic disparity in safety or effectiveness with respect to a drug or
    biological product, then--
                ``(1)(A) in the case of a drug, the investigations required
            under section 505(b)(1)(A) shall include adequate and well-
            controlled investigations of the disparity; or
                ``(B) in the case of a biological product, the evidence
            required under section 351(a) of the Public Health Service Act
            for approval of a biologics license application for the
            biological product shall include adequate and well-controlled
            investigations of the disparity; and
                ``(2) if the investigations described in subparagraph (A)
            or (B) of paragraph (1) confirm that there is such a disparity,
            the labeling of the drug or biological product shall include
            appropriate information about the disparity.
        ``(b) Postmarket Studies.--
                ``(1) In general.--If there is evidence of a racial or
            ethnic disparity in safety or effectiveness with respect to a
            drug for which there is an approved application under section
            505 of this Act or of a biological product for which there is
            an approved license under section 351 of the Public Health
            Service Act, the Secretary may by order require the holder of
            the approved application or license to conduct, by a date
            specified by the Secretary, postmarket studies to investigate
            the disparity.
                ``(2) Labeling.--If the Secretary determines that the
            postmarket studies confirm that there is a disparity described
            in paragraph (1), the labeling of the drug or biological
            product shall include appropriate information about the
            disparity.
                ``(3) Study design.--The Secretary may, in an order under
            paragraph (1), specify all aspects of the design of the
            postmarket studies required under such paragraph for a drug or
            biological product, including the number of studies and study
            participants, and the other demographic characteristics of the
            study participants.
                ``(4) Modifications of study design.--The Secretary may, by
            order and as necessary, modify any aspect of the design of a
            postmarket study required in an order under paragraph (1) after
            issuing such order.
                ``(5) Study results.--The results from a study required
            under paragraph (1) shall be submitted to the Secretary as a
            supplement to the drug application or biologics license
            application.
        ``(c) Applications Under Section 505(j).--
                ``(1) In general.--A drug for which an application has been
            submitted or approved under section 505(j) shall not be
            considered ineligible for approval under that section or
            misbranded under section 502 on the basis that the labeling of
            the drug omits information relating to a disparity on the basis
            of racial or ethnic background as to the safety or
            effectiveness of the drug, whether derived from investigations
            or studies required under this section or derived from other
            sources, when the omitted information is protected by patent or
            by exclusivity under section 505(j)(5)(F).
                ``(2) Labeling.--Notwithstanding paragraph (1), the
            Secretary may require that the labeling of a drug approved
            under section 505(j) that omits information relating to a
            disparity on the basis of racial or ethnic background as to the
            safety or effectiveness of the drug include a statement of any
            appropriate contraindications, warnings, or precautions related
            to the disparity that the Secretary considers necessary.
        ``(d) Definition.--In this section, the term `evidence of a racial
    or ethnic disparity in safety or effectiveness', with respect to a drug
    or biological product, includes--
                ``(1) evidence that there is a disparity on the basis of
            racial or ethnic background as to safety or effectiveness of a
            drug or biological product in the same chemical class as the
            drug or biological product;
                ``(2) evidence that there is a disparity on the basis of
            racial or ethnic background in the way the drug or biological
            product is metabolized; and
                ``(3) other evidence as the Secretary may determine
            appropriate.''.
        (b) Enforcement.--Section 502 of the Federal Food, Drug, and
    Cosmetic Act (21 U.S.C. 352) is amended by adding at the end the
    following:
        ``(gg) 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 required under section 505H, or comply with any other
    requirement of such section 505H.''.
        (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 505H''.

    SEC. 1009. IMPROVING HEALTH DATA REGARDING NATIVE HAWAIIANS AND 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 PACIFIC ISLANDER HEALTH DATA.

        ``(a) Definitions.--In this section:
                ``(1) 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.
                ``(2) Native hawaiians and pacific islanders (nhpi).--The
            term `Native Hawaiians and Pacific Islanders' or `NHPI' 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.
                ``(3) NHPI stakeholder groups.--The term `NHPI stakeholder
            group' includes each of the following:
                        ``(A) Community group.--A group of NHPI who are
                    organized at the community level, and may include a
                    church group, social service group, national advocacy
                    organization, or cultural group.
                        ``(B) Nonprofit, nongovernmental organization.--A
                    group of NHPI with a demonstrated history of addressing
                    NHPI issues, including a NHPI coalition.
                        ``(C) Designated organization.--An entity
                    established to represent NHPI populations and which has
                    statutory responsibilities to provide, or has community
                    support for providing, health care.
                        ``(D) Government representatives of nhpi
                    populations.--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.
        ``(b) 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 NHPI 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 of NHPI populations; or
                        ``(B) required for developing or implementing the
                    national strategy under subsection (c).
                ``(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 NHPI stakeholder groups.
                ``(4) Timeframe.--The survey required under this subsection
            shall be completed not later than 18 months after the date of
            enactment of the Health Equity and Accountability Act of 2022.
        ``(c) 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 a
            sustainable national strategy for identifying and evaluating
            the health status and health care needs of NHPI populations
            living in the continental United States, Hawaii, American
            Samoa, the Commonwealth of the Northern Mariana Islands, the
            Federated States of Micronesia, Guam, the Republic of Palau,
            and the Republic of the Marshall Islands.
                ``(2) Consultation.--In developing and implementing a
            national strategy, as described in paragraph (1), not later
            than 180 days after the date of enactment of the Health Equity
            and Accountability Act of 2022, the Secretary--
                        ``(A) shall consult with representatives of NHPI
                    stakeholder groups; and
                        ``(B) may solicit the participation of
                    representatives from other Federal agencies.
        ``(d) Progress Report.--Not later than 2 years after the date of
    enactment of the Health Equity and Accountability Act of 2022, the
    Secretary shall submit to Congress a progress report, which shall
    include the national strategy described in subsection (c)(1).
        ``(e) Study and Report by the Health and Medicine Division.--
                ``(1) In general.--The Secretary shall enter into an
            agreement with the Health and Medicine Division of the National
            Academies of Sciences, Engineering, and Medicine to conduct a
            study, with input from stakeholders in insular areas, on each
            of the following:
                        ``(A) The standards and definitions of health care
                    applied to health care systems in insular areas and the
                    appropriateness of such standards and definitions.
                        ``(B) The status and performance of health care
                    systems in insular areas, evaluated based upon
                    standards and definitions, as the Secretary determines
                    appropriate.
                        ``(C) The effectiveness of donor aid in addressing
                    health care needs and priorities in insular areas.
                        ``(D) The progress toward implementation of
                    recommendations of the Committee on Health Care
                    Services in the United States--Associated Pacific Basin
                    that are set forth in the 1998 report entitled `Pacific
                    Partnerships for Health: Charting a New Course'.
                ``(2) Report.--An agreement described in paragraph (1)
            shall require the Health and Medicine Division to submit to the
            Secretary and to Congress, not later than 2 years after the
            date of the enactment of the Health Equity and Accountability
            Act of 2022, 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 2023 through 2027.''.

    SEC. 1010. CLARIFICATION OF SIMPLIFIED ADMINISTRATIVE REPORTING
                  REQUIREMENT.

        Section 11(a) of the Food and Nutrition Act of 2008 (7 U.S.C.
    2020(a)) is amended by adding at the end the following:
                ``(5) Simplified administrative reporting requirement.--
            With respect to any obligation of a State agency to comply with
            the notification requirement under paragraph (2) of section
            421(e) of the Personal Responsibility and Work Opportunity
            Reconciliation Act of 1996 (8 U.S.C. 1631(e)), notwithstanding
            the requirement to include in that notification the names of
            the sponsor and the sponsored alien involved, the State agency
            shall be considered to have complied with the notification
            requirement if the State agency submits to the Attorney General
            a report that includes the aggregate number of exceptions
            granted by the State agency under paragraph (1) of that
            section.''.

    SEC. 1011. DATA COLLECTION REGARDING PANDEMIC PREPAREDNESS, TESTING,
                  INFECTIONS, AND DEATHS.

        (a) Skilled Nursing Facilities Quality Reporting.--Section 1819 of
    the Social Security Act (42 U.S.C. 1395i-3) is amended by adding at the
    end the following new subsection:
        ``(l) Requirements Relating to Reporting During Public Health
    Emergencies.--During a public health emergency declared by the
    Secretary pursuant to section 319 of the Public Health Service Act, a
    skilled nursing facility shall, not later than one year after the first
    day of such declaration, and monthly thereafter during the application
    of such declaration, submit to the Secretary the following information,
    with respect to such facility and the residents of such facility:
                ``(1) Information described in section 483.80(g)(1) of
            title 42, Code of Federal Regulations.
                ``(2) The age, race, ethnicity, sex, sexual orientation,
            gender identity, socioeconomic status, disability status, and
            preferred language of the residents of such skilled nursing
            facility.''.
        (b) Transparency of Demographic Information in Certain Settings.--
                (1) Demographic information.--The Secretary of Health and
            Human Services shall post the following information with
            respect to skilled nursing facilities (as defined in section
            1819(a) of the Social Security Act (42 U.S.C. 1395i-3(a))),
            congregate care settings (including skilled nursing facilities,
            assisted living facilities, prisons and jails, residential
            behavioral health care and psychiatric facilities, and
            facilities providing services for aging adults and people with
            disabilities), and nursing facilities (as defined in section
            1919(a) of such Act (42 U.S.C. 1396r(a))) on the Nursing Home
            Compare website (as described in section 1819(i) of the Social
            Security Act (42 U.S.C. 1395i-3(i))), or a successor website,
            aggregated by State:
                        (A) The age, race, ethnicity, sex, sexual
                    orientation, gender identity, socioeconomic status,
                    disability status, and preferred language of the
                    residents of such skilled nursing facilities,
                    congregate care settings (including skilled nursing
                    facilities, assisted living facilities, prisons and
                    jails, residential behavioral health care and
                    psychiatric facilities, and facilities providing
                    services for aging adults and people with
                    disabilities), and nursing facilities with suspected or
                    confirmed infections, including residents previously
                    treated for COVID-19.
                        (B) The age, race, ethnicity, sex, sexual
                    orientation, gender identity, socioeconomic status,
                    disability status, and preferred language relating to
                    total deaths and public health emergency-related deaths
                    among residents of such skilled nursing facilities,
                    congregate settings (including skilled nursing
                    facilities, assisted living facilities, prisons and
                    jails, residential behavioral health care and
                    psychiatric facilities, and facilities providing
                    services for aging adults and people with
                    disabilities), and nursing facilities.
                (2) Confidentiality.--Any information reported under this
            subsection that is made available to the public shall be made
            so available in a manner that protects the identity of
            residents of skilled nursing facilities, congregate care
            settings (including skilled nursing facilities, assisted living
            facilities, prisons and jails, residential behavioral health
            care and psychiatric facilities, and facilities providing
            services for aging adults and people with disabilities), and
            nursing facilities.
                (3) Implementation.--The Secretary may implement the
            provisions of this subsection by program instruction or
            otherwise.
        (c) Equitable Data Collection and Disclosure Regarding Pandemics.--
    Part A of title XI of the Social Security Act (42 U.S.C. 1301 et seq.)
    as amended by section 1003, is further amended by adding at the end the
    following new section:

    ``SEC. 1150E. EQUITABLE DATA COLLECTION AND DISCLOSURE REGARDING
                  PANDEMICS.

        ``(a) In General.--Not later than 60 days after the Secretary
    submits to Congress written notification of the determination that a
    disease or disorder presents a public health emergency or that a public
    health emergency otherwise exists, subject to the succeeding
    subsections, the Secretary, acting through the Director of the Centers
    for Disease Control and Prevention and the Administrator of the Centers
    for Medicare & Medicaid Services and in consultation with the Director
    of the Indian Health Service, shall collect and make publicly available
    on the website of the Centers for Disease Control and Prevention and
    the Centers for Medicare & Medicaid Services, and update every day
    during a pandemic, data collected across all surveillance systems
    relating to a public health emergency declared under section 319 of the
    Public Health Service Act that is caused by a disease (as determined by
    the Secretary), disaggregated by race, ethnicity, sex, sexual
    orientation, gender identity, age, preferred language, socioeconomic
    status, disability status, and county, including the following:
                ``(1) Data relating to all testing for the pathogen or
            pathogens causing the pandemic, including the number of
            individuals tested and the number of tests that were positive.
                ``(2) Data relating to treatment for the pathogen causing
            the pandemic, including hospitalizations and intensive care
            unit admissions.
                ``(3) Data relating to pandemic outcomes, including total
            fatalities and case fatality rates (expressed as the proportion
            of individuals who were infected with the pathogen causing the
            pandemic and died from the pathogen).
                ``(4) In the case a vaccine is developed in response to a
            pandemic, data relating to such vaccination, including--
                        ``(A) the number of vaccines administered;
                        ``(B) the number of vaccinations offered, accepted,
                    and refused;
                        ``(C) the most common reasons for refusal; and
                        ``(D) the percentage of vaccine doses allocated and
                    administered to each priority group.
        ``(b) Application of Certain Standards With Respect to Data
    Collection.--To the extent practicable, data collected under subsection
    (a) 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.
        ``(c) Privacy.--In publishing data pursuant to subsection (a), the
    Secretary shall take all necessary steps to protect the privacy of
    individuals whose information is included in such data, including--
                ``(1) complying with privacy protections provided under the
            regulations promulgated under section 264(c) of the Health
            Insurance and Accountability Act of 1996; and
                ``(2) 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.''.
        (d) Report Requirements Following Public Health Emergencies.--
                (1) Publicly available summary.--Not later than 60 days
            after the date on which the Secretary of Health and Human
            Services certifies that a public health emergency declared
            under section 319 of the Public Health Service Act has ended,
            the Secretary shall make publicly available on the website of
            the Department of Health and Human Services a summary of the
            final statistics related to such emergency.
                (2) Report to congress.--Not later than 60 days after the
            date on which the Secretary certifies that a public health
            emergency declared under section 319 of the Public Health
            Service Act has ended, the Secretary shall submit 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 report--
                        (A) describing the testing, hospitalization,
                    mortality rates, vaccination rates, and preferred
                    language of patients associated with the pandemic by
                    race and ethnicity, rural and urban areas (as defined
                    in section 1886(d)(2)(D) of the Social Security Act (42
                    U.S.C. 1395ww(d)(2)(D)), and congregate care settings
                    (including skilled nursing facilities, assisted living
                    facilities, prisons and jails, residential behavioral
                    health care and psychiatric facilities, and facilities
                    providing services for aging adults and people with
                    disabilities) and noncongregate care settings (as such
                    terms are defined by the Secretary); and
                        (B) proposing evidenced-based response strategies
                    to safeguard the health of these communities in future
                    pandemics.

    SEC. 1012. COMMISSION ON ENSURING DATA FOR HEALTH EQUITY.

        (a) In General.--Not later than 30 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 a commission, to be
    known as the ``Commission on Ensuring Data for Health Equity''
    (referred to in this section as the ``Commission'') to provide clear
    and robust guidance to improve the collection, analysis, and use of
    demographic data in responding to future public health emergencies.
        (b) Membership and Chairperson.--
                (1) Membership.--The Commission shall be composed of--
                        (A) the Assistant Secretary for Preparedness and
                    Response;
                        (B) the Director of the Centers for Disease Control
                    and Prevention;
                        (C) the Director of the National Institutes of
                    Health;
                        (D) the Commissioner of Food and Drugs;
                        (E) the Administrator of the Federal Emergency
                    Management Agency;
                        (F) the Director of the National Institute on
                    Minority Health and Health Disparities;
                        (G) the Director of the Indian Health Service;
                        (H) the Administrator of the Centers for Medicare &
                    Medicaid Services;
                        (I) the Director of the Agency for Healthcare
                    Research and Quality;
                        (J) the Surgeon General;
                        (K) the Administrator of the Health Resources and
                    Services Administration;
                        (L) the Director of the Office of Minority Health;
                        (M) the Director of the Office of Women's Health;
                        (N) the Chairperson of the National Council on
                    Disability;
                        (O) at least 4 State, local, territorial, and
                    Tribal public health officials representing departments
                    of public health, or an Urban Indian health
                    representative, who shall represent jurisdictions from
                    different regions of the United States with relatively
                    high concentrations of historically marginalized
                    populations and rural populations, to be appointed by
                    the Secretary;
                        (P) the National Coordinator for Health Information
                    Technology;
                        (Q) at least 3 independent individuals with
                    expertise on racially and ethnically diverse
                    representation with knowledge or field experience with
                    community-based participatory research on racial and
                    ethnic disparities in public health, to be appointed by
                    the Secretary; and
                        (R) at least 4 individuals with expertise on health
                    equity and demographic data disparities with knowledge
                    of, or field experience in, language, ability, sex,
                    sexual orientation, gender identity, or socioeconomic
                    status.
                (2) Chairperson.--The Assistant Secretary for Preparedness
            and Response shall serve as the Chairperson of the Commission.
        (c) Duties.--The Commission shall--
                (1) examine barriers to collecting, analyzing, and using
            demographic data in public health;
                (2) determine how to best use such data to promote health
            equity across the United States and reduce racial, Tribal, and
            other demographic disparities in health outcomes;
                (3) gather available data related to treatment of
            individuals with disabilities during the COVID-19 pandemic and
            other public health emergencies, including access to
            vaccinations, denial of treatment for preexisting conditions,
            removal or denial of disability related equipment (including
            ventilators and continuous positive airway pressure (commonly
            referred to as CPAP) machines), and data on completion of do-
            not-resuscitate orders, and identify barriers to obtaining
            accurate and timely data related to treatment of such
            individuals;
                (4) solicit input from public health officials, community-
            connected organizations, health care providers, State and local
            agency officials, Tribal officials, and other experts on
            barriers to, and best practices for, collecting demographic
            data; and
                (5) recommend policy changes that the data indicates are
            necessary to reduce demographic disparities in health outcomes.
        (d) Report.--Not later than 1 year after the date of the enactment
    of this Act, the Commission shall submit to Congress, and publish on
    the website of the Department of Health and Human Services, a report
    containing--
                (1) the findings of the Commission pursuant to subsection
            (c);
                (2) to the extent possible, an analysis of--
                        (A) racial and other demographic disparities in
                    COVID-19 mortality, including an analysis of
                    comorbidities and case fatality rates;
                        (B) sex, sexual orientation, and gender identity
                    disparities in COVID-19 treatment and mortality; and
                        (C) Federal Government policies that disparately
                    exacerbate the COVID-19 impact, and recommendations to
                    improve racial and other demographic disparities in
                    health outcomes;
                (3) 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;
                (4) an analysis of what demographic data is currently being
            collected, 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; and
                (5) the Commission's recommendations with respect to--
                        (A) how to enhance State, local, territorial, and
                    Tribal capacity to conduct public health research on
                    COVID-19 and in future public health emergencies, with
                    a focus on expanded capacity to analyze data on
                    disparities correlated with race, ethnicity, income,
                    sex, sexual orientation, gender identity, age,
                    disability status, specific geographic areas, and other
                    relevant demographic characteristics;
                        (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, local, and Tribal response to public health
                    emergencies;
                        (C) how to improve demographic data collection
                    related to COVID-19 and other public health emergencies
                    in the short-term and long-term, including how to
                    continue to grow and value the Tribal sovereignty of
                    data and information concerning urban and rural Tribal
                    communities;
                        (D) how to improve transparency and equity of
                    treatment for individuals with disabilities during the
                    COVID-19 public health emergency and future
                    emergencies; and
                        (E) how to support State, local, and Tribal
                    capacity to eliminate barriers to vaccinations,
                    testing, and treatment during the COVID-19 pandemic and
                    future public health emergencies.
        (e) Staff of Commission.--
                (1) Additional staff.--The Chairperson of the Commission
            may appoint and fix the pay of additional staff to the
            Commission as the Chairperson considers appropriate.
                (2) Applicability of certain civil service laws.--The staff
            of the Commission may be appointed without regard to the
            provisions of title 5, United States Code, governing
            appointments in the competitive service, and may be paid
            without regard to the provisions of chapter 51 and subchapter
            III of chapter 53 of that title relating to classification and
            General Schedule pay rates.
                (3) Detailees.--Any Federal Government employee may be
            detailed to the Commission without reimbursement from the
            Commission, and the detailee shall retain the rights, status,
            and privileges of his or her regular employment without
            interruption.
        (f) Coordination With Other Efforts.--The Secretary shall, in
    establishing the Commission under this section, take such steps as may
    be necessary to ensure that the work of the Commission does not overlap
    with, or otherwise duplicate, other Federal Government efforts with
    respect to ensuring health equity in data collection in public health
    emergencies.
        (g) Authorization of Appropriations.--There are authorized to be
    appropriated such sums as may be necessary to carry out this section.

    SEC. 1013. TASK FORCE ON PREVENTING BIAS IN AI AND ALGORITHMS.

        (a) In General.--Not later than 30 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 a Task Force to be
    known as the ``Task Force on Preventing AI and Algorithmic Bias in
    Healthcare'' (referred to in this section as the ``Task Force'') to
    provide clear and robust guidance on how to ensure that the development
    and integration of artificial intelligence and algorithmic technologies
    within the health care service delivery process does not exacerbate
    health disparities and expands access to health care services.
        (b) Membership and Chairperson.--
                (1) Membership.--The Task Force shall be composed of--
                        (A) the Chief Information Officer of the Department
                    of Health and Human Services;
                        (B) the Director of the Centers for Disease Control
                    and Prevention;
                        (C) the Director of the National Institutes of
                    Health;
                        (D) the Commissioner of Food and Drugs;
                        (E) the Administrator of the Federal Emergency
                    Management Agency;
                        (F) the Director of the National Institute on
                    Minority Health and Health Disparities;
                        (G) the Director of the Indian Health Service;
                        (H) the Administrator of the Centers for Medicare &
                    Medicaid Services;
                        (I) the Director of the Agency for Healthcare
                    Research and Quality;
                        (J) the Surgeon General;
                        (K) the Administrator of the Health Resources and
                    Services Administration;
                        (L) the Director of the Office of Minority Health;
                        (M) the Director of the Office of Women's Health;
                        (N) the Chairperson of the National Council on
                    Disability;
                        (O) the National Coordinator for Health Information
                    Technology;
                        (P) at least 4 State, local, territorial, and
                    Tribal public health officials representing departments
                    of public health, or an Urban Indian health
                    representative, 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;
                        (Q) at least 3 independent individuals with
                    expertise on racially and ethnically diverse
                    representation with knowledge or field experience with
                    community-based participatory research on racial and
                    ethnic disparities in public health, to be appointed by
                    the Secretary; and
                        (R) at least 4 individuals with expertise on health
                    equity and demographic data disparities with knowledge
                    of, or field experience in, language, ability, sex,
                    sexual orientation, gender identity, or socioeconomic
                    status.
                (2) Chairperson.--The Chief Information Officer of the
            Department of Health and Human Services (or the Chief
            Information Officer's designee) shall serve as the Chairperson
            of the Task Force.
        (c) Duties.--The Task Force shall--
                (1) examine where to place artificial intelligence and
            algorithms in the health care service delivery process relative
            to the use of autonomous human decision-makers;
                (2) identify the risks of health care system utilization of
            artificial intelligence and algorithms in terms of civil
            rights, civil liberties, and discriminatory bias in health care
            access, quality, and outcomes; and
                (3) prepare and submit the report under subsection (d).
        (d) Report.--Not later than 1 year after the date of enactment of
    this Act, the Task Force shall--
                (1) submit a written report of the findings of the
            examination under paragraph (1) and recommendations to Congress
            with respect to implementation of artificial intelligence and
            algorithms in health care delivery and mitigation of the risks
            associated with that implementation; and
                (2) publish such report on the website of the Department of
            Health and Human Services.
        (e) Public Comment.--Not later than 60 days after the date of the
    date of the enactment of this Act, the Task Force shall publish in the
    Federal Register a notice providing for a public comment period on the
    duties and activities of the Task Force of not less than 90 days,
    beginning on the date of that publication.
        (f) Staff of Commission.--
                (1) Additional staff.--The Chairperson of the Task Force
            may appoint and fix the pay of additional staff to the Task
            Force as the Chairperson considers appropriate.
                (2) Applicability of certain civil service laws.--The staff
            of the Task Force may be appointed without regard to the
            provisions of title 5, United States Code, governing
            appointments in the competitive service, and may be paid
            without regard to the provisions of chapter 51 and subchapter
            III of chapter 53 of that title relating to classification and
            General Schedule pay rates.
                (3) Detailees.--Any Federal Government employee may be
            detailed to the Task Force without reimbursement from the Task
            Force, and the detailee shall retain the rights, status, and
            privileges of his or her regular employment without
            interruption.

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

    SEC. 2001. DEFINITIONS; FINDINGS.

        (a) Definitions.--In this title, the definitions in section 3400 of
    the Public Health Service Act, as added by section 2004, shall apply.
        (b) Findings.--Congress finds the following:
                (1) Effective communication is essential to meaningful
            access to quality physical and mental health care.
                (2) Research indicates that the lack of appropriate
            language services creates language barriers that result in
            increased risk of misdiagnosis, ineffective treatment plans,
            and poor health outcomes for individuals with limited English
            proficiency and individuals with communication disabilities
            such as cognitive, hearing, vision, or print impairments.
                (3) The number of limited English speaking residents in the
            United States who speak English less than very well and,
            therefore, cannot effectively communicate with health and
            social service providers continues to increase significantly.
                (4) The responsibility to fund language services in the
            provision of health care and health care-related services to
            individuals with limited English proficiency and individuals
            with communication disabilities such as cognitive hearing,
            vision, or print impairments is a societal one that cannot
            fairly be placed solely upon the health care, public health, or
            social services community.
                (5) Title VI of the Civil Rights Act of 1964 (42 U.S.C.
            2000d et seq.) prohibits discrimination based on the grounds of
            race, color, or national origin by any entity receiving Federal
            financial assistance. In order to avoid discrimination on the
            grounds of national origin, all programs or activities
            administered by the Federal Government must take adequate steps
            to ensure that their policies and procedures do not deny or
            have the effect of denying individuals with limited English
            proficiency with equal access to benefits and services for
            which such persons qualify.
                (6) Both the Americans with Disabilities Act of 1990 (42
            U.S.C. 12101 et seq.) and the Rehabilitation Act of 1973 (29
            U.S.C. 701 et seq.) prohibit discrimination on the basis of
            disability and require the provision of appropriate auxiliary
            aids and services necessary to ensure effective communication
            with individuals with disabilities. The type of auxiliary aid
            or service necessary to ensure effective communication will
            vary in accordance with the method of communication used by the
            individual; the nature, length, and complexity of the
            communication involved; and the context in which the
            communication is taking place. A public accommodation should
            consult with individuals with disabilities whenever possible to
            determine what type of auxiliary aid is needed to ensure
            effective communication. The public accommodation should use
            the individual's preferred method of communication whenever
            possible, unless it would be an undue burden to the public
            accommodation and an alternative would provide an equally
            effective means of communication. The ultimate decision as to
            what measures to take rests with the public accommodation,
            provided that the method chosen results in effective
            communication.
                (7) Section 1557 of the Patient Protection and Affordable
            Care Act (42 U.S.C. 18116) builds on title VI of the Civil
            Rights Act of 1964 (42 U.S.C. 2000d et seq.) and section 504 of
            the Rehabilitation Act of 1973 (29 U.S.C. 794), prohibits
            discrimination on the basis of race, color, national origin,
            disability, sex, and age, requires the provision of language
            services to ensure effective communication with individuals
            with limited English proficiency, and requires the provision of
            appropriate auxiliary aids and services necessary to ensure
            effective communication with individuals with disabilities.
                (8) Linguistic diversity in the health care and health
            care-related services workforce is important for providing all
            patients the environment most conducive to positive health
            outcomes.
                (9) All members of the health care and health care-related
            services community should continue to educate their staff and
            constituents about limited English proficient and disability
            communication issues and help them identify resources to
            improve access to quality care for individuals with limited
            English proficiency and individuals with communication
            disabilities such as cognitive, hearing, vision, or print
            impairments.
                (10) Access to English as a second language, foreign
            language, and sign language interpreters, translated and
            alternative format documents, readers, and other auxiliary aids
            and services, are essential to ensure effective communication
            and eliminate the language barriers that impede access to
            health care.
                (11) Culturally competent language services in health care
            settings should be available as a matter of course.

    SEC. 2002. IMPROVING ACCESS TO SERVICES FOR INDIVIDUALS WITH LIMITED
                  ENGLISH PROFICIENCY.

        (a) Purpose.--Consistent with the goals provided in Executive Order
    13166 (42 U.S.C. 2000d-1 note; relating to improving access to services
    for persons with limited English proficiency), it is the purpose of
    this section--
                (1) to improve Federal agency performance regarding access
            to federally conducted and federally assisted programs and
            activities for individuals with limited English proficiency;
                (2) to require each Federal agency to examine the services
            it provides and develop and implement a system by which
            individuals with limited English proficiency can obtain
            culturally competent services and meaningful access to those
            services consistent with, and without substantially burdening,
            the fundamental mission of the agency;
                (3) to require each Federal agency to translate any English
            language written material prepared for the general public
            relating to a public health emergency, including vaccine
            distribution and education, 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) not
            later than 7 days after any such material is made available in
            English;
                (4) to require each Federal agency to ensure that
            recipients of Federal financial assistance provide culturally
            competent services and meaningful access to applicants and
            beneficiaries who are individuals with limited English
            proficiency;
                (5) to ensure that recipients of Federal financial
            assistance take reasonable steps, consistent with the
            guidelines set forth in the ``Guidance to Federal Financial
            Assistance Recipients Regarding Title VI Prohibition Against
            National Origin Discrimination Affecting Limited English
            Proficient Persons (67 Fed. Reg. 41455 (June 18, 2002))'', to
            ensure culturally and linguistically appropriate access to
            their programs and activities by individuals with limited
            English proficiency; and
                (6) to ensure compliance with title VI of the Civil Rights
            Act of 1964 (42 U.S.C. 2000d et seq.) and section 1557 of the
            Patient Protection and Affordable Care Act (42 U.S.C. 18116)
            (prohibiting health care providers and organizations from
            discriminating in the provision of services).
        (b) Federally Conducted Programs and Activities.--
                (1) In general.--Not later than 120 days after the date of
            enactment of this Act, each Federal agency providing financial
            assistance to, or administering, a health program or activity
            described in section 2003(a) shall prepare a plan or update a
            plan to improve culturally and linguistically appropriate
            access to such program or activity with respect to individuals
            with limited English proficiency. Not later than 1 year after
            the date of enactment of this title, each such Federal agency
            shall ensure that such plan is fully implemented.
                (2) Plan requirement.--Each plan under paragraph (1) shall
            include--
                        (A) the steps the agency will take to ensure that
                    individuals with limited English proficiency have
                    access to each health program or activity supported or
                    administered by the agency;
                        (B) the policies and procedures for identifying,
                    assessing, and meeting the culturally and
                    linguistically appropriate language needs of its
                    beneficiaries that are individuals with limited English
                    proficiency served by such program or activity;
                        (C) the steps the agency will take for such program
                    or activity to be culturally and linguistically
                    appropriate by--
                                (i) providing a range of language
                            assistance options;
                                (ii) giving notice to individuals with
                            limited English proficiency of the right to
                            competent language services;
                                (iii) training staff (at least annually);
                            and
                                (iv) monitoring and assessing the quality
                            of the language services (at least annually);
                        (D) the steps the agency will take for such program
                    or activity to provide reasonable accommodations
                    necessary for individuals with limited English
                    proficiency, including those individuals with a
                    communication disability, to understand communications
                    from the agency;
                        (E) the steps the agency will take to ensure that
                    applications, forms, and other significant documents
                    for such program or activity are competently translated
                    into the primary language of a client that is an
                    individual with limited English proficiency where such
                    materials are needed to improve access of such client
                    to such program or activity;
                        (F) the resources the agency will provide to
                    improve cultural and linguistic appropriateness to
                    assist recipients of Federal funds to improve access to
                    health care-related programs and activities for
                    individuals with limited English proficiency;
                        (G) the resources the agency will provide to ensure
                    that competent language assistance is provided to
                    patients that are individuals with limited English
                    proficiency by interpreters or trained bilingual staff;
                        (H) the resources the agency will provide to ensure
                    that family, particularly minor children, and friends
                    are not used to provide interpretation services, except
                    as permitted under section 1557 of the Patient
                    Protection and Affordable Care Act (42 U.S.C. 18116);
                    and
                        (I) the steps the agency will take and resources
                    the agency will provide to ensure that individuals know
                    their rights, including the ability to file a
                    complaint.
                (3) Submission of plan to doj.--Each agency that is
            required to prepare a plan under paragraph (1) shall--
                        (A) consult with populations who are directly
                    impacted by policies in the plan and their
                    representatives in the development of the plan; and
                        (B) when the plan is finalized, send a copy of such
                    plan to the Attorney General, to serve as the central
                    repository of all such plans.

    SEC. 2003. ENSURING STANDARDS FOR CULTURALLY AND LINGUISTICALLY
                  APPROPRIATE SERVICES IN HEALTH CARE.

        (a) Applicability.--This section shall apply to any health program
    or activity--
                (1) of which any part is receiving Federal financial
            assistance, including credits, subsidies, or contracts of
            insurance; or
                (2) that is carried out (including indirectly through
            contracts, subcontracts, or other support) 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, at least annually,
            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
            assessments;
                (7) shall ensure that, consistent with the privacy
            protections provided for under the regulations promulgated
            under section 264(c) of the Health Insurance Portability and
            Accountability Act of 1996 (42 U.S.C. 1320-2 note), data on an
            individual required to be collected pursuant to section 3101,
            including the individual's alternative format preferences and
            policy modification needs, are--
                        (A) collected in health records;
                        (B) integrated into the management information
                    systems of the program or activity;
                        (C) reported in such a way as to be interoperable
                    with health information systems at the Federal and
                    State levels; and
                        (D) 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 community-based organizations 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 annually make available to the public
            information about their progress and successful innovations in
            implementing the standards under this section, translated
            materials of such information that is culturally and
            linguistically appropriate to the communities served under this
            section, and provide public notice in such 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 or activity described in subsection (a)--
                (1) shall ensure that comments with respect to such program
            or activity that are accepted through notice and comment
            rulemaking are accepted in all languages;
                (2) may not require such comments to be submitted only in
            English; and
                (3) shall ensure that any such comments that are not
            submitted in English are considered, during the agency's review
            of such comments, equally as such comments that are submitted
            in English.

    SEC. 2004. CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE IN THE
                  PUBLIC HEALTH SERVICE ACT.

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

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

    ``SEC. 3400. DEFINITIONS.

        ``(a) In General.--In this title:
                ``(1) Bilingual.--The term `bilingual', with respect to an
            individual, means an individual who has a 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, age, 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 cognitive disability, 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,
            including a provider of services under part B of such title
            XVIII, and may include a hospital, a hospice provider, a
            palliative care provider, and any other individual or entity
            furnishing services covered under any such program that is
            affiliated with the health care group.
                ``(7) Health care.--The term `health care' includes all
            health care needed throughout the life cycle and the end of
            life.
                ``(8) Health care services.--The term `health care
            services' means services that address physical and mental
            health conditions, as well as conditions impacted by social
            determinants of health, in all care settings throughout the
            life cycle and the end of life.
                ``(9) 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 services.
                ``(10) 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, health education
            (including education on end-of-life care options), end-of-life
            care, or chronic disease prevention programs.
                ``(11) 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.
                ``(12) 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.
                ``(13) Individual with limited english proficiency.--The
            term `individual with limited English proficiency' means an
            individual who self-identifies on the Census as speaking
            English less than `very well'.
                ``(14) 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,
            hospice and palliative care, and related disciplines to improve
            the health outcomes of an individual and the community. Such
            providers may include hospitals, health, mental health, or
            substance use prevention and treatment clinics and providers,
            home health agencies, home- and community-based services
            providers, congregate care settings (including any skilled
            nursing facilities, assisted living facilities, prisons and
            jails, residential behavioral health care and psychiatric
            facilities, and facilities providing services for aging adults
            and people with disabilities), ambulatory surgery centers,
            rehabilitation centers, and employed, independent, or
            contracted physicians.
                ``(15) 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.
                ``(16) 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.
                ``(17) Language assistance services.--The term `language
            assistance services' includes--
                        ``(A) oral language assistance, including
                    interpretation in non-English languages provided in-
                    person or remotely by a qualified interpreter for an
                    individual with limited English proficiency, and the
                    use of qualified bilingual or multilingual staff to
                    communicate directly with individuals with limited
                    English proficiency;
                        ``(B) written translation, performed by a qualified
                    translator, of written content in paper or electronic
                    form into languages other than English; and
                        ``(C) taglines.
                ``(18) 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.
                ``(19) Minority group.--The term `minority group' means a
            racial and ethnic minority group as defined in this section.
                ``(20) 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.
                ``(21) 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.
                ``(22) Qualified interpreter for an individual with a
            disability.--The term `qualified interpreter for an individual
            with a disability', with respect to an individual with a
            disability--
                        ``(A) means an interpreter for such individual who
                    by means of a remote interpreting service or an onsite
                    appearance--
                                ``(i) adheres to generally accepted
                            interpreter ethics principles, including client
                            confidentiality; and
                                ``(ii) is able to interpret effectively,
                            accurately, and impartially, both receptively
                            and expressively, using any necessary
                            specialized vocabulary, terminology, and
                            phraseology; and
                        ``(B) may include--
                                ``(i) sign language interpreters;
                                ``(ii) oral transliterators, which are
                            individuals who represent or spell in the
                            characters of another alphabet; and
                                ``(iii) cued language transliterators,
                            which are individuals who represent or spell by
                            using a small number of handshapes.
                ``(23) Qualified interpreter for an individual with limited
            english proficiency.--The term `qualified interpreter for an
            individual with limited English proficiency' means an
            interpreter who by means of a remote interpreting service or an
            onsite appearance--
                        ``(A) adheres to generally accepted interpreter
                    ethics principles, including client confidentiality;
                        ``(B) has demonstrated proficiency in speaking and
                    understanding both spoken English and one or more other
                    spoken languages; and
                        ``(C) is able to interpret effectively, accurately,
                    and impartially, both receptively and expressly, to and
                    from such languages and English, using any necessary
                    specialized vocabulary, terminology, and phraseology.
                ``(24) 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.
                ``(25) 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),
            Middle Easterners and North Africans, and Native Hawaiians and
            other Pacific Islanders.
                ``(26) Secretary.--The term `Secretary' means the Secretary
            of Health and Human Services, acting through the Director of
            the Agency for Healthcare Research and Quality.
                ``(27) 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.
                ``(28) 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.
                ``(29) 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.
                ``(30) 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.
                ``(31) 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.
                ``(32) Underserved communities.--The term `underserved
            communities' means populations sharing a particular
            characteristic, as well as geographic communities, who have
            been systematically denied a full opportunity to participate in
            aspects of economic, social, and civic life, such as--
                        ``(A) Black, Latino, and Indigenous and Native
                    American persons, Asian Americans and Pacific
                    Islanders, Middle Easterners and North Africans, and
                    other persons of color;
                        ``(B) members of religious minorities;
                        ``(C) lesbian, gay, bisexual, transgender, and
                    queer persons;
                        ``(D) persons with disabilities;
                        ``(E) persons who live in rural areas; and
                        ``(F) persons otherwise adversely affected by
                    persistent poverty or inequality as defined in
                    Executive Order 13985.
                ``(33) Underserved populations.--The term `underserved
            populations' means populations sharing a particular
            characteristic, as well as geographic communities, who have
            been systematically denied a full opportunity to participate in
            aspects of economic, social, and civic life, as defined in
            Executive Order 13985.
                ``(34) 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.
                ``(35) Vital document.--The term `vital document' includes
            applications for government programs that provide health care
            services, medical or financial consent forms, financial
            assistance documents, letters containing important information
            regarding patient instructions (such as prescriptions,
            referrals to other providers, and discharge plans) and
            participation in a program (such as a Medicaid managed care
            program), notices pertaining to the reduction, denial, or
            termination of services or benefits, notices of the right to
            appeal such actions, and notices advising individuals with
            limited English proficiency with communication disabilities of
            the availability of free language services, alternative
            formats, and other outreach materials.
        ``(b) Reference.--In any reference in this title to a regulatory
    provision applicable to a `handicapped individual', the term
    `handicapped individual' in such provision shall have the same meaning
    as the term `individual with a disability' as defined in subsection
    (a).

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

    ``SEC. 3401. ROBERT T. MATSUI CENTER FOR CULTURALLY AND LINGUISTICALLY
                  APPROPRIATE HEALTH CARE.

        ``(a) Establishment.--The Secretary 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.--
                        ``(A) In general.--The Center shall provide
                    resources via the internet to identify and link health
                    care providers to competent and qualified interpreter
                    and translation services.
                        ``(B) Training.--For purposes of providing the
                    services described in subparagraph (A), the Center
                    shall adopt a language access plan that includes
                    training requirements for Center staff to provide such
                    services.
                ``(2) Translation of written material.--
                        ``(A) Vital documents.--The Center shall provide,
                    directly or through contract, to providers of health
                    care services and health care-related services, at no
                    cost to such providers and in a timely and reasonable
                    manner, vital documents--
                                ``(i) which may be submitted by covered
                            entities (as defined in section 92.4 of title
                            45, Code of Federal Regulations, as in effect
                            on May 18, 2016) for translation into non-
                            English languages or alternative formats at a
                            fifth-grade reading level; and
                                ``(ii) from competent translation services,
                            the quality of which 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, not later than
                    45 calendar days of the Secretary receiving final
                    approval of the form from the Office of Management and
                    Budget--
                                ``(i) 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; and
                                ``(ii) post all translated forms on the
                            Center's website.
                ``(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
            that is linked to the toll-free telephone number 1-800-MEDICARE
            and a toll-free telephone hotline provided for pursuant to
            section 1311(d)(4)(B) of the Patient Protection and Affordable
            Care Act by an Exchange established under title I of such Act--
                        ``(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, and coverage
                    available through an Exchange established under title I
                    of the Patient Protection and Affordable Care Act, and
                    other sources of free or reduced care including
                    federally qualified health centers, entities receiving
                    assistance under title X, 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, and make available on the internet and in
                    print, an information clearinghouse that includes the
                    information described in subparagraphs (B) through
                    (F)--
                                ``(i) to facilitate the provision of
                            language services by providers of health care
                            services and health care-related services to
                            reduce medical errors;
                                ``(ii) to improve medical outcomes, improve
                            cultural competence, reduce health care costs
                            caused by miscommunication with individuals
                            with limited English proficiency; and
                                ``(iii) to reduce or eliminate the
                            duplication of efforts to translate materials.
                        ``(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 such 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, at no cost, to
                    all health care providers and all providers of health
                    care-related services, information relating to
                    culturally and linguistically appropriate health care
                    for minority populations residing in the United States,
                    including--
                                ``(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 for health care services and
                            health care-related services; and
                                ``(v) culturally and linguistically
                            appropriate information for educators,
                            practitioners, students, 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 such glossaries available--
                                        ``(I) free of charge;
                                        ``(II) in each language in which
                                    the Center translates forms under
                                    paragraph (2)(B);
                                        ``(III) in alternative formats in
                                    accordance with the Americans with
                                    Disabilities Act of 1990 (42 U.S.C.
                                    12101 et seq.); and
                                        ``(IV) in paper format upon
                                    request.
                        ``(G) Information about progress.--The Center
                    shall--
                                ``(i) regularly collect and make publicly
                            available information about the progress of
                            entities receiving grants under section 3402
                            regarding successful innovations in
                            implementing the requirements of this
                            subsection; and
                                ``(ii) provide public notice in the
                            entities' communities about the availability of
                            such 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 of the Center
    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,
    community health centers, social service providers, and community-based
    organizations 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 2023 through 2027.

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

        ``(a) In General.--
                ``(1) Grants.--The Secretary 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 and
            communication disabilities.
                ``(2) Coordination.--In making grants under this section,
            and in the design and implementation of the program established
            under this section, the Secretary 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.
        ``(b) Eligibility.--To be eligible to receive a grant under
    subsection (a), an entity shall be--
                ``(1) a city, county, Indian Tribe, State, or subdivision
            thereof;
                ``(2) 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;
                ``(3) a community health, mental health, or substance use
            disorder center or clinic;
                ``(4) a solo or group physician practice;
                ``(5) an integrated health care delivery system;
                ``(6) a public hospital;
                ``(7) a health care group, university, or college; or
                ``(8) any other entity designated by the Secretary.
        ``(c) Application.--An eligible entity seeking a grant under this
    section shall 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.
        ``(d) 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;
                ``(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; and
                ``(14) ensure that culturally competent care and language
            assistance are available to individuals with limited English
            proficiency.
        ``(e) 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.
        ``(f) 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.
        ``(g) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section $5,000,000 for each of fiscal
    years 2023 through 2027.

    ``SEC. 3403. RESEARCH ON CULTURAL AND LANGUAGE COMPETENCE.

        ``(a) In General.--The Secretary shall expand research concerning
    language access in the provision of health care services.
        ``(b) Eligibility.--The Secretary 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' knowledge and awareness of the barriers to
            quality health care services that are faced by individuals with
            limited English proficiency and communication disabilities.
                ``(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 whether the
                    encounter occurs during 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 2023 through 2027.''.

    SEC. 2005. PILOT PROGRAM FOR IMPROVEMENT AND DEVELOPMENT OF STATE
                  MEDICAL INTERPRETING SERVICES.

        (a) Grants Authorized.--The Secretary of Health and Human Services
    shall award 1 grant in accordance with this section to each of 3 States
    (to be selected by the Secretary) to assist each such State in
    designing, implementing, and evaluating a statewide program to provide
    onsite interpreter services under the State Medicaid plan.
        (b) Grant Period.--A grant awarded under this section is authorized
    for the period of 3 fiscal years beginning on October 1, 2023, and
    ending on September 30, 2026.
        (c) Preference.--In awarding a grant under this section, the
    Secretary shall give preference to a State--
                (1) that has a high proportion of qualified LEP enrollees,
            as determined by the Secretary;
                (2) that has a large number of qualified LEP enrollees, as
            determined by the Secretary;
                (3) that has a high growth rate of the population of
            individuals with limited English proficiency, as determined by
            the Secretary; and
                (4) that has a population of qualified LEP enrollees that
            is linguistically diverse, requiring interpreter services in at
            least 200 non-English languages.
        (d) Use of Funds.--A State receiving a grant under this section
    shall use the grant funds to--
                (1) ensure that all health care providers in the State
            participating in the State Medicaid plan have access to onsite
            interpreter services, for the purpose of enabling effective
            communication between such providers and qualified LEP
            enrollees during the furnishing of items and services and
            administrative interactions;
                (2) establish, expand, procure, or contract for--
                        (A) a statewide health care information technology
                    system that is designed to achieve efficiencies and
                    economies of scale with respect to onsite interpreter
                    services provided to health care providers in the State
                    participating in the State Medicaid plan; and
                        (B) an entity to administer such system, the duties
                    of which shall include--
                                (i) procuring and scheduling interpreter
                            services for qualified LEP enrollees;
                                (ii) procuring and scheduling interpreter
                            services for individuals with limited English
                            proficiency seeking to enroll in the State
                            Medicaid plan;
                                (iii) ensuring that interpreters receive
                            payment for interpreter services rendered under
                            the system; and
                                (iv) consulting regularly with
                            organizations representing LEP consumers,
                            interpreters, and health care providers; and
                (3) develop mechanisms to establish, improve, and
            strengthen the competency of the medical interpretation
            workforce that serves qualified LEP enrollees in the State,
            including a national certification process that is valid,
            credible, and vendor-neutral.
        (e) Application.--To receive a grant under this section, a State
    shall submit an application at such time and containing such
    information as the Secretary may require, which shall include the
    following:
                (1) A description of the language access needs of
            individuals in the State enrolled in the State Medicaid plan.
                (2) A description of the extent to which the program will--
                        (A) use the grant funds for the purposes described
                    in subsection (d);
                        (B) meet the health care needs of rural populations
                    of the State; and
                        (C) collect information that accurately tracks the
                    language services requested by consumers as compared to
                    the language services provided by health care providers
                    in the State participating in the State Medicaid plan.
                (3) A description of how the program will be evaluated,
            including a proposal for collaboration with organizations
            representing interpreters, consumers, and individuals with
            limited English proficiency.
        (f) Definitions.--In this section:
                (1) Qualified lep enrollee.--The term ``qualified LEP
            enrollee'' means an individual--
                        (A) who is limited English proficient; and
                        (B) who is enrolled in a State Medicaid plan.
                (2) State.--The term ``State'' has the meaning given the
            term in section 1101(a)(1) of the Social Security Act (42
            U.S.C. 1301(a)(1)), for purposes of title XIX of such Act (42
            U.S.C. 1396 et seq.).
                (3) State medicaid plan.--The term ``State Medicaid plan''
            means a State plan under title XIX of the Social Security Act
            (42 U.S.C. 1396 et seq.) or a waiver of such a plan.
                (4) United states.--The term ``United States'' has the
            meaning given the term in section 1101(a)(2) of the Social
            Security Act (42 U.S.C. 1301(a)(2)), for purposes of title XIX
            of such Act (42 U.S.C. 1396 et seq.).
        (g) Continuation Past Demonstration.--Any State receiving a grant
    under this section must agree to directly pay for language services in
    Medicaid for all Medicaid providers by the end of the grant period.
        (h) Funding.--
                (1) Authorization of appropriations.--There is authorized
            to be appropriated $5,000,000 to carry out this section.
                (2) Availability of funds.--Amounts appropriated pursuant
            to the authorization in paragraph (1) are authorized to remain
            available without fiscal year limitation.
                (3) Increased federal financial participation.--Section
            1903(a)(2)(E) of the Social Security Act (42 U.S.C.
            1396b(a)(2)(E)) is amended by inserting ``(or, in the case of a
            State that was awarded a grant under section 2003 of the Health
            Equity and Accountability Act of 2022, 100 percent for each
            quarter occurring during the grant period specified in
            subsection (b) of such section)'' after ``75 percent''.
        (i) Limitation.--No Federal funds awarded under this section may be
    used to provide interpreter services from a location outside the United
    States.

    SEC. 2006. 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 medically underserved
                    populations (as defined in section 330(b)(3) of the
                    Public Health Service Act).''.
        (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 moving the left margin of such clause and each
            subclause and item therein 2 ems to the left; 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. 2007. 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 provide
                    culturally and linguistically appropriate services to
                    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 individuals with limited English
                    proficiency, 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 10 grants to providers of services
                    described in paragraph (2)(A)(i);
                        (B) at least 10 grants to service providers
                    described in paragraph (2)(A)(ii);
                        (C) at least 10 grants to organizations described
                    in paragraph (2)(A)(iii); and
                        (D) at least 10 grants to sponsors described in
                    paragraph (2)(A)(iv).
                (4) Considerations in awarding grants.--
                        (A) Variation among 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 represent each Centers
                            for Medicare & Medicaid Services region, 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
                    individuals with limited English proficiency.
                        (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 limited English proficient, 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 individuals with limited English proficiency 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.--A grantee that is an MA organization or
                    prescription drug sponsor must provide at least 50
                    percent of the grant funds that the grantee 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 individuals with
                    limited English proficiency.
                        (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 limited
                    English proficiency 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 individuals with limited English
                            proficiency 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 limited
                    English proficient 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 at
                    least annually;
                        (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 2002 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 must also
                            be collected on the parent or legal guardian of
                            such recipient.
                (8) No cost sharing.--Medicare beneficiaries who are
            limited English proficient 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, disaggregated
                    by age and entitlement basis (on the basis of age,
                    disability, or determination of end stage renal
                    disease).
                        (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 individuals with limited English proficiency
                    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 with respect to
                            both health service delivery and language
                            assistance;
                                (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) Limited english proficient defined.--In this
            subsection, the term ``limited English proficient'' refers to
            individuals who self-identify on the Census as speaking English
            less than ``very well''.
        (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
            (lll),''; and
                        (B) by adding at the end the following new
                    subsection:

                ``Language Assistance Services and Related Terms

        ``(lll) 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).''.
                (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(lll)).''.
                (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
                    (9);
                        (B) by striking the period at the end of paragraph
                    (10) and inserting ``; and''; and
                        (C) by inserting after paragraph (10) the following
                    new paragraph:
                ``(11) in the case of language assistance services (as
            defined in section 1861(lll)), 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(lll) 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:
                ``(6) Reporting requirements relating to effective language
            services.--A contract under this part shall require a Medicare
            Advantage organization (and, through application of section
            1860D-12(b)(3)(D), a contract under section 1860D-12 shall
            require a PDP sponsor) to annually submit (for each year of the
            contract) a report that contains information on the internal
            policies and procedures of the organization (or sponsor)
            related to recruitment and retention efforts directed to
            workforce diversity and linguistically and culturally
            appropriate provision of services in each of the following
            contexts:
                        ``(A) The collection of data in a manner that meets
                    the requirements of title I of the Health Equity and
                    Accountability Act of 2022, 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 2005(h)(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 (30)'' and inserting ``(30), and (31)''.
                (3) Definition of medical assistance.--Section 1905(a) of
            the Social Security Act (42 U.S.C. 1396d(a)) is amended--
                        (A) in paragraph (29), by striking ``and'' at the
                    end;
                        (B) by redesignating paragraph (31) as paragraph
                    (32); and
                        (C) by inserting after paragraph (30) the following
                    new paragraph:
                ``(31) language assistance services, as such term is
            defined in section 1861(lll), provided in a timely manner to
            individuals with limited English proficiency as defined in
            section 3400 of the Public Health Service Act; and''.
                (4) Use of deductions and cost sharing.--Section 1916(a)(2)
            of the Social Security Act (42 U.S.C. 1396o(a)(2)) is amended--
                        (A) in subparagraph (G), by inserting at the end
                    ``, and''; and
                        (B) by adding at the end the following new
                    subparagraph:
                        ``(H) language assistance services described in
                    section 1905(a)(31);''.
                (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 ``(7), and (8)'' and
                    inserting ``(7), (8), (9), (10), (11), and (12)'';
                        (B) in subsection (c), by adding at the end the
                    following new paragraph:
                ``(12) 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(l), 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 ``language assistance
                            services described in subsection (c)(12),''
                            before ``visits described in''.
                (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)(12)''.
                (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)--
                                (i) in the matter preceding subparagraph
                            (A), by striking ``75'' and inserting ``95'';
                            and
                                (ii) in subparagraph (D)(iv), by striking
                            ``translation or interpretation services'' and
                            inserting ``language assistance services''; 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 individuals with limited English
                    proficiency 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 2022 through
                    2026.
                        (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 is 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 limited English
                    proficient individuals, 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 individuals with limited
                            English proficiency who are provided language
                            assistance services by the entity and for whom
                            no reimbursement is available for such services
                            under the amendments made by subsection (a),
                            (b), (c), or (d) or by private health
                            insurance.
                        (B) Eligible entity.--The term ``eligible entity''
                    means an entity that--
                                (i) is a Medicaid provider that is--
                                        (I) a physician;
                                        (II) a hospital with a low-income
                                    utilization rate (as defined in section
                                    1923(b)(3) of the Social Security Act
                                    (42 U.S.C. 1396r-4(b)(3))) of greater
                                    than 25 percent;
                                        (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)));
                                        (IV) a hospice provider; or
                                        (V) a palliative care provider;
                                (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) 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, 2023.
                (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.) or a State plan
            for child health assistance under title XXI of such Act (42
            U.S.C. 1397aa 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, such 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. 2008. INCREASING UNDERSTANDING OF AND IMPROVING HEALTH LITERACY.

        (a) In General.--The Secretary, 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 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
            under subsection (a) that is awarded through the Director of
            the Agency for Healthcare Research and Quality shall be used--
                        (A) to define and increase the understanding of
                    health literacy across all areas of health care,
                    including end of life care;
                        (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
            under subsection (a) that is awarded 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 and
                    end of life care programs for patients with low health
                    literacy;
                        (B) the tailoring of disease management programs
                    and end of life care 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:
                (1) Low health literacy.--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.
                (2) Secretary.--The term ``Secretary'' means the Secretary
            of Health and Human Services--
                        (A) acting through the Director of the Agency for
                    Healthcare Research and Quality, with respect to grants
                    under subsection (c)(1); and
                        (B) acting through the Administrator of the Health
                    Resources and Services Administration with respect to
                    grants under subsection (c)(2).
        (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 2023 through 2027.

    SEC. 2009. 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 45, Code of Federal Regulations,
            as in effect on May 18, 2016 (81 Fed. Reg. 31466); and
                (2) the term ``health program or activity'' has the meaning
            given such term in section 92.4 of title 45, Code of Federal
            Regulations, as in effect on May 18, 2016 (81 Fed. Reg. 31466).
        (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 at least annually;
                (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. 2010. 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 2023 through 2027.

    SEC. 2011. ENGLISH INSTRUCTION FOR INDIVIDUALS WITH LIMITED ENGLISH
                  PROFICIENCY.

        (a) Grants Authorized.--The Secretary of Education is authorized to
    provide grants to eligible entities for the provision of English as a
    second language (in this section referred to as ``ESL'') instruction to
    individuals with limited English proficiency, including health care-
    related English instruction, and shall determine, after consultation
    with appropriate stakeholders, the mechanism for administering and
    distributing such grants.
        (b) Eligible Entity.--In this section, the term ``eligible entity''
    means--
                (1) a State; or
                (2) a community-based organization that predominantly
            employs and serves racial and ethnic minority groups (as
            defined in section 1707(g) of the Public Health Service Act (42
            U.S.C. 300u-6(g)).
        (c) Application.--An eligible entity that desires to receive a
    grant under this section shall apply by submitting to the Secretary of
    Education an application at such time, in such manner, and containing
    such information as the Secretary may require.
        (d) Use of Grant.--An eligible entity shall use grant funds
    provided under this section to--
                (1) develop and implement a plan for assuring the
            availability of ESL instruction, free of charge, to the
            community served by the eligible entity, 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 with
            limited English proficiency to access and regularly negotiate
            the health care system effectively;
                (2) develop a plan for making ESL instruction available
            free to charge to individuals with limited English proficiency
            in the community served by the eligible entity who are seeking
            instruction, including, where appropriate, through the use of
            public-private partnerships; and
                (3) provide ESL instruction to individuals with limited
            English proficiency in the community served by the eligible
            entity.
        (e) Supplement, Not Supplant.--An eligible entity awarded a grant
    under this section shall use funds made available under this section to
    supplement, and not supplant, other Federal, State, and local funds
    that would otherwise be expended to carry out activities under this
    section.
        (f) Duties of the Secretary.--The Secretary of Education shall--
                (1) collect and make publicly available annual data on how
            much Federal, State, and local governments spend annually on
            ESL instruction;
                (2) collect data from eligible entities awarded a grant
            under this section to identify the unmet needs of individuals
            with limited English proficiency for appropriate ESL
            instruction, including--
                        (A) the preferred written and spoken language of
                    such individuals;
                        (B) the availability of enrollment in ESL
                    instruction programs in the communities served by each
                    eligible entity awarded a grant under this section,
                    including the extent of waiting lists for ESL
                    instruction, how many programs maintain waiting lists,
                    and, for programs that do not have waiting lists, the
                    reasons why such a list is unnecessary or otherwise not
                    maintained;
                        (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 of individuals with limited English
                    proficiency and the number of individuals enrolled in
                    ESL instruction programs in the communities served by
                    each eligible entity awarded a grant under this
                    section;
                        (F) the effectiveness of the ESL instruction
                    provided through grants awarded under this section in
                    meeting the needs of individuals receiving such
                    instruction; and
                        (G) an assessment of the need for programs that
                    integrate job training and ESL instruction, to assist
                    individuals with limited English proficiency in
                    obtaining better jobs;
                (3) determine the cost and most appropriate methods of
            making ESL instruction available to all individuals with
            limited English proficiency in the United States who are
            seeking instruction; and
                (4) not later than 1 year after the date of enactment of
            this Act, issue a report to Congress that--
                        (A) assesses the information collected in
                    paragraphs (1), (2), and (3) and makes recommendations
                    on steps that should be taken to realize the goal of
                    making ESL instruction available to all individuals
                    with limited English proficiency in the United States
                    who are seeking instruction; and
                        (B) evaluates the impact of the grant program
                    authorized under this section on the accessibility of,
                    and ability to effectively negotiate, the health care
                    system for individuals with limited English proficiency
                    who have received ESL instruction funded by a grant
                    under this section.
        (g) Authorization of Appropriations.--There are authorized to be
    appropriated to the Secretary of Education $250,000,000 for each of
    fiscal years 2023 through 2027 to carry out this section.

    SEC. 2012. IMPLEMENTATION.

        (a) General Provisions.--
                (1) Immunity.--A person injured by a violation of this
            title (including an amendment made by this title) by a State
            may bring a civil action in the appropriate Federal court for
            such injury in accordance with this section.
                (2) Remedies.--In a civil action under this section for a
            violation of this title, such remedies shall be available as
            would be available in a civil action for such violation against
            any party other than a State.
        (b) Rule of Construction.--Nothing in this title may be construed
    to limit otherwise existing obligations of recipients of Federal
    financial assistance under title VI of the Civil Rights Act of 1964 (42
    U.S.C. 2000d et seq.) or any other Federal statute.

    SEC. 2013. LANGUAGE ACCESS SERVICES.

        (a) Essential Benefits.--Section 1302(b)(1) of the Patient
    Protection and Affordable Care Act (42 U.S.C. 18022(b)(1)) is amended
    by adding at the end the following:
                        ``(K) Language access services, including oral
                    interpretation and written translations.''.
        (b) Employer-Sponsored Minimum Essential Coverage.--
                (1) In general.--Section 36B(c)(2)(C) of the Internal
            Revenue Code of 1986 is amended by redesignating clauses (iii)
            and (iv) as clauses (iv) and (v), respectively, and by
            inserting after clause (ii) the following new clause:
                                ``(iii) Coverage must include language
                            access and services.--Except as provided in
                            clause (iv), an employee shall not be treated
                            as eligible for minimum essential coverage if
                            such coverage consists of an eligible employer-
                            sponsored plan (as defined in section
                            5000A(f)(2)) and the plan does not provide
                            coverage for language access services,
                            including oral interpretation and written
                            translations.''.
                (2) Conforming amendments.--
                        (A) Section 36B(c)(2)(C) of such Code is amended by
                    striking ``clause (iii)'' each place it appears in
                    clauses (i) and (ii) and inserting ``clause (iv)''.
                        (B) Section 36B(c)(2)(C)(iv) of such Code, as
                    redesignated by this subsection, is amended by striking
                    ``(i) and (ii)'' and inserting ``(i), (ii), and
                    (iii)''.
        (c) Quality Reporting.--Section 2717(a)(1) of the Public Health
    Service Act (42 U.S.C. 300gg-17(a)(1)) is amended--
                (1) by striking ``and'' at the end of subparagraph (C);
                (2) by striking the period at the end of subparagraph (D)
            and inserting ``; and''; and
                (3) by adding at the end the following new subparagraph:
                        ``(E) reduce health disparities through the
                    provision of language access services, including oral
                    interpretation and written translations.''.
        (d) Regulations Regarding Internal Claims and Appeals and External
    Review Processes for Health Plans and Health Insurance Issuers.--The
    Secretary of the Treasury, the Secretary of Labor, and the Secretary of
    Health and Human Services shall amend the regulations in section
    54.9815-2719(e) of title 26, Code of Federal Regulations, section
    2590.715- 2719(e) of title 29, Code of Federal Regulations, and section
    147.136(e) of title 45, Code of Federal Regulations (or a successor
    regulation), respectively, to require group health plans and health
    insurance issuers offering group or individual health insurance
    coverage to which such sections apply--
                (1) to provide oral interpretation services without any
            threshold requirements;
                (2) to provide in the English versions of all notices a
            statement prominently displayed in not less than 15 non-English
            languages clearly indicating how to access the language
            services provided by the plan or issuer; and
                (3) with respect to the requirements for providing relevant
            notices in a culturally and linguistically appropriate manner
            in the applicable non-English languages, to apply a threshold
            that 5 percent of the population, or not less than 500
            individuals, in the county is literate only in the same non-
            English language in order for the language to be considered an
            applicable non-English language.
        (e) Data Collection and Reporting.--The Secretary of Health and
    Human Services shall--
                (1) amend the single streamlined application form developed
            pursuant to section 1413 of the Patient Protection and
            Affordable Care Act (42 U.S.C. 18083) to collect the preferred
            spoken and written language for each household member applying
            for coverage under a qualified health plan through an Exchange
            under title I of such Act (42 U.S.C. 18001 et seq.);
                (2) require navigators, certified application counselors,
            and other individuals assisting with enrollment to collect and
            report requests for language assistance; and
                (3) require the toll-free telephone hotlines established
            pursuant to section 1311(d)(4)(B) of the Patient Protection and
            Affordable Care Act (42 U.S.C. 18031(d)(4)(B)) to submit an
            annual report documenting the number of language assistance
            requests, the types of languages requested, the range and
            average wait time for a consumer to speak with an interpreter,
            the number of complaints and any steps the hotline, and any
            entity contracting with the Secretary to provide language
            services, have taken to actively address some of the consumer
            complaints.
        (f) Effective Date.--The amendments made by this section shall not
    apply to plans beginning prior to the date of the enactment of this
    Act.

    SEC. 2014. MEDICALLY UNDERSERVED POPULATIONS.

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

                     TITLE III--HEALTH WORKFORCE DIVERSITY

    SEC. 3001. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

        Title XXXIV of the Public Health Service Act, as added by section
    2004, is amended by adding at the end the following:

              ``Subtitle B--Diversifying the Health Care Workplace

    ``SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE DIVERSITY.

        ``(a) In General.--The Secretary, acting through the Bureau of
    Health Workforce of the Health Resources and Services Administration,
    shall award a grant to an entity determined appropriate by the
    Secretary for the establishment of a national working group on
    workforce diversity.
        ``(b) Representation.--In establishing the national working group
    under subsection (a):
                ``(1) The grantee shall ensure that the group has
            representatives of each of the following:
                        ``(A) The Health Resources and Services
                    Administration.
                        ``(B) The Department of Health and Human Services
                    Data Council.
                        ``(C) The Office of Minority Health of the
                    Department of Health and Human Services.
                        ``(D) The Substance Abuse and Mental Health
                    Services Administration.
                        ``(E) The Bureau of Labor Statistics of the
                    Department of Labor.
                        ``(F) The National Institute on Minority Health and
                    Health Disparities.
                        ``(G) The Agency for Healthcare Research and
                    Quality.
                        ``(H) The Institute of Medicine Study Committee for
                    the 2004 workforce diversity report.
                        ``(I) The Indian Health Service.
                        ``(J) The Department of Education.
                        ``(K) Minority-serving academic institutions.
                        ``(L) Consumer organizations.
                        ``(M) Health professional associations, including
                    those that represent underrepresented minority
                    populations.
                        ``(N) Researchers in the area of health workforce.
                        ``(O) Health workforce accreditation entities.
                        ``(P) Private (including nonprofit) foundations
                    that have sponsored workforce diversity initiatives.
                        ``(Q) Local and State health departments.
                        ``(R) Representatives of community members to be
                    included on admissions committees for health profession
                    schools pursuant to subsection (c)(9).
                        ``(S) National community-based organizations that
                    serve as a national intermediary to their urban
                    affiliate members and have demonstrated capacity to
                    train health care professionals.
                        ``(T) The Veterans Health Administration.
                        ``(U) Other entities determined appropriate by the
                    Secretary.
                ``(2) The grantee shall ensure that, in addition to the
            representatives under paragraph (1), the working group has not
            less than 5 health professions students representing various
            health profession fields and levels of training.
        ``(c) Activities.--The working group established under subsection
    (a) shall convene at least twice each year to complete the following
    activities:
                ``(1) Review public and private health workforce diversity
            initiatives.
                ``(2) Identify successful health workforce diversity
            programs and practices.
                ``(3) Examine challenges relating to the development and
            implementation of health workforce diversity initiatives.
                ``(4) Draft a national strategic work plan for health
            workforce diversity, including recommendations for public and
            private sector initiatives.
                ``(5) Develop a framework and methods for the evaluation of
            current and future health workforce diversity initiatives.
                ``(6) Develop recommended standards for workforce diversity
            that could be applicable to all health professions programs and
            programs funded under this Act.
                ``(7) Develop guidelines to train health professionals to
            care for a diverse population.
                ``(8) Develop a workforce data collection or tracking
            system to identify where racial and ethnic minority health
            professionals practice.
                ``(9) Develop a strategy for the inclusion of community
            members on admissions committees for health profession schools.
                ``(10) Help with monitoring and implementation of standards
            for diversity, equity, and inclusion.
                ``(11) Other activities determined appropriate by the
            Secretary.
        ``(d) Annual Report.--Not later than 1 year after the establishment
    of the working group under subsection (a), and annually thereafter, the
    working group shall prepare and make available to the general public
    for comment, an annual report on the activities of the working group.
    Such report shall include the recommendations of the working group for
    improving health workforce diversity.
        ``(e) Coordination With Other Efforts.--In providing for the
    establishment of the working group under subsection (a), the Secretary
    shall take such steps as may be necessary to ensure that the work of
    the working group does not overlap with, or otherwise duplicate, other
    Federal Government efforts with respect to ensuring health equity in
    data collection in public health emergencies.
        ``(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 2023 through 2027.

    ``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 are authorized to be
    appropriated to carry out this section such sums as may be necessary
    for each of fiscal years 2023 through 2027.

    ``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 Director of
    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) historically Black professional or graduate
                    institutions eligible for grants under section 326 of
                    the Higher Education Act of 1965;
                        ``(C) Hispanic-serving health professions schools;
                        ``(D) Hispanic-serving institutions, as defined in
                    section 502 of such Act;
                        ``(E) Tribal Colleges or Universities, as defined
                    in section 316 of such Act;
                        ``(F) Asian American and Native American Pacific
                    Islander-serving institutions, as defined in section
                    371(c) of such Act;
                        ``(G) institutions that have programs to recruit
                    and retain underrepresented minority health
                    professionals, in which a significant number of the
                    enrolled participants are underrepresented minorities;
                        ``(H) health professional associations, which may
                    include underrepresented minority health professional
                    associations; and
                        ``(I) 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 are authorized to be
    appropriated to carry out this section such sums as may be necessary
    for each of fiscal years 2023 through 2027.

    ``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 are authorized to be
    appropriated to carry out this section such sums as may be necessary
    for each of fiscal years 2023 through 2027.

    ``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 universities and other institutions to enter into
    agreements with eligible individuals under which--
                ``(1) the university or institution supports the eligible
            individual's career in a nonresearch-related health and
            wellness profession; and
                ``(2) the eligible individual commits to performing a
            period of obligated service in such a career to serve, or to
            work on health issues affecting, underserved communities, such
            as racial and ethnic minority communities.
        ``(b) Eligible Individuals.--To be an eligible individual for
    purposes of subsection (a), an individual shall 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.
        ``(c) Application.--To seek a grant under this section, a
    university or other institution shall submit to the Secretary an
    application at such time, in such manner, and containing such
    information as the Secretary may require.
        ``(d) Use of Funds.--A university or other institution receiving a
    grant under this section shall use the grant for agreements described
    in subsection (a). Such agreements may--
                ``(1) support an eligible individual's health activities or
            projects that involve underserved communities, including racial
            and ethnic minority communities;
                ``(2) support an eligible individual's health-related
            career advancement activities;
                ``(3) pay, or reimburse for payment of, student loans or
            training or credentialing costs for eligible individuals who
            are health professionals and are focused on health issues
            affecting underserved communities, including racial and ethnic
            minority communities; and
                ``(4) establish and promote leadership training programs
            for eligible individuals to decrease health disparities and to
            increase cultural competence with the goal of increasing
            diversity in leadership positions.
        ``(e) Definition.--In this section, the term `career in a
    nonresearch-related health and wellness profession' 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.
        ``(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 2023 through 2027.

    ``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 this section referred to as the `Director'),
    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 are authorized to be
    appropriated to carry out this section such sums as may be necessary
    for each of fiscal years 2023 through 2027.

    ``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 are authorized to be
    appropriated to carry out this section such sums as may be necessary
    for each of fiscal years 2023 through 2027.''.

    SEC. 3002. HISPANIC-SERVING INSTITUTIONS, HISTORICALLY BLACK COLLEGES
                  AND UNIVERSITIES, HISTORICALLY BLACK PROFESSIONAL OR
                  GRADUATE INSTITUTIONS, 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, HISTORICALLY BLACK PROFESSIONAL OR
                  GRADUATE INSTITUTIONS, 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,
    historically Black professional or graduate institutions eligible for
    grants under section 326 of the Higher Education Act of 1965, 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;
                ``(2) providing financial assistance information for
            continued education and applications to health professional
            schools; and
                ``(3) retaining existing enrolled underrepresented minority
            students in a health professions school.
        ``(b) Definitions.--In this section:
                ``(1) Asian american and native american pacific islander-
            serving institution.--The term `Asian American and Native
            American Pacific Islander-serving institution' has the meaning
            given such term in section 320(b) of the Higher Education Act
            of 1965.
                ``(2) Hispanic-serving institution.--The term `Hispanic-
            serving institution' means an entity that--
                        ``(A) is a school or program for which there is a
                    definition under section 799B;
                        ``(B) has an enrollment of full-time equivalent
                    students that is made up of at least 9 percent Hispanic
                    students;
                        ``(C) has been effective in carrying out programs
                    to recruit Hispanic individuals to enroll in and
                    graduate from the school;
                        ``(D) has been effective in recruiting and
                    retaining Hispanic faculty members;
                        ``(E) has a significant number of graduates who are
                    providing health services to medically underserved
                    populations or to individuals in health professional
                    shortage areas; and
                        ``(F) is a Hispanic Center of Excellence in Health
                    Professions Education designated under section
                    736(d)(2) of the Public Health Service Act (42 U.S.C.
                    293(d)(2)).
                ``(3) Historically black college and university.--The term
            `historically Black college and university' has the meaning
            given the term `part B institution' as defined in section 322
            of the Higher Education Act of 1965.
                ``(4) Tribal college or university.--The term `Tribal
            College or University' has the meaning given such term in
            section 316(b) of the Higher Education Act of 1965.
        ``(c) Certain Loan Repayment Programs.--In carrying out the
    National Health Service Corps Loan Repayment Program established under
    subpart III of part D of title III and the loan repayment program under
    section 317F, the Secretary shall ensure, notwithstanding such subpart
    or section, that loan repayments of not less than $50,000 per year per
    person are awarded for repayment of loans incurred for enrollment or
    participation of underrepresented minority individuals in health
    professional schools and other health programs described in this
    section.
        ``(d) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section such sums as may be necessary
    for each of fiscal years 2023 through 2027.''.

    SEC. 3003. 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 by striking ``$500,000 for fiscal year 1994,
    and such sums as may be necessary for each of the fiscal years 1995
    through 2002'' and inserting ``such sums as may be necessary for each
    of fiscal years 2023 through 2027''.

    SEC. 3004. ALLIED HEALTH WORKFORCE DIVERSITY.

        (a) Increasing Workforce Diversity in the Professions of Physical
    Therapy, Occupational Therapy, Respiratory Therapy, Audiology, and
    Speech-Language Pathology.--Title VII of the Public Health Service Act
    is amended--
                (1) by redesignating part G (42 U.S.C. 295j et seq.) as
            part H; and
                (2) by inserting after part F (42 U.S.C. 295h) the
            following new part:

    ``PART G--INCREASING WORKFORCE DIVERSITY IN THE PROFESSIONS OF PHYSICAL
      THERAPY, OCCUPATIONAL THERAPY, RESPIRATORY THERAPY, AUDIOLOGY, AND
                           SPEECH-LANGUAGE PATHOLOGY

    ``SEC. 783. SCHOLARSHIPS AND STIPENDS.

        ``(a) In General.--The Secretary may award grants and contracts to
    eligible entities to increase educational opportunities in the
    professions of physical therapy, occupational therapy, respiratory
    therapy, audiology, and speech-language pathology for eligible
    individuals by--
                ``(1) providing student scholarships or stipends, including
            for--
                        ``(A) completion of an accelerated degree program;
                        ``(B) completion of an associate's, bachelor's,
                    master's, or doctoral degree program; and
                        ``(C) entry by a diploma or associate's degree
                    practitioner into a bridge or degree completion
                    program;
                ``(2) providing assistance for completion of prerequisite
            courses or other preparation necessary for acceptance for
            enrollment in the eligible entity; and
                ``(3) carrying out activities to increase the retention of
            students in one or more programs in the professions of physical
            therapy, occupational therapy, respiratory therapy, audiology,
            and speech-language pathology.
        ``(b) Consideration of Recommendations.--In carrying out subsection
    (a), the Secretary shall take into consideration the recommendations of
    national organizations representing the professions of physical
    therapy, occupational therapy, respiratory therapy, audiology, and
    speech-language pathology, including the American Physical Therapy
    Association, the American Occupational Therapy Association, the
    American Speech-Language-Hearing Association, the American Association
    for Respiratory Care, the American Academy of Audiology, and the
    Academy of Doctors of Audiology.
        ``(c) Required Information and Conditions for Award Recipients.--
                ``(1) In general.--The Secretary may require recipients of
            awards under this section to report to the Secretary concerning
            the annual admission, retention, and graduation rates for
            eligible individuals in programs of the recipient leading to a
            degree in any of the professions of physical therapy,
            occupational therapy, respiratory therapy, audiology, and
            speech-language pathology.
                ``(2) Falling rates.--If any of the rates reported by a
            recipient under paragraph (1) fall below the average for such
            recipient over the two years preceding the year covered by the
            report, the recipient shall provide the Secretary with plans
            for immediately improving such rates.
                ``(3) Ineligibility.--A recipient described in paragraph
            (2) shall be ineligible for continued funding under this
            section if the plan of the recipient fails to improve the rates
            within the 1-year period beginning on the date such plan is
            implemented.
        ``(d) Definitions.--In this section:
                ``(1) Eligible entities.--The term `eligible entity' means
            an accredited education program that is carrying out a program
            for recruiting and retaining students underrepresented in the
            professions of physical therapy, occupational therapy,
            respiratory therapy, audiology, and speech-language pathology
            (including racial or ethnic minorities, or students from
            disadvantaged backgrounds).
                ``(2) Eligible individual.--The term `eligible individual'
            means an individual who--
                        ``(A) is a member of a class of persons who are
                    underrepresented in the professions of physical
                    therapy, occupational therapy, respiratory therapy,
                    audiology, and speech-language pathology, including
                    individuals who are--
                                ``(i) racial or ethnic minorities;
                                ``(ii) from disadvantaged backgrounds; or
                                ``(iii) individuals with a disability (as
                            defined in section 3(1) of the Americans with
                            Disabilities Act of 1990), or who have an
                            individualized education program (as defined in
                            section 602 of the Individuals with
                            Disabilities Education Act), are covered under
                            section 504 of the Rehabilitation Act of 1973,
                            or have other documentation establishing the
                            student's disability (as such term is defined
                            in section 3(1) of the Americans with
                            Disabilities Act of 1990);
                        ``(B) has a financial need for a scholarship or
                    stipend; and
                        ``(C) is enrolled (or accepted for enrollment) at
                    an audiology, speech-language pathology, respiratory
                    therapy, physical therapy, or occupational therapy
                    program as a full-time student at an eligible entity.
        ``(e) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section $8,000,000 for the first fiscal
    year commencing after the date of enactment of the Health Equity and
    Accountability Act of 2022 and each of the 4 succeeding fiscal
    years.''.
        (b) Eligibility Clarification Regarding Students Supported Through
    Mental and Behavioral Health Education and Training Grants.--Section
    756(a)(1) of the Public Health Service Act (42 U.S.C. 294e-1(a)(1)) is
    amended by inserting after ``occupational therapy'' the following:
    ``(which may include master's and doctoral level programs)''.

    SEC. 3005. COOPERATIVE AGREEMENTS FOR ONLINE DEGREE PROGRAMS AT SCHOOLS
                  OF PUBLIC HEALTH AND SCHOOLS OF ALLIED HEALTH.

        Part B of title VII of the Public Health Service Act (42 U.S.C. 293
    et seq.) is amended by inserting after section 755 of such Act (42
    U.S.C. 294e) the following:

    ``SEC. 755A. COOPERATIVE AGREEMENTS FOR ONLINE DEGREE PROGRAMS.

        ``(a) Cooperative Agreements.--The Secretary, acting through the
    Administrator of the Health Resources and Services Administration, in
    consultation with the Director of the Centers for Disease Control and
    Prevention, the Director of the Agency for Healthcare Research and
    Quality, and the Deputy Assistant Secretary for Minority Health, shall
    enter into cooperative agreements with schools of public health and
    schools of allied health to design and implement online degree
    programs.
        ``(b) Priority.--In entering into cooperative agreements under this
    section, the Secretary shall give priority to any school of public
    health or school of allied health that has an established track record
    of serving medically underserved communities.
        ``(c) Requirements.--As a condition of entering into a cooperative
    agreement with the Secretary under this section, a school of public
    health or school of allied health shall agree to design and implement
    an online degree program that meets the following restrictions:
                ``(1) Enrollment of individuals who have obtained a
            secondary school diploma or its recognized equivalent.
                ``(2) Maintaining a significant enrollment of
            underrepresented minority or disadvantaged students.
                ``(3) Achieving a high completion rate of enrolled
            underrepresented minority or disadvantaged students.
        ``(d) Period of Cooperative Agreements.--The period during which
    payments are made through a cooperative agreement entered into under
    this section may not exceed 3 years.
        ``(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 2023 through 2027.''.

    SEC. 3006. NATIONAL HEALTH CARE WORKFORCE COMMISSION.

        (a) Sense of Congress.--It is the sense of Congress that the
    National Health Care Workforce Commission established by section 5101
    of the Patient Protection and Affordable Care Act (42 U.S.C. 294q)
    should, in carrying out its assigned duties under that section, give
    attention to the needs of racial and ethnic minorities, individuals
    with lower socioeconomic status, individuals with mental,
    developmental, and physical disabilities, lesbian, gay, bisexual,
    transgender, queer, and questioning populations, and individuals who
    are members of multiple minority or special population groups.
        (b) Reauthorization.--Section 5101(h)(2) of the Patient Protection
    and Affordable Care Act (42 U.S.C. 294q(h)(2)) is amended by striking
    ``such sums as may be necessary'' and inserting ``$3,000,000 for each
    of fiscal years 2023 through 2025''.

    SEC. 3007. SCHOLARSHIP AND FELLOWSHIP PROGRAMS.

        Subtitle B of title XXXIV of the Public Health Service Act, as
    added by section 3001, is further amended by inserting after section
    3417 the following:

    ``SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH SERVICES CORPS.

        ``(a) In General.--The Director of the Centers for Disease Control
    and Prevention, in collaboration with the Administrator of the Health
    Resources and Services Administration and the Deputy Assistant
    Secretary for Minority Health, shall award grants to eligible entities
    to increase awareness among secondary and postsecondary students of
    career opportunities in the health professions.
        ``(b) Eligibility.--To be eligible to receive a grant under
    subsection (a), an entity shall--
                ``(1) be a clinical, public health, or health services
            organization, community-based or nonprofit entity, or other
            entity determined appropriate by the Director of the Centers
            for Disease Control and Prevention;
                ``(2) serve a health professional shortage area, as
            determined by the Secretary;
                ``(3) work with students, including those from racial and
            ethnic minority backgrounds, that have expressed an interest in
            the health professions; and
                ``(4) submit to the Secretary an application at such time,
            in such manner, and containing such information as the
            Secretary may require.
        ``(c) Use of Funds.--Grant awards under subsection (a) shall be
    used to support internships that will increase awareness among students
    of non-research-based, career opportunities in the following health
    professions:
                ``(1) Medicine.
                ``(2) Nursing.
                ``(3) Public health.
                ``(4) Pharmacy.
                ``(5) Health administration and management.
                ``(6) Health policy.
                ``(7) Psychology.
                ``(8) Dentistry.
                ``(9) International health.
                ``(10) Social work.
                ``(11) Allied health.
                ``(12) Psychiatry.
                ``(13) Hospice care.
                ``(14) Community health, patient navigation, and peer
            support.
                ``(15) Other professions determined appropriate by the
            Director of the Centers for Disease Control and Prevention.
        ``(d) Priority.--In awarding grants under subsection (a), the
    Director of the Centers for Disease Control and Prevention shall give
    priority to those entities that--
                ``(1) serve a high proportion of individuals from
            disadvantaged backgrounds;
                ``(2) have experience in health disparity elimination
            programs;
                ``(3) facilitate the entry of disadvantaged individuals
            into institutions of higher education; and
                ``(4) provide counseling or other services designed to
            assist disadvantaged individuals in successfully completing
            their education at the postsecondary level.
        ``(e) Stipends.--
                ``(1) In general.--Subject to paragraph (2), an entity
            receiving a grant under this section may use the funds made
            available through such grant to award stipends for educational
            and living expenses to students participating in the internship
            supported by the grant.
                ``(2) Limitations.--A stipend awarded under paragraph (1)
            to an individual--
                        ``(A) may not be provided for a period that exceeds
                    6 months; and
                        ``(B) may not exceed $20 per day for an individual
                    (notwithstanding any other provision of law regarding
                    the amount of a stipend).
        ``(f) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section such sums as may be necessary
    for each of fiscal years 2023 through 2027.

    ``SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS PROGRAM.

        ``(a) In General.--The Director of the Centers for Disease Control
    and Prevention, in collaboration with the Deputy Assistant Secretary
    for Minority Health, shall award scholarships to eligible individuals
    under subsection (b) who seek a career in public health.
        ``(b) Eligibility.--To be eligible to receive a scholarship under
    subsection (a), an individual shall--
                ``(1) have interest, knowledge, or skill in public health
            research or public health practice, or other health professions
            as determined appropriate by the Director of the Centers for
            Disease Control and Prevention;
                ``(2) reside in a health professional shortage area as
            determined by the Secretary;
                ``(3) demonstrate promise for becoming a leader in public
            health;
                ``(4) secure admission to a 4-year institution of higher
            education; and
                ``(5) submit to the Secretary an application at such time,
            in such manner, and containing such information as the
            Secretary may require.
        ``(c) Use of Funds.--Amounts received under an award under
    subsection (a) shall be used to support opportunities for students to
    become public health professionals.
        ``(d) Priority.--In awarding grants under subsection (a), the
    Director shall give priority to those students that--
                ``(1) are from disadvantaged backgrounds;
                ``(2) have secured admissions to a minority-serving
            institution; and
                ``(3) have identified a health professional as a mentor at
            their school or institution and an academic advisor to assist
            in the completion of their baccalaureate degree.
        ``(e) Scholarships.--The Secretary may approve payment of
    scholarships under this section for such individuals for any period of
    education in student undergraduate tenure, except that such a
    scholarship may not be provided to an individual for more than 4 years,
    and such a scholarship may not exceed $10,000 per academic year for an
    individual (notwithstanding any other provision of law regarding the
    amount of a scholarship).
        ``(f) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section such sums as may be necessary
    for each of fiscal years 2023 through 2027.

    ``SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH FELLOWSHIP PROGRAM.

        ``(a) In General.--The Director of the Centers for Disease Control
    and Prevention, in collaboration with the Deputy Assistant Secretary
    for Minority Health, the Assistant Secretary for Mental Health and
    Substance Use, and the Director of the Indian Health Service, shall
    award research fellowships to eligible individuals under subsection (b)
    to conduct research that will examine gender and health disparities and
    to pursue a career in the health professions.
        ``(b) Eligibility.--To be eligible to receive a fellowship under
    subsection (a), an individual shall--
                ``(1) have experience in health research or public health
            practice;
                ``(2) reside in a health professional shortage area
            designated by the Secretary under section 332;
                ``(3) have expressed an interest in the health professions;
                ``(4) demonstrate promise for becoming a leader in the
            field of women's sexual and reproductive health, including
            family planning;
                ``(5) secure admission to a health professions school or
            graduate program with an emphasis in gender studies; and
                ``(6) submit to the Secretary an application at such time,
            in such manner, and containing such information as the
            Secretary may require.
        ``(c) Use of Funds.--A fellowship awarded under subsection (a) to
    an eligible individual shall be used to support an opportunity for the
    individual to become a researcher and advance the research base on the
    intersection between gender and health.
        ``(d) Priority.--In awarding fellowships under subsection (a), the
    Director of the Centers for Disease Control and Prevention shall give
    priority to those applicants that--
                ``(1) are from disadvantaged backgrounds; and
                ``(2) have identified a mentor and academic advisor who
            will assist in the completion of their graduate or professional
            degree and have secured a research assistant position with a
            researcher working in the area of gender and health.
        ``(e) Fellowships.--The Director of the Centers for Disease Control
    and Prevention may approve fellowships for individuals under this
    section for any period of education in the student's graduate or health
    profession tenure, except that such a fellowship may not be provided to
    an individual for more than 3 years, and such a fellowship may not
    exceed $18,000 per academic year for an individual (notwithstanding any
    other provision of law regarding the amount of a fellowship).
        ``(f) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section such sums as may be necessary
    for each of fiscal years 2023 through 2027.

    ``SEC. 3421. PAUL DAVID WELLSTONE INTERNATIONAL HEALTH FELLOWSHIP
                  PROGRAM.

        ``(a) In General.--The Director of the Agency for Healthcare
    Research and Quality, in collaboration with the Deputy Assistant
    Secretary for Minority Health, shall award research fellowships to
    eligible individuals under subsection (b) to advance their
    understanding of international health.
        ``(b) Eligibility.--To be eligible to receive a fellowship under
    subsection (a), an individual shall--
                ``(1) have educational experience in the field of
            international health;
                ``(2) reside in a health professional shortage area as
            determined by the Secretary;
                ``(3) demonstrate promise for becoming a leader in the
            field of international health;
                ``(4) be a college senior or recent graduate of a 4-year
            institution of higher education; and
                ``(5) submit to the Secretary an application at such time,
            in such manner, and containing such information as the
            Secretary may require.
        ``(c) Use of Funds.--A fellowship awarded under subsection (a) to
    an eligible individual shall be used to support an opportunity for the
    individual to become a health professional and to advance the knowledge
    of the individual about international issues relating to health care
    access and quality.
        ``(d) Priority.--In awarding fellowships under subsection (a), the
    Director shall give priority to eligible individuals that--
                ``(1) are from a disadvantaged background; and
                ``(2) have identified a mentor at a health professions
            school or institution, an academic advisor to assist in the
            completion of their graduate or professional degree, and an
            advisor from an international health non-governmental
            organization, private volunteer organization, or other
            international institution or program that focuses on increasing
            health care access and quality for residents in developing
            countries.
        ``(e) Fellowships.--A fellowship awarded under this section may
    not--
                ``(1) be provided to an eligible individual for more than a
            period of 6 months;
                ``(2) be awarded to a graduate of a 4-year institution of
            higher education that has not been enrolled in such institution
            for more than 1 year; or
                ``(3) exceed $4,000 per academic year (notwithstanding any
            other provision of law regarding the amount of a fellowship).
        ``(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 2023 through 2027.

    ``SEC. 3422. EDWARD R. ROYBAL HEALTH SCHOLAR PROGRAM.

        ``(a) In General.--The Director of the Agency for Healthcare
    Research and Quality, the Administrator of the Centers for Medicare &
    Medicaid Services, and the Administrator of the Health Resources and
    Services Administration, in collaboration with the Deputy Assistant
    Secretary for Minority Health, shall award grants to eligible entities
    to expose entering graduate students to the health professions.
        ``(b) Eligibility.--To be eligible to receive a grant under
    subsection (a), an entity shall--
                ``(1) be a clinical, public health, or health services
            organization, community-based, academic, or nonprofit entity,
            or other entity determined appropriate by the Director of the
            Agency for Healthcare Research and Quality;
                ``(2) serve in a health professional shortage area
            designated by the Secretary under section 332;
                ``(3) work with students obtaining a degree in the health
            professions; and
                ``(4) submit to the Secretary an application at such time,
            in such manner, and containing such information as the
            Secretary may require.
        ``(c) Use of Funds.--Amounts received under a grant awarded under
    subsection (a) shall be used to support opportunities that expose
    students to non-research-based health professions, including--
                ``(1) public health policy;
                ``(2) health care and pharmaceutical policy;
                ``(3) health care administration and management;
                ``(4) health economics; and
                ``(5) other professions determined appropriate by the
            Director of the Agency for Healthcare Research and Quality, the
            Administrator of the Centers for Medicare & Medicaid Services,
            or the Administrator of the Health Resources and Services
            Administration.
        ``(d) Priority.--In awarding grants under subsection (a), the
    Director of the Agency for Healthcare Research and Quality, the
    Administrator of the Centers for Medicare & Medicaid Services, and the
    Administrator of the Health Resources and Services Administration, in
    collaboration with the Deputy Assistant Secretary for Minority Health,
    shall give priority to entities that--
                ``(1) have experience with health disparity elimination
            programs;
                ``(2) facilitate training in the fields described in
            subsection (c); and
                ``(3) provide counseling or other services designed to
            assist students in successfully completing their education at
            the postsecondary level.
        ``(e) Stipends.--
                ``(1) In general.--Subject to paragraph (2), an entity
            receiving a grant under this section may use the funds made
            available through such grant to award stipends for educational
            and living expenses to students participating in the
            opportunities supported by the grant.
                ``(2) Limitations.--A stipend awarded under paragraph (1)
            to an individual--
                        ``(A) may not be provided for a period that exceeds
                    2 months; and
                        ``(B) may not exceed $100 per day (notwithstanding
                    any other provision of law regarding the amount of a
                    stipend).
        ``(f) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section such sums as may be necessary
    for each of fiscal years 2023 through 2027.

    ``SEC. 3423. LEADERSHIP FELLOWSHIP PROGRAMS.

        ``(a) In General.--The Secretary shall award grants to national
    minority medical or health professional associations to develop
    leadership fellowship programs for underrepresented health
    professionals in order to--
                ``(1) assist such professionals in becoming future leaders
            in public health and health care delivery institutions; and
                ``(2) increase diversity in decision-making positions that
            can improve the health of underserved communities.
        ``(b) Use of Funds.--A leadership fellowship program supported
    under this section shall--
                ``(1) focus on training mid-career physicians and health
            care executives who have documented leadership experience and a
            commitment to public health services in underserved
            communities; and
                ``(2) support Federal public health policy and budget
            programs, and priorities that impact health equity, through
            activities such as didactic lectures and leader site visits.
        ``(c) Period of Grants.--The period during which payments are made
    under a grant awarded under subsection (a) may not exceed 3 years.
        ``(d) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section such sums as may be necessary
    for each of fiscal years 2023 through 2027.''.

    SEC. 3008. MCNAIR POSTBACCALAUREATE ACHIEVEMENT PROGRAM.

        Section 402E of the Higher Education Act of 1965 (20 U.S.C. 1070a-
    15) is amended by striking subsection (g) and inserting the following:
        ``(g) Collaboration in Health Profession Diversity Training
    Programs.--The Secretary shall coordinate with the Secretary of Health
    and Human Services to ensure that there is collaboration between the
    goals of the program under this section and programs of the Health
    Resources and Services Administration that promote health workforce
    diversity. The Secretary of Education shall take such measures as may
    be necessary to encourage students participating in projects assisted
    under this section to consider health profession careers.
        ``(h) Funding.--From amounts appropriated pursuant to the authority
    of section 402A(g), the Secretary shall, to the extent practicable,
    allocate funds for projects authorized by this section in an amount
    that is not less than $31,000,000 for each of the fiscal years 2023
    through 2027.''.

    SEC. 3009. RULES FOR DETERMINATION OF FULL-TIME EQUIVALENT RESIDENTS
                  FOR COST-REPORTING PERIODS.

        (a) DGME Determinations.--Section 1886(h)(4) of the Social Security
    Act (42 U.S.C. 1395ww(h)(4)), as amended by section 2006(a), is
    amended--
                (1) in subparagraph (E), by striking ``Subject to
            subparagraphs (J) and (K), such rules'' and inserting ``Subject
            to subparagraphs (J), (K), and (M), such rules'';
                (2) in subparagraph (J), by striking ``Such rules'' and
            inserting ``Subject to subparagraph (M), such rules'';
                (3) in subparagraph (K), by striking ``In determining'' and
            inserting ``Subject to subparagraph (M), in determining''; and
                (4) by adding at the end the following new subparagraph:
                        ``(M) Treatment of certain residents and interns.--
                    For purposes of cost-reporting periods beginning on or
                    after October 1, 2021, in determining the hospital's
                    number of full-time equivalent residents for purposes
                    of this paragraph, all time spent by an intern or
                    resident in an approved medical residency training
                    program shall be counted toward the determination of
                    full-time equivalency if the hospital--
                                ``(i) is recognized as a subsection (d)
                            hospital;
                                ``(ii) is recognized as a subsection (d)
                            Puerto Rico hospital;
                                ``(iii) is reimbursed under a reimbursement
                            system authorized under section 1814(b)(3); or
                                ``(iv) is a provider-based hospital
                            outpatient department.''.
        (b) IME Determinations.--Section 1886(d)(5)(B)(xi) of the Social
    Security Act (42 U.S.C. 1395ww(d)(5)(B)(xi)), as redesignated by
    section 2006(b), is amended--
                (1) in subclause (II), by striking ``In determining'' and
            inserting ``Subject to subclause (IV), in determining'';
                (2) in subclause (III), by striking ``In determining'' and
            inserting ``Subject to subclause (IV), in determining''; and
                (3) by inserting after subclause (III) the following new
            subclause:
                        ``(IV) For purposes of cost-reporting periods
                    beginning on or after October 1, 2021, the provisions
                    of subparagraph (M) of subsection (h)(4) shall apply
                    under this subparagraph in the same manner as they
                    apply under such subsection.''.

    SEC. 3010. DEVELOPING AND IMPLEMENTING STRATEGIES FOR LOCAL HEALTH
                  EQUITY.

        (a) Grants.--The Secretary of Health and Human Services, acting
    jointly with the Secretary of Education and the Secretary of Labor,
    shall make grants to an eligible institution of higher education for
    the purposes of--
                (1) in accordance with subsection (b), developing
            capacity--
                        (A) to build an evidence base for successful
                    strategies for increasing local health equity; and
                        (B) to serve as national models of driving local
                    health equity; and
                (2) in accordance with subsection (c), developing a
            strategic partnership with the community in which the
            institution is located.
        (b) Developing Capacity for Increasing Local Health Equity.--As a
    condition on receipt of a grant under subsection (a), an institution of
    higher education shall agree to use such grant to build an evidence
    base for successful strategies for increasing local health equity, and
    to serve as a national model of driving local health equity, by
    supporting--
                (1) resources to strengthen institutional metrics and
            capacity to execute institution-wide health workforce goals
            that can serve as models for increasing health equity in
            communities across the United States;
                (2) collaborations among a cohort of institutions in
            implementing systemic change, partnership development, and
            programmatic efforts supportive of health equity goals across
            disciplines and populations; and
                (3) enhanced or newly developed data systems and research
            infrastructure capable of informing current and future
            workforce efforts and building a foundation for a broader
            research agenda targeting urban health disparities.
        (c) Strategic Partnerships.--As a condition on receipt of a grant
    under subsection (a), an institution of higher education shall agree to
    use the grant to develop a strategic partnership with the community in
    which such institution is located for the purposes of--
                (1) strengthening connections between such institution and
            the community--
                        (A) to improve evaluation of, and address, the
                    health and health workforce needs of such community;
                    and
                        (B) to engage such community in health workforce
                    development;
                (2) developing, enhancing, or accelerating innovative
            undergraduate and graduate programs in the biomedical sciences
            and health professions; and
                (3) strengthening pipeline programs in the biomedical
            sciences and health professions, including by developing
            partnerships between institutions of higher education and
            elementary schools and secondary schools to recruit the next
            generation of health professionals earlier in the pipeline to a
            health care career.
        (d) Eligible Institution of Higher Education Defined.--For purposes
    of this section, an ``eligible institution of higher education''
    includes--
                (1) a program authorized under section 317(a) of the Higher
            Education Act of 1965 (20 U.S.C. 1059d(a)); or
                (2) a professional or graduate institution described in
            section 326 of such Act.
        (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 2023 through 2027.

    SEC. 3011. HEALTH PROFESSIONS WORKFORCE FUND.

        (a) Establishment.--There is established in the Health Resources
    and Services Administration of the Department of Health and Human
    Services a Health Professions Workforce Fund to provide for expanded
    and sustained national investment in the health professions and nursing
    workforce development programs under title VII and title VIII of the
    Public Health Service Act (42 U.S.C. 292 et seq.; 42 U.S.C. 296 et
    seq.).
        (b) Funding.--
                (1) In general.--There is authorized to be appropriated,
            and there is appropriated, out of any monies in the Treasury
            not otherwise appropriated, to the Health Professions Workforce
            Fund--
                        (A) $392,000,000 for fiscal year 2023;
                        (B) $412,000,000 for fiscal year 2024;
                        (C) $432,000,000 for fiscal year 2025;
                        (D) $454,000,000 for fiscal year 2026;
                        (E) $476,000,000 for fiscal year 2027;
                        (F) $500,000,000 for fiscal year 2028;
                        (G) $525,000,000 for fiscal year 2029; and
                        (H) $552,000,000 for fiscal year 2030.
                (2) Health professions education programs.--For the purpose
            of carrying out health professions education programs
            authorized under title VII of the Public Health Service Act (42
            U.S.C. 292 et seq.), in addition to any other amounts
            authorized to be appropriated for such purpose, there is
            authorized to be appropriated out of any monies in the Health
            Professions Workforce Fund, the following:
                        (A) $265,000,000 for fiscal year 2023.
                        (B) $278,000,000 for fiscal year 2024.
                        (C) $292,000,000 for fiscal year 2025.
                        (D) $307,000,000 for fiscal year 2026.
                        (E) $322,000,000 for fiscal year 2027.
                        (F) $338,000,000 for fiscal year 2028.
                        (G) $355,000,000 for fiscal year 2029.
                        (H) $373,000,000 for fiscal year 2030.
                (3) Nursing workforce development programs.--For the
            purpose of carrying out nursing workforce development programs
            authorized under title VIII of the Public Health Service Act
            (42 U.S.C. 296 et seq.), in addition to any other amounts
            authorized to be appropriated for such purpose, there is
            authorized to be appropriated out of any monies in the Health
            Professions Workforce Fund, the following:
                        (A) $127,000,000 for fiscal year 2023.
                        (B) $134,000,000 for fiscal year 2024.
                        (C) $140,000,000 for fiscal year 2025.
                        (D) $147,000,000 for fiscal year 2026.
                        (E) $154,000,000 for fiscal year 2027.
                        (F) $162,000,000 for fiscal year 2028.
                        (G) $170,000,000 for fiscal year 2029.
                        (H) $179,000,000 for fiscal year 2030.

    SEC. 3012. FUTURE ADVANCEMENT OF ACADEMIC NURSING.

        (a) Support for Nursing Education and the Future Nursing
    Workforce.--Part D of title VIII of the Public Health Service Act (42
    U.S.C. 296p et seq.) is amended by adding at the end the following:

    ``SEC. 832. NURSING EDUCATION ENHANCEMENT AND MODERNIZATION GRANTS IN
                  UNDERSERVED AREAS.

        ``(a) In General.--The Secretary, acting through the Administrator
    of the Health Resources and Services Administration, may award grants
    to schools of nursing (as defined in section 801) for--
                ``(1) increasing the number of faculty and students at such
            schools in order to enhance the preparedness of the United
            States for, and the ability of the United States to address and
            quickly respond to, public health emergencies declared under
            section 319 and pandemics; or
                ``(2) the enhancement and modernization of nursing
            education programs.
        ``(b) Priority.--In selecting grant recipients under this section,
    the Secretary shall give priority to schools of nursing that--
                ``(1) are located in a medically underserved community;
                ``(2) are located in a health professional shortage area as
            defined under section 332(a); or
                ``(3) are institutions of higher education listed under
            section 371(a) of the Higher Education Act of 1965.
        ``(c) Consideration.--In awarding grants under this section, the
    Secretary, to the extent practicable, may ensure equitable distribution
    of awards among the geographic regions of the United States.
        ``(d) Use of Funds.--A school of nursing that receives a grant
    under this section may use the funds awarded through such grant for
    activities that include--
                ``(1) enhancing enrollment and retention of students at
            such school, with a priority for students from disadvantaged
            backgrounds (including racial or ethnic groups underrepresented
            in the nursing workforce), individuals from rural and
            underserved areas, low-income individuals, and first generation
            college students (as defined in section 402A(h)(3) of the
            Higher Education Act of 1965);
                ``(2) creating, supporting, or modernizing educational
            programs and curriculum at such school;
                ``(3) retaining current faculty, and hiring new faculty,
            with an emphasis on faculty from racial or ethnic groups who
            are underrepresented in the nursing workforce;
                ``(4) modernizing infrastructure at such school, including
            audiovisual or other equipment, personal protective equipment,
            simulation and augmented reality resources, telehealth
            technologies, and virtual and physical laboratories;
                ``(5) partnering with a health care facility, nurse-managed
            health clinic, community health center, or other facility that
            provides health care in order to provide educational
            opportunities for the purpose of establishing or expanding
            clinical education;
                ``(6) enhancing and expanding nursing programs that prepare
            nurse researchers and scientists;
                ``(7) establishing nurse-led intradisciplinary and
            interprofessional educational partnerships; and
                ``(8) other activities that the Secretary determines
            further the development, improvement, and expansion of schools
            of nursing.
        ``(e) Reports From Entities.--Each school of nursing awarded a
    grant under this section shall submit an annual report to the Secretary
    on the activities conducted under such grant, and other information as
    the Secretary may require.
        ``(f) Report to Congress.--Not later than 5 years after the date of
    the enactment of this section, the Secretary shall submit to the
    Committee on Health, Education, Labor, and Pensions of the Senate and
    the Committee on Energy and Commerce of the House of Representatives a
    report that provides a summary of the activities and outcomes
    associated with grants made under this section. Such report shall
    include--
                ``(1) a list of schools of nursing receiving grants under
            this section, including the primary geographic location of any
            school of nursing that was improved or expanded through such a
            grant;
                ``(2) the total number of students who are enrolled at or
            who have graduated from any school of nursing that was improved
            or expanded through a grant under this section, which such
            statistic shall--
                        ``(A) to the extent such information is available,
                    be deidentified and disaggregated by race, ethnicity,
                    age, sex, geographic region, disability status, and
                    other relevant factors; and
                        ``(B) include an indication of the number of such
                    students who are from racial or ethnic groups
                    underrepresented in the nursing workforce, such
                    students who are from rural or underserved areas, such
                    students who are low-income students, and such students
                    who are first generation college students (as defined
                    in section 402A(h)(3) of the Higher Education Act of
                    1965);
                ``(3) to the extent such information is available, the
            effects of the grants awarded under this section on retaining
            and hiring of faculty, including any increase in diverse
            faculty, the number of clinical education partnerships, the
            modernization of nursing education infrastructure, and other
            ways this section helps address and quickly respond to public
            health emergencies and pandemics;
                ``(4) recommendations for improving the grants awarded
            under this section; and
                ``(5) any other considerations as the Secretary determines
            appropriate.
        ``(g) Authorization of Appropriations.--To carry out this section,
    there is authorized to be appropriated $1,000,000,000, to remain
    available until expended.''.
        (b) Strengthening Nurse Education.--The heading of part D of title
    VIII of the Public Health Service Act (42 U.S.C. 296p et seq.) is
    amended by striking ``basic''.

    SEC. 3013. FINDINGS; SENSE OF CONGRESS RELATING TO GRADUATE MEDICAL
                  EDUCATION.

        (a) Findings.--Congress finds the following:
                (1) Projections by the Association of American Medical
            Colleges and other expert entities, such as the Health
            Resources and Services Administration, have indicated a
            nationwide shortage of up to 121,900 physicians, split evenly
            between primary care and specialists, by 2032.
                (2) Primarily due to the growing and aging population, over
            the next decade, physician demand is expected to grow up to 17
            percent.
                (3) The United States Census Bureau estimates that the
            United States population will grow from 321,000,000 in 2015 to
            347,000,000 in 2025. Further, the number of Medicare
            beneficiaries is estimated to increase from 47,800,000 in 2015
            to approximately 66,000,000 in 2025.
                (4) Approximately 36 percent of practicing physicians are
            over the age of 55 and are likely to retire within the next
            decade.
                (5) A nationwide physician shortage will result in many
            individuals in the United States waiting longer and traveling
            farther for health care; seeking nonemergent care in emergency
            departments; and delaying treatment until the health care needs
            of such individuals become more serious, complex, and costly.
                (6) Changing demographics (such as an aging population),
            new health care delivery models (such as medical homes), and
            other factors (such as disaster preparedness) are contributing
            to a shortage of both generalist and specialist physicians.
                (7) These shortages will have the most severe impact on
            vulnerable and underserved populations, including racial and
            ethnic minorities and the approximately 20 percent of people in
            the United States who live in rural or inner-city locations
            designated as health professional shortage areas.
                (8) The health care utilization equity model of the
            Association of American Medical Colleges estimates that if
            racial and ethnic minorities and individuals from rural areas
            utilized health care in a similar way to their Caucasian
            counterparts living in metropolitan areas, the physician
            shortage would require an additional 96,000 physicians.
                (9) To address the physician shortage in rural and
            medically underserved areas, medical education and training
            need to be accessible to underrepresented minorities (including
            individuals who are African American, Hispanic, Native
            American, or Native Hawaiian), and need to increase pathway
            programs for such underrepresented minorities who make up less
            than 12 percent of individuals enrolled in graduate medical
            education and for international students who make up 25 percent
            of individuals enrolled in graduate medical education.
            Immigration pathways like student, exchange-visitor, and
            employment visas, and programs like the National Interest
            Waiver and Conrad 30 J-1 Visa Waiver, help improve health
            access across the United States.
                (10) United States medical school enrollment was expected
            to grow by 30 percent from 2018 to 2019 to help reduce the
            shortage of quality physicians in the United States.
                (11) An increase in United States medical school graduates
            must be accompanied by an increase of 4,000 graduate medical
            education training positions each year.
                (12) Graduate medical education programs and teaching
            hospitals provide venues in which the next generation of
            physicians learns to work collaboratively with other physicians
            and health professionals, adopt more efficient care delivery
            models (such as care coordination and medical homes),
            incorporate health information technology and electronic health
            records in every aspect of their work, apply new methods of
            assuring quality and safety, and participate in groundbreaking
            clinical and public health research.
                (13) The Medicare program under title XVIII of the Social
            Security Act (42 U.S.C. 1395 et seq.) (having more
            beneficiaries than any other health care program), supports its
            ``fair share'' of the costs associated with graduate medical
            education.
                (14) In general, the level of support of graduate medical
            education by the Medicare program has been capped since 1997
            and has not been increased to support the expansion of graduate
            medical education programs needed to avert the projected
            physician shortage or to accommodate the increase in United
            States medical school graduates.
        (b) Sense of Congress.--It is the sense of Congress that
    eliminating the limit of the number of residency positions that receive
    some level of Medicare support under section 1886(h) of the Social
    Security Act (42 U.S.C. 1395ww(h)), also referred to as the Medical
    graduate medical education cap, is critical to--
                (1) ensuring an appropriate supply of physicians to meet
            the health care needs in the United States;
                (2) facilitating equitable access for all who seek health
            care;
                (3) increasing the racial and ethnic diversity of
            physicians in the United States; and
                (4) mitigating disparities in health and health care.

    SEC. 3014. CAREER SUPPORT FOR SKILLED, INTERNATIONALLY EDUCATED HEALTH
                  PROFESSIONALS.

        (a) Findings.--Congress finds the following:
                (1) According to a 2018 study, the State and local public
            health workforce has shrunk by more than 50,000 individuals
            since the beginning of the 2008 Great Recession, and almost one
            quarter of individuals comprising the governmental public
            health workforce plan to leave or retire in the coming years.
                (2) Shortages are projected for other health professions,
            including within the fields of nursing (500,000 by 2025),
            dentistry (15,000 by 2025), pharmacy (38,000 by 2030), mental
            and behavioral health (236,880 by 2025), and primary care
            (46,000 by 2025).
                (3) A nationwide health workforce shortage will result in
            serious health threats and more severe and costly health care
            needs, due to, in part, a delayed response to food-borne
            outbreaks, emerging infectious diseases, natural disasters,
            fewer cancer screenings, and delayed treatment.
                (4) Vulnerable and underserved populations and health
            professional shortage areas will be most severely impacted by
            the health workforce shortage.
                (5) According to the Migration Policy Institute, more than
            2,000,000 college-educated immigrants in the United States
            today are unemployed or underemployed in low- or semi-skilled
            jobs that fail to draw on their education and expertise.
                (6) Approximately 2 out of every 5 internationally educated
            immigrants are unemployed or underemployed.
                (7) According to the Drexel University Center for Labor
            Markets and Policy, underemployment for internationally
            educated immigrant women is 28 percent higher than for their
            male counterparts.
                (8) According to the Drexel University Center for Labor
            Markets and Policy, the mean annual earnings of underemployed
            immigrants were $32,000, or 43 percent less than United States
            born college graduates employed in the college labor market.
                (9) According to Upwardly Global and the Welcome Back
            Initiative, with proper guidance and support, underemployed
            skilled immigrants typically increase their income by 215
            percent to 900 percent.
                (10) According to the Brookings Institution and the
            Partnership for a New American Economy, immigrants working in
            the health workforce are, on average, better educated than
            United States-born workers in the health workforce.
        (b) Grants to Eligible Entities.--
                (1) Authority to provide grants.--The Secretary of Health
            and Human Services acting through the Bureau of Health
            Workforce within the Health Resources and Services
            Administration, the National Institute on Minority Health and
            Health Disparities, or the Office of Minority Health (in this
            section referred to as the ``Secretary'') may award grants to
            eligible entities to carry out activities described in
            subsection (c).
                (2) Eligibility.--To be eligible to receive a grant under
            this section, an entity shall--
                        (A) be a clinical, public health, or health
                    services organization, a community-based or nonprofit
                    entity, an academic institution, a faith-based
                    organization, a State, county, or local government, an
                    area health education center, or another entity
                    determined appropriate by the Secretary; and
                        (B) submit to the Secretary an application at such
                    time, in such manner, and containing such information
                    as the Secretary may require.
        (c) Authorized Activities.--A grant awarded under this section
    shall be used--
                (1) to provide services to assist unemployed and
            underemployed skilled immigrants, residing in the United
            States, who have legal, permanent work authorization and who
            are internationally educated health professionals, enter into
            the health workforce of the United States with employment
            matching their health professional skills and education, and
            advance in employment to positions that better match their
            health professional education and expertise;
                (2) to provide training opportunities to reduce barriers to
            entry and advancement in the health workforce for skilled,
            internationally educated immigrants;
                (3) to educate employers regarding the abilities and
            capacities of internationally educated health professionals;
                (4) to assist in the evaluation of foreign credentials;
                (5) to support preceptorships for international medical
            graduates in hospital primary care training; and
                (6) to facilitate access to contextualized and accelerated
            courses on English as a second language.

    SEC. 3015. 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. 3016. CONRAD STATE 30 PROGRAM; PHYSICIAN RETENTION.

        (a) Conrad State 30 Program Extension.--Section 220(c) of the
    Immigration and Nationality Technical Corrections Act of 1994 (Public
    Law 103-416; 8 U.S.C. 1182 note) is amended by striking ``September 30,
    2015'' and inserting ``September 30, 2022''.
        (b) Retaining Physicians Who Have Practiced in Medically
    Underserved Communities.--Section 201(b)(1) of the Immigration and
    Nationality Act (8 U.S.C. 1151(b)(1)) is amended by adding at the end
    the following:
                        ``(F)(i) Alien physicians who have completed
                    service requirements for a national interest waiver
                    requested under section 203(b)(2)(B)(ii), including--
                                ``(I) alien physicians who completed such
                            service before the date of the enactment of the
                            Health Equity and Accountability Act of 2022;
                            and
                                ``(II) the spouse or children of an alien
                            physician described in subclause (I).
                        ``(ii) Nothing in this subparagraph may be
                    construed--
                                ``(I) to prevent the filing of a petition
                            with the Secretary of Homeland Security for
                            classification under section 204(a) or the
                            filing of an application for adjustment of
                            status under section 245 by an alien physician
                            described in clause (i) before the date on
                            which such alien physician completes the
                            service described in section 214(l) or worked
                            full-time as a physician for an aggregate of 5
                            years at the location identified in the waiver
                            of the 2-year foreign residence requirement
                            under section 214(l) or in an area or areas
                            designated by the Secretary of Health and Human
                            Services as having a shortage of health care
                            professionals; or
                                ``(II) to permit the Secretary of Homeland
                            Security to grant a petition or application
                            described in subclause (I) until the alien has
                            satisfied all of the requirements of the waiver
                            received under section 214(l).''.
        (c) Employment Protections for Physicians.--
                (1) Exceptions to 2-year foreign residency requirement.--
            Section 214(l)(1) of the Immigration and Nationality Act (8
            U.S.C. 1184(l)(1)) is amended--
                        (A) in the matter preceding subparagraph (A), by
                    striking ``Attorney General shall not'' and inserting
                    ``Secretary of Homeland Security may not'';
                        (B) in subparagraph (A), by striking ``Director of
                    the United States Information Agency'' and inserting
                    ``Secretary of State'';
                        (C) in subparagraph (B), by inserting ``, except as
                    provided in paragraphs (7) and (8)'' before the
                    semicolon at the end;
                        (D) in subparagraph (C), by amending clauses (i)
                    and (ii) to read as follows:
                                ``(i) the alien demonstrates a bona fide
                            offer of full-time employment at a health
                            facility or health care organization, which
                            employment has been determined by the Secretary
                            of Homeland Security to be in the public
                            interest; and
                                ``(ii) the alien--
                                        ``(I) has accepted employment with
                                    the health facility or health care
                                    organization in a geographic area or
                                    areas which are designated by the
                                    Secretary of Health and Human Services
                                    as having a shortage of health care
                                    professionals;
                                        ``(II) begins employment by the
                                    later of the date that is--
                                                ``(aa) 120 days after
                                            receiving such waiver;
                                                ``(bb) 120 days after
                                            completing graduate medical
                                            education or training under a
                                            program approved pursuant to
                                            section 212(j)(1); or
                                                ``(cc) 120 days after
                                            receiving nonimmigrant status
                                            or employment authorization, if
                                            the alien or the alien's
                                            employer petitions for such
                                            nonimmigrant status or
                                            employment authorization not
                                            later than 120 days after the
                                            date on which the alien
                                            completes his or her graduate
                                            medical education or training
                                            under a program approved
                                            pursuant to section 212(j)(1);
                                            and
                                        ``(III) agrees to continue to work
                                    for a total of not less than 3 years in
                                    the status authorized for such
                                    employment under this subsection,
                                    except as provided in paragraph (8);
                                    and''; and
                        (E) in subparagraph (D), in the matter preceding
                    clause (i), by inserting ``, subject to paragraph
                    (8),'' before ``in the case''.
                (2) Allowable visa status for physicians fulfilling waiver
            requirements in medically underserved areas.--Section
            214(l)(2)(A) of such Act (8 U.S.C. 1184(l)(2)(A)) is amended to
            read as follows:
                        ``(A) Upon the request of an interested Federal
                    agency or an interested State agency for recommendation
                    of a waiver under this section by a physician who is
                    maintaining valid nonimmigrant status under section
                    101(a)(15)(J) and received a favorable recommendation
                    by the Secretary of State, the Secretary of Homeland
                    Security may change the status of such physician to any
                    status authorized for employment under this Act. The
                    numerical limitations set forth in subsection (g)(1)(A)
                    shall not apply to any alien whose status is changed
                    under this subparagraph.''.
                (3) Violation of agreements.--Section 214(l)(3)(A) of such
            Act (8 U.S.C. 1184(l)(3)(A)) is amended by inserting
            ``substantial requirement of an'' before ``agreement entered
            into''.
                (4) Physician employment in underserved areas.--Section
            214(l) of such Act (8 U.S.C. 1184(l)), as amended by this
            section, is further amended by adding at the end the following:
                ``(4)(A) If an interested State agency denies the
            application for a waiver under paragraph (1)(B) from a
            physician pursuing graduate medical education or training
            pursuant to section 101(a)(15)(J) because the State has
            requested the maximum number of waivers permitted for that
            fiscal year, the physician's nonimmigrant status shall be
            extended for up to 6 months if the physician agrees to seek a
            waiver under this subsection (except for paragraph (1)(D)(ii))
            to work for an employer described in paragraph (1)(C) in a
            State that has not yet requested the maximum number of waivers.
                ``(B) A physician described in subparagraph (A) may only
            work for the employer referred to in subparagraph (A) during
            the period beginning on the date on which a new waiver
            application is filed with such State and ending on the earlier
            of--
                        ``(i) the date on which the Secretary of Homeland
                    Security denies such waiver; or
                        ``(ii) the date on which the Secretary approves an
                    application for change of status under paragraph (2)(A)
                    pursuant to the approval of such waiver.''.
                (5) Contract requirements.--Section 214(l) of such Act, as
            amended by this section, is further amended by adding at the
            end the following:
                ``(5) An alien granted a waiver under paragraph (1)(C)
            shall enter into an employment agreement with the contracting
            health facility or health care organization that--
                        ``(A) specifies the maximum number of on-call hours
                    per week (which may be a monthly average) that the
                    alien will be expected to be available and the
                    compensation the alien will receive for on-call time;
                        ``(B) specifies--
                                ``(i) whether the contracting facility or
                            organization will pay the alien's malpractice
                            insurance premiums;
                                ``(ii) whether the employer will provide
                            malpractice insurance; and
                                ``(iii) the amount of such insurance that
                            will be provided;
                        ``(C) describes all of the work locations that the
                    alien will work including a statement that the
                    contracting facility or organization will not add
                    additional work locations without the approval of the
                    Federal agency or State agency that requested the
                    waiver; and
                        ``(D) does not include a non-compete provision.
                ``(6) An alien granted a waiver under this subsection whose
            employment relationship with a health facility or health care
            organization terminates under paragraph (1)(C)(ii) during the
            3-year service period required under paragraph (1) shall be
            considered to be maintaining lawful status in an authorized
            period of stay during the 120-day period referred to in items
            (aa) and (bb) of subclause (III) of paragraph (1)(C)(ii) or the
            45-day period referred to in subclause (III)(cc) of such
            paragraph.''.
                (6) Recapturing waiver slots lost to other states.--Section
            214(l) of such Act, as amended by this section, is further
            amended by adding at the end the following:
                ``(7) If a recipient of a waiver under this subsection
            terminates the recipient's employment with a health facility or
            health care organization pursuant to paragraph (1)(C)(ii),
            including termination of employment because of circumstances
            described in paragraph (1)(C)(ii)(III), and accepts new
            employment with such a facility or organization in a different
            State, the State from which the alien is departing may be
            accorded an additional waiver by the Secretary of State for use
            in the fiscal year in which the alien's employment was
            terminated.''.
                (7) Exception to 3-year work requirement.--Section 214(l)
            of such Act, as amended by this section, is further amended by
            adding at the end the following:
                ``(8) The 3-year work requirement set forth in
            subparagraphs (C) and (D) of paragraph (1) shall not apply if--
                        ``(A)(i) the Secretary of Homeland Security
                    determines that extenuating circumstances, including
                    violations by the employer of the employment agreement
                    with the alien or of labor and employment laws, exist
                    that justify a lesser period of employment at such
                    facility or organization; and
                        ``(ii) not later than 120 days after the employment
                    termination date (unless the Secretary determines that
                    extenuating circumstances would justify an extension),
                    the alien demonstrates another bona fide offer of
                    employment at a health facility or health care
                    organization in a geographic area or areas which are
                    designated by the Secretary of Health and Human
                    Services as having a shortage of health care
                    professionals, for the remainder of such 3-year period;
                        ``(B)(i) the interested State agency that requested
                    the waiver attests that extenuating circumstances,
                    including violations by the employer of the employment
                    agreement with the alien or of labor and employment
                    laws, exist that justify a lesser period of employment
                    at such facility or organization; and
                        ``(ii) the alien demonstrates, not later than 120
                    days after the employment termination date (unless the
                    Secretary determines that extenuating circumstances
                    would justify an extension), another bona fide offer of
                    employment at a health facility or health care
                    organization in a geographic area or areas which are
                    designated by the Secretary of Health and Human
                    Services as having a shortage of health care
                    professionals, for the remainder of such 3-year period;
                    or
                        ``(C) the alien--
                                ``(i) elects not to pursue a determination
                            of extenuating circumstances pursuant to
                            subparagraph (A) or (B);
                                ``(ii) terminates the alien's employment
                            relationship with the health facility or health
                            care organization at which the alien was
                            employed;
                                ``(iii) not later than 45 days after the
                            employment termination date, demonstrates
                            another bona fide offer of employment at a
                            health facility or health care organization in
                            a geographic area or areas, in the State that
                            requested the alien's waiver, which are
                            designated by the Secretary of Health and Human
                            Services as having a shortage of health care
                            professionals; and
                                ``(iv) agrees to be employed for the
                            remainder of such 3-year period, and 1
                            additional year for each termination under
                            clause (ii).''.
        (d) Allotment of CONRAD 30 Waivers.--
                (1) In general.--Section 214(l) of the Immigration and
            Nationality Act (8 U.S.C. 1184(l)), as amended by subsection
            (c), is further amended by adding at the end the following:
        ``(9)(A)(i) All States shall be allotted 35 waivers under paragraph
    (1)(B) for each fiscal year if 90 percent of the waivers available to
    the States receiving at least 5 waivers were used in the previous
    fiscal year.
        ``(ii) When an allotment occurs under clause (i), all States shall
    be allotted an additional 5 waivers under paragraph (1)(B) for each
    subsequent fiscal year if 90 percent of the waivers available to the
    States receiving at least 5 waivers were used in the previous fiscal
    year. If the States are allotted 45 or more waivers for a fiscal year,
    the States will only receive an additional increase of 5 waivers the
    following fiscal year if 95 percent of the waivers available to the
    States receiving at least 1 waiver were used in the previous fiscal
    year.
        ``(B) Any increase in allotments under subparagraph (A) shall be
    maintained indefinitely, unless in a fiscal year the total number of
    such waivers granted is 5 percent lower than in the last year in which
    there was an increase in the number of waivers allotted pursuant to
    this paragraph. In such case--
                ``(i) the number of waivers allotted beginning in the next
            fiscal year shall be decreased by 5 for all States; and
                ``(ii) each additional 5 percent decrease in such waivers
            granted from the last year in which there was an increase in
            the allotment, shall result in an additional decrease of 5
            waivers allotted for all States, provided that the number of
            waivers allotted for all States shall not drop below 30.''.
                (2) Academic medical centers.--Section 214(l)(1)(D) of such
            Act, as amended by subsection (c)(1)(E), is further amended--
                        (A) in clause (ii), by striking ``and'' at the end;
                        (B) in clause (iii), by striking the period at the
                    end and inserting ``; and''; and
                        (C) by adding at the end the following:
                        ``(iv) in the case of a request by an interested
                    State agency--
                                ``(I) the head of such agency determines
                            that the alien is to practice medicine in, or
                            be on the faculty of a residency program at, an
                            academic medical center (as defined in section
                            411.355(e)(2) of title 42, Code of Federal
                            Regulations), without regard to whether such
                            facility is located within an area designated
                            by the Secretary of Health and Human Services
                            as having a shortage of health care
                            professionals; and
                                ``(II) the head of such agency determines
                            that--
                                        ``(aa) the alien physician's work
                                    is in the public interest; and
                                        ``(bb) subject to paragraph (6),
                                    the grant of such waiver would not
                                    cause the number of the waivers granted
                                    on behalf of aliens for such State for
                                    a fiscal year to exceed 3, within the
                                    limitation under subparagraph (B).''.
        (e) Amendments to the Procedures, Definitions, and Other Provisions
    Related to Physician Immigration.--
                (1) Dual intent for physicians seeking graduate medical
            training.--Section 214(b) of the Immigration and Nationality
            Act (8 U.S.C. 1184(b)) is amended by striking ``and other than
            a nonimmigrant described in any provision of section
            101(a)(15)(H)(i) except subclause (b1) of such section)'' and
            inserting ``a nonimmigrant described in any provision of
            section 101(a)(15)(H)(i) (except subclause (b1) of such
            section), and an alien coming to the United States to receive
            graduate medical education or training as described in section
            212(j) or to take examinations required to receive graduate
            medical education or training as described in section
            212(j))''.
                (2) Physician national interest waiver clarifications.--
                        (A) Practice and geographic area.--Section
                    203(b)(2)(B)(ii)(I) of the Immigration and Nationality
                    Act (8 U.S.C. 1153(b)(2)(B)(ii)(I)) is amended by
                    striking items (aa) and (bb) and inserting the
                    following:
                                ``(aa) the alien physician agrees to work
                            on a full-time basis practicing primary care,
                            specialty medicine, or a combination thereof,
                            in an area or areas designated by the Secretary
                            of Health and Human Services as having a
                            shortage of health care professionals, or at a
                            health care facility under the jurisdiction of
                            the Secretary of Veterans Affairs; or
                                ``(bb) the alien physician is pursuing such
                            waiver based upon service at a facility or
                            facilities that serve patients who reside in a
                            geographic area or areas designated by the
                            Secretary of Health and Human Services as
                            having a shortage of health care professionals
                            (without regard to whether such facility or
                            facilities are located within such an area) and
                            a Federal agency, or a local, county, regional,
                            or State department of public health determines
                            the alien physician's work was or will be in
                            the public interest.''.
                        (B) Five-year service requirement.--Section
                    203(b)(2)(B)(ii) of such Act is amended--
                                (i) by moving subclauses (II), (III), and
                            (IV) 4 ems to the left; and
                                (ii) in subclause (II)--
                                        (I) by inserting ``(aa)'' after
                                    ``(II)''; and
                                        (II) by adding at the end the
                                    following:
                                ``(bb) The 5-year service requirement
                            described in item (aa) shall begin on the date
                            on which the alien physician begins work in the
                            shortage area in any legal status and not on
                            the date on which an immigrant visa petition is
                            filed or approved. Such service shall be
                            aggregated without regard to when such service
                            began and without regard to whether such
                            service began during or in conjunction with a
                            course of graduate medical education.
                                ``(cc) An alien physician shall not be
                            required to submit an employment contract with
                            a term exceeding the balance of the 5-year
                            commitment yet to be served or an employment
                            contract dated within a minimum time period
                            before filing a visa petition under this
                            subsection.
                                ``(dd) An alien physician shall not be
                            required to file additional immigrant visa
                            petitions upon a change of work location from
                            the location approved in the original national
                            interest immigrant petition.''.
                (3) Technical clarification regarding advanced degree for
            physicians.--Section 203(b)(2)(A) of such Act is amended by
            adding at the end the following: ``An alien physician holding a
            foreign medical degree that has been deemed sufficient for
            acceptance by an accredited United States medical residency or
            fellowship program shall be considered a member of the
            professions holding an advanced degree or its equivalent for
            purposes of this paragraph.''.
                (4) Short-term work authorization for physicians completing
            their residencies.--
                        (A) In general.--A physician completing graduate
                    medical education or training described in section
                    212(j) of the Immigration and Nationality Act (8 U.S.C.
                    1182(j)) as a nonimmigrant described in section
                    101(a)(15)(H)(i) of such Act (8 U.S.C.
                    1101(a)(15)(H)(i))--
                                (i) shall have such nonimmigrant status
                            automatically extended until October 1 of the
                            fiscal year for which a petition for a
                            continuation of such nonimmigrant status has
                            been submitted in a timely manner and the
                            employment start date for the beneficiary of
                            such petition is October 1 of that fiscal year;
                            and
                                (ii) shall be authorized to be employed
                            incident to status during the period between
                            the filing of such petition and October 1 of
                            such fiscal year.
                        (B) Termination.--The status and employment
                    authorization of a physician described in subparagraph
                    (A) shall terminate on the date that is 30 days after
                    the date on which a petition described in clause (i)(I)
                    is rejected, denied or revoked.
                        (C) Automatic extension.--The status and employment
                    authorization of a physician described in subparagraph
                    (A) will automatically extend to October 1 of the next
                    fiscal year if all of the visas described in section
                    101(a)(15)(H)(i) of the Immigration and Nationality Act
                    (8 U.S.C. 1101(a)(15)(H)(i)) that were authorized to be
                    issued for the fiscal year have been issued.
                (5) Applicability of section 212(e) to spouses and children
            of j-1 exchange visitors.--A spouse or child of an exchange
            visitor described in section 101(a)(15)(J) of the Immigration
            and Nationality Act (8 U.S.C. 1101(a)(15)(J)) shall not be
            subject to the requirements under section 212(e) of such Act (8
            U.S.C. 1182(e)).

    SEC. 3017. NATIONAL HISPANIC NURSES DAY.

        (a) Findings.--Congress finds the following:
                (1) A special group of nurses in the Nation are the
            Hispanic nurses.
                (2) Hispanic nurses provide culturally and ethnically
            competent care and are educated to be sensitive to regional and
            community customs of persons needing care.
                (3) Hispanic nurses are well-positioned to provide
            leadership to eliminate health care disparities that exist in
            the Nation.
                (4) Since 1975, the National Association of Hispanic Nurses
            (NAHN) has represented Hispanic nurses (RNs/LPNs) in the United
            States and is the only nursing organization for Hispanic nurses
            whose mission is to advance the health in Hispanic communities
            and to lead, promote, and advocate for educational,
            professional, and leadership opportunities for Hispanic nurses.
                (5) Since September is the month that has been set aside to
            honor the contributions of Hispanics, it is only fitting that
            Hispanic nurses be recognized and honored during this time for
            their outstanding contributions to their community and country.
                (6) The designation of an observation day will help to
            raise awareness of the accomplishments of Hispanic nurses and
            pave the way for the important work that they must continue to
            carry out.
                (7) Each February, the NAHN convenes nearly 100 nursing
            leaders from academia, research, education, and practice in the
            District of Columbia for a day on Capitol Hill promoting
            legislation that improves the health of Hispanic communities.
                (8) Hispanic nurses are strong allies to Congress as they
            help inform, educate, and work closely with legislators to
            improve the education, retention, recruitment, and practice of
            all nurses and, more importantly, the health and safety of the
            patients they care for.
                (9) Hispanic nurses add needed diversity to the nursing
            profession, and these nurses have engaged in numerous ways to
            support communities and the needs of an overlooked, under
            resourced, and underserved population being severely impacted
            by COVID-19.
        (b) Sense of Congress.--The Congress--
                (1) supports the goals and ideals, and the designation, of
            National Hispanic Nurses Day, as proposed by the National
            Association of Hispanic Nurses;
                (2) recognizes the significant contributions of Hispanic
            nurses to the health care system of the United States; and
                (3) encourages the people of the United States to observe
            National Hispanic Nurses Day with appropriate recognition,
            ceremonies, activities, and programs to demonstrate the
            importance of Hispanic nurses to the everyday lives of patients
            and the communities they serve.

    SEC. 3018. EXPANDING MEDICAL EDUCATION.

        Subpart II of part C of title VII of the Public Health Service Act
    (42 U.S.C. 293m et seq.) is amended by adding at the end the following:

    ``SEC. 749C. GRANTS FOR SCHOOLS OF MEDICINE AND SCHOOLS OF OSTEOPATHIC
                  MEDICINE IN UNDERSERVED AREAS.

        ``(a) In General.--The Secretary, acting through the Administrator
    of the Health Resources and Services Administration, may award grants
    to institutions of higher education (including consortiums of such
    institutions) for the establishment, improvement, or expansion of a
    school of medicine or osteopathic medicine, or a branch campus of a
    school of medicine or osteopathic medicine.
        ``(b) Priority.--In selecting grant recipients under this section,
    the Secretary shall give priority to any institution of higher
    education (or consortium of such institutions) that--
                ``(1) proposes to use the grant for the establishment of a
            school of medicine or osteopathic medicine, or a branch campus
            of a school of medicine or osteopathic medicine, in an area--
                        ``(A) in which no other such school is based; and
                        ``(B) that is a medically underserved community or
                    a health professional shortage area; or
                ``(2) is a minority-serving institution described in
            section 371(a) of the Higher Education Act of 1965.
        ``(c) Considerations.--In awarding grants under this section, the
    Secretary, to the extent practicable, may ensure equitable distribution
    of awards among the geographical regions of the United States.
        ``(d) Use of Funds.--An institution of higher education (or a
    consortium of such institutions)--
                ``(1) shall use grant amounts received under this section
            to--
                        ``(A) recruit, enroll, and retain students,
                    including individuals who are from disadvantaged
                    backgrounds (including racial and ethnic groups
                    underrepresented among medical students and health
                    professions), individuals from rural and underserved
                    areas, low-income individuals, and first generation
                    college students, at a school of medicine or
                    osteopathic medicine or branch campus of a school of
                    medicine or osteopathic medicine; and
                        ``(B) develop, implement, and expand curriculum
                    that emphasizes care for rural and underserved
                    populations, including accessible and culturally and
                    linguistically appropriate care and services, at such
                    school or branch campus; and
                ``(2) may use grant amounts received under this section
            to--
                        ``(A) plan and construct--
                                ``(i) a school of medicine or osteopathic
                            medicine in an area in which no other such
                            school is based; or
                                ``(ii) a branch campus of a school of
                            medicine or osteopathic medicine in an area in
                            which no other such school is based;
                        ``(B) plan, develop, and meet criteria for
                    accreditation for a school of medicine or osteopathic
                    medicine or branch campus of a school of medicine or
                    osteopathic medicine;
                        ``(C) hire faculty, including faculty from racial
                    and ethnic groups who are underrepresented among the
                    medical and other health professions, and other staff
                    to serve at such a school or branch campus;
                        ``(D) support educational programs at such a school
                    or branch campus;
                        ``(E) modernize and expand infrastructure at such a
                    school or branch campus; and
                        ``(F) support other activities that the Secretary
                    determines further the establishment, improvement, or
                    expansion of a school of medicine or osteopathic
                    medicine or branch campus of a school of medicine or
                    osteopathic medicine.
        ``(e) Application.--To be eligible to receive a grant under
    subsection (a), an institution of higher education (or a consortium of
    such institutions), shall submit an application to the Secretary at
    such time, in such manner, and containing such information as the
    Secretary may require, including a description of the institution's or
    consortium's planned activities described in subsection (d).
        ``(f) Reporting.--
                ``(1) Reports from entities.--Each institution of higher
            education, or consortium of such institutions, awarded a grant
            under this section shall submit an annual report to the
            Secretary on the activities conducted under such grant, and
            other information as the Secretary may require.
                ``(2) Report to congress.--Not later than 5 years after the
            date of enactment of this section and every 5 years thereafter,
            the Secretary shall submit to the Committee on Health,
            Education, Labor, and Pensions of the Senate and the Committee
            on Energy and Commerce of the House of Representatives a report
            that provides a summary of the activities and outcomes
            associated with grants made under this section. Such reports
            shall include--
                        ``(A) a list of awardees, including their primary
                    geographic location, and location of any school of
                    medicine or osteopathic medicine, or a branch campus of
                    school of medicine or osteopathic medicine that was
                    established, improved, or expanded under this program;
                        ``(B) the total number of students (including the
                    number of students from racial and ethnic groups
                    underrepresented among medical students and health
                    professions, low-income students, and first generation
                    college students) who--
                                ``(i) are enrolled at or who have graduated
                            from any school of medicine or osteopathic
                            medicine, or a branch campus of school of
                            medicine or osteopathic medicine, that was
                            established, improved, or expanded under this
                            program, deidentified and disaggregated by
                            race, ethnicity, age, sex, geographic region,
                            disability status, and other relevant factors,
                            to the extent such information is available;
                            and
                                ``(ii) who subsequently participate in an
                            accredited internship or medical residency
                            program upon graduation from any school of
                            medicine or osteopathic medicine, or a branch
                            campus of a school of medicine or osteopathic
                            medicine, that was established, improved, or
                            expanded under this program, deidentified and
                            disaggregated by race, ethnicity, age, sex,
                            geographic region, disability status, medical
                            specialty pursued, and other relevant factors,
                            to the extent such information is available;
                        ``(C) the effects of such program on the health
                    care provider workforce, including any impact on
                    demographic representation disaggregated by race,
                    ethnicity, and sex, and the fields or specialties
                    pursued by students who have graduated from any school
                    of medicine or osteopathic medicine, or a branch campus
                    of school of medicine or osteopathic medicine, that was
                    established, improved, or expanded under this program;
                        ``(D) the effects of such program on health care
                    access in underserved areas, including medically
                    underserved communities and health professional
                    shortage areas; and
                        ``(E) recommendations for improving the program
                    described in this section, and any other considerations
                    as the Secretary determines appropriate.
                ``(3) Public availability.--The Secretary shall make
            reports submitted under paragraph (2) publicly available on the
            internet website of the Department of Health and Human
            Services.
        ``(g) Definitions.--In this section:
                ``(1) Branch campus.--
                        ``(A) In general.--The term `branch campus', with
                    respect to a school of medicine or osteopathic
                    medicine, means an additional location of such school
                    that is geographically apart and independent of the
                    main campus, at which the school offers at least 50
                    percent of the program leading to a degree of doctor of
                    medicine or doctor of osteopathy that is offered at the
                    main campus.
                        ``(B) Independence from main campus.--For purposes
                    of subparagraph (A), the location of a school described
                    in such subparagraph shall be considered to be
                    independent of the main campus described in such
                    subparagraph if the location--
                                ``(i) is permanent in nature;
                                ``(ii) offers courses in educational
                            programs leading to a degree, certificate, or
                            other recognized educational credential;
                                ``(iii) has its own faculty and
                            administrative or supervisory organization; and
                                ``(iv) has its own budgetary and hiring
                            authority.
                ``(2) First generation college student.--The term `first
            generation college student' has the meaning given such term in
            section 402A(h)(3) of the Higher Education Act of 1965.
                ``(3) Health professional shortage area.--The term `health
            professional shortage area' has the meaning given such term in
            section 332(a).
                ``(4) Institution of higher education.--The term
            `institution of higher education' has the meaning given such
            term in section 101 of the Higher Education Act of 1965.
                ``(5) Medically underserved community.--The term `medically
            underserved community' has the meaning given such term in
            section 799B(6).
        ``(h) Authorization of Appropriations.--To carry out this section,
    there is authorized to be appropriated $1,000,000,000, to remain
    available until expended.''.

               TITLE IV--IMPROVING HEALTH CARE ACCESS AND QUALITY

    SEC. 4000. DEFINITION.

        In this title and the amendments made by this title, the term
    ``health care'' includes all health care needed throughout the life
    cycle and the end of life.

                Subtitle A--Reducing Barriers to Accessing Care

    SEC. 4001. PROTECTING PROTECTED AREAS.

        Section 287 of the Immigration and Nationality Act (8 U.S.C. 1357)
    is amended--
                (1) by striking ``Service'' each place such term appears
            and inserting ``Department of Homeland Security'';
                (2) by striking ``Attorney General'' each place such term
            appears and inserting ``Secretary of Homeland Security'';
                (3) in subsection (f)(1), by striking ``Commissioner'' and
            inserting ``Director of U.S. Citizenship and Immigration
            Services'';
                (4) in subsection (h)--
                        (A) by striking ``of the Immigration and
                    Nationality Act''; and
                        (B) by striking ``of such Act''; and
                (5) by adding at the end the following:
        ``(i)(1) In this subsection:
                ``(A) The term `appropriate congressional committees'
            means--
                        ``(i) the Committee on Homeland Security and
                    Governmental Affairs of the Senate;
                        ``(ii) the Committee on the Judiciary of the
                    Senate;
                        ``(iii) the Committee on Homeland Security of the
                    House of Representatives; and
                        ``(iv) the Committee on the Judiciary of the House
                    of Representatives.
                ``(B) The term `enforcement action'--
                        ``(i) means an apprehension, arrest, inspection
                    interview, request for identification, search, seizure,
                    service of charging documents or subpoenas, or
                    surveillance for the purposes of immigration
                    enforcement; and
                        ``(ii) includes an enforcement action at, or
                    focused on, a protected area that is part of a joint
                    case led by another law enforcement agency.
                ``(C) The term `exigent circumstances' means a situation
            involving--
                        ``(i) the imminent risk of death, violence, or
                    physical harm to any person or property, including a
                    situation implicating terrorism or the national
                    security of the United States;
                        ``(ii) the immediate arrest or pursuit of a
                    dangerous felon, terrorist suspect, or other individual
                    presenting an imminent danger; or
                        ``(iii) the imminent risk of destruction of
                    evidence that is material to an ongoing criminal case.
                ``(D) The term `protected area' includes all of the
            physical space located within 1,000 feet of--
                        ``(i) any medical treatment or mental health care
                    facility, including any hospital, doctor's office,
                    health clinic, alcohol or drug prevention, counseling,
                    or treatment facilities, syringe exchange services,
                    vaccination, treatment, or testing sites, emergent or
                    urgent care facility, sites that serve pregnant
                    individuals, or community health centers;
                        ``(ii) any public or private school, including any
                    known and licensed day care facility, preschool, sites
                    of early childhood programs, primary school, secondary
                    school, postsecondary school (including colleges and
                    universities), or other institution of learning
                    (including vocational or trade schools);
                        ``(iii) any scholastic or education-related
                    activity or event or before or after school program,
                    including field trips and interscholastic events;
                        ``(iv) any school bus or school bus stop;
                        ``(v) places where children gather such as a
                    playground, recreation center, library, foster care
                    facility, or group home for children;
                        ``(vi) any physical structure of an organization or
                    subdivision of government that--
                                ``(I) assists children, pregnant women,
                            victims of crime or abuse, or individuals with
                            significant mental or physical disabilities;
                                ``(II) provides social services and
                            assistance, including homeless shelters,
                            community-based organizations, facilities that
                            serve disabled persons, drug or alcohol
                            counseling and treatment facilities, food banks
                            or food pantries, and other places providing
                            emergency and disaster services or assistance
                            with food and nutrition, housing affordability
                            and income or other services funded by State or
                            local government, charitable giving, the
                            Special Supplemental Nutrition Program for
                            Women, Infants, and Children (WIC),
                            Supplemental Nutrition Assistance Program
                            (SNAP), Temporary Assistance for Needy Families
                            (TANF), Social Security, or the United States
                            Housing Act; or
                                ``(III) provides hospice, palliative, or
                            other available end-of-life care services to
                            terminally ill persons;
                        ``(vii) any church, synagogue, mosque, or other
                    place of worship or religious study, including
                    buildings rented for the purpose of religious services,
                    retreats, counseling, workshops, instruction, and
                    education;
                        ``(viii) any Federal, State, or local courthouse,
                    including the office of an individual's legal counsel
                    or representative, and a probation, parole, or
                    supervised release office;
                        ``(ix) the site of a funeral, grave-side ceremony,
                    rosary, wedding, or other religious ceremony or
                    observance;
                        ``(x) any public demonstration, such as a march,
                    rally, or parade;
                        ``(xi) any domestic violence shelter, rape crisis
                    center, child advocacy center, supervised visitation
                    center, family justice center, or victim services
                    provider;
                        ``(xii) congressional district offices;
                        ``(xiii) indoor and outdoor premises of departments
                    of motor vehicles;
                        ``(xiv) a place where disaster or emergency
                    response and relief is provided, including evacuation
                    routes, places where shelter or emergency supplies,
                    food, or water are distributed, or places where
                    registration for disaster-relief assistance or family
                    reunification is underway; or
                        ``(xv) any other location specified by the
                    Secretary of Homeland Security for purposes of this
                    subsection.
                ``(E) The term `prior approval' means--
                        ``(i) in the case of officers and agents of U.S.
                    Immigration and Customs Enforcement, prior written
                    approval to carry out an enforcement action involving a
                    specific individual or individuals authorized by--
                                ``(I) the Assistant Director of Operations,
                            Homeland Security Investigations;
                                ``(II) the Executive Associate Director,
                            Homeland Security Investigations;
                                ``(III) the Assistant Director for Field
                            Operations, Enforcement and Removal Operations;
                            or
                                ``(IV) the Executive Associate Director for
                            Field Operations, Enforcement and Removal
                            Operations;
                        ``(ii) in the case of officers and agents of U.S.
                    Customs and Border Protection, prior written approval
                    to carry out an enforcement action involving a specific
                    individual or individuals authorized by--
                                ``(I) a Chief Patrol Agent;
                                ``(II) the Director of Field Operations;
                                ``(III) the Director of Air and Marine
                            Operations; or
                                ``(IV) the Internal Affairs Special Agent
                            in Charge; and
                        ``(iii) in the case of other Federal, State, or
                    local law enforcement officers, to carry out an
                    enforcement action involving a specific individual or
                    individuals authorized by--
                                ``(I) the head of the Federal agency
                            carrying out the enforcement action; or
                                ``(II) the head of the State or local law
                            enforcement agency carrying out the enforcement
                            action.
        ``(2)(A) An enforcement action may not take place at, or be focused
    on, a protected area unless--
                ``(i) the action involves exigent circumstances; and
                ``(ii) prior approval for the enforcement action was
            obtained.
        ``(B) If an enforcement action is initiated pursuant to
    subparagraph (A) and the exigent circumstances permitting the
    enforcement action cease, the enforcement action shall be discontinued
    until such exigent circumstances reemerge.
        ``(C) If an enforcement action is carried out in violation of this
    subsection--
                ``(i) no information resulting from the enforcement action
            may be entered into the record or received into evidence in a
            removal proceeding resulting from the enforcement action; and
                ``(ii) the noncitizen who is the subject of such removal
            proceeding may file a motion for the immediate termination of
            the removal proceeding.
        ``(3)(A) This subsection shall apply to any enforcement action by
    officers or agents of the Department of Homeland Security, including--
                ``(i) officers or agents of U.S. Immigration and Customs
            Enforcement;
                ``(ii) officers or agents of U.S. Customs and Border
            Protection; and
                ``(iii) any individual designated to perform immigration
            enforcement functions pursuant to subsection (g).
        ``(B) While carrying out an enforcement action at a protected area,
    officers and agents referred to in subparagraph (A) shall make every
    effort--
                ``(i) to limit the time spent at the protected area;
                ``(ii) to limit the enforcement action at the protected
            area to the person or persons for whom prior approval was
            obtained; and
                ``(iii) to conduct themselves discreetly.
        ``(C) If, while carrying out an enforcement action that is not
    initiated at or focused on a protected area, officers or agents are led
    to a protected area, and no exigent circumstance and prior approval
    with respect to the protected area, such officers or agents shall--
                ``(i) cease before taking any further enforcement action;
                ``(ii) conduct themselves in a discreet manner;
                ``(iii) maintain surveillance on an individual; and
                ``(iv) immediately consult their supervisor in order to
            determine whether such enforcement action should be
            discontinued.
        ``(D) The limitations under this paragraph shall not apply to the
    transportation of an individual apprehended at or near a land or sea
    border to a hospital or health care provider for the purpose of
    providing medical care to such individual.
        ``(4)(A) Each official specified in subparagraph (B) shall ensure
    that the employees under his or her supervision receive annual training
    on compliance with--
                ``(i) the requirements under this subsection with respect
            to enforcement actions at or focused on protected areas and
            enforcement actions that lead officers or agents to a protected
            area; and
                ``(ii) the requirements under section 239 of this Act and
            section 384 of the Illegal Immigration Reform and Immigrant
            Responsibility Act of 1996 (8 U.S.C. 1367).
        ``(B) The officials specified in this subparagraph are--
                ``(i) the Chief Counsel of each Field Office of U.S.
            Immigration and Customs Enforcement;
                ``(ii) each Field Office Director of U.S. Immigration and
            Customs Enforcement;
                ``(iii) each Special Agent in Charge of U.S. Immigration
            and Customs Enforcement;
                ``(iv) each Chief Patrol Agent of U.S. Customs and Border
            Protection;
                ``(v) the Director of Field Operations of U.S. Customs and
            Border Protection;
                ``(vi) the Director of Air and Marine Operations of U.S.
            Customs and Border Protection;
                ``(vii) the Internal Affairs Special Agent in Charge of
            U.S. Customs and Border Protection; and
                ``(viii) the chief law enforcement officer of each State or
            local law enforcement agency that enters into a written
            agreement with the Department of Homeland Security pursuant to
            subsection (g).
        ``(5) Not later than 180 days after the date of the Health Equity
    and Accountability Act, the Secretary of Homeland Security shall modify
    the Notice to Appear form (I-862)--
                ``(A) to provide the subject of an enforcement action with
            information, written in plain language, summarizing the
            restrictions against enforcement actions at protected areas set
            forth in this subsection and the remedies available to the
            individual if such action violates such restrictions;
                ``(B) to ensure that the information described in
            subparagraph (A) is accessible to an individual with limited
            English proficiency; and
                ``(C) to ensure that a subject of an enforcement action is
            not permitted to verify that the officers or agents that
            carried out such action complied with the restrictions set
            forth in this subsection.
        ``(6)(A) The Director of U.S. Immigration and Customs Enforcement
    and the Commissioner of U.S. Customs and Border Protection shall each
    submit an annual report to the appropriate congressional committees
    that includes the information set forth in subparagraph (B) with
    respect to the respective agency.
        ``(B) Each report submitted under subparagraph (A) shall include,
    with respect to the submitting agency during the reporting period--
                ``(i) the number of enforcement actions that were carried
            out at, or focused on, a protected area;
                ``(ii) the number of enforcement actions in which officers
            or agents were subsequently led to a protected area; and
                ``(iii) for each enforcement action described in clause (i)
            or (ii)--
                        ``(I) the date on which it occurred;
                        ``(II) the specific site, city, county, and State
                    in which it occurred;
                        ``(III) whether the site was a protected area and,
                    if so--
                                ``(aa) identification of the protected
                            area;
                                ``(bb) each reason why the enforcement
                            action was taken there;
                                ``(cc) where the enforcement action was
                            taken without prior approval, certification
                            that notification to headquarters of a
                            submitting agency was provided after the
                            enforcement action took place; and
                                ``(dd) a report of what occurred during and
                            immediately after the enforcement action;
                        ``(IV) the components of the agency involved in the
                    enforcement action;
                        ``(V) a description of the enforcement action,
                    including the nature of the criminal activity of its
                    intended target;
                        ``(VI) the number of individuals, if any, arrested
                    or taken into custody;
                        ``(VII) the number of collateral arrests, if any,
                    and the reasons for each such arrest;
                        ``(VIII) a certification whether the location
                    administrator of a protected area was contacted before,
                    during, or after the enforcement action; and
                        ``(IX) the percentage of all of the staff members
                    and supervisors reporting to the officials listed in
                    paragraph (4)(B) who completed the training required
                    under paragraph (4)(A).
        ``(7) Nothing in the subsection may be construed--
                ``(A) to affect the authority of Federal, State, or local
            law enforcement agencies--
                        ``(i) to enforce generally applicable Federal or
                    State criminal laws unrelated to immigration; or
                        ``(ii) to protect residents from imminent threats
                    to public safety; or
                ``(B) to limit or override the protections provided in--
                        ``(i) section 239; or
                        ``(ii) section 384 of the Illegal Immigration
                    Reform and Immigrant Responsibility Act of 1996 (8
                    U.S.C. 1367).''.

    SEC. 4002. 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 (27) as paragraphs (22) through (26),
                    respectively; and
                        (B) by redesignating subsections (y), (z), and (aa)
                    as subsections (x), (y), and (z), 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 on the date of enactment of this Act.

    SEC. 4003. AVAILABILITY OF BASIC ASSISTANCE TO LAWFULLY PRESENT
                  NONCITIZENS.

        (a) Elimination of Arbitrary Eligibility Restrictions.--Sections
    402, 403, 411, 412, 421, and 422 of the Personal Responsibility and
    Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1612, 1613, 1621,
    1622, 1631, and 1632) are repealed.
        (b) Notification and Information Reporting.--Section 404 of the
    Personal Responsibility and Work Opportunity Reconciliation Act of 1996
    (8 U.S.C. 1614) is amended by striking ``, 402, or 403''.
        (c) Qualified Noncitizens.--Title IV of the Personal Responsibility
    and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1601 et seq.)
    is amended--
                (1) in the header, by striking ``ALIENS'' and inserting
            ``NONCITIZENS'';
                (2) by striking ``alien'' each place it appears and
            inserting ``noncitizen'';
                (3) by striking ``aliens'' each place it appears and
            inserting ``noncitizens'';
                (4) by striking ``alien's'' each place it appears and
            inserting ``noncitizen's'';
                (5) by striking ``an alien'' each place that it appears and
            inserting ``a noncitizen'';
                (6) by striking ``alien'' each place that it appears and
            inserting ``noncitizen'';
                (7) by striking ``qualified alien'' each place that it
            appears and inserting ``qualified noncitizen'';
                (8) by striking ``qualified aliens'' each place that it
            appears and inserting ``qualified noncitizens'';
                (9) by striking ``qualified alien's'' each place that it
            appears and inserting ``qualified noncitizen's''; and
                (10) in section 402--
                        (A) in the header, by striking ``qualified aliens''
                    and inserting ``qualified noncitizens''; and
                        (B) in subsection (a)(2)(L), by striking
                    ``qualified aliens'' and inserting ``qualified
                    noncitizens''.
        (d) Access to Basic Services for Lawfully Residing Noncitizens.--
    Section 431 of the Personal Responsibility and Work Opportunity
    Reconciliation Act of 1996 (8 U.S.C. 1641) is amended--
                (1) in subsection (b)--
                        (A) in the header, by striking ``Qualified Alien''
                    and inserting ``Qualified Noncitizen'';
                        (B) by striking ``qualified alien'' and inserting
                    ``qualified noncitizen'';
                        (C) by striking ``alien'' and inserting
                    ``noncitizen'';
                        (D) by striking ``an alien'' and inserting ``a
                    noncitizen''; and
                        (E) by striking ``benefit'' and all that follows
                    through the period at the end of the subsection and
                    inserting ``benefit, is lawfully present in the United
                    States.'';
                (2) in subsection (c)--
                        (A) in the header, by striking ``Qualified Aliens''
                    and inserting ``Qualified Noncitizens'';
                        (B) by striking ``; or'' at the end of paragraph
                    (3) and inserting ``;'';
                        (C) by striking the period at the end of paragraph
                    (4) and inserting ``; or''; and
                        (D) by inserting after paragraph (4) the following
                    new paragraph:
                ``(5) a noncitizen--
                        ``(A) in a category that was treated as lawfully
                    present for purposes of section 1101 of the Patient
                    Protection and Affordable Care Act of 2010 (42 U.S.C.
                    18001);
                        ``(B) who met the requirements of section
                    402(a)(2)(D) of the Personal Responsibility and Work
                    Opportunity Reconciliation Act of 1996 (8 U.S.C.
                    1612(a)(2)(D)) on or before January 1, 2023;
                        ``(C) who is granted special immigrant juvenile
                    status as described by section 101(a)(27)(J) of the
                    Immigration and Nationality Act (8 U.S.C.
                    1101(a)(27)(J));
                        ``(D) who has a pending, bona fide application for
                    nonimmigrant status under section 101(a)(15)(U) of the
                    Immigration and Nationality Act (8 U.S.C.
                    1101(1)(15)(U));
                        ``(E) who was granted relief under the Deferred
                    Action for Childhood Arrivals program; or
                        ``(F) any other person who is not a citizen of the
                    United States but who resides in a State or territory
                    of the United States and is Federally authorized to be
                    present in the United States.''; and
                (3) by adding at the end the following new subsection:
        ``(d) Noncitizen.--For the purposes of this title, the term
    `noncitizen' means any individual who is not a citizen of the United
    States.''.
        (e) Child Nutrition Programs.--Section 742 of the Personal
    Responsibility and Work Opportunity Reconciliation Act of 1996 (8
    U.S.C. 1615) is amended--
                (1) in subsection (a)--
                        (A) in the header by striking ``School Lunch and
                    Breakfast Programs'' and inserting ``Child Nutrition
                    Programs'';
                        (B) by striking ``the school lunch program'' and
                    inserting ``any program''; and
                        (C) by striking ``the school breakfast program
                    under section 4 of the'' and inserting ``any program
                    under the''; and
                (2) in subsection (b)(1)--
                        (A) by striking ``Nothing in this Act shall
                    prohibit or require a State to provide to an individual
                    who is not a citizen or a qualified alien, as defined
                    in section 431(b),'' and inserting ``A State shall not
                    deny''; and
                        (B) by striking ``paragraph (2)'' and inserting
                    ``paragraph (2) on the basis of an individual's
                    citizenship or citizenship, alienage, or immigration
                    status''.
        (f) Exclusion of Medical Assistance Expenditures for Citizens of
    Freely Associated States.--Section 1108(h) of the Social Security Act
    (42 U.S.C. 1308(h)) is amended--
                (1) by striking ``Expenditures'' and inserting:
                ``(1) Expenditures''; and
                (2) by adding at the end the following new paragraph:
                ``(2) With respect to eligibility for benefits for the
            designated Federal program defined in paragraph (3)(C) of
            section 402(b)(3)(c) (relating to the Medicaid program),
            paragraph (1) shall not apply to any individual who lawfully
            resides in 1 of the 50 States or the District of Columbia in
            accordance with the Compacts of Free Association between the
            Government of the United States and the Governments of the
            Federated States of Micronesia, the Republic of the Marshall
            Islands, and the Republic of Palau and shall not apply, at the
            option of the Governor of Puerto Rico, the Virgin Islands,
            Guam, the Northern Mariana Islands, or American Samoa as
            communicated to the Secretary of Health and Human Services in
            writing, to any individual who lawfully resides in the
            respective territory in accordance with such Compacts.''.
        (g) Child Health Insurance Program.--Section 2107(e)(1) of the
    Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended--
                (1) by striking subparagraph (O); and
                (2) by redesignating subparagraphs (P), (Q), (R), (S), (T),
            and (U) as subparagraphs (O), (P), (Q), (R), (S), and (T).
        (h) Conforming Amendments.--
                (1) Supplemental food assistance program.--The Food and
            Nutrition Act of 2008 (7 U.S.C. 2011 et seq.) is amended--
                        (A) in section 5--
                                (i) by striking subsection (i); and
                                (ii) by redesignating subsections (j)
                            through (n) as subsection (i) through (m),
                            respectively;
                        (B) in section 6--
                                (i) in subsection (f), by striking ``an
                            alien lawfully admitted for permanent'' and all
                            that follows through the end of the subsection
                            and inserting``a noncitizen lawfully present in
                            the United States.''; and
                                (ii) in subsection (s)(2), by striking
                            ``(m), and (n)'' and inserting ``and (m)''; and
                        (C) in section 11(e)(2)(B)(v)(II) by striking
                    ``aliens'' each place it appears and inserting
                    ``noncitizens''.
                (2) Medicaid.--Section 1903(v) of the Social Security Act
            (42 U.S.C. 1396b(v)) is amended--
                        (A) in paragraph (1), by striking ``admitted for''
                    and all that follows through the end of the paragraph
                    and inserting ``present in the United States.''; and
                        (B) by striking paragraph (4).
                (3) Housing assistance.--Section 214(a) of the Housing and
            Community Development Act of 1980 (42 U.S.C. 1436a(a)) is
            amended--
                        (A) by redesignating paragraphs (6) and (7) as
                    paragraphs (7) and (8), respectively; and
                        (B) by inserting after paragraph (5):
                ``(6) a qualified noncitizen as defined in section 431 of
            the Personal Responsibility and Work Opportunity Reconciliation
            Act of 1996 (8 U.S.C. 1641);''.
                (4) General rule on noncitizens' eligibility.--Section 401
            of Personal Responsibility and Work Opportunity Reconciliation
            Act of 1996 (8 U.S.C. 1611) is amended--
                        (A) in section 401, in the header--
                                (i) by striking ``qualified aliens'' and
                            inserting ``qualified noncitizens''; and
                                (ii) by striking ``aliens'' and inserting
                            ``noncitizens'';
                        (B) by striking ``qualified alien'' wherever it
                    occurs and inserting ``qualified noncitizen''; and
                        (C) by striking ``alien'' wherever it occurs and
                    inserting ``noncitizen''.
                (5) Assistance not treated as debt absent fraud.--Section
            213A(b)(1)(A) of the Immigration and Nationality Act is amended
            by striking ``benefit,'' and inserting ``benefit by fraud,''.
        (i) Preserving Access to Health Care.--Section 36B(c)(1)(B) of the
    Internal Revenue Code of 1986 is amended to read as follows:
                        ``(B) Special rule for certain individuals lawfully
                    present in the united states.--If--
                                ``(i) a taxpayer has a household income
                            which is not greater than 100 percent of an
                            amount equal to the poverty line for a family
                            of the size involved,
                                ``(ii) the taxpayer is a non-citizen
                            lawfully present in the United States,
                                ``(iii) the taxpayer is ineligible for
                            minimum essential coverage under section
                            5000A(f)(1)(A)(ii), and
                                ``(iv) under the Medicaid eligibility
                            criteria for non-citizens in effect on December
                            26, 2020, the taxpayer would be ineligible for
                            such minimum essential coverage by reason of
                            the taxpayer's immigration status,
                    the taxpayer shall, for purposes of the credit under
                    this section, be treated as an applicable taxpayer with
                    a household income which is equal to 100 percent of the
                    poverty line for a family of the size involved.''.
        (j) Federal Agency Guidance.--Not later than 180 days after the
    date of the enactment of this Act, each Federal agency, as applicable,
    shall issue guidance with respect to implementing the amendments made
    by this section.
        (k) Effective Date.--The amendments made by this section shall take
    effect on the date of enactment of this Act and shall apply to services
    furnished on or after the date that is 180 days after the date on which
    any guidance is issued pursuant to subsection (i).

    SEC. 4004. IMPROVE AFFORDABILITY AND REDUCE PREMIUM COSTS OF HEALTH
                  INSURANCE FOR CONSUMERS.

        (a) In General.--Section 36B(b)(3)(A) of the Internal Revenue Code
    of 1986 is amended to read as follows:
                        ``(A) Applicable percentage.--The applicable
                    percentage for any taxable year shall be the percentage
                    such that the applicable percentage for any taxpayer
                    whose household income is within an income tier
                    specified in the following table shall increase, on a
                    sliding scale in a linear manner, from the initial
                    premium percentage to the final premium percentage
                    specified in such table for such income tier:

    ------------------------------------------------------------------------
                                                    The initial   The final
     ``In the case of household income (expressed     premium      premium
       as a percent of poverty line) within the      percentage   percentage
                following income tier:                  is--         is--
    ------------------------------------------------------------------------
    Up to 150 percent.............................          0.0          0.0
    150 percent up to 200 percent.................          0.0          3.0
    200 percent up to 250 percent.................          3.0          4.0
    250 percent up to 300 percent.................          4.0          6.0
    300 percent up to 400 percent.................          6.0          8.5
    400 percent and higher........................          8.5      8.5.''.
    ------------------------------------------------------------------------

        (b) Conforming Amendment.--Section 36B(c)(1)(A) of the Internal
    Revenue Code of 1986 is amended by striking ``but does not exceed 400
    percent''.
        (c) Effective Date.--The amendments made by this section shall
    apply to taxable years beginning after December 31, 2021.

    SEC. 4005. REMOVING CITIZENSHIP AND IMMIGRATION BARRIERS TO ACCESS TO
                  AFFORDABLE HEALTH CARE UNDER THE 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), to read as follows:
                                ``(ii) the taxpayer is a noncitizen who is
                            not eligible for the Medicaid program under
                            title XIX of the Social Security Act by reason
                            of the individual's immigration status,''; 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--
                        (A) by striking subsection (e); and
                        (B) by redesignating subsection (f) as 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--
                        (A) by striking subsection (d); and
                        (B) by redesignating subsection (e) as subsection
                    (d).
                (5) Requirement to maintain minimum essential coverage.--
            Section 5000A(d) of the Internal Revenue Code of 1986 is
            amended--
                        (A) by striking paragraph (3); and
                        (B) by redesignating paragraph (4) as paragraph
                    (3).
        (b) Conforming Amendments.--
                (1) Establishment of program.--Section 1411(a) of the
            Patient Protection and Affordable Care Act (42 U.S.C. 18081(a))
            is amended--
                        (A) by striking paragraph (1); and
                        (B) by redesignating paragraphs (2), (3), and (4)
                    as paragraphs (1), (2), and (3), respectively.
                (2) Qualified individuals.--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).
        (c) Effective Date.--The amendments made by this section shall
    apply to years, plan years, and taxable years, as applicable, beginning
    after December 31, 2022.

    SEC. 4006. REMOVING BARRIERS TO ACCESS TO AFFORDABLE HEALTH CARE FOR
                  LAWFULLY RESIDING IMMIGRANTS UNDER MEDICAID AND CHIP.

        (a) Medicaid.--Section 1903(v)(4) of the Social Security Act (42
    U.S.C. 1396b(v)(4)) is amended--
                (1) by amending subparagraph (A) to read as follows:
                ``(A) Notwithstanding sections 401(a), 402(b), 403, and 421
            of the Personal Responsibility and Work Opportunity
            Reconciliation Act of 1996, a State shall provide medical
            assistance under this title to individuals who are lawfully
            residing in the United States (including individuals described
            in paragraph (1), battered individuals described in section
            431(c) of such Act, and individuals with an approved or pending
            application for deferred action or other federally authorized
            presence), if they otherwise meet the eligibility requirements
            for medical 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).'';
                (2) by amending subparagraph (B) to read as follows:
                ``(B) No debt shall accrue under an affidavit of support
            against any sponsor of an individual provided medical
            assistance under subparagraph (A) on the basis of provision of
            assistance to such individual and the cost of such assistance
            shall not be considered as an unreimbursed cost.''; and
                (3) in subparagraph (C)--
                        (A) by striking ``an election by the State under
                    subparagraph (A)'' and inserting ``the application of
                    subparagraph (A)'';
                        (B) by inserting ``or be lawfully present'' after
                    ``lawfully reside''; and
                        (C) by inserting ``or present'' after ``lawfully
                    residing'' each place it appears.
        (b) CHIP.--Subparagraph (O) of section 2107(e)(1) of the Social
    Security Act (42 U.S.C. 1397gg(e)(1)) is amended to read as follows:
                        ``(O) Paragraph (4) of section 1903(v) (relating to
                    lawfully residing individuals).''.
        (c) Effective Date.--
                (1) In general.--Except as provided in paragraph (2), the
            amendments made by this section shall take effect on the date
            of enactment of this Act and shall apply to services furnished
            on or after the date that is 90 days after such date of
            enactment.
                (2) Exception if state legislation required.--In the case
            of a State plan for medical assistance under title XIX, or a
            State child health plan under title XXI, of the Social Security
            Act which the Secretary of Health and Human Services determines
            requires State legislation (other than legislation
            appropriating funds) in order for the plan to meet the
            additional requirements imposed by the amendments made by this
            section, the respective State plan shall not be regarded as
            failing to comply with the requirements of such title solely on
            the basis of its failure to meet these additional requirements
            before the first day of the first calendar quarter beginning
            after the close of the first regular session of the State
            legislature that begins after the date of enactment of this
            Act. For purposes of the previous sentence, in the case of a
            State that has a 2-year legislative session, each year of such
            session shall be deemed to be a separate regular session of the
            State legislature.
        (d) Preserving Coverage.--
                (1) In general.--Nothing in this section, including the
            amendments made by this section, shall prevent lawfully present
            noncitizens who are ineligible for full benefits under the
            Medicaid program under title XIX of the Social Security Act
            from securing a credit for which such lawfully present
            noncitizens would be eligible under section 36B(c)(1)(B) of the
            Internal Revenue Code of 1986 and under the Medicaid provisions
            for lawfully present noncitizens, as in effect on the date
            prior to the date of enactment of this Act.
                (2) Definition.--For purposes of paragraph (1), the term
            ``full benefits'' means, with respect to an individual and
            State, medical assistance for all services covered under the
            State plan under title XIX of the Social Security Act that is
            not less in amount, duration, or scope, or is determined by the
            Secretary of Health and Human Services to be substantially
            equivalent to the medical assistance available for an
            individual described in section 1902(a)(10)(A)(i) of the Social
            Security Act (42 U.S.C. 1396a(a)(10)(A)(i)).

    SEC. 4007. CONSISTENCY IN HEALTH INSURANCE COVERAGE FOR INDIVIDUALS
                  WITH FEDERALLY AUTHORIZED PRESENCE, INCLUDING DEFERRED
                  ACTION.

        (a) In General.--For purposes of eligibility under any of the
    provisions described in subsection (b), all individuals granted lawful
    presence in the United States shall be considered to be lawfully
    present in the United States.
        (b) Provisions Described.--The provisions described in this
    subsection are the following:
                (1) Exchange eligibility.--Section 1411 of the Patient
            Protection and Affordable Care Act (42 U.S.C. 18031).
                (2) Reduced cost-sharing eligibility.--Section 1402 of the
            Patient Protection and Affordable Care Act (42 U.S.C. 18071).
                (3) Premium subsidy eligibility.--Section 36B of the
            Internal Revenue Code of 1986 (26 U.S.C. 36B).
                (4) Medicaid and chip eligibility.--Titles XIX and XXI of
            the Social Security Act, including under section 1903(v) of
            such Act (42 U.S.C. 1396b(v)).
        (c) Effective Date.--
                (1) In general.--Subsection (a) shall take effect on the
            date of enactment of this Act.
                (2) Transition through special enrollment period.--In the
            case of an individual described in subsection (a) who, before
            the first day of the first annual open enrollment period under
            subparagraph (B) of section 1311(c)(6) of the Patient
            Protection and Affordable Care Act (42 U.S.C. 18031(c)(6))
            beginning after the date of enactment of this Act, is granted
            lawful presence in the United States and who, as a result of
            such subsection, qualifies for a subsidy under a provision
            described in paragraph (2) or (3) of subsection (b), the
            Secretary of Health and Human Services shall establish a
            special enrollment period under subparagraph (C) of such
            section 1311(c)(6) during which such individual may enroll in
            qualified health plans through Exchanges under title I of the
            Patient Protection and Affordable Care Act (42 U.S.C. 18001
            note et seq.) and qualify for such a subsidy. For such an
            individual who has been granted federally authorized presence
            in the United States as of the date of enactment of this Act,
            such special enrollment period shall begin not later than 90
            days after such date of enactment. Nothing in this paragraph
            shall be construed as affecting the authority of the Secretary
            to establish additional special enrollment periods under such
            subparagraph (C).

    SEC. 4008. 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 (as defined in section
                    1707(g)(1) of the Public Health Service Act, as amended
                    by section 101 of this Act), and 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, 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, or any information
                    gathered in preparing such report--
                                (i) to engage in or anticipate any
                            deportation or immigration related enforcement
                            action by any entity, including the Department
                            of Homeland Security; or
                        (C) for the exploitation of, or discrimination
                    against, communities of color or the LGBTQ+ population.

    SEC. 4009. MEDICAID FALLBACK COVERAGE PROGRAM FOR LOW-INCOME ADULTS IN
                  NON-EXPANSION STATES.

        (a) In General.--As soon as possible after the date of enactment of
    this Act the Secretary of Health and Human Services (in this section
    referred to as the ``Secretary'') shall--
                (1) directly or by contract, establish a program that
            offers eligible individuals the opportunity to enroll in health
            benefits coverage that meets the requirements described in
            subsection (c) and any requirements applicable to such coverage
            pursuant to subsection (d); and
                (2) ensure that such program is administered consistent
            with the requirements of section 431.10(c)(2) of title 42, Code
            of Federal Regulations.
        (b) Definition of Eligible Individual.--In this section, the term
    ``eligible individual'' means an individual who--
                (1) is described in section 1902(a)(10)(A)(i)(VIII) of the
            Social Security Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII));
                (2) resides in a State that--
                        (A) does not expend amounts for medical assistance
                    under title XIX of the Social Security Act (42 U.S.C.
                    1396 et seq.) for all individuals described in such
                    section; and
                        (B) did not expend amounts for medical assistance
                    under such title for all such individuals as of the
                    date of enactment of this Act; and
                (3) would not be eligible for medical assistance under such
            State's plan for medical assistance under title XIX of the
            Social Security Act (42 U.S.C. 1396 et seq.), or a waiver of
            such plan, as such plan or waiver was in effect on such date.
        (c) Health Benefits Coverage Requirements.--The requirements
    described in this subsection with respect to health benefits coverage
    are the following:
                (1) Essential health benefits.--At a minimum, the coverage
            meets the minimum standards required under paragraph (5) of
            section 1937(b) of the Social Security Act (42 U.S.C. 1396u-
            7(b)) for benchmark coverage described in paragraph (1) of such
            section or benchmark equivalent coverage described in paragraph
            (2) of such section.
                (2) Premiums and cost-sharing.--No premiums are imposed for
            the coverage, and deductibles, cost sharing, or similar charges
            may only be imposed in accordance with the requirements imposed
            on State Medicaid plans under section 1916 of the Social
            Security Act (42 U.S.C. 1396o).
        (d) Application of Requirements and Provisions of Title XIX of the
    Social Security Act.--The Secretary shall specify that--
                (1) any requirement applicable to the furnishing of medical
            assistance under title XIX of the Social Security Act (42
            U.S.C. 1396 et seq.) by States that have elected to make
            medical assistance available to individuals described in
            section 1902(a)(10)(A)(i)(VIII) of such title (42 U.S.C.
            1396a(a)(10)(A)(i)(VIII)) that does not conflict with the
            requirements specified in subsection (c) applies to the program
            established under this section; and
                (2) other provisions of such title apply to such program.
        (e) No State Mandate.--Nothing in this section shall be construed
    as requiring a State to make expenditures related to the program
    established under this section and the Secretary shall not impose any
    such requirement.
        (f) Funding.--There are appropriated to the Secretary for each
    fiscal year beginning with fiscal year 2022 from any funds in the
    Treasury not otherwise appropriated, such sums as are necessary to
    carry out this section.

    SEC. 4010. INCREASE AND EXTENSION OF TEMPORARY ENHANCED FMAP FOR STATES
                  WHICH BEGIN TO EXPEND AMOUNTS FOR CERTAIN MANDATORY
                  INDIVIDUALS.

        (a) In General.--Section 1905(ii)(1) of the Social Security Act (42
    U.S.C. 1396d(ii)(1)) is amended--
                (1) by striking ``8-quarter period'' and inserting ``40-
            quarter period''; and
                (2) by striking ``5 percentage points'' and inserting ``10
            percentage points''.
        (b) Effective Date.--The amendments made by this section shall take
    effect as if included in the enactment of section 9814 of the American
    Rescue Plan Act of 2021 (Public Law 117-2).

                      Subtitle B--Improvement of Coverage

    SEC. 4101. 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 ``subsections (g) and (h)''
                    and inserting ``subsections (g), (h), and (i)'';
                        (B) in subsection (g)(2), in the matter preceding
                    subparagraph (A), by inserting ``subsection (i) and''
                    after ``subject to''; and
                        (C) by adding at the end the following new
                    subsection:
        ``(i) Sunset of Medicaid Funding Limitations for Puerto Rico, the
    Virgin Islands, Guam, the Northern Mariana Islands, and American
    Samoa.--Subsections (f) and (g) shall not apply to Puerto Rico, the
    Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa
    beginning with fiscal year 2024.''.
                (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).
                (3) Effective date.--The amendments made by this section
            shall apply beginning with fiscal year 2024.
        (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 2024'' after ``American
    Samoa''.
        (c) Permitting Medicaid DSH Allotments for Territories.--Section
    1923(f) of the Social Security Act (42 U.S.C. 1396r-4(f)) is amended--
                (1) in paragraph (6), by adding at the end the following
            new subparagraph:
                        ``(C) Territories.--
                                ``(i) Fiscal year 2023.--For fiscal year
                            2023, the DSH allotment for Puerto Rico, the
                            Virgin Islands, 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 (3).''; and
                (2) in paragraph (9), by inserting before the period at the
            end the following: ``, and includes, beginning with fiscal year
            2023, Puerto Rico, the Virgin Islands, Guam, the Northern
            Mariana Islands, and American Samoa''.

    SEC. 4102. EXTENSION OF THE SUPPLEMENTAL SECURITY INCOME PROGRAM TO
                  PUERTO RICO, THE UNITED STATES VIRGIN ISLANDS, GUAM, AND
                  AMERICAN SAMOA.

        (a) In General.--Section 303 of the Social Security Amendments of
    1972 (86 Stat. 1484) is amended by striking subsection (b).
        (b) Conforming Amendments.--
                (1) Definition of state.--Section 1101(a)(1) of the Social
            Security Act (42 U.S.C. 1301(a)(1)) is amended by striking the
            5th sentence and inserting the following: ``Such term when used
            in title XVI includes Puerto Rico, the United States Virgin
            Islands, Guam, and American Samoa.''.
                (2) Elimination of limit on total payments to the
            territories.--Section 1108 of such Act (42 U.S.C. 1308) is
            amended--
                        (A) in the section heading, by striking ``;
                    limitation on total payments'';
                        (B) by striking subsection (a); and
                        (C) in subsection (c), by striking paragraphs (2)
                    and (4) and redesignating paragraphs (3) and (5) as
                    paragraphs (2) and (4), respectively.
                (3) United states nationals treated the same as citizens.--
            Section 1614(a)(1)(B) of such Act (42 U.S.C. 1382c(a)(1)(B)) is
            amended--
                        (A) in clause (i)(I), by inserting ``or national,''
                    after ``citizen'';
                        (B) in clause (i)(II), by adding ``; or'' at the
                    end; and
                        (C) in clause (ii), by inserting ``or national''
                    after ``citizen''.
                (4) Territories included in geographic meaning of united
            states.--Section 1614(e) of such Act (42 U.S.C. 1382c(e)) is
            amended by striking ``and the District of Columbia'' and
            inserting ``, the District of Columbia, Puerto Rico, the United
            States Virgin Islands, Guam, and American Samoa''.
        (c) Waiver Authority.--The Commissioner of Social Security may
    waive or modify any statutory requirement relating to the provision of
    benefits under the Supplemental Security Income Program under title XVI
    of the Social Security Act in Puerto Rico, the United States Virgin
    Islands, Guam, or American Samoa, to the extent that the Commissioner
    deems it necessary in order to adapt the program to the needs of the
    territory involved.
        (d) Effective Date.--This section and the amendments made by this
    section shall take effect on the 1st day of the 1st Federal fiscal year
    that begins 1 year or more after the date of the enactment of this Act.

    SEC. 4103. EXTENSION OF MEDICARE SECONDARY PAYER.

        (a) In General.--Section 1862(b)(1)(C) of the Social Security Act
    (42 U.S.C. 1395y(b)(1)(C)) is amended--
                (1) in the last sentence, by inserting ``, and before
            January 1, 2023'' after ``prior to such date)''; and
                (2) by adding at the end the following new sentence:
            ``Effective for items and services furnished on or after
            January 1, 2023 (with respect to periods beginning on or after
            the date that is 42 months prior to such date), clauses (i) and
            (ii) shall be applied by substituting `42-month' for `12-month'
            each place it appears.''.
        (b) Effective Date.--The amendments made by this section shall take
    effect on the date of enactment of this Act. For purposes of
    determining an individual's status under section 1862(b)(1)(C) of the
    Social Security Act (42 U.S.C. 1395y(b)(1)(C)), as amended by
    subsection (a), an individual who is within the coordinating period as
    of the date of enactment of this Act shall have that period extended to
    the full 42 months described in the last sentence of such section, as
    added by the amendment made by subsection (a)(2).

    SEC. 4104. INDIAN DEFINED IN TITLE I OF THE PATIENT PROTECTION AND
                  AFFORDABLE CARE ACT.

        (a) Definition of Indian.--Section 1304 of the Patient Protection
    and Affordable Care Act (42 U.S.C. 18024) is amended by adding at the
    end the following:
        ``(f) Indian.--In this title:
                ``(1) In general.--The term `Indian' means--
                        ``(A) an Indian, California Indian, or Urban
                    Indian, as such terms are defined in section 4 of the
                    Indian Health Care Improvement Act (25 U.S.C. 1603); or
                        ``(B) an individual who is--
                                ``(i) of Indian descent and a member of an
                            Indian community served by a local facility or
                            program of the Indian Health Service; or
                                ``(ii) described in paragraph (2).
                ``(2) Inclusions.--The term `Indian' includes the following
            individuals:
                        ``(A) A member of a federally recognized Indian
                    Tribe.
                        ``(B) A resident of an urban center who meets one
                    or more of the following criteria:
                                ``(i) A member of a Tribe, band, or other
                            organized group of Indians, including those
                            Tribes, bands, or groups terminated since 1940
                            and those recognized as of the date of
                            enactment of the Health Equity and
                            Accountability Act of 2022 or later by the
                            State in which they reside, or being a
                            descendant, in the first or second degree, of
                            any such member.
                                ``(ii) An Eskimo or Aleut or other Alaska
                            Native.
                                ``(iii) An individual who is determined to
                            be an Indian under regulations promulgated by
                            the Secretary.
                        ``(C) An individual who is considered by the
                    Secretary of the Interior to be an Indian for any
                    purpose.
                        ``(D) An individual who is considered by the
                    Secretary to be an Indian for purposes of eligibility
                    for services provided by the Indian Health Service,
                    including as a California Indian, Eskimo, Aleut, or
                    other Alaska Native.''.
        (b) Conforming Amendments.--
                (1) Affordable choices health benefit plans.--Section
            1311(c)(6)(D) of the Patient Protection and Affordable Care Act
            (42 U.S.C. 18031(c)(6)(D)) is amended by striking ``(as defined
            in section 4 of the Indian Health Care Improvement Act)''.
                (2) Reduced cost-sharing for individuals enrolling in
            qualified health plans.--Section 1402(d) of the Patient
            Protection and Affordable Care Act (42 U.S.C. 18071(d)) is
            amended--
                        (A) in paragraph (1), in the matter preceding
                    subparagraph (A), by striking ``(as defined in section
                    4(d) of the Indian Self-Determination and Education
                    Assistance Act (25 U.S.C. 450b(d))''; and
                        (B) in paragraph (2), in the matter preceding
                    subparagraph (A), by striking ``(as so defined)''.
                (3) Exemption from penalty for not maintaining minimum
            essential coverage.--Section 5000A(e) of the Internal Revenue
            Code of 1986 is amended by striking paragraph (3) and inserting
            the following:
                ``(3) Indians.--Any applicable individual who is an Indian
            (as defined in section 1304(f) of the Patient Protection and
            Affordable Care Act).''.
        (c) Effective Date of IRC Provision.--The amendment made by
    subsection (b)(3) shall apply to taxable years beginning after the date
    of the enactment of this section.

    SEC. 4105. 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. 4106. LOWERING MEDICARE PREMIUMS AND PRESCRIPTION DRUG COSTS.

        (a) Medicare Cost Assistance Program.--
                (1) In general.--Title XVIII of the Social Security Act (42
            U.S.C. 1395 et seq.) is amended by adding at the end the
            following new section:

    ``SEC. 1899C. MEDICARE COST ASSISTANCE PROGRAM.

        ``(a) In General.--Effective beginning January 1, 2023, in the case
    of a Medicare Cost Assistance Program eligible individual (as defined
    in subsection (b)(1)), the Secretary shall provide Medicare cost
    assistance for the following costs incurred with respect to the
    individual:
                ``(1)(A) premiums under section 1818; and
                ``(B) premiums under section 1839.
                ``(2) Coinsurance under this title (including coinsurance
            described in section 1813).
                ``(3) Deductibles established under this title (including
            those described in section 1813 and section 1833(b)).
                ``(4) The difference between the amount that is paid under
            section 1833(a) and the amount that would be paid under such
            section if any reference to a percent less than 100 percent
            therein were deemed a reference to `100 percent'.
        ``(b) Determination of Eligibility.--
                ``(1) Medicare cost assistance program eligible individual
            defined.--The term `Medicare Cost Assistance Program eligible
            individual' means an individual who--
                        ``(A) is eligible for and is receiving medical
                    assistance for the payment of medicare cost-sharing
                    under a State Medicaid program pursuant to clause (i),
                    (iii), or (iv) of section 1902(a)(10)(E) as of December
                    31, 2022; or
                        ``(B)(i) is entitled to hospital insurance benefits
                    under part A (including an individual entitled to such
                    benefits pursuant to an enrollment under section 1818);
                    and
                        ``(ii) has income at or below 200 percent of the
                    poverty line applicable to a family of the size
                    involved.
                ``(2) Joint determination by commissioner of social
            security for lis and medicare cost assistance.--
                        ``(A) In general.--The determination of whether an
                    individual is a Medicare Cost Assistance Program
                    eligible individual described in paragraph (1) shall be
                    determined by the Commissioner of Social Security
                    jointly with the determination of whether an individual
                    is a subsidy eligible individual described in section
                    1860D-14(a)(3). Such determination shall be made with
                    respect to eligibility for Medicare cost assistance
                    under this section and premium and cost-sharing
                    subsidies under section 1860D-14 upon application of an
                    individual for a determination with respect to
                    eligibility for either such assistance or such
                    subsidies. There are authorized to be appropriated to
                    the Social Security Administration such sums as may be
                    necessary for the determination of eligibility under
                    this paragraph.
                        ``(B) Effective period.--Determinations under this
                    paragraph with respect to eligibility for each of such
                    assistance or such subsidies shall be effective
                    beginning with the month in which the individual
                    applies for a determination described in subparagraph
                    (A) and shall remain in effect until such time as the
                    Secretary determines the individual is no longer
                    eligible as determined under subparagraph (C)(ii).
                        ``(C) Redeterminations.--With respect to
                    eligibility determinations under this paragraph--
                                ``(i) redeterminations shall be made at the
                            same time with respect to eligibility for
                            Medicare cost assistance under this section and
                            cost-sharing subsidies under section 1860D-14,
                            but not more frequently than once every 12
                            months;
                                ``(ii) a redetermination shall
                            automatically determine that an individual
                            remains eligible for such assistance or
                            subsidies unless--
                                        ``(I) the Commissioner has
                                    information indicating that the
                                    individual's circumstances have changed
                                    such that the individual is no longer
                                    eligible for such assistance or
                                    subsidies;
                                        ``(II) the Commissioner sends
                                    notice to the individual regarding such
                                    information that requests a response
                                    either confirming or correcting such
                                    information; and
                                        ``(III) the individual either
                                    confirms such information or fails to
                                    provide documentation indicating that
                                    such circumstances have not changed
                                    within 60 days of receiving the notice
                                    described in subclause (II);
                                ``(iii) the Commissioner shall establish
                            procedures for appeals of such determinations
                            that are similar to the procedures described in
                            the third sentence of section 1631(c)(1)(A);
                            and
                                ``(iv) judicial review of the final
                            decision of the Commissioner made after a
                            hearing shall be available to the same extent,
                            and with the same limitations, as provided in
                            subsections (g) and (h) of section 205.
                        ``(D) Treatment of medicaid beneficiaries.--The
                    Secretary shall provide that individuals who are full-
                    benefit dual eligible individuals (as defined in
                    section 1935(c)(6)) or who are recipients of
                    supplemental security income benefits under title XVI
                    shall be treated as a Medicare Cost Assistance Program
                    eligible individual described in paragraph (1) and, in
                    the case of such individual who is a part D eligible
                    individual, a subsidy eligible individual described in
                    section 1860D-14(a)(3).
                        ``(E) Simplified application form.--
                                ``(i) In general.--The Secretary shall
                            develop and distribute a simplified application
                            form for use by individuals in applying for
                            Medicare cost assistance under this section and
                            premium and cost-sharing subsidies under
                            section 1860D-14. Such form shall be easily
                            readable based on culturally fluid language for
                            all demographics beyond just the various
                            languages offered. An audio version, digital
                            version and photo-voice option should also be
                            provided for all learners. The Secretary shall
                            provide for the translation of such application
                            form into at least the 10 languages (other than
                            English) that are most often used by
                            individuals applying for hospital insurance
                            benefits under section 226 or 226A and shall
                            make the translated forms available to the
                            Commissioner of Social Security.
                                ``(ii) Consultation.--In developing such
                            form, the Secretary shall consult with
                            beneficiary groups.
                ``(3) Income determinations.--For purposes of applying this
            section--
                        ``(A) in the case of an individual who is not
                    treated as a Medicare Cost Assistance Program eligible
                    individual or a subsidy eligible individual under
                    paragraph (2)(D), income shall be determined in the
                    manner described under section 1612 for purposes of the
                    supplemental security income program, except that
                    support and maintenance furnished in kind shall not be
                    counted as income; and
                        ``(B) the term `poverty line' has the meaning given
                    such term in section 673(2) of the Community Services
                    Block Grant Act (42 U.S.C. 9902(2)), including any
                    revision required by such section.
        ``(c) Beneficiary Protections.--
                ``(1) In general.--In the case in which the payment for
            Medicare cost assistance for a Medicare Cost Assistance Program
            eligible individual with respect to an item or service is
            reduced or eliminated the individual shall not have any legal
            liability to make payment to a provider of services or supplier
            or to an organization described in section 1903(m)(1)(A) for
            the service, and any lawful sanction that may be imposed upon a
            provider of services or supplier or such an organization for
            excess charges under this title or title XIX shall apply to the
            imposition of any charge imposed upon the individual in such
            case.
                ``(2) Clarification.--This paragraph shall not be construed
            as preventing payment of any medicare cost assistance by a
            medicare supplemental policy or an employer retiree health plan
            on behalf of an individual.
        ``(d) Administration.--
                ``(1) In general.--The Secretary shall establish procedures
            for the administration of the program under this section.
                ``(2) Funding.--For purposes of carrying out this section,
            the Secretary shall make payments from the Federal Hospital
            Insurance Trust Fund under section 1817 and the Federal
            Supplementary Medical Insurance Trust Fund under section 1841,
            in such proportion as the Secretary determines appropriate, of
            such amounts as the Secretary determines necessary to provide
            Medicare cost assistance under this section.
        ``(e) References to Medicare Cost-Sharing.--Effective beginning
    January 1, 2023, any reference to medicare cost-sharing described in
    section 1905(p) shall be deemed a reference to Medicare cost assistance
    under this section.
        ``(f) Outreach Efforts.--For provisions relating to outreach
    efforts to increase awareness of the availability of Medicare cost
    assistance, see section 1144.''.
                (2) Special enrollment period.--
                        (A) No premium penalty.--Section 1839(b) of the
                    Social Security Act (42 U.S.C. 1395r(b)) is amended, in
                    the last sentence, by inserting the following before
                    the period: ``or, effective beginning January 1, 2023,
                    for individuals who are Medicare Cost Assistance
                    Program eligible individuals (as defined in section
                    1899B(b)(1)).''.
                        (B) Special enrollment period.--Section 1837 of the
                    Social Security Act (42 U.S.C. 1395p) is amended by
                    adding at the end the following new subsection:
        ``(o) Special Enrollment Period for Medicare Cost Assistance
    Program Eligible Individual.--
                ``(1) In general.--Effective beginning January 1, 2023, the
            Secretary shall establish special enrollment periods for
            Medicare Cost Assistance Program eligible individuals (as
            defined in section 1899B(b)(1)).
                ``(2) Coverage period.--In the case of an individual who
            enrolls during the special enrollment period provided under
            paragraph (1), the coverage period under this part shall--
                        ``(A) begin on the first day of the first month in
                    which the individual applies for a determination under
                    section 1899B(b)(2)(A); and
                        ``(B) remain in effect until such time as the
                    Secretary determines the individual no longer eligible
                    as determined under section 1899B(b)(2)(C)(ii).''.
                        (C) Conforming sunset of state agreements relating
                    to enrollment of qualified medicare beneficiaries.--
                                (i) Part a.--Section 1818(g) of the Social
                            Security Act (42 U.S.C. 1395i-2(g)) is amended
                            by adding at the end the following new
                            paragraph:
        ``(3) Sunset.--This subsection shall not apply on or after January
    1, 2023.''.
                                (ii) Part b.--Section 1843(h) of the Social
                            Security Act (42 U.S.C. 1395v(h)) is amended by
                            adding at the end the following new paragraph:
        ``(3) Sunset With Respect to Qualified Medicare Beneficiaries.--
    This subsection shall not apply with respect to qualified medicare
    beneficiaries on or after January 1, 2023.''.
                (3) Public awareness campaign.--Section 1144 of the Social
            Security Act (42 U.S.C. 1320b-14) is amended by adding at the
            end the following new subsection:
        ``(d) Public Awareness Campaign.--
                ``(1) In general.--The Commissioner shall conduct a public
            awareness campaign to educate Medicare beneficiaries on the
            availability of Medicare cost assistance for low-income
            individuals under section 1899B.
                ``(2) Coordination.--In carrying out such public awareness
            campaign, the Commissioner shall coordinate with State health
            insurance assistance programs described in subsection (a)(1)(A)
            of section 119 of the Medicare Improvements for Patients and
            Providers Act of 2008 (42 U.S.C. 1395b-3 note)), the
            Administrator of the Administration for Community Living, and
            the Administrator of the Centers for Medicare & Medicaid
            Services.
                ``(3) Funding.--There are hereby appropriated to the
            Commissioner, out of any funds in the Treasury not otherwise
            appropriated, $10,000,000 for each of fiscal years 2023 through
            2025, to provide grants to State health insurance assistance
            programs to carry out outreach and education activities under
            the public awareness campaign pursuant to this subsection.''.
        (b) Moving Medicare Cost-Sharing Benefits From Medicaid to
    Medicare.--
                (1) Ending most medicare cost-sharing benefits under
            medicaid.--Section 1902(a)(10) of the Social Security Act (42
            U.S.C. 1396a(a)(10)) is amended--
                        (A) by inserting ``for calendar quarters beginning
                    before January 1, 2023,'' before ``for making'' each
                    place it appears in clauses (i), (iii), and (iv) of
                    subparagraph (E); and
                        (B) in the matter following subparagraph (G)--
                                (i) by inserting ``furnished during
                            calendar quarters beginning before January 1,
                            2023'' after ``(described in section
                            1905(p)(3))'';
                                (ii) by striking ``(XV)'' and inserting ``,
                            (XV)'';
                                (iii) by striking ``and (XVIII)'' and
                            inserting ``, (XVIII)''; and
                                (iv) by inserting ``, and (XIX) no medical
                            assistance for medicare cost-sharing, other
                            than medical assistance for medicare cost-
                            sharing for qualified disabled and working
                            individuals described in section 1905(s), shall
                            be made available after January 1, 2023''
                            before the semicolon at the end.
                (2) Conforming amendments.--
                        (A) Title xix.--
                                (i) Section 1903(i) of such Act (42 U.S.C.
                            1396b(i)) is amended--
                                        (I) in paragraph (26), by striking
                                    ``; and'' and inserting a semicolon;
                                        (II) in paragraph (27), by striking
                                    the period at the end and inserting ``;
                                    and''; and
                                        (III) by inserting after paragraph
                                    (27) the following new paragraph:
                ``(28) with respect to any amount expended for medical
            assistance for medicare cost-sharing (other than medical
            assistance for medicare cost-sharing for qualified disabled and
            working individuals described in section 1905(s)) furnished
            during calendar quarters beginning on or after January 1,
            2023.''.
                                (ii) Section 1905(a) of such Act (42 U.S.C.
                            1396d(a)) is amended, in the first sentence, by
                            inserting ``furnished during calendar quarters
                            beginning before January 1, 2023'' after
                            ``medicare cost-sharing''.
                                (iii) Section 1933(g) of such Act (42
                            U.S.C. 1396u-3(g)) is amended--
                                        (I) in paragraph (2)(Q), by
                                    striking ``paragraph (4), for each
                                    subsequent year'' and inserting
                                    ``paragraphs (4) and (5), for each
                                    subsequent year before 2023''; and
                                        (II) by adding at the end the
                                    following:
                ``(5) Sunset.--No individual shall be selected to be a
            qualifying individual for any calendar year or period under
            this section beginning on or after January 1, 2023, and no
            State allocation shall be made for any fiscal year or period
            under this section beginning on or after January 1, 2023.''.
                                (iv) Section 1935(a) of such Act (42 U.S.C.
                            1396u-5(a)) is amended--
                                        (I) in paragraph (2), by striking
                                    ``make determinations'' and inserting
                                    ``prior to January 1, 2023, make
                                    determinations''; and
                                        (II) in paragraph (3), by inserting
                                    ``prior to January 1, 2023,'' before
                                    ``the State shall''.
                        (B) Title xi.--Section 1144 of the Social Security
                    Act (42 U.S.C. 1320b-14) is amended--
                                (i) in subsection (a)--
                                        (I) in paragraph (1)(A)--
                                                (aa) by striking ``sections
                                            1902(a)(10)(E) and 1933'' and
                                            inserting ``section
                                            1902(a)(10)(E) and (prior to
                                            January 1, 2023) section
                                            1933'';
                                                (bb) by striking ``for the
                                            transitional assistance under
                                            section 1860D-31(f), or'' and
                                            inserting a comma; and
                                                (cc) by inserting ``, or
                                            for Medicare premium and cost-
                                            sharing assistance under
                                            section 1899B (in the case of
                                            months beginning on or after
                                            January 1, 2023)'' before the
                                            semicolon; and
                                        (II) by striking paragraph (2) and
                                    inserting the following:
                ``(2) Content of notice.--Any notice furnished under
            paragraph (1) shall state that eligibility for such medical
            assistance, subsidies, or program is conditioned upon meeting
            the applicable eligibility criteria.'';
                                (ii) in subsection (b)(1)(A)--
                                        (I) by striking ``sections
                                    1902(a)(10)(E) and 1933'' and inserting
                                    ``section 1902(a)(10)(E) and (prior to
                                    January 1, 2023) section 1933'';
                                        (II) by striking ``for transitional
                                    assistance under section 1860D-31(f),
                                    or''; and
                                        (III) by inserting ``, or for
                                    Medicare premium and cost-sharing
                                    assistance under section 1899B'' before
                                    the semicolon; and
                                (iii) in subsection (c)--
                                        (I) in paragraph (1)(B), by
                                    inserting ``, and (beginning January 1,
                                    2023), provide an application for
                                    enrollment under the Medicare Savings
                                    Program'' before the period;
                                        (II) in paragraph (2), in the
                                    paragraph header, by inserting
                                    ``medicare savings program application
                                    and'' before ``lis application''; and
                                        (III) in paragraph (7), by striking
                                    ``means the program of medical
                                    assistance'' and all that follows
                                    through the period and inserting
                                    ``means--
                        ``(A) prior to January 1, 2023, the program of
                    medical assistance for payment of the cost of medicare
                    cost-sharing under the Medicaid program pursuant to
                    sections 1902(a)(10)(E) and 1933; and
                        ``(B) beginning January 1, 2023, the program for
                    medical assistance for payment of the cost of medicare
                    cost-sharing for qualified disabled and working
                    individuals described in section 1905(s) pursuant to
                    section 1902(a)(10)(E)(ii) and medicare premium and
                    cost-sharing assistance provided under section
                    1899B.''.
                (3) Ensuring that medicare cost-sharing beneficiaries under
            medicaid receive medicare cost assistance.--Not later than June
            1, 2022, the Secretary of Health and Human Services and the
            Commissioner of Social Security shall jointly develop and
            implement a transition plan to ensure that all individuals who
            are eligible for and are receiving medical assistance for the
            payment of medicare cost-sharing under a State Medicaid program
            pursuant to clauses (i), (iii), and (iv) of section
            1902(a)(10)(E) of the Social Security Act (42 U.S.C.
            1396a(a)(10)(E)) as of December 31, 2022, receive Medicare cost
            assistance under section 1899B of such Act, as added by
            subsection (a), as of January 1, 2023.
        (c) Enhancing Prescription Drug Affordability by Expanding Access
    to Assistance With Out-of-Pocket Costs Under Medicare Part D for Low-
    Income Seniors and Individuals With Disabilities.--
                (1) Expanding access.--Section 1860D-14 of the Social
            Security Act (42 U.S.C. 1395w-114) is amended--
                        (A) in subsection (a)--
                                (i) in the heading, by striking ``150
                            Percent'' and inserting ``200 Percent'';
                                (ii) in paragraph (1)--
                                        (I) in the heading, by striking
                                    ``135 percent'' and inserting ``200
                                    percent''; and
                                        (II) in the matter preceding
                                    subparagraph (A)--
                                                (aa) by striking ``135
                                            percent'' and inserting ``200
                                            percent''; and
                                                (bb) by striking ``and who
                                            meets the resources requirement
                                            described in paragraph (3)(D)
                                            or who is covered under this
                                            paragraph under paragraph
                                            (3)(B)(i)'' and inserting ``or
                                            who is covered under this
                                            paragraph under paragraph
                                            (3)(B)(v)'';
                                (iii) by striking paragraph (2);
                                (iv) in paragraph (3)--
                                        (I) in subparagraph (A)--
                                                (aa) in clause (i), by
                                            adding ``and'' at the end;
                                                (bb) in clause (ii)--

                                                        (AA) by striking
                                                    ``150 percent'' and
                                                    inserting ``200
                                                    percent''; and

                                                        (BB) by striking
                                                    ``; and'' at the end
                                                    and inserting a period;
                                                    and

                                                (cc) by striking clause
                                            (iii);
                                        (II) by striking subparagraphs (B)
                                    and (C) and inserting the following:
                        ``(B) Determinations.--For provisions relating to
                    joint determinations with respect to eligibility for
                    Medicare cost assistance under section 1899B and
                    premium and cost-sharing subsidies under this section,
                    see section 1899B(b)(2).
                        ``(C) Income determinations.--For purposes of
                    applying this section--
                                ``(i) in the case of an individual who is
                            not treated as a Medicare cost-sharing
                            assistance eligible individual and a subsidy
                            eligible individual under section
                            1899B(b)(2)(D), income shall be determined in
                            the manner described under section 1612 for
                            purposes of the supplemental security income
                            program, except that support and maintenance
                            furnished in kind shall not be counted as
                            income; and
                                ``(ii) the term `poverty line' has the
                            meaning given such term in section 673(2) of
                            the Community Services Block Grant Act (42
                            U.S.C. 9902(2)), including any revision
                            required by such section.''; and
                                        (III) by striking subparagraphs
                                    (D), (E), and (G); and
                                (v) in paragraph (4), by striking
                            subparagraph (B); and
                        (B) in subsection (c)(1), in the second sentence,
                    by striking ``subsections (a)(1)(D) and (a)(2)(E)'' and
                    inserting ``subsection (a)(1)(D)''.
                (2) Treatment of reduction of cost-sharing for individuals
            receiving home and community based services.--Section 1860D-
            14(a)(1)(D) of the Social Security Act (42 U.S.C. 1395w-
            114(a)(1)(D)) is amended--
                        (A) by striking ``who would be such an
                    institutionalized individual or couple, if the full-
                    benefit dual eligible individual were not''; and
                        (B) by striking ``or subsection (c) or (d) of
                    section 1915 or under a State plan amendment under
                    subsection (i) of such section'' and inserting ``,
                    section 1115A, section 1915, or under a State plan
                    amendment''.
                (3) Effective date.--The amendments made by this subsection
            shall apply to plan year 2023 and subsequent plan years.

    SEC. 4107. REDUCING COST-SHARING, ALIGNING INCOME AND RESOURCE
                  ELIGIBILITY TESTS, SIMPLIFYING ENROLLMENT, AND OTHER
                  PROGRAM IMPROVEMENTS FOR LOW-INCOME BENEFICIARIES.

        (a) Increase in Income Eligibility to 135 Percent of FPL for
    Qualified Medicare Beneficiaries.--
                (1) In general.--Section 1905(p)(2)(A) of the Social
            Security Act (42 U.S.C. 1396d(p)(2)(A)) is amended by striking
            ``shall be at least the percent provided under subparagraph (B)
            (but not more than 100 percent) of the official poverty line''
            and all that follows through the period at the end and
            inserting the following: ``shall be--
                                ``(i) before January 1, 2023, at least the
                            percent provided under subparagraph (B) (but
                            not more than 100 percent) of the official
                            poverty line (as defined by the Office of
                            Management and Budget, and revised annually in
                            accordance with section 673(2) of the Omnibus
                            Budget Reconciliation Act of 1981) applicable
                            to a family of the size involved; and
                                ``(ii) on or after January 1, 2023, equal
                            to 135 percent of the official poverty line (as
                            so defined and revised) applicable to a family
                            of the size involved.''.
                (2) Not counting in-kind support and maintenance as
            income.--Section 1905(p)(2)(D) of the Social Security Act (42
            U.S.C. 1396d(p)(2)(D)) is amended by adding at the end the
            following new clause:
                ``(iii) In determining income under this subsection,
            support and maintenance furnished in kind shall not be counted
            as income.''.
        (b) Increase in Income Eligibility to 200 Percent of FPL for
    Specified Low-Income Medicare Beneficiaries.--
                (1) Eligibility of individuals with incomes below 150
            percent of fpl.--Section 1902(a)(10)(E) of the Social Security
            Act (42 U.S.C. 1396a(a)(10)(E)) is amended--
                        (A) by adding ``and'' at the end of clause (ii);
                        (B) in clause (iii)--
                                (i) by striking ``and 120 percent in 1995
                            and years thereafter'' and inserting ``120
                            percent in 1995 and years thereafter before
                            2023, and 200 percent in 2023 and years
                            thereafter''; and
                                (ii) by striking ``and'' at the end; and
                        (C) by striking clause (iv).
                (2) References.--Section 1905(p)(1) of the Social Security
            Act (42 U.S.C. 1396d(p)(1)) is amended by adding at and below
            subparagraph (C) the following flush sentence:
    ``The term `specified low-income medicare beneficiary' means an
    individual described in section 1902(a)(10)(E)(iii).''.
                (3) Conforming amendments.--
                        (A) The first sentence of section 1905(b) of such
                    Act (42 U.S.C. 1396d(b)) is amended by striking ``and
                    section 1933(d)''.
                        (B) Section 1933 of such Act (42 U.S.C. 1396u-3) is
                    repealed.
        (c) 100 Percent FMAP.--Section 1905 of the Social Security Act (42
    U.S.C. 1396d) is amended by adding at the end the following new
    subsection:
        ``(jj) Increased FMAP for Expanded Medicare Cost-Sharing
    Populations.--
                ``(1) In general.--Notwithstanding subsection (b), with
            respect to expenditures described in paragraph (2) the Federal
            medical assistance percentage shall be equal to 100 percent.
                ``(2) Expenditures described.--The expenditures described
            in this paragraph are expenditures made on or after January 1,
            2023, for medical assistance for medicare cost-sharing provided
            to any individual under clause (i), (ii), or (iii) of section
            1902(a)(10)(E) who would not have been eligible for medicare
            cost-sharing under any such clause under the income or resource
            eligibility standards in effect on October 1, 2018.''.
        (d) Consolidation of Low-Income Subsidy Resource Eligibility
    Tests.--
                (1) In general.--Section 1860D-14(a)(3) of the Social
            Security Act (42 U.S.C. 1395w-114(a)(3)) is amended--
                        (A) by striking subparagraph (D);
                        (B) by redesignating subparagraphs (E) through (G)
                    as subparagraphs (D) through (F), respectively; and
                        (C) in the heading of subparagraph (D), as so
                    redesignated, by striking ``Alternative''.
                (2) Clarification of certain rules relating to income and
            resource determinations.--Section 1860D-14(a)(3) of the Social
            Security Act (42 U.S.C. 1395w-114(a)(3)), as amended by
            paragraph (1), is amended by striking subparagraph (F) and
            inserting the following new subparagraphs:
                        ``(F) Resource exclusions.--In determining the
                    resources of an individual (and the eligible spouse of
                    the individual, if any) under section 1613 for purposes
                    of subparagraph (D)--
                                ``(i) no part of the value of any life
                            insurance policy shall be taken into account;
                                ``(ii) no part of the value of any vehicle
                            shall be taken into account;
                                ``(iii) there shall be excluded an amount
                            equal to $1,500 each with respect to any
                            individual or eligible spouse of an individual
                            who attests that some of the resources of such
                            individual or spouse will be used to meet the
                            burial and related expenses of such individual
                            or spouse; and
                                ``(iv) no balance in, or benefits received
                            under, an employee pension benefit plan (as
                            defined in section 3 of the Employee Retirement
                            Income Security Act of 1974) shall be taken
                            into account.
                        ``(G) Family size.--In determining the size of the
                    family of an individual for purposes of determining the
                    income eligibility of such individual under this
                    section, an individual's family shall consist of--
                                ``(i) the individual;
                                ``(ii) the individual's spouse who lives in
                            the same household as the individual (if any);
                            and
                                ``(iii) any other individuals who--
                                        ``(I) are related to the individual
                                    whose income eligibility is in question
                                    or such individual's spouse who lives
                                    in the same household;
                                        ``(II) are living in the same
                                    household as such individual; and
                                        ``(III) are dependent on such
                                    individual or such individual's spouse
                                    who is living in the same household for
                                    at least one-half of their financial
                                    support.''.
                (3) Conforming amendments.--Section 1860D-14(a) of the
            Social Security Act (42 U.S.C. 1395w-114(a)) is amended--
                        (A) in paragraph (1), in the matter preceding
                    subparagraph (A), by inserting ``(as determined under
                    paragraph (3)(G))'' after ``family of the size
                    involved''; and
                        (B) in paragraph (3), as amended by paragraphs (1)
                    and (2)--
                                (i) in subparagraph (A), in the matter
                            preceding clause (i), by striking
                            ``subparagraph (F)'' and inserting
                            ``subparagraph (E)'';
                                (ii) in subparagraph (A)(ii), by inserting
                            ``(as determined under subparagraph (G))''
                            after ``family of the size involved'';
                                (iii) in subparagraph (A)(iii), by striking
                            ``or (E)'';
                                (iv) in subparagraph (B)(v), in the matter
                            preceding subclause (I), by striking
                            ``subparagraph (F)'' and inserting
                            ``subparagraph (E)''; and
                                (v) in subparagraph (D)(i), in the matter
                            preceding subclause (I), by striking ``subject
                            to the life insurance policy exclusion provided
                            under subparagraph (G)'' and inserting
                            ``subject to the resource exclusions provided
                            under subparagraph (F)''.
        (e) Alignment of Low-Income Subsidy and Medicare Savings Program
    Income and Resource Eligibility Tests.--
                (1) Application of medicaid spousal impoverishment resource
            allowance to msp and lis resource eligibility.--Section
            1905(p)(1)(C) of the Social Security Act (42 U.S.C.
            1396d(p)(1)(C)) is amended to read as follows:
                ``(C) whose resources (as determined under section 1613 for
            purposes of the supplemental security income program subject to
            the resource exclusions under subparagraph (G) of section
            1860D-14(a)(3)) do not exceed--
                        ``(i) in the case of an individual with a spouse,
                    an amount equal to the sum of the first amount
                    specified in subsection (f)(2)(A)(i) of section 1924
                    (as adjusted under subsection (g) of such section) and
                    the amount specified in subsection (f)(2)(A)(ii)(II) of
                    such section (as so adjusted); or
                        ``(ii) in the case of an individual who does not
                    have a spouse, an amount equal to \1/2\ of the amount
                    described in clause (i).''.
                (2) Application to qdwis.--Section 1905(s)(3) of the Social
            Security Act (42 U.S.C. 1396d(s)(3)) is amended to read as
            follows:
                ``(3) whose resources (as determined under section 1613 for
            purposes of the supplemental security income program subject to
            the resource exclusions under subparagraph (G) of section
            1860D-14(a)(3)) do not exceed--
                        ``(A) in the case of an individual with a spouse,
                    the amount in effect for the year under clause (i) of
                    subsection (p)(1)(C); and
                        ``(B) in the case of an individual who does not
                    have a spouse, the amount in effect for the year under
                    clause (ii) of subsection (p)(1)(C); and''.
                (3) Application to lis.--Clause (i) of section 1860D-
            14(a)(3)(D) of the Social Security Act (42 U.S.C. 1395w-
            114(a)(3)(D)), as redesignated and amended by subsection
            (d)(1), is amended to read as follows:
                                ``(i) In general.--The resources
                            requirement of this subparagraph is that an
                            individual's resources (as determined under
                            section 1613 for purposes of the supplemental
                            security income program subject to the resource
                            exclusions provided under subparagraph (G)) do
                            not exceed the amount in effect for the year
                            under section 1905(p)(1)(C)(ii).''.
        (f) Enrollment Simplifications.--
                (1) Application of 3-month retroactive eligibility to
            qmbs.--
                        (A) In general.--Section 1902(e)(8) of the Social
                    Security Act (42 U.S.C. 1396a(e)(8)) is amended by
                    striking ``after the end of the month in which the
                    determination first occurs'' and inserting ``in or
                    after the third month before the month in which the
                    individual makes application for assistance''.
                        (B) Process for submitting claims during
                    retroactive eligibility period.--Section 1902(e)(8) of
                    the Social Security Act (42 U.S.C. 1396a(e)(8)) is
                    further amended by adding at the end the following:
                    ``The Secretary shall provide for a process under which
                    claims for medical assistance under the State plan may
                    be submitted for services furnished to such an
                    individual during such 3-month period before the month
                    in which the individual made application for
                    assistance.''.
                        (C) Conforming amendment.--Section 1905(a) of the
                    Social Security Act (42 U.S.C. 1396d(a)) is amended, in
                    the matter preceding paragraph (1), by striking ``or,
                    in the case of medicare cost-sharing with respect to a
                    qualified medicare beneficiary described in subsection
                    (p)(1), if provided after the month in which the
                    individual becomes such a beneficiary''.
                (2) State option for 12-month continuous eligibility for
            slmbs and qwdis.--Section 1902(e)(12) of the Social Security
            Act (42 U.S.C. 1396a(e)(12)) is amended--
                        (A) by redesignating subparagraphs (A) and (B) as
                    clauses (i) and (ii), respectively;
                        (B) by inserting ``(A)'' after ``(12)''; and
                        (C) by adding at the end the following:
        ``(B) At the option of the State, the plan may provide that an
    individual who is determined to be eligible for benefits under a State
    plan approved under this title under any of the following eligibility
    categories, or who is redetermined to be eligible for such benefits
    under any of such categories, shall be considered to meet the
    eligibility requirements met on the date of application and shall
    remain eligible for those benefits until the end of the 12-month period
    following the date of the determination or redetermination of
    eligibility, except that a State may provide for such determinations
    more frequently, but not more frequently than once every 6 months for
    an individual:
                ``(i) A specified low-income medicare beneficiary described
            in subsection (a)(10)(E)(iii) of this section who is determined
            eligible for medicare cost sharing described in section
            1905(p)(3)(A)(ii).
                ``(ii) A qualified disabled and working individual
            described in section 1905(s) who is determined eligible for
            medicare cost-sharing described in section 1905(p)(3)(A)(i).''.
                (3) State option to use express lane eligibility for the
            medicare savings program.--Section 1902(e)(13)(A) of the Social
            Security Act (42 U.S.C. 1396a(e)(13)(A)) is amended by adding
            at the end the following new clause:
                        ``(iii) State option to extend express lane
                    eligibility to other populations.--
                                ``(I) In general.--At the option of the
                            State, the State may apply the provisions of
                            this paragraph with respect to determining
                            eligibility under this title for an eligible
                            individual (as defined in subclause (II)). In
                            applying this paragraph in the case of a State
                            making such an option, any reference in this
                            paragraph to a child with respect to this title
                            (other than a reference to child health
                            assistance) shall be deemed to be a reference
                            to an eligible individual.
                                ``(II) Eligible individual defined.--In
                            this clause, the term `eligible individual'
                            means any of the following:
                                        ``(aa) A qualified medicare
                                    beneficiary described in section
                                    1905(p)(1) for purposes of determining
                                    eligibility for medicare cost-sharing
                                    (as defined in section 1905(p)(3)).
                                        ``(bb) A specified low-income
                                    medicare beneficiary described in
                                    subsection (a)(10)(E)(iii) of this
                                    section for purposes of determining
                                    eligibility for medicare cost-sharing
                                    described in section 1905(p)(3)(A)(ii).
                                        ``(cc) A qualified disabled and
                                    working individual described in section
                                    1905(s) for purposes of determining
                                    eligibility for medicare cost-sharing
                                    described in section
                                    1905(p)(3)(A)(i).''.
        (g) Medicaid Treatment of Certain Medicare Providers.--Section
    1902(n) of the Social Security Act (42 U.S.C. 1396a(n)) is amended by
    adding at the end the following new paragraph:
        ``(4) A State plan shall not deny a claim from a provider or
    supplier with respect to medicare cost-sharing described in
    subparagraph (B), (C), or (D) of section 1905(p)(3) for an item or
    service which is eligible for payment under title XVIII on the basis
    that the provider or supplier does not have a provider agreement in
    effect under this title or does not otherwise serve all individuals
    entitled to medical assistance under this title. The State shall create
    a mechanism through which provider or suppliers that do not otherwise
    have provider agreements with the State can bill the State for medicare
    cost-sharing for qualified medicare beneficiaries.''.
        (h) Eligibility for Other Programs.--Section 1905(p) of the Social
    Security Act (42 U.S.C. 1396d(p)) is amended by adding at the end the
    following new paragraph:
        ``(7) Notwithstanding any other provision of law, any medical
    assistance for some or all medicare cost-sharing under this title shall
    not be considered income or resources in determining eligibility for,
    or the amount of assistance or benefits provided under, any other
    public benefit provided under Federal law or the law of any State or
    political subdivision thereof.''.
        (i) Treatment of Qualified Medicare Beneficiaries, Specified Low-
    Income Medicare Beneficiaries, and Other Dual Eligibles as Medicare
    Beneficiaries.--Section 1862 of the Social Security Act (42 U.S.C.
    1395y) is amended by adding at the end the following new subsection:
        ``(p) Treatment of Qualified Medicare Beneficiaries (QMBs),
    Specified Low-Income Medicare Beneficiaries (SLMBs), and Other Dual
    Eligibles.--Nothing in this title shall be construed as authorizing a
    provider of services or supplier to discriminate (through a private
    contractual arrangement or otherwise) against an individual who is
    otherwise entitled to services under this title on the basis that the
    individual is a qualified medicare beneficiary (as defined in section
    1905(p)(1)), a specified low-income medicare beneficiary, or is
    otherwise eligible for medical assistance for medicare cost-sharing or
    other benefits under title XIX.''.
        (j) Additional Funding for State Health Insurance Assistance
    Programs.--
                (1) Grants.--
                        (A) In general.--The Secretary of Health and Human
                    Services (in this subsection referred to as the
                    ``Secretary'') shall use amounts made available under
                    subparagraph (B) to make grants to States for State
                    health insurance assistance programs receiving
                    assistance under section 4360 of the Omnibus Budget
                    Reconciliation Act of 1990.
                        (B) Funding.--For purposes of making grants under
                    this subsection, the Secretary shall provide for the
                    transfer, 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), in the same proportion as the Secretary
                    determines under section 1853(f) of such Act (42 U.S.C.
                    1395w-23(f)), of $50,000,000 to the Centers for
                    Medicare & Medicaid Services Program Management Account
                    for each of the fiscal years 2024 through 2028, to
                    remain available until expended.
                (2) Amount of grants.--The amount of a grant to a State
            under this subsection from the total amount made available
            under paragraph (1) shall be equal to the sum of the amount
            allocated to the State under paragraph (3)(A) and the amount
            allocated to the State under subparagraph (3)(B).
                (3) Allocation to states.--
                        (A) Allocation based on percentage of low-income
                    beneficiaries.--The amount allocated to a State under
                    this subparagraph from \2/3\ of the total amount made
                    available under paragraph (1) shall be based on the
                    number of individuals who meet the requirement under
                    subsection (a)(3)(A)(ii) of section 1860D-14 of the
                    Social Security Act (42 U.S.C. 1395w-114) but who have
                    not enrolled to receive a subsidy under such section
                    1860D-14 relative to the total number of individuals
                    who meet the requirement under such subsection
                    (a)(3)(A)(ii) in each State, as estimated by the
                    Secretary.
                        (B) Allocation based on percentage of rural
                    beneficiaries.--The amount allocated to a State under
                    this subparagraph from \1/3\ of the total amount made
                    available under paragraph (1) shall be based on the
                    number of part D eligible individuals (as defined in
                    section 1860D-1(a)(3)(A) of such Act (42 U.S.C. 1395w-
                    101(a)(3)(A))) residing in a rural area relative to the
                    total number of such individuals in each State, as
                    estimated by the Secretary.
                (4) Portion of grant based on percentage of low-income
            beneficiaries to be used to provide outreach to individuals who
            may be subsidy eligible individuals or eligible for the
            medicare savings program.--Each grant awarded under this
            subsection with respect to amounts allocated under paragraph
            (3)(A) shall be used to provide outreach to individuals who may
            be subsidy eligible individuals (as defined in section 1860D-
            14(a)(3)(A) of the Social Security Act (42 U.S.C. 1395w-
            114(a)(3)(A))) or eligible for the program of medical
            assistance for payment of the cost of medicare cost-sharing
            under the Medicaid program pursuant to sections 1902(a)(10)(E)
            and 1933 of such Act (42 U.S.C. 1396a(a)(10)(E), 1396u-3).
        (k) Effective Date.--
                (1) In general.--Except as provided in paragraph (2), the
            amendments and repeal made by this section take effect on
            January 1, 2023, and, with respect to title XIX of the Social
            Security Act, apply to calendar quarters beginning on or after
            January 1, 2023.
                (2) Exception for state legislation.--In the case of a
            State plan for medical assistance under title XIX of the Social
            Security Act which the Secretary of Health and Human Services
            determines requires State legislation (other than legislation
            appropriating funds) in order for the plan to meet the
            additional requirements imposed by the amendments and repeal
            made by this section, the State plan shall not be regarded as
            failing to comply with the requirements of such title solely on
            the basis of its failure to meet these additional requirements
            before the first day of the first calendar quarter beginning
            after the close of the first regular session of the State
            legislature that begins after the date of 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. 4108. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE PROVIDED BY URBAN
                  INDIAN ORGANIZATIONS.

        (a) In General.--The third sentence of section 1905(b) of the
    Social Security Act (42 U.S.C. 1396(b)) is amended by inserting ``or
    are received through a program operated by an urban Indian organization
    through a grant or contract under title V of the Indian Health Care
    Improvement Act'' after ``(as defined in section 4 of the Indian Health
    Care Improvement Act)''.
        (b) Effective Date.--The amendment made by this section shall apply
    to medical assistance provided on or after the date of enactment of
    this Act.

    SEC. 4109. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE PROVIDED TO A NATIVE
                  HAWAIIAN THROUGH A FEDERALLY QUALIFIED HEALTH CENTER OR A
                  NATIVE HAWAIIAN HEALTH CARE SYSTEM UNDER THE MEDICAID
                  PROGRAM.

        (a) In General.--The third sentence of section 1905(b) of the
    Social Security Act (42 U.S.C. 1396d(b)) is amended by striking ``, for
    such 8 fiscal year quarters''.
        (b) Effective Date.--The amendment made by this section shall apply
    to medical assistance provided on or after the date of enactment of
    this Act.

    SEC. 4110. REPEAL OF REQUIREMENT FOR ESTATE RECOVERY UNDER THE MEDICAID
                  PROGRAM.

         Section 1917 of the Social Security Act (42 U.S.C. 1396p) is
    amended--
                (1) in subsection (a)--
                        (A) by amending paragraph (1) to read as follows:
                ``(1) No lien may be imposed against the property of any
            individual prior to his death on account of medical assistance
            paid or to be paid on his behalf under the State plan, except
            pursuant to the judgment of a court on account of benefits
            incorrectly paid on behalf of such individual.'';
                        (B) by striking paragraph (2);
                        (C) in paragraph (3), by striking ``(1)(B)'' and
                    inserting ``(1)''; and
                        (D) by redesignating paragraph (3) as paragraph
                    (2); and
                (2) by amending subsection (b) to read as follows:
        ``(b) Adjustment or Recovery of Medical Assistance Correctly Paid
    Under a State Plan.--No adjustment or recovery of any medical
    assistance correctly paid on behalf of an individual under the State
    plan may be made.''.

    SEC. 4111. ALLOW FOR SUSPENSION OF MEDICARE BENEFITS AND PREMIUM
                  LIABILITY FOR INDIVIDUALS WHO ARE INCARCERATED AND
                  PROVIDE A SPECIAL ENROLLMENT PERIOD AROUND THE DATE OF
                  RELEASE.

        (a) Special Enrollment Period for Individuals Incarcerated at Time
    of Medicare Eligibility.--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) at the time the individual first satisfies
                    paragraph (1) or (2) of section 1836(a), is
                    incarcerated; or
                        ``(ii) has elected not to enroll (or to be deemed
                    enrolled) under this section during the individual's
                    initial enrollment period;
                    there shall be a special enrollment period described in
                    subparagraph (B).
                        ``(B) The special enrollment period referred to in
                    subparagraph (A) is the 6-month period on the first day
                    after which the individual is no longer
                    incarcerated.''.
        (b) Premium Amount.--Section 1839(b) of the Social Security Act (42
    U.S.C. 1395r(b)) is amended--
                (1) by inserting ``(1)'' after ``(b)'';
                (2) in paragraph (1), as so redesignated by paragraph (1),
            by striking ``or (l)'' and inserting ``(l), or (m)''; and
                (3) by adding at the end the following new paragraph:
        ``(2) In the case of an individual whose coverage period includes
    months in which by reason of custody under penal authority coverage is
    excluded pursuant to section 1862(a)(3), the premium amount for such
    months such individual is in custody under penal authority shall be
    zero.''.
        (c) Conforming Amendment.--Section 1818(d)(5) of the Social
    Security Act (42 U.S.C. 1395i-2(d)(5)) is amended by adding at the end
    the following:
                        ``(D) In the case of an individual who is a person
                    who is excluded from coverage pursuant to section
                    1862(a)(3) by reason of custody under penal authority,
                    the amount of the monthly premium for such individual
                    shall be zero for any month in which such individual is
                    in custody under penal authority.''.

    SEC. 4112. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS.

        (a) Coverage of Pregnancy.--The Director of the Office of Personnel
    Management shall issue such regulations as are necessary to ensure that
    pregnancy is considered a change in family status and a qualifying life
    event for an individual who is eligible to enroll, but is not enrolled,
    in a health benefit plan under chapter 89 of title 5, United States
    Code.
        (b) Effective Date.--The requirement in paragraph (1) shall apply
    with respect to any contract entered into under section 8902 of such
    title beginning 12 months after the date of enactment of this Act.

    SEC. 4113. CONTINUATION OF MEDICAID INCOME ELIGIBILITY STANDARD FOR
                  PREGNANT INDIVIDUALS AND INFANTS.

        Section 1902(l)(2)(A) of the Social Security Act (42 U.S.C.
    1396a(l)(2)(A)) is amended--
                (1) in clause (i), by striking ``and not more than 185
            percent'';
                (2) in clause (ii)--
                        (A) in subclause (I), by striking ``and'' after the
                    comma;
                        (B) in subclause (II), by striking the period at
                    the end and inserting ``, and''; and
                        (C) by adding at the end the following:
                                        ``(III) January 1, 2023, is the
                                    percentage provided under clause
                                    (v).''; and
                (3) by adding at the end the following new clause:
                                ``(v) The percentage provided under clause
                            (ii) for medical assistance provided on or
                            after January 1, 2023, with respect to
                            individuals described in subparagraph (A) or
                            (B) of paragraph (1) shall not be less than--
                                        ``(I) the percentage specified for
                                    such individuals by the State in an
                                    amendment to its State plan (whether
                                    approved or not) as of January 1, 2014;
                                    or
                                        ``(II) if no such percentage is
                                    specified as of January 1, 2014, the
                                    percentage established for such
                                    individuals under the State's
                                    authorizing legislation or provided for
                                    under the State's appropriations as of
                                    that date.''.

                        Subtitle C--Expansion of Access

                           PART 1--GENERAL PROVISIONS

    SEC. 4201. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

        Title XXXIV of the Public Health Service Act, as amended by titles
    I, II, and III of this Act, is further amended by inserting after
    subtitle D the following:

     ``Subtitle D--Reconstruction and Improvement Grants for Public Health
        Care Facilities Serving Pacific Islanders and the Insular Areas

    ``SEC. 3441. 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, hospice or palliative care provider,
            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 (as defined in
                    section 1707(g)(1)); or
                        ``(ii) that--
                                ``(I) serves a disproportionate percentage
                            of local patients who are from a racial and
                            ethnic minority group, or 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 eligible entities 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;
                        ``(G) comprehensive and patient-centric health
                    care;
                        ``(H) creation and distribution of education
                    materials on available health care options; or
                        ``(I) 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;
                        ``(F) health information technology;
                        ``(G) accessibility and availability of information
                    on health care;
                        ``(H) comprehensiveness of health care; and
                        ``(I) patient involvement and choice in health
                    care; 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) preparing for end of life and ensuring that
                    end-of-life care is accessible and available, as well
                    as 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 2023 through 2030.

    ``SEC. 3442. 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 3441(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 high-
            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 2023 through 2030.

    ``SEC. 3443. 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, are receiving assistance
            under title XVIII of the Social Security Act or under a State
            plan under title XIX of such Act (or under a waiver of such
            plan), or 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. 4202. BORDER HEALTH GRANTS.

        (a) Definitions.--In this section:
                (1) Border area.--The term ``border area'' means the United
            States-Mexico Border Area, as defined in section 8 of the
            United States-Mexico Border Health Commission Act (22 U.S.C.
            290n-6).
                (2) Eligible entity.--The term ``eligible entity'' means an
            entity that is located in the border area and is any of the
            following:
                        (A) A State, local government, or Tribal
                    government.
                        (B) A public institution of higher education.
                        (C) A nonprofit health organization.
                        (D) A community health center.
                        (E) A community clinic that is a health center
                    receiving assistance under section 330 of the Public
                    Health Service Act (42 U.S.C. 254b).
                        (F) A nonprofit organization serving immigrants.
        (b) Authorization.--From funds appropriated pursuant to subsection
    (f), the Secretary of Health and Human Services (in this section
    referred to as the ``Secretary''), acting through the United States
    members of the United States-Mexico Border Health Commission, shall
    award grants to eligible entities to address priorities and
    recommendations to improve the health of border area residents that are
    established by--
                (1) the United States members of the United States-Mexico
            Border Health Commission;
                (2) the State border health offices; and
                (3) the Secretary.
        (c) Application.--An eligible entity that desires a grant under
    subsection (b) shall submit an application to the Secretary at such
    time, in such manner, and containing such information as the Secretary
    may require and demonstrating the entity's capacity to provide
    culturally and linguistically appropriate services to border area
    residents.
        (d) Use of Funds.--An eligible entity that receives a grant under
    subsection (b) shall use the grant funds for--
                (1) programs relating to--
                        (A) maternal and child health;
                        (B) primary care and preventative health;
                        (C) public health and public health infrastructure;
                        (D) musculoskeletal health and obesity;
                        (E) health education and promotion;
                        (F) oral health;
                        (G) mental and behavioral health;
                        (H) substance use disorders;
                        (I) health conditions that have a high prevalence
                    in the border area;
                        (J) medical and health services research;
                        (K) workforce training and development;
                        (L) community health workers, patient navigators,
                    and promotores;
                        (M) health care infrastructure problems in the
                    border area (including planning and construction
                    grants);
                        (N) health disparities in the border area;
                        (O) environmental health;
                        (P) outreach and enrollment services with respect
                    to Federal programs (including programs authorized
                    under titles XIX and XXI of the Social Security Act (42
                    U.S.C. 1396 et seq.; 42 U.S.C. 1397aa et seq.));
                        (Q) end-of-life care; and
                        (R) addressing social determinants of health; and
                (2) other programs determined appropriate by the Secretary.
        (e) Supplement, Not Supplant.--Amounts provided to an eligible
    entity awarded a grant under subsection (b) shall be used to supplement
    and not supplant other funds available to the eligible entity to carry
    out the activities described in subsection (d).
        (f) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section, $200,000,000 for fiscal year
    2024, and such sums as may be necessary for each succeeding fiscal
    year.

    SEC. 4203. CRITICAL ACCESS HOSPITAL IMPROVEMENTS.

        (a) Elimination of Isolation Test for Cost-Based Ambulance
    Reimbursement.--
                (1) In general.--Section 1834(l)(8) of the Social Security
            Act (42 U.S.C. 1395m(l)(8)) is amended--
                        (A) in subparagraph (B)--
                                (i) by striking ``owned and''; and
                                (ii) by inserting ``(including when such
                            services are provided by the entity under an
                            arrangement with the hospital)'' after
                            ``hospital''; and
                        (B) by striking the comma at the end of
                    subparagraph (B) and all that follows and inserting a
                    period.
                (2) Effective date.--The amendments made by this subsection
            shall apply to services furnished on or after January 1, 2021.
        (b) Provision of a More Flexible Alternative to the CAH Designation
    25 Inpatient Bed Limit Requirement.--
                (1) In general.--Section 1820(c)(2) of the Social Security
            Act (42 U.S.C. 1395i-4(c)(2)) is amended--
                        (A) in subparagraph (B)(iii), by striking
                    ``provides not more than'' and inserting ``subject to
                    subparagraph (F), provides not more than''; and
                        (B) by adding at the end the following new
                    subparagraph:
                        ``(F) Alternative to 25 inpatient bed limit
                    requirement.--
                                ``(i) In general.--A State may elect to
                            treat a facility, with respect to the
                            designation of the facility for a cost-
                            reporting period, as satisfying the requirement
                            of subparagraph (B)(iii) relating to a maximum
                            number of acute care inpatient beds if the
                            facility elects, in accordance with a method
                            specified by the Secretary and before the
                            beginning of the cost reporting period, to meet
                            the requirement under clause (ii).
                                ``(ii) Alternate requirement.--The
                            requirement under this clause, with respect to
                            a facility and a cost-reporting period, is that
                            the total number of inpatient bed days
                            described in subparagraph (B)(iii) during such
                            period will not exceed 7,300. For purposes of
                            this subparagraph, an individual who is an
                            inpatient in a bed in the facility for a single
                            day shall be counted as one inpatient bed day.
                                ``(iii) Withdrawal of election.--The option
                            described in clause (i) shall not apply to a
                            facility for a cost-reporting period if the
                            facility (for any two consecutive cost-
                            reporting periods during the previous 5 cost-
                            reporting periods) was treated under such
                            option and had a total number of inpatient bed
                            days for each of such two cost-reporting
                            periods that exceeded the number specified in
                            such clause.''.
                (2) Effective date.--The amendments made by paragraph (1)
            shall apply to cost-reporting periods beginning on or after the
            date of the enactment of this Act.
        (c) Expanding the Funding Authority for Renovating, Constructing,
    and Expanding Certain Facilities.--Section 509 of the Indian Health
    Care Improvement Act (25 U.S.C. 1659) is amended--
                (1) by striking ``minor'' before ``renovations''; and
                (2) by striking ``, to assist'' and all that follows
            through ``standards''.

    SEC. 4204. MEDICARE REMOTE MONITORING PILOT PROJECTS.

        (a) Pilot Projects.--
                (1) In general.--Not later than 9 months after the date of
            enactment of this Act, the Secretary of Health and Human
            Services (in this section referred to as the ``Secretary'')
            shall conduct pilot projects under title XVIII of the Social
            Security Act (42 U.S.C. 1395 et seq.) for the purpose of
            providing incentives to home health agencies to utilize home
            monitoring and communications technologies that--
                        (A) enhance health and health care outcomes for
                    Medicare beneficiaries; and
                        (B) reduce expenditures under such title.
                (2) Site requirements.--
                        (A) Urban and rural.--The Secretary shall conduct
                    the pilot projects under this section in both urban and
                    rural areas.
                        (B) Site in a small state.--The Secretary shall
                    conduct at least 3 of the pilot projects in a State
                    with a population of less than 1,000,000.
                (3) Definition of home health agency.--In this section, the
            term ``home health agency'' has the meaning given that term in
            section 1861(o) of the Social Security Act (42 U.S.C.
            1395x(o)).
        (b) Medicare Beneficiaries Within the Scope of Projects.--The
    Secretary shall specify the criteria for identifying those Medicare
    beneficiaries who shall be considered within the scope of the pilot
    projects under this section for purposes of the application of
    subsection (c) and for the assessment of the effectiveness of the home
    health agency in achieving the objectives of this section. Such
    criteria may provide for the inclusion in the projects of Medicare
    beneficiaries who begin receiving home health services under title
    XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) after the
    date of the implementation of the projects.
        (c) Incentives.--
                (1) Performance targets.--The Secretary shall establish for
            each home health agency participating in a pilot project under
            this section a performance target using one of the following
            methodologies, as determined appropriate by the Secretary:
                        (A) Adjusted historical performance target.--The
                    Secretary shall establish for the agency--
                                (i) a base expenditure amount equal to the
                            average total payments made to the agency under
                            parts A and B of title XVIII of the Social
                            Security Act (42 U.S.C. 1395 et seq.) for
                            Medicare beneficiaries determined to be within
                            the scope of the pilot project in a base period
                            determined by the Secretary; and
                                (ii) an annual per capita expenditure
                            target for such beneficiaries, reflecting the
                            base expenditure amount adjusted for risk and
                            adjusted growth rates.
                        (B) Comparative performance target.--The Secretary
                    shall establish for the agency a comparative
                    performance target equal to the average total payments
                    under such parts A and B during the pilot project for
                    comparable individuals in the same geographic area that
                    are not determined to be within the scope of the pilot
                    project.
                (2) Incentive.--Subject to paragraph (3), the Secretary
            shall pay to each participating home care agency an incentive
            payment for each year under the pilot project equal to a
            portion of the Medicare savings realized for such year relative
            to the performance target under paragraph (1).
                (3) Limitation on expenditures.--The Secretary shall limit
            incentive payments under this section in order to ensure that
            the aggregate expenditures under title XVIII of the Social
            Security Act (42 U.S.C. 1395 et seq.) (including incentive
            payments under this subsection) do not exceed the amount that
            the Secretary estimates would have been expended if the pilot
            projects under this section had not been implemented.
        (d) Waiver Authority.--The Secretary may waive such provisions of
    titles XI and XVIII of the Social Security Act (42 U.S.C. 1301 et seq.;
    42 U.S.C. 1395 et seq.) as the Secretary determines to be appropriate
    for the conduct of the pilot projects under this section.
        (e) Report to Congress.--Not later than 5 years after the date that
    the first pilot project under this section is implemented, the
    Secretary shall submit to Congress a report on the pilot projects. Such
    report shall contain a detailed description of issues related to the
    expansion of the projects under subsection (f) and recommendations for
    such legislation and administrative actions as the Secretary considers
    appropriate.
        (f) Expansion.--If the Secretary determines that any of the pilot
    projects under this section enhance health outcomes for Medicare
    beneficiaries and reduce expenditures under title XVIII of the Social
    Security Act (42 U.S.C. 1395 et seq.), the Secretary may initiate
    comparable projects in additional areas.
        (g) Incentive Payments Have No Effect on Other Medicare Payments to
    Agencies.--An incentive payment under this section--
                (1) shall be in addition to the payments that a home health
            agency would otherwise receive under title XVIII of the Social
            Security Act for the provision of home health services; and
                (2) shall have no effect on the amount of such payments.

    SEC. 4205. COMMUNITY HEALTH CENTER COLLABORATIVE ACCESS EXPANSION.

        Section 330(r)(4) of the Public Health Service Act (42 U.S.C.
    254b(r)(4)) is amended--
                (1) in subparagraph (A), by striking ``primary health care
            services'' each place it appears and inserting ``primary health
            care and other mental, dental, and physical health services'';
            and
                (2) in subparagraph (B)--
                        (A) in clause (i), by striking ``and'' at the end;
                        (B) in clause (ii), by striking the period at the
                    end and inserting ``; and''; and
                        (C) by adding at the end the following:
                                ``(iii) in the case of a rural health
                            clinic described in such subparagraph--
                                        ``(I) that such clinic provides, to
                                    the extent possible, enabling services,
                                    such as transportation and language
                                    assistance (including translation and
                                    interpretation); and
                                        ``(II) that the primary health care
                                    and other services described in such
                                    subparagraph are subject to full
                                    reimbursement according to the
                                    prospective payment system for
                                    Federally qualified health center
                                    services under section 1834(o) of the
                                    Social Security Act.''.

    SEC. 4206. FACILITATING THE PROVISION OF TELEHEALTH SERVICES ACROSS
                  STATE LINES.

        (a) In General.--For purposes of expediting the provision of
    telehealth services, for which payment is made under the Medicare
    Program, across State lines, the Secretary of Health and Human Services
    shall, in consultation with representatives of States, physicians,
    health care practitioners, and patient advocates, encourage and
    facilitate the adoption of provisions allowing for multistate
    practitioner practice across State lines.
        (b) Definitions.--In subsection (a):
                (1) Telehealth service.--The term ``telehealth service''
            has the meaning given that term in subparagraph (F) of section
            1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4)).
                (2) Physician, practitioner.--The terms ``physician'' and
            ``practitioner'' have the meaning given those terms in
            subparagraphs (D) and (E), respectively, of such section.
                (3) Medicare program.--The term ``Medicare Program'' means
            the program of health insurance administered by the Secretary
            of Health and Human Services under title XVIII of the Social
            Security Act (42 U.S.C. 1395 et seq.).

    SEC. 4207. SCORING OF PREVENTIVE HEALTH SAVINGS.

        Section 202 of the Congressional Budget and Impoundment Control Act
    of 1974 (2 U.S.C. 602) is amended by adding at the end the following:
        ``(h) Scoring of Preventive Health Savings.--
                ``(1) Determination by the director.--Upon a request by the
            chairman or ranking minority member of the Committee on the
            Budget of the Senate, or by the chairman or ranking minority
            member of the Committee on the Budget of the House of
            Representatives, the Director shall determine if a proposed
            measure would result in reductions in budget outlays in
            budgetary outyears through the use of preventive health and
            preventive health services.
                ``(2) Projections.--If the Director determines that a
            measure would result in substantial reductions in budget
            outlays as described in paragraph (1), the Director--
                        ``(A) shall include, in any projection prepared by
                    the Director, a description and estimate of the
                    reductions in budget outlays in the budgetary outyears
                    and a description of the basis for such conclusions;
                    and
                        ``(B) may prepare a budget projection that includes
                    some or all of the budgetary outyears, notwithstanding
                    the time periods for projections described in
                    subsection (e) and sections 308, 402, and 424.
                ``(3) Definitions.--As used in this subsection--
                        ``(A) the term `budgetary outyears' means the 2
                    consecutive 10-year periods beginning with the first
                    fiscal year that is 10 years after the budget year
                    provided for in the most recently agreed to concurrent
                    resolution on the budget; and
                        ``(B) the term `preventive health' means an action
                    that focuses on the health of the public, individuals,
                    and defined populations in order to protect, promote,
                    and maintain health, wellness, and functional ability,
                    and prevent disease, disability, and premature death
                    that is demonstrated by credible and publicly available
                    epidemiological projection models, incorporating
                    clinical trials or observational studies in humans, to
                    avoid future health care costs.''.

    SEC. 4208. SENSE OF CONGRESS ON MAINTENANCE OF EFFORT PROVISIONS
                  REGARDING CHILDREN'S HEALTH.

        It is the sense of the Congress that--
                (1) the maintenance of effort provisions added to sections
            1902 and 2105(d) of the Social Security Act (42 U.S.C. 1396a;
            42 U.S.C. 1397ee(d)) by sections 2001(b) and 2101(b) of the
            Patient Protection and Affordable Care Act were intended to
            maintain the eligibility standards for the Medicaid program
            under title XIX of the Social Security Act (42 U.S.C. 1396 et
            seq.) and Children's Health Insurance Program under title XXI
            of such Act (42 U.S.C. 1397aa et seq.) to protect vulnerable
            and disabled adults, children, and senior citizens, many of
            whom are also members of communities of color;
                (2) the maintenance of effort provisions for children's
            coverage have been extended by the Congress through September
            30, 2027;
                (3) the maintenance of effort provisions ensure the
            continued success of the Medicaid program and Children's Health
            Insurance Program and were intended to specifically protect
            vulnerable and disabled children, many of whom are also members
            of communities of color; and
                (4) the maintenance of effort provisions must be strictly
            enforced and proposals to weaken or waive the maintenance of
            effort provisions must not be considered.

    SEC. 4209. 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 the
    Offices of Minority Health referred to in subsection (a) play a
    critical role in addressing health disparities and should be adequately
    funded and given a prominent role in evaluating and establishing health
    policies and programs.

    SEC. 4210. OFFICE OF MINORITY HEALTH IN VETERANS HEALTH ADMINISTRATION
                  OF DEPARTMENT OF VETERANS AFFAIRS.

        (a) Establishment and Functions.--Subchapter I of chapter 73 of
    title 38, United States Code, is amended by inserting after section
    7308 the following new section:
    ``Sec. 7308A. Office of Minority Health
        ``(a) Establishment.--There is established in the Department within
    the Office of the Under Secretary for Health an office to be known as
    the `Office of Minority Health' (in this section referred to as the
    `Office').
        ``(b) Head.--The Director of the Office of Minority Health shall be
    the head of the Office. The Director of the Office of Minority Health
    shall be appointed by the Under Secretary for Health from among
    individuals qualified to perform the duties of the position.
        ``(c) Functions.--The functions of the Office are as follows:
                ``(1) To establish short-range and long-range goals and
            objectives and coordinate all other activities within the
            Veterans Health Administration that relate to disease
            prevention, health promotion, health care services delivery,
            health and health care education, health care quality, and
            health care research concerning veterans who are members of a
            racial or ethnic minority group.
                ``(2) To support research, demonstrations, and evaluations
            to test new and innovative models for the discharge of
            activities described in paragraph (1).
                ``(3) To increase knowledge and understanding of health
            risk factors for veterans who are members of a racial or ethnic
            minority group.
                ``(4) To develop mechanisms that support better health care
            information dissemination, education, prevention, and services
            delivery to veterans from disadvantaged backgrounds, including
            veterans who are members of a racial or ethnic minority group.
                ``(5) To enter into contracts or agreements with
            appropriate public and nonprofit private entities to develop
            and carry out programs to provide bilingual or interpretive
            services to assist veterans who are members of a racial or
            ethnic minority group and who lack proficiency in speaking the
            English language in accessing and receiving health care
            services through the Veterans Health Administration.
                ``(6) To carry out programs to improve access to health
            care services through the Veterans Health Administration for
            veterans with limited proficiency in speaking the English
            language, including the development and evaluation of
            demonstration and pilot projects for that purpose.
                ``(7) To advise the Under Secretary for Health on matters
            relating to the development, implementation, and evaluation of
            health professions education in decreasing disparities in
            health care outcomes between veterans who are members of a
            racial or ethnic minority group and other veterans, including
            cultural competency as a method of eliminating such health
            disparities.
                ``(8) To perform such other functions and duties as the
            Secretary or the Under Secretary for Health considers
            appropriate.
        ``(d) Definitions.--In this section:
                ``(1) The term `racial or ethnic minority group' means any
            of the following:
                        ``(A) American Indians (including Alaska Natives,
                    Eskimos, and Aleuts).
                        ``(B) Asian Americans.
                        ``(C) Native Hawaiians and Pacific Islanders.
                        ``(D) Blacks.
                        ``(E) Hispanics.
                ``(2) The term `Hispanic' means individuals whose origin is
            Mexican, Puerto Rican, Cuban, Central or South American, or any
            other Spanish-speaking country.''.
        (b) Clerical Amendment.--The table of sections at the beginning of
    such subchapter is amended by inserting after the item relating to
    section 7308 the following new item:

    ``7308A. Office of Minority Health.''.

    SEC. 4211. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL ACCESS FOR LOW-
                  INCOME PATIENTS.

        (a) In General.--Not later than January 1, 2021, the Comptroller
    General of the United States shall conduct a study on how amendments
    made by the Patient Protection and Affordable Care Act (Public Law 111-
    148) and the Health Care and Education Reconciliation Act of 2010
    (Public Law 111-152) to titles XVIII and XIX of the Social Security Act
    (42 U.S.C. 1395 et seq.; 42 U.S.C. 1396 et seq.) relating to
    disproportionate share hospital adjustment payments under Medicare and
    Medicaid (and subsequent amendments made with respect to such payments)
    affect the timely access to health care services for low-income
    patients. Such study shall--
                (1) evaluate and examine whether States electing to make
            medical assistance available under section
            1902(a)(10)(A)(i)(VIII) of the Social Security Act (42 U.S.C.
            1396a(a)(10)(A)(i)(VIII)) (including States making such an
            election through a waiver of the State plan) to individuals
            described in such section mitigate the need for payments to
            disproportionate share hospitals under section 1886(d)(5)(F) of
            the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)) and section
            1923 of such Act (42 U.S.C. 1396r-4), including the impact of
            such States electing to make medical assistance available to
            such individuals on--
                        (A) the number of individuals in the United States
                    who are without health insurance and the distribution
                    of such individuals in relation to areas primarily
                    served by disproportionate share hospitals; and
                        (B) the low-income utilization rate of such
                    hospitals and the resulting fiscal sustainability of
                    such hospitals;
                (2) evaluate the appropriate level and distribution of such
            payments among such disproportionate share hospitals for
            purposes of--
                        (A) sufficiently accounting for the level of
                    uncompensated care provided by such hospitals to low-
                    income patients; and
                        (B) providing timely access to health care services
                    for individuals in medically underserved areas; and
                (3) assess, with respect to such disproportionate share
            hospitals--
                        (A) the role played by such hospitals in providing
                    critical access to emergency, inpatient, and outpatient
                    health services, including end-of-life services, as
                    well as the location of such hospitals in relation to
                    medically underserved areas; and
                        (B) the extent to which such hospitals satisfy the
                    requirements established for charitable hospital
                    organizations under section 501(r) of the Internal
                    Revenue Code of 1986 with respect to community health
                    needs assessments, financial assistance policy
                    requirements, limitations on charges, and billing and
                    collection requirements.
        (b) Reports.--
                (1) Report to congress.--Not later than 180 days after the
            date on which the study under subsection (a) is completed, the
            Comptroller General of the United States shall submit to the
            Committee on Energy and Commerce of the House of
            Representatives and the Committee on Finance of the Senate a
            report that contains--
                        (A) the results of the study;
                        (B) recommendations to Congress for any legislative
                    changes to the payments to disproportionate share
                    hospitals under section 1886(d)(5)(F) of the Social
                    Security Act (42 U.S.C. 1395ww(d)(5)(F)) and section
                    1923 of such Act (42 U.S.C. 1396r-4) that are needed to
                    ensure access to health services for low-income
                    patients that--
                                (i) are based on the number of individuals
                            without health insurance, the amount of
                            uncompensated care provided by such hospitals,
                            and the impact of reduced payment levels on
                            low-income communities; and
                                (ii) takes into account any reports
                            submitted by the Secretary of the Treasury, in
                            consultation with the Secretary of Health and
                            Human Services, to congressional committees
                            regarding the costs incurred by charitable
                            hospital organizations for charity care, bad
                            debt, nonreimbursed expenses for services
                            provided to individuals under the Medicare
                            program under title XVIII of the Social
                            Security Act and the Medicaid program under
                            title XIX of such Act, and any community
                            benefit activities provided by such
                            organizations.
                (2) Report to the secretary of health and human services.--
            Not later than 180 days after the date on which the study under
            subsection (a) is completed, the Comptroller General of the
            United States shall submit to the Secretary of Health and Human
            Services a report that contains--
                        (A) the results of the study; and
                        (B) any recommendations for purposes of assisting
                    in the development of the methodology for the
                    adjustment of payments to disproportionate share
                    hospitals, as required under section 1886(r) of the
                    Social Security Act (42 U.S.C. 1395ww(r)) and the
                    reduction of such payments under section 1923(f)(7) of
                    such Act (42 U.S.C. 1396r-4(f)(7)), taking into account
                    the reports referred to in paragraph (1)(B)(ii).

    SEC. 4212. REAUTHORIZATION OF THE NATIVE HAWAIIAN HEALTH CARE
                  IMPROVEMENT ACT.

        (a) Native Hawaiian Health Care Systems.--Section 6(h)(1) of the
    Native Hawaiian Health Care Improvement Act (42 U.S.C. 11705(h)(1)) is
    amended by striking ``may be necessary for fiscal years 1993 through
    2019'' and inserting ``are necessary''.
        (b) Administrative Grant for Papa Ola Lokahi.--Section 7(b) of the
    Native Hawaiian Health Care Improvement Act (42 U.S.C. 11706(b)) is
    amended by striking ``may be necessary for fiscal years 1993 through
    2019'' and inserting ``are necessary''.
        (c) Native Hawaiian Health Scholarships.--Section 10(c) of the
    Native Hawaiian Health Care Improvement Act (42 U.S.C. 11709(c)) is
    amended by striking ``may be necessary for fiscal years 1993 through
    2019'' and inserting ``are necessary''.

                                 PART 2--RURAL

    SEC. 4221. ESTABLISHMENT OF RURAL COMMUNITY HOSPITAL (RCH) PROGRAM.

        (a) In General.--Section 1861 of the Social Security Act (42 U.S.C.
    1395x), as amended by the previous sections, is amended by adding at
    the end of the following new subsection:

         ``Rural Community Hospital; Rural Community Hospital Services

        ``(lll)(1) The term `rural community hospital' means a hospital (as
    defined in subsection (e)) that--
                ``(A) is located in a rural area (as defined in section
            1886(d)(2)(D)) or treated as being so located pursuant to
            section 1886(d)(8)(E);
                ``(B) subject to paragraph (2), has less than 51 acute care
            inpatient beds, as reported in its most recent cost report;
                ``(C) makes available 24-hour emergency care services;
                ``(D) subject to paragraph (3), has a provider agreement in
            effect with the Secretary and is open to the public as of
            January 1, 2010; and
                ``(E) applies to the Secretary for such designation.
        ``(2) For purposes of paragraph (1)(B), beds in a psychiatric or
    rehabilitation unit of the hospital which is a distinct part of the
    hospital shall not be counted.
        ``(3) Paragraph (1)(D) shall not be construed to prohibit any of
    the following from qualifying as a rural community hospital:
                ``(A) A replacement facility (as defined by the Secretary
            in regulations in effect on January 1, 2012) with the same
            service area (as defined by the Secretary in regulations in
            effect on such date).
                ``(B) A facility obtaining a new provider number pursuant
            to a change of ownership.
                ``(C) A facility which has a binding written agreement with
            an outside, unrelated party for the construction,
            reconstruction, lease, rental, or financing of a building as of
            January 1, 2012.
        ``(4) Nothing in this subsection shall be construed as prohibiting
    a critical access hospital from qualifying as a rural community
    hospital if the critical access hospital meets the conditions otherwise
    applicable to hospitals under subsection (e) and section 1866.
        ``(5) Nothing in this subsection shall be construed as prohibiting
    a rural community hospital participating in the demonstration program
    under section 410A of the Medicare Prescription Drug, Improvement, and
    Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2313) from
    qualifying as a rural community hospital if the rural community
    hospital meets the conditions otherwise applicable to hospitals under
    subsection (e) and section 1866.''.
        (b) Payment.--
                (1) Inpatient hospital services.--Section 1814 of the
            Social Security Act (42 U.S.C. 1395f) is amended by adding at
            the end the following new subsection:

    ``Payment for Inpatient Services Furnished in Rural Community Hospitals

        ``(m) The amount of payment under this part for inpatient hospital
    services furnished in a rural community hospital, other than such
    services furnished in a psychiatric or rehabilitation unit of the
    hospital which is a distinct part, is, at the election of the hospital
    in the application referred to in section 1861(lll)(1)(E)--
                ``(1) 101 percent of the reasonable costs of providing such
            services, without regard to the amount of the customary or
            other charge, or
                ``(2) the amount of payment provided for under the
            prospective payment system for inpatient hospital services
            under section 1886(d).''.
                (2) Outpatient services.--Section 1834 of such Act (42
            U.S.C. 1395m) is amended by adding at the end the following new
            subsection:
        ``(z) Payment for Outpatient Services Furnished in Rural Community
    Hospitals.--The amount of payment under this part for outpatient
    services furnished in a rural community hospital is, at the election of
    the hospital in the application referred to in section
    1861(lll)(1)(E)--
                ``(1) 101 percent of the reasonable costs of providing such
            services, without regard to the amount of the customary or
            other charge and any limitation under section 1861(v)(1)(U), or
                ``(2) the amount of payment provided for under the
            prospective payment system for covered OPD services under
            section 1833(t).''.
                (3) Exemption from 30-percent reduction in reimbursement
            for bad debt.--Section 1861(v)(1)(T) of such Act (42 U.S.C.
            1395x(v)(1)(T)) is amended by inserting ``(other than for a
            rural community hospital)'' after ``In determining such
            reasonable costs for hospitals''.
        (c) Beneficiary Cost-Sharing for Outpatient Services.--Section
    1834(z) of such Act (as added by subsection (b)(2)) is amended--
                (1) by redesignating paragraphs (1) and (2) as
            subparagraphs (A) and (B), respectively;
                (2) by inserting ``(1)'' after ``(z)''; and
                (3) by adding at the end the following:
        ``(2) The amounts of beneficiary cost-sharing for outpatient
    services furnished in a rural community hospital under this part shall
    be as follows:
                ``(A) For items and services that would have been paid
            under section 1833(t) if furnished by a hospital, the amount of
            cost-sharing determined under paragraph (8) of such section.
                ``(B) For items and services that would have been paid
            under section 1833(h) if furnished by a provider of services or
            supplier, no cost-sharing shall apply.
                ``(C) For all other items and services, the amount of cost-
            sharing that would apply to the item or service under the
            methodology that would be used to determine payment for such
            item or service if provided by a physician, provider of
            services, or supplier, as the case may be.''.
        (d) Conforming Amendments.--
                (1) Part a payment.--Section 1814(b) of such Act (42 U.S.C.
            1395f(b)) is amended in the matter preceding paragraph (1) by
            inserting ``other than inpatient hospital services furnished by
            a rural community hospital,'' after ``critical access hospital
            services,''.
                (2) Part b payment.--Section 1833(a) of such Act (42 U.S.C.
            1395l(a)), as amended by section 207(b)(3), is amended--
                        (A) by striking ``and'' at the end of paragraph
                    (9);
                        (B) by striking the period at the end of paragraph
                    (10) and inserting ``; and''; and
                        (C) by adding at the end the following:
                ``(11) in the case of outpatient services furnished by a
            rural community hospital, the amounts described in section
            1834(z).''.
                (3) Technical amendments.--
                        (A) Consultation with state agencies.--Section 1863
                    of such Act (42 U.S.C. 1395z) is amended by striking
                    ``and (dd)(2)'' and inserting ``(dd)(2), and
                    (lll)(1)''.
                        (B) Provider agreements.--Section 1866(a)(2)(A) of
                    such Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by
                    inserting ``section 1834(z)(2),'' after ``section
                    1833(b),''.
        (e) Effective Date.--The amendments made by this section shall
    apply to items and services furnished on or after October 1, 2022.

    SEC. 4222. RURAL HEALTH QUALITY ADVISORY COMMISSION AND DEMONSTRATION
                  PROJECTS.

        (a) Rural Health Quality Advisory Commission.--
                (1) Establishment.--Not later than 6 months after the date
            of the enactment of this section, the Secretary of Health and
            Human Services (in this section referred to as the
            ``Secretary'') shall establish a commission to be known as the
            Rural Health Quality Advisory Commission (in this section
            referred to as the ``Commission'').
                (2) Duties of commission.--
                        (A) National plan.--The Commission shall develop,
                    coordinate, and facilitate implementation of a national
                    plan for rural health quality improvement. The national
                    plan shall--
                                (i) identify objectives for rural health
                            quality improvement;
                                (ii) identify strategies to eliminate known
                            gaps in rural health system capacity and
                            improve rural health quality; and
                                (iii) provide recommendations for Federal
                            programs to identify opportunities for
                            strengthening and aligning policies and
                            programs to improve rural health quality.
                        (B) Demonstration projects.--The Commission shall
                    design demonstration projects to recommend to the
                    Secretary to test alternative models for rural health
                    quality improvement, including with respect to both
                    personal and population health.
                        (C) Monitoring.--The Commission shall monitor
                    progress toward the objectives identified pursuant to
                    subparagraph (A)(i).
                (3) Membership.--
                        (A) Number.--The Commission shall be composed of 11
                    members appointed by the Secretary.
                        (B) Selection.--The Secretary shall select the
                    members of the Commission from among individuals with
                    significant rural health care and health care quality
                    expertise, including expertise in clinical health care,
                    health care quality research, end-of-life care,
                    population or public health, or purchaser
                    organizations.
                (4) Contracting authority.--Subject to the availability of
            funds, the Commission may enter into contracts and make other
            arrangements, as may be necessary to carry out the duties
            described in paragraph (2).
                (5) Staff.--Upon the request of the Commission, the
            Secretary may detail, on a reimbursable basis, any of the
            personnel of the Office of Rural Health Policy of the Health
            Resources and Services Administration, the Agency for
            Healthcare Research and Quality, or the Centers for Medicare &
            Medicaid Services to the Commission to assist in carrying out
            this subsection.
                (6) Reports to congress.--Not later than 1 year after the
            establishment of the Commission, and annually thereafter, the
            Commission shall submit a report to the Congress on rural
            health quality. Each such report shall include the following:
                        (A) An inventory of relevant programs and
                    recommendations for improved coordination and
                    integration of policy and programs.
                        (B) An assessment of achievement of the objectives
                    identified in the national plan developed under
                    paragraph (2) and recommendations for realizing such
                    objectives.
                        (C) Recommendations on Federal legislation,
                    regulations, or administrative policies to enhance
                    rural health quality and outcomes.
        (b) Rural Health Quality Demonstration Projects.--
                (1) In general.--Not later than 270 days after the date of
            the enactment of this section, the Secretary, in consultation
            with the Rural Health Quality Advisory Commission, the Office
            of Rural Health Policy of the Health Resources and Services
            Administration, the Agency for Healthcare Research and Quality,
            and the Centers for Medicare & Medicaid Services, shall make
            grants to eligible entities for a total of 5 demonstration
            projects to implement and evaluate methods for improving the
            quality of health care in rural communities. Each such
            demonstration project shall include--
                        (A) alternative community models that--
                                (i) will achieve greater integration of
                            personal and population health services; and
                                (ii) address safety, effectiveness,
                            patient- or community-centeredness, timeliness,
                            efficiency, and equity (the 6 aims identified
                            by the National Academy of Medicine (formerly
                            known as the ``Institute of Medicine'') in its
                            report entitled ``Crossing the Quality Chasm: A
                            New Health System for the 21st Century''
                            released on March 1, 2001);
                        (B) innovative approaches to the financing and
                    delivery of health care services to achieve rural
                    health quality and accessibility goals for patients;
                    and
                        (C) development of quality improvement support
                    structures to assist rural health systems and
                    professionals in the provision of health care (such as
                    workforce support structures, quality monitoring and
                    reporting, clinical care protocols, and information
                    technology applications).
                (2) Eligible entities.--In this subsection, the term
            ``eligible entity'' means a consortium that--
                        (A) shall include--
                                (i) at least one health care provider or
                            health care delivery system located in a rural
                            area; and
                                (ii) at least one organization representing
                            multiple community stakeholders; and
                        (B) may include other partners such as rural
                    research centers.
                (3) Consultation.--In developing the program for awarding
            grants under this subsection, the Secretary shall consult with
            the Administrator of the Agency for Healthcare Research and
            Quality, rural health care providers, rural health care
            researchers, and private and nonprofit groups (including
            national associations) which are undertaking similar efforts.
                (4) Expedited waivers.--The Secretary shall expedite the
            processing of any waiver that--
                        (A) is authorized under title XVIII or XIX of the
                    Social Security Act (42 U.S.C. 1395 et seq.; 42 U.S.C.
                    1396 et seq.); and
                        (B) is necessary to carry out a demonstration
                    project under this subsection.
                (5) Demonstration project sites.--The Secretary shall
            ensure that the 5 demonstration projects funded under this
            subsection are conducted at a variety of sites representing the
            diversity of rural communities in the United States.
                (6) Duration.--Each demonstration project under this
            subsection shall be for a period of 4 years.
                (7) Independent evaluation.--The Secretary shall enter into
            an arrangement with an entity that has experience working
            directly with rural health systems for the conduct of an
            independent evaluation of the program carried out under this
            subsection.
                (8) Report.--Not later than 1 year after the conclusion of
            all of the demonstration projects funded under this subsection,
            the Secretary shall submit a report to the Congress on the
            results of such projects. The report shall include--
                        (A) an evaluation of patient access to care,
                    patient outcomes, and an analysis of the cost
                    effectiveness of each such project; and
                        (B) recommendations on Federal legislation,
                    regulations, or administrative policies to enhance
                    rural health quality and outcomes.
        (c) Appropriation.--
                (1) In general.--Out of funds in the Treasury not otherwise
            appropriated, there are appropriated to the Secretary to carry
            out this section $30,000,000 for the period of fiscal years
            2023 through 2027.
                (2) Availability.--
                        (A) In general.--Funds appropriated under paragraph
                    (1) shall remain available for expenditure through
                    fiscal year 2027.
                        (B) Report.--For purposes of carrying out
                    subsection (b)(8), funds appropriated under paragraph
                    (1) shall remain available for expenditure through
                    fiscal year 2028.
                (3) Reservation.--Of the amount appropriated under
            paragraph (1), the Secretary shall reserve--
                        (A) $5,000,000 to carry out subsection (a); and
                        (B) $25,000,000 to carry out subsection (b), of
                    which--
                                (i) 2 percent shall be for the provision of
                            technical assistance to grant recipients; and
                                (ii) 5 percent shall be for independent
                            evaluation under subsection (b)(7).

    SEC. 4223. RURAL HEALTH CARE SERVICES.

        Section 330A of the Public Health Service Act (42 U.S.C. 254c) is
    amended to read as follows:

    ``SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, RURAL HEALTH NETWORK
                  DEVELOPMENT, DELTA RURAL DISPARITIES AND HEALTH SYSTEMS
                  DEVELOPMENT, AND SMALL RURAL HEALTH CARE PROVIDER QUALITY
                  IMPROVEMENT GRANT PROGRAMS.

        ``(a) Purpose.--The purpose of this section is to provide for
    grants--
                ``(1) under subsection (b), to promote rural health care
            services outreach;
                ``(2) under subsection (c), to provide for the planning and
            implementation of integrated health care networks in rural
            areas;
                ``(3) under subsection (d), to assist rural communities in
            the Delta Region to reduce health disparities and to promote
            and enhance health system development; and
                ``(4) under subsection (e), to provide for the planning and
            implementation of small rural health care provider quality
            improvement activities.
        ``(b) Rural Health Care Services Outreach Grants.--
                ``(1) Grants.--The Director of the Office of Rural Health
            Policy of the Health Resources and Services Administration
            (referred to in this section as the `Director') may award
            grants to eligible entities to promote rural health care
            services outreach by expanding the delivery of health care
            services to include new and enhanced services in rural areas.
            The Director may award the grants for periods of not more than
            3 years.
                ``(2) Eligibility.--To be eligible to receive a grant under
            this subsection for a project, an entity--
                        ``(A) shall be a rural public or rural nonprofit
                    private entity, a facility that qualifies as a rural
                    health clinic under title XVIII of the Social Security
                    Act, a public or nonprofit entity existing exclusively
                    to provide services to migrant and seasonal farm
                    workers in rural areas, or a Tribal government whose
                    grant-funded activities will be conducted within
                    federally recognized Tribal areas;
                        ``(B) shall represent a consortium composed of
                    members--
                                ``(i) that include 3 or more independently
                            owned health care entities; and
                                ``(ii) that may be nonprofit or for-profit
                            entities; and
                        ``(C) shall not previously have received a grant
                    under this subsection for the same or a similar
                    project, unless the entity is proposing to expand the
                    scope of the project or the area that will be served
                    through the project.
                ``(3) Applications.--To be eligible to receive a grant
            under this subsection, an eligible entity shall prepare and
            submit to the Director an application at such time, in such
            manner, and containing such information as the Director may
            require, including--
                        ``(A) a description of the project that the
                    eligible entity will carry out using the funds provided
                    under the grant;
                        ``(B) a description of the manner in which the
                    project funded under the grant will meet the health
                    care needs of rural populations in the local community
                    or region to be served;
                        ``(C) a plan for quantifying how health care needs
                    will be met through identification of the target
                    population and benchmarks of service delivery or health
                    status, such as--
                                ``(i) quantifiable measurements of health
                            and health care status improvement for projects
                            focusing on health promotion; or
                                ``(ii) benchmarks of increased access to
                            primary and end-of-life care, including
                            tracking factors such as the number and type of
                            primary and end-of-life care visits,
                            identification of a medical home, or other
                            general measures of such access;
                        ``(D) a description of how the local community or
                    region to be served will be involved in the development
                    and ongoing operations of the project;
                        ``(E) a plan for sustaining the project after
                    Federal support for the project has ended;
                        ``(F) a description of how the project will be
                    evaluated;
                        ``(G) the administrative capacity to submit annual
                    performance data electronically as specified by the
                    Director; and
                        ``(H) other such information as the Director
                    determines to be appropriate.
        ``(c) Rural Health Network Development Grants.--
                ``(1) Grants.--
                        ``(A) In general.--The Director may award rural
                    health network development grants to eligible entities
                    to promote, through planning and implementation, the
                    development of integrated health care networks that
                    have combined the functions of the entities
                    participating in the networks in order to--
                                ``(i) achieve efficiencies and economies of
                            scale;
                                ``(ii) expand access to, coordinate, and
                            improve the quality of the health care delivery
                            system through development of organizational
                            efficiencies;
                                ``(iii) implement health information
                            technology to achieve efficiencies, reduce
                            medical errors, and improve quality;
                                ``(iv) coordinate care and manage chronic
                            and terminal illness; and
                                ``(v) strengthen the rural health care
                            system as a whole and across all facets of the
                            health care delivery system, including end-of-
                            life care, in such a manner as to show a
                            quantifiable return on investment to the
                            participants in the network.
                        ``(B) Grant periods.--The Director may award such a
                    rural health network development grant--
                                ``(i) for a period of 3 years for
                            implementation activities; or
                                ``(ii) for a period of 1 year for planning
                            activities to assist in the initial development
                            of an integrated health care network, if the
                            proposed participants in the network do not
                            have a history of collaborative efforts and a
                            3-year grant would be inappropriate.
                ``(2) Eligibility.--To be eligible to receive a grant under
            this subsection, an entity--
                        ``(A) shall be a rural public or rural nonprofit
                    private entity, a facility that qualifies as a rural
                    health clinic under title XVIII of the Social Security
                    Act, a public or nonprofit entity existing exclusively
                    to provide services to migrant and seasonal farm
                    workers in rural areas, or a Tribal government whose
                    grant-funded activities will be conducted within
                    federally recognized Tribal areas;
                        ``(B) shall represent a network composed of
                    participants--
                                ``(i) that include 3 or more independently
                            owned health care entities; and
                                ``(ii) that may be nonprofit or for-profit
                            entities; and
                        ``(C) shall not previously have received a grant
                    under this subsection (other than a 1-year grant for
                    planning activities) for the same or a similar project.
                ``(3) Applications.--To be eligible to receive a grant
            under this subsection, an eligible entity, in consultation with
            the appropriate State office of rural health or another
            appropriate State entity, shall prepare and submit to the
            Director an application at such time, in such manner, and
            containing such information as the Director may require,
            including--
                        ``(A) a description of the project that the
                    eligible entity will carry out using the funds provided
                    under the grant;
                        ``(B) an explanation of the reasons why Federal
                    assistance is required to carry out the project;
                        ``(C) a description of--
                                ``(i) the history of collaborative
                            activities carried out by the participants in
                            the network;
                                ``(ii) the degree to which the participants
                            are ready to integrate their functions; and
                                ``(iii) how the local community or region
                            to be served will benefit from and be involved
                            in the activities carried out by the network;
                        ``(D) a description of how the local community or
                    region to be served will experience increased access to
                    quality health care services across the continuum of
                    care as a result of the integration activities carried
                    out by the network, including a description of--
                                ``(i) return on investment for the
                            community and the network members; and
                                ``(ii) other quantifiable performance
                            measures that show the benefit of the network
                            activities;
                        ``(E) a plan for sustaining the project after
                    Federal support for the project has ended;
                        ``(F) a description of how the project will be
                    evaluated;
                        ``(G) the administrative capacity to submit annual
                    performance data electronically as specified by the
                    Director; and
                        ``(H) other such information as the Director
                    determines to be appropriate.
        ``(d) Delta Rural Disparities and Health Systems Development
    Grants.--
                ``(1) Grants.--The Director may award grants to eligible
            entities to support reduction of health disparities, improve
            access to health care, and enhance rural health system
            development in the Delta Region.
                ``(2) Eligibility.--To be eligible to receive a grant under
            this subsection, an entity shall be a rural public or rural
            nonprofit private entity, a facility that qualifies as a rural
            health clinic under title XVIII of the Social Security Act, a
            public or nonprofit entity existing exclusively to provide
            services to migrant and seasonal farm workers in rural areas,
            or a Tribal government whose grant-funded activities will be
            conducted within federally recognized Tribal areas.
                ``(3) Applications.--To be eligible to receive a grant
            under this subsection, an eligible entity shall prepare and
            submit to the Director an application at such time, in such
            manner, and containing such information as the Director may
            require, including--
                        ``(A) a description of the project that the
                    eligible entity will carry out using the funds provided
                    under the grant;
                        ``(B) an explanation of the reasons why Federal
                    assistance is required to carry out the project;
                        ``(C) a description of the manner in which the
                    project funded under the grant will meet the health
                    care needs of the Delta Region;
                        ``(D) a description of how the local community or
                    region to be served will experience increased access to
                    quality health care services as a result of the
                    activities carried out by the entity;
                        ``(E) a description of how health disparities will
                    be reduced or the health system will be improved;
                        ``(F) a plan for sustaining the project after
                    Federal support for the project has ended;
                        ``(G) a description of how the project will be
                    evaluated including process and outcome measures
                    related to the quality of care provided or how the
                    health care system improves its performance;
                        ``(H) a description of how the grantee will develop
                    an advisory group made up of representatives of the
                    communities to be served to provide guidance to the
                    grantee to best meet community need; and
                        ``(I) other such information as the Director
                    determines to be appropriate.
        ``(e) Small Rural Health Care Provider Quality Improvement
    Grants.--
                ``(1) Grants.--The Director may award grants to provide for
            the planning and implementation of small rural health care
            provider quality improvement activities. The Director may award
            the grants for periods of 1 to 3 years.
                ``(2) Eligibility.--To be eligible for a grant under this
            subsection, an entity--
                        ``(A) shall be--
                                ``(i) a rural public or rural nonprofit
                            private health care provider or provider of
                            health care services, such as a rural health
                            clinic; or
                                ``(ii) another rural provider or network of
                            small rural providers identified by the
                            Director as a key source of local care; and
                        ``(B) shall not previously have received a grant
                    under this subsection for the same or a similar
                    project.
                ``(3) Preference.--In awarding grants under this
            subsection, the Director shall give preference to facilities
            that qualify as rural health clinics under title XVIII of the
            Social Security Act.
                ``(4) Applications.--To be eligible to receive a grant
            under this subsection, an eligible entity shall prepare and
            submit to the Director an application at such time, in such
            manner, and containing such information as the Director may
            require, including--
                        ``(A) a description of the project that the
                    eligible entity will carry out using the funds provided
                    under the grant;
                        ``(B) an explanation of the reasons why Federal
                    assistance is required to carry out the project;
                        ``(C) a description of the manner in which the
                    project funded under the grant will assure continuous
                    quality improvement in the provision of services by the
                    entity;
                        ``(D) a description of how the local community or
                    region to be served will experience increased access to
                    quality health care services as a result of the
                    activities carried out by the entity;
                        ``(E) a plan for sustaining the project after
                    Federal support for the project has ended;
                        ``(F) a description of how the project will be
                    evaluated including process and outcome measures
                    related to the quality of care provided; and
                        ``(G) other such information as the Director
                    determines to be appropriate.
        ``(f) General Requirements.--
                ``(1) Prohibited uses of funds.--An entity that receives a
            grant under this section may not use funds provided through the
            grant--
                        ``(A) to build or acquire real property; or
                        ``(B) for construction.
                ``(2) Coordination with other agencies.--The Director shall
            coordinate activities carried out under grant programs
            described in this section, to the extent practicable, with
            Federal and State agencies and nonprofit organizations that are
            operating similar grant programs, to maximize the effect of
            public dollars in funding meritorious proposals.
        ``(g) Report.--Not later than September 30, 2024, the Secretary
    shall prepare and submit to the appropriate committees of Congress a
    report on the progress and accomplishments of the grant programs
    described in subsections (b), (c), (d), and (e).
        ``(h) Definition of Delta Region.--In this section, the term `Delta
    Region' has the meaning given to the term `region' in section 382A of
    the Consolidated Farm and Rural Development Act (7 U.S.C. 2009aa).
        ``(i) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section such sums as may be necessary
    for each of fiscal years 2024 through 2027.''.

                           PART 3--INDIAN COMMUNITIES

    SEC. 4231. ASSISTANT SECRETARY OF THE INDIAN HEALTH SERVICE.

        (a) References.--Any reference in a law, regulation, document,
    paper, or other record of the United States to the Director of the
    Indian Health Service shall be deemed to be a reference to the
    Assistant Secretary of the Indian Health Service.
        (b) Executive Schedule.--Section 5315 of title 5, United States
    Code, is amended in the matter relating to the Assistant Secretaries of
    Health and Human Services by striking ``(6)'' and inserting ``(7), one
    of whom shall be the Assistant Secretary of the Indian Health
    Service''.
        (c) Conforming Amendment.--Section 5316 of title 5, United States
    Code, is amended by striking ``Director, Indian Health Service,
    Department of Health and Human Services.''.

    SEC. 4232. EXTENSION OF FULL FEDERAL MEDICAL ASSISTANCE PERCENTAGE TO
                  INDIAN HEALTH CARE PROVIDERS.

        Section 1905 of the Social Security Act (42 U.S.C. 1396d) is
    amended--
                (1) in subsection (a), by amending paragraph (9) to read as
            follows:
                ``(9) clinic services furnished by or under the direction
            of a physician, without regard to whether the clinic itself is
            administered by a physician, including--
                        ``(A) such services furnished outside the clinic by
                    clinic personnel to an eligible individual who does not
                    reside in a permanent dwelling or does not have a fixed
                    home or mailing address; and
                        ``(B) such services furnished outside the clinic by
                    any Indian Health Service facility, a health program or
                    facility operated by a tribe or tribal organization
                    under the Indian Self-Determination Act (Public Law 93-
                    638), or an urban Indian organization receiving funds
                    under title V of the Indian Health Care Improvement
                    Act;''; and
                (2) in subsection (b), by inserting after ``Papa Ola Lokahi
            under section 8 of such Act'' the following: ``; the Federal
            medical assistance percentage shall also be 100 per centum with
            respect to amounts expended as medical assistance for services
            which are received by an Indian Health Service facility, a
            health program or facility operated by a tribe or tribal
            organization under the Indian Self-Determination Act (Public
            Law 93-638), or an urban Indian organization receiving funds
            under title V of the Indian Health Care Improvement Act''.

    SEC. 4233. CONFERRING WITH URBAN INDIAN ORGANIZATIONS.

        Section 514(b) of the Indian Health Care Improvement Act (25 U.S.C.
    1660d) is amended to read as follows:
        ``(b) Requirement.--The Secretary shall ensure that the Service and
    the other agencies and offices of the Department of Health and Human
    Services and the Department of Veterans Affairs confer, to the maximum
    extent practicable, with urban Indian organizations in carrying out--
                ``(1) this Act; and
                ``(2) other provisions of law relating to Indian health
            care.''.

                               PART 4--PROVIDERS

    SEC. 4241. AVAILABILITY OF NON-ENGLISH LANGUAGE SPEAKING PROVIDERS.

        (a) In General.--Section 1311(c)(1)(B) of the Patient Protection
    and Affordable Care Act (42 U.S.C. 18031(c)(1)(B)) is amended by
    inserting before the semicolon the following: ``and the ability of such
    provider to provide care in a language other than English either
    through the provider speaking such language or by the provider having a
    qualified interpreter for an individual with limited English
    proficiency (as defined in section 3400 of such Act) who speaks such
    language available during office hours''.
        (b) Effective Date.--The amendment made by subsection (a) shall not
    apply to any plan beginning on or prior to the date that is 1 year
    after the date of the enactment of this Act.

    SEC. 4242. ACCESS TO ESSENTIAL COMMUNITY PROVIDERS.

        (a) Essential Community Providers.--Section 1311(c)(1)(C) of the
    Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(1)(C))
    is amended--
                (1) by inserting ``(i)'' after ``(C)''; and
                (2) by adding at the end the following new clauses:
                        ``(ii) not later than January 1, 2023, increase the
                    percentage of essential community providers as
                    described in clause (i) included in its network by 10
                    percent annually (based on the level in the plan for
                    2016) until 90 percent of all federally qualified
                    health centers and 75 percent of all other such
                    essential community providers in the contract service
                    area are in-network; and
                        ``(iii) include at least one essential community
                    provider in each of the essential community provider
                    categories described in section 156.235(a)(2)(ii)(B) of
                    title 45, Code of Federal Regulations (as in effect on
                    the date of enactment of the Health Equity and
                    Accountability Act of 2022), in each county in the
                    service area, where available;''.
        (b) Reporting Requirements.--Section 1311(e)(3) of the Patient
    Protection and Affordable Care Act (42 U.S.C. 18031(e)(3)) is amended
    by adding at the end the following new subparagraph:
                        ``(E) Data on essential community providers.--The
                    Secretary shall require qualified health plans to
                    submit annually to the Secretary data on the percentage
                    of essential community providers as described in clause
                    (ii) of subsection (c)(1)(C), by county, that contract
                    with each qualified health plan offered in that county
                    and the percentage of such essential community
                    providers, by category as described in clause (iii) of
                    such subsection, that contract with each qualified
                    health plan offered in that county. Such data shall be
                    made available to the general public.''.
        (c) Essential Community Provider Provisions Applied Under Medicare
    and Medicaid.--
                (1) Medicare.--Section 1852(d)(1) of the Social Security
            Act (42 U.S.C. 1395w-22(d)(1)) is amended--
                        (A) by striking ``and'' at the end of subparagraph
                    (D);
                        (B) by striking the period at the end of
                    subparagraph (E) and inserting ``; and''; and
                        (C) by adding at the end the following new
                    subparagraph:
                        ``(F) the plan meets the requirements of clauses
                    (ii) and (iii) of section 1311(c)(1)(C) of the Patient
                    Protection and Affordable Care Act (relating to
                    inclusion in networks of essential community
                    providers).''.
                (2) Medicaid.--Section 1932(b)(5) of the Social Security
            Act (42 U.S.C. 1396u-2(b)(5)) is amended--
                        (A) by striking ``and'' at the end of subparagraph
                    (A);
                        (B) by striking the period at the end of
                    subparagraph (B) and inserting ``; and''; and
                        (C) by adding at the end the following new
                    subparagraph:
                        ``(C) meets the requirements of clauses (ii) and
                    (iii) of section 1311(c)(1)(C) of the Patient
                    Protection and Affordable Care Act (relating to
                    inclusion in networks of essential community providers)
                    with respect to services offered in the service area
                    involved.''.

    SEC. 4243. PROVIDER NETWORK ADEQUACY IN COMMUNITIES OF COLOR.

        (a) In General.--Section 1311(c)(1)(B) of the Patient Protection
    and Affordable Care Act (42 U.S.C. 18031(c)(1)(B)), as amended by
    section 4241(a), is further amended--
                (1) by inserting ``(i)'' after ``(B)''; and
                (2) by adding at the end the following new clauses:
                                ``(ii) meet such network adequacy standards
                            as the Secretary may establish with regard to--
                                        ``(I) appointment wait time;
                                        ``(II) travel time and distance to
                                    health care provider facilities and
                                    providers by public and private
                                    transit;
                                        ``(III) hours of operation to
                                    accommodate individuals who cannot come
                                    to provider appointments during
                                    standard business hours;
                                        ``(IV) availability of health care
                                    options for patients; and
                                        ``(V) other network adequacy
                                    standards to ensure that care through
                                    these plans is accessible to diverse
                                    communities, including individuals with
                                    limited English proficiency as defined
                                    in section 3400 of such Act; and
                                ``(iii) provide coverage for services for
                            enrollees through out-of-network providers at
                            no additional cost to the enrollees in cases
                            where in-network providers are unable to comply
                            with the standards established under subclause
                            (III) or (IV) of clause (ii) for such services
                            and the out-of-network providers can deliver
                            such services in compliance with such
                            standards.''.
        (b) Effective Date.--The amendments made by subsection (a) shall
    not apply to plans beginning on or prior to the date that is 1 year
    after the date of the enactment of the Health Equity and Accountability
    Act of 2022.

                                 PART 5--DENTAL

    SEC. 4251. IMPROVING ACCESS TO DENTAL CARE.

        (a) Reports to Congress.--
                (1) GAO reports.--Not later than 1 year after the date of
            the enactment of this Act, the Comptroller General of the
            United States shall submit to Congress--
                        (A) a report on the Alaska Dental Health Aide
                    Therapists program and the Dental Therapist and
                    Advanced Dental Therapist programs in Minnesota, to
                    assess the effectiveness of dental therapists in--
                                (i) improving access to timely dental care
                            among communities of color;
                                (ii) providing high-quality care;
                                (iii) providing culturally competent care;
                            and
                                (iv) providing accessible care to people
                            with disabilities;
                        (B) a report on State variations in the use of
                    dental hygienists and the effectiveness of expanding
                    the scope of practice for dental hygienists in--
                                (i) improving access to timely dental care
                            among communities of color;
                                (ii) providing high-quality care;
                                (iii) providing culturally competent care;
                            and
                                (iv) providing accessible care to people
                            with disabilities; and
                        (C) a report on the use of telehealth services to
                    enhance services provided by dental hygienists and
                    therapists, including recommendations for any
                    modifications to the Medicare program under title XVIII
                    of the Social Security Act and the Medicaid program
                    under title XIX of such Act to better provide for
                    telehealth consultations in conjunction with
                    therapists' and hygienists' care.
                (2) HRSA report on dental shortage areas.--Not later than 1
            year after the date of the enactment of this Act, the Secretary
            of Health and Human Services, acting through the Administrator
            of the Health Resources and Services Administration, shall
            submit to Congress a report which details geographic dental
            access shortages and the preparedness of dental providers to
            offer culturally and linguistically appropriate, affordable,
            accessible, and timely services.
        (b) Expansion of Dental Health Aid Therapists in Tribal and Urban
    Indian Communities.--Section 119 of the Indian Health Care Improvement
    Act (25 U.S.C. 1616l) is amended--
                (1) in subsection (d)--
                        (A) in paragraph (2), to read as follows:
                ``(2) Requirement; exclusion.--Subject to paragraphs (3)
            and (4), in establishing a national program under paragraph
            (1), the Secretary--
                        ``(A) shall not reduce the amounts provided for the
                    Community Health Aide Program described in subsections
                    (a) and (b);
                        ``(B) shall exclude dental health aide therapist
                    services from services covered under such Program; and
                        ``(C) shall include urban Indian organizations.'';
                    and
                        (B) in paragraph (3), by striking ``or tribal
                    organization'' each place it appears and inserting ``,
                    tribal organization, or urban Indian organization'';
                    and
                (2) in subsection (e), by striking ``or a tribal
            organization'' and inserting ``a tribal organization, or an
            urban Indian organization''.
        (c) Coverage of Dental Services Under the Medicare Program.--
                (1) Coverage.--Section 1861(s)(2) of the Social Security
            Act (42 U.S.C. 1395x(s)(2)) is amended--
                        (A) in subparagraph (GG), by striking ``and'' at
                    the end;
                        (B) in subparagraph (HH), by striking the period
                    and inserting ``; and''; and
                        (C) by adding at the end the following new
                    subparagraph:
                ``(II) dental and oral health services (as defined in
            subsection (mmm));''.
                (2) Dental and oral health services defined.--Section 1861
            of the Social Security Act (42 U.S.C. 1395x), as amended by
            previous provisions of this Act, is amended by adding at the
            end the following new subsection:

                       ``Dental and Oral Health Services

        ``(mmm)(1) The term `dental and oral health services' means
    services (as defined by the Secretary) that are necessary to prevent
    disease and promote oral health, restore oral structures to health and
    function, and treat emergency conditions, including--
                ``(A) routine diagnostic and preventive care such as dental
            cleanings, exams, and x-rays;
                ``(B) basic dental services such as fillings and
            extractions;
                ``(C) major dental services such as root canals, crowns,
            and dentures;
                ``(D) emergency dental care; and
                ``(E) other necessary services related to dental and oral
            health (as defined by the Secretary).
        ``(2) For purposes of paragraph (1), such term shall include mobile
    and portable oral health services (as defined by the Secretary) that--
                ``(A) are provided for the purpose of overcoming mobility,
            transportation, and access barriers for individuals; and
                ``(B) satisfy the standards and certification requirements
            established under section 1902(a)(82)(B) for the State in which
            the services are provided.''.
                (3) Payment and coinsurance.--Section 1833(a)(1) of the
            Social Security Act (42 U.S.C. 1395l(a)(1)) is amended--
                        (A) by striking ``and'' before ``(DD)''; and
                        (B) by inserting before the semicolon at the end
                    the following: ``and (EE) with respect to dental and
                    oral health services (as defined in section 1861(mmm)),
                    the amount paid shall be (i) in the case of such
                    services that are preventive, 100 percent of the lesser
                    of the actual charge for the services or the amount
                    determined under the payment basis determined under
                    section 1848, and (ii) in the case of all other such
                    services, 80 percent of the lesser of the actual charge
                    for the services or the amount determined under the
                    payment basis determined under section 1848''.
                (4) Payment under physician fee schedule.--Section
            1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3))
            is amended by inserting ``, (2)(II),'' after ``(including
            administration of the health risk assessment)''.
                (5) Dentures.--Section 1861(s)(8) of the Social Security
            Act (42 U.S.C. 1395x(s)(8)) is amended--
                        (A) by striking ``(other than dental)'' and
                    inserting ``(including dentures)''; and
                        (B) by striking ``internal body''.
                (6) Repeal of ground for exclusion.--Section 1862(a) of the
            Social Security Act (42 U.S.C. 1395y) is amended by striking
            paragraph (12).
                (7) Effective date.--The amendments made by this section
            shall apply to services furnished on or after January 1, 2023.
        (d) Requiring Coverage of Dental Services Under the Medicaid
    Program.--
                (1) Mandatory coverage.--
                        (A) In general.--
                                (i) Requirement.--Section 1902(a)(10)(A) of
                            the Social Security Act (42 U.S.C.
                            1396a(a)(10)(A)) is amended by inserting ``,
                            (10)'' after ``(5)''.
                                (ii) Effective date.--The amendment made by
                            clause (i) shall apply with respect to medical
                            assistance furnished in calendar quarters
                            beginning on or after the date that is 1 year
                            after the date of the enactment of this Act.
                        (B) Benchmark coverage.--Section 1937(b)(5) of the
                    Social Security Act (42 U.S.C. 1396u-7(b)(5)) is
                    amended by striking the period and inserting ``, and,
                    beginning with the first quarter beginning on or after
                    the date of the enactment of the Health Equity and
                    Accountability Act of 2022, coverage of dental and oral
                    health services (as defined in section 1905(jj)).''.
                (2) Definition of services.--Section 1905 of the Social
            Security Act (42 U.S.C. 1396d) is amended--
                        (A) in subsection (a)(10), by striking ``dental
                    services'' and inserting ``dental and oral health
                    services (as defined in subsection (jj)(1))''; and
                        (B) by adding at the end the following new
                    subsection:
        ``(jj) Dental and Oral Health Services.--(1) For purposes of this
    title, the term `dental and oral health services' means services
    necessary to prevent disease and promote oral health, restore oral
    structures to health and function, reduce oral pain, and treat
    emergency oral conditions. Such term includes the services specified in
    paragraph (2).
        ``(2) For purposes of paragraph (1), the services specified in this
    paragraph are the following:
                ``(A) Routine diagnostic and preventive care (such as
            dental cleanings, exams, and x-rays).
                ``(B) Basic dental services (such as fillings and
            extractions) and major dental services (such as root canals,
            crowns, and dentures).
                ``(C) Emergency dental care.
                ``(D) Temporomandibular (TMD) and orofacial pain disorder
            treatment.
                ``(E) Other necessary services related to dental and oral
            health (as specified by the Secretary).
        ``(3) For purposes of paragraph (1), such term shall not include
    dental care or services provided to individuals under the age of 21
    under subsection (r)(3).''.
                (3) Conforming amendments.--
                        (A) State plan requirements.--Section 1902(a) of
                    the Social Security Act (42 U.S.C. 1396a(a)) is
                    amended--
                                (i) in paragraph (10)(A), in the matter
                            preceding clause (i), by inserting ``(10),''
                            after ``(5),'';
                                (ii) in paragraph (85), by striking ``and''
                            at the end;
                                (iii) in paragraph (86), by striking the
                            period at the end and inserting ``; and''; and
                                (iv) by inserting after paragraph (86) the
                            following:
                ``(87) provide for--
                        ``(A) informing, in writing, all individuals who
                    have been determined to be eligible for medical
                    assistance of the availability of oral health services
                    (as defined in section 1905(gg));
                        ``(B) conducting targeted outreach to pregnant
                    women who have been determined to be eligible for
                    medical assistance about the availability of medical
                    assistance for such dental services and the importance
                    of receiving dental care while pregnant; and
                        ``(C) establishing and maintaining standards for
                    and certification of mobile and portable oral health
                    services (as described in subsections (r)(3)(C) and
                    (jj)(2)(B) of section 1905).''.
                        (B) Definition of medical assistance.--Section
                    1905(a)(12) of the Social Security Act (42 U.S.C.
                    1396d(a)(12)) is amended by striking ``, dentures,''.
                (4) Mobile and portable oral health services under epsdt.--
            Section 1905(r)(3) of the Social Security Act (42 U.S.C.
            1396d(r)(3)) is amended--
                        (A) in subparagraph (A)(ii), by striking ``; and''
                    and inserting a semicolon;
                        (B) in subparagraph (B), by striking the period at
                    the end and inserting ``; and''; and
                        (C) by adding at the end the following new
                    subparagraph:
                        ``(C) which shall include mobile and portable oral
                    health services (as defined by the Secretary) that--
                                ``(i) are provided for the purpose of
                            overcoming mobility, transportation, or access
                            barriers for children; and
                                ``(ii) satisfy the standards and
                            certification requirements established under
                            section 1902(a)(87)(C) for the State in which
                            the services are provided.''.
                (5) Enhanced fmap; maintenance of effort.--
                        (A) Medicaid.--Section 1905 of the Social Security
                    Act (42 U.S.C. 1396d), as amended by paragraph (2), is
                    further amended--
                                (i) in subsection (b), by striking ``and
                            (ii)'' and inserting ``(ii), and (kk)''; and
                                (ii) by adding at the end of the following
                            new subsection:
        ``(kk) Increased FMAP for Expenditures for Dental and Oral Health
    Services.--
                ``(1) In general.--The Federal medical assistance
            percentage with respect to amounts expended by such State for
            medical assistance consisting of dental and oral health
            services (as defined in subsection (jj)) furnished during the
            first calendar quarter beginning on or after the date that is 1
            year after the date of the enactment of this subsection or
            during any subsequent quarter) to individuals 21 years of age
            or older shall be equal to, in the case of such services
            furnished--
                        ``(A) during the 3-year period beginning on the
                    first day of such first calendar year, 100 percent;
                        ``(B) during the 1-year period immediately
                    following the period described in subparagraph (A), 95
                    percent;
                        ``(C) during each subsequent 1-year period (through
                    the third such subsequent period), the percentage
                    specified under this paragraph for the preceding 1-year
                    period, reduced by 5 percentage points; and
                        ``(D) during any quarter beginning after the 7-year
                    period beginning on the first day described in
                    subparagraph (A), 80 percent.
                ``(2) No reduction in fmap.--Paragraph (1) shall not apply
            with respect to amounts expended by a State if the Federal
            medical assistance percentage otherwise applicable to such
            amounts without application of such paragraph would be higher
            than such percentage available to such amounts with application
            of such paragraph.''.
                (6) Exclusion of amounts attributable to increased fmap
            from territorial caps.--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 ``subsections (g), (h), and
                    (i)''; and
                        (B) by adding at the end the following:
        ``(i) Exclusion From Caps of Amounts Attributable to Increased FMAP
    for Coverage of Dental and Oral Services.--Any payment made to a
    territory for expenditures for medical assistance that are subject to
    an increase in the Federal medical assistance percentage applicable to
    such expenditures under section 1905(kk) shall not be taken into
    account for purposes of applying payment limits under subsections (f)
    and (g) to the extent that such payment exceeds the amount of the
    payment that would have been made to the territory for such
    expenditures without regard to such section.''.
        (e) Oral Health Services as an Essential Health Benefit.--Section
    1302(b) of the Patient Protection and Affordable Care Act (42 U.S.C.
    18022(b)) is amended--
                (1) in paragraph (1)--
                        (A) in subparagraph (J), by striking ``oral and'';
                    and
                        (B) by adding at the end the following:
                        ``(K) Oral health services for children and
                    adults.''; and
                (2) by adding at the end the following:
                ``(6) Oral health services.--For purposes of paragraph
            (1)(K), the term `oral health services' means services (as
            defined by the Secretary) that are necessary to prevent any
            oral disease and promote oral health, restore oral structures
            to health and function, and treat emergency oral conditions.''.
        (f) Demonstration Program on Training and Employment of Alternative
    Dental Health Care Providers for Dental Health Care Services for
    Veterans in Rural and Other Underserved Communities.--
                (1) Demonstration program authorized.--The Secretary of
            Veterans Affairs may carry out a demonstration program to
            establish programs to train and employ alternative dental
            health care providers in order to increase access to dental
            health care services for veterans who are entitled to such
            services from the Department of Veterans Affairs and reside in
            rural and other underserved communities.
                (2) Telehealth.--For purposes of alternative dental health
            care providers and other dental care providers who are licensed
            to provide clinical care, dental services provided under the
            demonstration program under this subsection may be administered
            by such providers through telehealth-enabled collaboration and
            supervision when appropriate and feasible.
                (3) Alternative dental health care providers defined.--In
            this subsection, the term ``alternative dental health care
            providers'' has the meaning given that term in section 340G-
            1(a)(2) of the Public Health Service Act (42 U.S.C. 256g-
            1(a)(2)).
                (4) Authorization of appropriations.--There are authorized
            to be appropriated such sums as are necessary to carry out the
            demonstration program under this subsection.
        (g) Demonstration Program on Training and Employment of Alternative
    Dental Health Care Providers for Dental Health Care Services for
    Members of the Armed Forces and Dependents Lacking Ready Access to Such
    Services.--
                (1) Demonstration program authorized.--The Secretary of
            Defense may carry out a demonstration program to establish
            programs to train and employ alternative dental health care
            providers in order to increase access to dental health care
            services for members of the Armed Forces and their dependents
            who lack ready access to such services, including the
            following:
                        (A) Members and dependents who reside in rural
                    areas or areas otherwise underserved by dental health
                    care providers.
                        (B) Members of a reserve component of the Armed
                    Forces in active status who are potentially deployable.
                (2) Telehealth.--For purposes of alternative dental health
            care providers and other dental care providers who are licensed
            to provide clinical care, dental services provided under the
            demonstration program under this subsection may be administered
            by such providers through telehealth-enabled collaboration and
            supervision when appropriate and feasible.
                (3) Definitions.--In this subsection:
                        (A) Active status.--The term ``active status'' has
                    the meaning given that term in section 101(d) of title
                    10, United States Code.
                        (B) Alternative dental health care providers.--The
                    term ``alternative dental health care providers'' has
                    the meaning given that term in section 340G-1(a)(2) of
                    the Public Health Service Act (42 U.S.C. 256g-1(a)(2)).
                (4) Authorization of appropriations.--There are authorized
            to be appropriated such sums as are necessary to carry out the
            demonstration program under this subsection.
        (h) Demonstration Program on Training and Employment of Alternative
    Dental Health Care Providers for Dental Health Care Services for
    Prisoners Within the Custody of the Bureau of Prisons.--
                (1) Demonstration program authorized.--The Attorney
            General, acting through the Director of the Bureau of Prisons,
            may carry out a demonstration program to establish programs to
            train and employ alternative dental health care providers in
            order to increase access to dental health services for
            prisoners within the custody of the Bureau of Prisons.
                (2) Telehealth.--For purposes of alternative dental health
            care providers and other dental care providers who are licensed
            to provide clinical care, dental services provided under the
            demonstration program under this subsection may be administered
            by such providers through telehealth-enabled collaboration and
            supervision when appropriate and feasible.
                (3) Alternative dental health care providers defined.--In
            this subsection and subsection (i), the term ``alternative
            dental health care providers'' has the meaning given that term
            in section 340G-1(a)(2) of the Public Health Service Act (42
            U.S.C. 256g-1(a)(2)).
                (4) Authorization of appropriations.--There are authorized
            to be appropriated such sums as are necessary to carry out the
            demonstration program under this subsection.
        (i) Demonstration Program on Training and Employment of Alternative
    Dental Health Care Providers for Dental Health Care Services Under the
    Indian Health Service.--
                (1) Demonstration program authorized.--The Secretary of
            Health and Human Services, acting through the Indian Health
            Service, may carry out a demonstration program to establish
            programs to train and employ alternative dental health care
            providers in order to help eliminate oral health disparities
            and increase access to dental services through health programs
            operated by the Indian Health Service, Indian tribes, tribal
            organizations, and urban Indian organizations (as the preceding
            3 terms are defined in section 4 of the Indian Health Care
            Improvement Act (25 U.S.C. 1603)).
                (2) Telehealth.--For purposes of alternative dental health
            care providers and other dental care providers who are licensed
            to provide clinical care, dental services provided under the
            demonstration program under this subsection may be administered
            by such providers through telehealth-enabled collaboration and
            supervision when appropriate and feasible.
                (3) Authorization of appropriations.--There are authorized
            to be appropriated such sums as are necessary to carry out the
            demonstration program under this subsection.

    SEC. 4252. ORAL HEALTH LITERACY AND AWARENESS CAMPAIGN.

        The Public Health Service Act is amended by inserting after section
    340G-1 of such Act (42 U.S.C. 256g-1) the following:

    ``SEC. 340G-2. ORAL HEALTH LITERACY AND AWARENESS.

        ``(a) Campaign.--The Secretary, acting through the Administrator of
    the Health Resources and Services Administration, shall establish a
    public education campaign (referred to in this subsection as the
    `campaign') across all relevant programs of the Health Resources and
    Services Administration (including the health center program, oral
    health workforce programs, maternal and child health programs, the Ryan
    White HIV/AIDS Program, and rural health programs) to increase oral
    health literacy and awareness.
        ``(b) Strategies.--In carrying out the campaign, the Secretary
    shall identify oral health literacy and awareness strategies that are
    evidence-based and focused on oral health care education, including
    education on prevention of oral disease such as early childhood and
    other caries, periodontal disease, and oral cancer.
        ``(c) Focus.--The Secretary shall design the campaign to
    communicate directly with specific populations, including children,
    pregnant women, parents, the elderly, individuals with disabilities,
    and ethnic and racial minority populations, including Indians, Alaska
    Natives, and Native Hawaiians, in a culturally and linguistically
    appropriate manner.
        ``(d) Outcomes.--In carrying out the campaign, the Secretary shall
    include a process for measuring outcomes and effectiveness.
        ``(e) Report to Congress.--Not later than 3 years after the date of
    enactment of 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
    report on the outcomes and effectiveness of the campaign.
        ``(f) Authorization of Appropriations.--To carry out this section,
    there is authorized to be appropriated $750,000 for each of fiscal
    years 2023 through 2027.''.

    Subtitle D--Advancing Health Equity Through Payment and Delivery Reform

    SEC. 4301. SENSE OF CONGRESS.

        It is the sense of Congress that--
                (1) the sustainability of the health care system in the
            United States hinges on restructuring how health care is paid
            for, shifting away from paying for the volume of services
            provided to the value the services provide;
                (2) high value care is care that provides higher quality
            care more efficiently, achieving greater health improvement and
            better health outcomes at lower cost (per patient and overall);
                (3) a high value health care system must deliver timely,
            accessible, well-coordinated, high-quality, culturally
            centered, and language-appropriate care to everyone;
                (4) eliminating health and health care disparities and
            achieving health equity must be central to and required in
            efforts to achieve a high value health care system;
                (5) eliminating such disparities and achieving such equity
            will require tailored interventions and targeted investments to
            address inequities in health and health care to make sure that
            health care delivery and payment efforts are responsive to and
            inclusive of the needs of communities of color and other
            communities experiencing disparities; and
                (6) new models of value-based payment and care delivery
            should prioritize primary care and consider the holistic needs
            of and other factors with respect to the patient population,
            including with respect to behavioral health, oral health, end-
            of-life care, history of adverse childhood experiences and
            adverse community environments, social determinants of health,
            social risk factors, unmet social needs, and the burden of
            intergenerational racial and other inequities.

    SEC. 4302. CENTERS FOR MEDICARE & MEDICAID SERVICES REPORTING AND
                  VALUE-BASED PROGRAMS.

        (a) Advancing Health Equity in Reporting and Value-Based Payment
    Programs.--
                (1) In general.--The Administrator of the Centers for
            Medicare & Medicaid Services (in this section referred to as
            the ``Administrator'') shall require that a clinician or other
            professional participating in any pay-for-reporting or value-
            based payment program stratify clinical quality measures by
            disparity variables, including race, ethnicity, sex, primary
            language, disability status, sexual orientation, gender
            identity, and socioeconomic status. A clinician or other
            professional may use existing demographic data collection
            fields in certified electronic health record technology (as
            defined in section 1848(o)(4) of the Social Security Act (42
            U.S.C. 1395w-4(o)(4))) to carry out such data stratification
            under the preceding sentence. Such stratified data will assist
            clinicians and other professionals in the identification of
            disparities obscured in aggregated data and assist with the
            provision of interventions that target reducing those
            disparities.
                (2) Clinician.--In assessing performance in any value-based
            payment program, the Administrator shall incorporate a
            clinician or other professional's performance in reducing
            disparities across race, ethnicity, sex, primary language,
            disability status, sexual orientation, gender identity, and
            socioeconomic status. Linking performance payments to the
            reduction of health care disparities across such variables will
            assist in holding clinicians and other professionals
            accountable for providing quality care that can lead to
            decreased health inequities.
                (3) Requirement of adoption of cert.--All entities,
            clinicians, or other professionals participating in the Quality
            Payment Program of the Centers for Medicare & Medicaid Services
            shall be required to adopt 2015 certified electronic health
            record technology (as so defined) as a condition of
            participating in such program.
        (b) Quality Improvement Activities.--The Administrator, upon yearly
    review of the Quality Payment Program, shall add quality improvement
    activities that implement the Culturally and Linguistically Accessible
    Standards (CLAS) as Improvement Activities under the Quality Payment
    Program.

    SEC. 4303. DEVELOPMENT AND TESTING OF DISPARITY REDUCING DELIVERY AND
                  PAYMENT MODELS.

        (a) In General.--The Center for Medicare and Medicaid Innovation
    established under section 1115A of the Social Security Act (42 U.S.C.
    1315a) (in this section referred to as the ``CMI'') shall establish a
    dedicated fund to identify, test, evaluate, and scale delivery and
    payment models under the applicable titles (as defined in subsection
    (a)(4)(B) of such section) that target health disparities among racial
    and ethnic minorities, including models that support high-value
    nonmedical services that address socially determined barriers to health
    in all stages of the life cycle through end-of-life, including English
    proficiency status, low health and health care literacy, lack of access
    to health care planning, including end-of-life care planning, case
    management, transportation, enrollment assistance needs, stable and
    affordable housing, utility assistance, employment and career
    development, and nutrition and food security which will help to reduce
    disparities and impact the overall cost of care.
        (b) Amendment to Social Security Act.--The second sentence of
    section 1115A(a)(1) of the Social Security Act (42 U.S.C. 1315a(a)(1))
    is amended by inserting ``and improve health equity'' after
    ``expenditures''.
        (c) Pilot Programs.--The CMI shall prioritize the testing of models
    under such section 1115A that include partnerships with entities,
    including community based organizations or other nonprofit entities, to
    help address socially determined barriers to health and health care.
        (d) Alternatives.--Any model tested by the CMI under such 1115A
    shall include measures to assess and track the impact of the model on
    health disparities, using existing measures such as the Healthcare
    Disparities and Cultural Competency Measures endorsed by the entity
    with a contract under section 1890(a) of the Social Security Act (42
    U.S.C. 1395aaa(a)), and stratified by race, ethnicity, English
    proficiency, gender identity, sexual orientation, and disability
    status.

    SEC. 4304. DIVERSITY IN CENTERS FOR MEDICARE AND MEDICAID CONSULTATION.

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

    SEC. 4305. SUPPORTING SAFETY NET AND COMMUNITY-BASED PROVIDERS TO
                  COMPETE IN VALUE-BASED PAYMENT SYSTEMS.

        (a) In General.--Any pay-for-performance or alternative payment
    model that is developed and tested by the Center for Medicare and
    Medicaid Innovation established under section 1115A of the Social
    Security Act (42 U.S.C. 1315a), or any other agency of the Department
    of Health and Human Services with respect to the programs under titles
    XVIII, XIX, or XXI of such Act, shall be assessed for potential impact
    on safety net, community based, and critical access providers,
    including Federally qualified health centers.
        (b) New Models.--The rollout of any such models shall include
    training and additional up front resources for community based and
    safety net providers to enable those providers to participate in the
    model.

                      Subtitle E--Health Empowerment Zones

    SEC. 4401. DESIGNATION OF HEALTH EMPOWERMENT ZONES.

        (a) In General.--The Secretary may, at the request of an eligible
    community partnership described in subsection (b)(1), designate an
    eligible area described in subsection (b)(2) as a health empowerment
    zone for the purpose of eligibility for a grant under section 4402.
        (b) Eligibility Criteria.--
                (1) Eligible community partnership.--A community
            partnership is eligible to submit a request under this section
            if the partnership--
                        (A) demonstrates widespread public support from key
                    individuals and entities in the eligible area,
                    including members of the target community, State and
                    local governments, nonprofit organizations including
                    national and regional intermediaries with demonstrated
                    capacity to serve low-income urban communities, and
                    community and industry leaders, for designation of the
                    eligible area as a health empowerment zone; and
                        (B) includes representatives of--
                                (i) a broad cross section of stakeholders
                            and residents from communities in the eligible
                            area experiencing disproportionate disparities
                            in health status and health care; and
                                (ii) organizations, facilities, and
                            institutions that have a history of working
                            within and serving such communities.
                (2) Eligible area.--An area is eligible to be designated as
            a health empowerment zone under this section if one or more
            communities in the area experience disproportionate disparities
            in health status and health care. In determining whether a
            community experiences such disparities, the Secretary shall
            consider data collected by the Department of Health and Human
            Services focusing on the following areas:
                        (A) Access to affordable, high-quality health care
                    services.
                        (B) The prevalence of disproportionate rates of
                    certain illnesses or diseases including the following:
                                (i) Arthritis, osteoporosis, chronic back
                            conditions, and other musculoskeletal diseases.
                                (ii) Cancer.
                                (iii) Chronic kidney disease.
                                (iv) Diabetes.
                                (v) Injury (intentional and unintentional).
                                (vi) Violence (intimate and nonintimate).
                                (vii) Maternal and paternal illnesses and
                            diseases.
                                (viii) Infant mortality.
                                (ix) Mental illness and other disabilities.
                                (x) Substance use disorder treatment and
                            prevention, including underage drinking.
                                (xi) Nutrition, obesity, and overweight
                            conditions.
                                (xii) Heart disease.
                                (xiii) Hypertension.
                                (xiv) Cerebrovascular disease or stroke.
                                (xv) Tuberculosis.
                                (xvi) HIV/AIDS and other sexually
                            transmitted infections.
                                (xvii) Viral hepatitis.
                                (xviii) Asthma.
                                (xix) Tooth decay and other oral health
                            issues.
                        (C) Within the community, the historical and
                    persistent presence of conditions that have been found
                    to contribute to health disparities including any such
                    conditions respecting any of the following:
                                (i) Poverty.
                                (ii) Educational status and the quality of
                            community schools.
                                (iii) Income.
                                (iv) Access to high-quality affordable
                            health care.
                                (v) Work and work environment.
                                (vi) Environmental conditions in the
                            community, including with respect to clean
                            water, clean air, and the presence or absence
                            of pollutants.
                                (vii) Language and English proficiency.
                                (viii) Access to affordable healthy food.
                                (ix) Access to ethnically and culturally
                            diverse health and human service providers and
                            practitioners.
                                (x) Access to culturally and linguistically
                            competent health and human services and health
                            and human service providers.
                                (xi) Health-supporting infrastructure.
                                (xii) Health insurance that is adequate and
                            affordable.
                                (xiii) Race, racism, and bigotry (conscious
                            and unconscious).
                                (xiv) Sexual orientation.
                                (xv) Health and health care literacy.
                                (xvi) Place of residence (such as urban
                            areas, rural areas, and reservations of Indian
                            Tribes).
                                (xvii) Stress.
        (c) Procedure.--
                (1) Request.--A request under subsection (a) shall--
                        (A) describe the bounds of the area to be
                    designated as a health empowerment zone and the process
                    used to select those bounds;
                        (B) demonstrate that the partnership submitting the
                    request is an eligible community partnership described
                    in subsection (b)(1);
                        (C) demonstrate that the area is an eligible area
                    described in subsection (b)(2);
                        (D) include a comprehensive assessment of
                    disparities in health status and health care experience
                    by one or more communities in the area;
                        (E) set forth--
                                (i) a vision and a set of values for the
                            area; and
                                (ii) a comprehensive and holistic set of
                            goals to be achieved in the area through
                            designation as a health empowerment zone; and
                        (F) include a strategic plan and an action plan for
                    achieving the goals described in subparagraph (E)(ii).
                (2) Approval.--Not later than 60 days after the receipt of
            a request for designation of an area as a health empowerment
            zone under this section, the Secretary shall approve or
            disapprove the request.
        (d) Minimum Number.--The Secretary--
                (1) shall designate not more than 110 health empowerment
            zones under this section; and
                (2) of such zones designated under paragraph (1), shall
            designate at least one health empowerment zone in each of the
            several States, the District of Columbia, and each territory or
            possession of the United States.

    SEC. 4402. ASSISTANCE TO THOSE SEEKING DESIGNATION.

        At the request of any organization or entity seeking to submit a
    request under section 4401(a), the Secretary shall provide technical
    assistance, and may award a grant, to assist such organization or
    entity--
                (1) to form an eligible community partnership described in
            section 4401(b)(1);
                (2) to complete a health assessment, including an
            assessment of health disparities under section 4401(c)(1)(D);
            or
                (3) to prepare and submit a request, including a strategic
            plan, in accordance with section 4401.

    SEC. 4403. BENEFITS OF DESIGNATION.

        (a) Priority.--In awarding a grant under subsection (b), a Federal
    official shall give priority to any applicant that--
                (1) meets the eligibility criteria for the grant;
                (2) proposes to use the grant for activities in a health
            empowerment zone; and
                (3) demonstrates that such activities will directly and
            significantly further the goals of the strategic plan approved
            for such zone under section 4401.
        (b) Grants for Initial Implementation of Strategic Plan.--
                (1) In general.--Upon designating an eligible area as a
            health empowerment zone at the request of an eligible community
            partnership, the Secretary shall, subject to the availability
            of appropriations, make a grant to the community partnership
            for implementation of the strategic plan for such zone.
                (2) Grant period.--A grant under paragraph (1) for a health
            empowerment zone shall be for a period of 2 years and may be
            renewed, except that the total period of grants under paragraph
            (1) for such zone may not exceed 10 years.
                (3) Limitation.--In awarding grants under this subsection,
            the Secretary shall not give less priority to an applicant or
            reduce the amount of a grant because the Secretary rendered
            technical assistance or made a grant to the same applicant
            under section 4401.
                (4) Reporting.--The Secretary shall establish metrics for
            measuring the progress of grantees under this subsection and,
            based on such metrics, require each such grantee to report to
            the Secretary not less than every 6 months on the progress in
            implementing the strategic plan for the health empowerment
            zone.

    SEC. 4404. DEFINITION OF SECRETARY.

        In this subtitle, the term ``Secretary'' means the Secretary of
    Health and Human Services, acting through the Administrator of the
    Health Resources and Services Administration and the Deputy Assistant
    Secretary for Minority Health, and in cooperation with the Director of
    the Office of Community Services and the Director of the National
    Institute on Minority Health and Health Disparities.

    SEC. 4405. AUTHORIZATION OF APPROPRIATIONS.

        To carry out this subtitle, there is authorized to be appropriated
    $100,000,000 for fiscal year 2023.

                   Subtitle F--Equitable Health Care For All

    SEC. 4501. FINDINGS.

        Congress finds the following:
                (1) In 1966, Dr. Martin Luther King, Jr., said ``Of all the
            forms of inequality, injustice in health care is the most
            shocking and inhuman because it often results in physical
            death.''.
                (2) Inequity in health care remains a persistent and
            devastating reality for many communities, and, in particular,
            communities of color.
                (3) The provision of inequitable health care has complex
            causes, many stemming from systemic inequality in access to
            health care, housing, nutrition, economic opportunity,
            education, and other factors.
                (4) Health care outcomes for Black communities in
            particular lag far behind those of the population as a whole.
                (5) Dr. Anthony Fauci, Director of the National Institute
            of Allergy and Infectious Diseases, said on April 7, 2020, the
            coronavirus outbreak is ``shining a bright light'' on
            ``unacceptable'' health disparities in the Black community.
                (6) A contributing factor in health disparities is explicit
            and implicit bias in the delivery of health care, resulting in
            inferior care and poorer outcomes for some patients on the
            basis of factors that include race, national origin, sex
            (including sexual orientation or gender identity), disability,
            age, and religion.
                (7) The National Academy of Medicine (formerly known as the
            ``Institute of Medicine'') issued a report in 2002 titled
            ``Unequal Treatment'', finding that racial and ethnic
            minorities receive lower-quality health care than Whites do,
            even when insurance status, income, age, and severity of
            condition is comparable.
                (8) Just as Congress has sought to eliminate bias, both
            explicit and implicit, in employment, housing, and other parts
            of our society, the elimination of bias and the legacy of
            structural racism in health care is of paramount importance.

    SEC. 4502. DATA COLLECTION AND REPORTING.

        (a) Required Reporting.--
                (1) In general.--The Secretary of Health and Human
            Services, in consultation with the Director for Civil Rights
            and Health Equity, the Director of the National Institutes of
            Health, the Administrator of the Centers for Medicare &
            Medicaid Services, the Director of the Agency for Healthcare
            Research and Quality, the Deputy Assistant Secretary for
            Minority Health, and the Director of the Centers for Disease
            Control and Prevention, shall by regulation require all health
            care providers and facilities that are required under other
            provisions of law to report data on specific health outcomes to
            the Department of Health and Human Services in aggregate form,
            to disaggregate such data by demographic characteristics,
            including by race, national origin, sex (including sexual
            orientation and gender identity), disability, and age, as well
            as any other factor that the Secretary of Health and Human
            Services determines would be useful for determining a pattern
            of provision of inequitable health care.
                (2) Proposed regulations.--Not later than 90 days after the
            date of enactment of this Act, the Secretary of Health and
            Human Services shall issue proposed regulations to carry out
            paragraph (1).
        (b) Repository.--The Secretary of Health and Human Services shall--
                (1) not later than 1 year after the date of enactment of
            this Act, establish a repository of the disaggregated data
            reported pursuant to subsection (a);
                (2) subject to paragraph (3), make the data in such
            repository publicly available; and
                (3) ensure that such repository does not contain any data
            that is individually identifiable.

    SEC. 4503. REQUIRING EQUITABLE HEALTH CARE IN THE HOSPITAL VALUE-BASED
                  PURCHASING PROGRAM.

        (a) Equitable Health Care as Value Measurement.--Section
    1886(b)(3)(B)(viii) of the Social Security Act (42 U.S.C.
    1395ww(b)(3)(B)(viii)) is amended by adding at the end the following
    new subclause:
        ``(XIII)(aa) Effective for payments beginning with fiscal year
    2024, in expanding the number of measures under subclause (III), the
    Secretary shall adopt measures that relate to equitable health care
    furnished by hospitals in inpatient settings.
        ``(bb) In carrying out this subclause, the Secretary shall solicit
    input and recommendations from individuals and groups representing
    communities of color and other protected classes and ensure measures
    adopted pursuant to this subclause account for social determinants of
    health, as defined in section 7(e)(10) of the Equal Health Care for All
    Act.
        ``(cc) For purposes of this subclause, the term `equitable health
    care' refers to the principle that high-quality care should be provided
    to all individuals and health care treatment and services should not
    vary on account of the real or perceived race, national origin, sex
    (including sexual orientation and gender identity), disability, or age
    of an individual, as well as any other factor that the Secretary
    determines would be useful for determining a pattern of provision of
    inequitable health care.''.
        (b) Inclusion of Equitable Health Care Measures.--Section
    1886(o)(2)(B) of the Social Security Act (42 U.S.C. 1395ww(o)(2)(B)) is
    amended by adding at the end the following new clause:
                                ``(iv) Inclusion of equitable health care
                            measures.--Beginning in fiscal year 2024,
                            measures selected under subparagraph (A) shall
                            include the equitable health care measures
                            described in subsection
                            (b)(3)(B)(viii)(XIII).''.

    SEC. 4504. PROVISION OF INEQUITABLE HEALTH CARE AS A BASIS FOR
                  PERMISSIVE EXCLUSION FROM MEDICARE AND STATE HEALTH CARE
                  PROGRAMS.

        Section 1128(b) of the Social Security Act (42 U.S.C. 1320a-7(b))
    is amended by adding at the end the following new paragraph:
                ``(18) Provision of inequitable health care.--
                        ``(A) In general.--Subject to subparagraph (B), any
                    health care provider that the Secretary determines has
                    engaged in a pattern of providing inequitable health
                    care (as defined in section 7(e)(7) of the Equal Health
                    Care for All Act) on the basis of race, national
                    origin, sex (including sexual orientation and gender
                    identity), disability, or age of an individual.
                        ``(B) Exception.--For purposes of carrying out
                    subparagraph (A), the Secretary shall not exclude any
                    health care provider from participation in the Medicare
                    program under title XVIII of the Social Security Act or
                    the Medicaid program under title XIX of such Act if the
                    exclusion of such health care provider would result in
                    increased difficulty in access to health care services
                    for underserved or low-income communities.''.

    SEC. 4505. OFFICE FOR CIVIL RIGHTS AND HEALTH EQUITY OF THE DEPARTMENT
                  OF HEALTH AND HUMAN SERVICES.

        (a) Name of Office.--Beginning on the date of enactment of this
    Act, the Office for Civil Rights of the Department of Health and Human
    Services shall be known as the ``Office for Civil Rights and Health
    Equity'' of the Department of Health and Human Services. Any reference
    to the Office for Civil Rights of the Department of Health and Human
    Services in any law, regulation, map, document, record, or other paper
    of the United States shall be deemed to be a reference to the Office
    for Civil Rights and Health Equity.
        (b) Head of Office.--The head of the Office for Civil Rights and
    Health Equity shall be the Director for Civil Rights and Health Equity,
    to be appointed by the President. Any reference to the Director of the
    Office for Civil Rights of the Department of Health and Human Services
    in any law, regulation, map, document, record, or other paper of the
    United States shall be deemed to be a reference to the Director for
    Civil Rights and Health Equity.

    SEC. 4506. PROHIBITING DISCRIMINATION IN HEALTH CARE.

        (a) Prohibiting Discrimination.--
                (1) In general.--No health care provider may, on the basis,
            in whole or in part, of race, sex (including sexual orientation
            and gender identity), disability, age, or religion, subject an
            individual to the provision of inequitable health care.
                (2) Notice of patient rights.--The Secretary shall provide
            to each patient a notice of a patient's rights under this
            section.
        (b) Administrative Complaint and Conciliation Process.--
                (1) Complaints and answers.--
                        (A) In general.--An aggrieved person may, not later
                    than 1 year after an alleged violation of subsection
                    (a) has occurred or concluded, file a complaint with
                    the Director alleging inequitable provision of health
                    care by a provider described in subsection (a).
                        (B) Complaint.--A complaint submitted pursuant to
                    subparagraph (A) shall be in writing and shall contain
                    such information and be in such form as the Director
                    requires.
                        (C) Oath or affirmation.--The complaint and any
                    answer made under this subsection shall be made under
                    oath or affirmation, and may be reasonably and fairly
                    modified at any time.
                (2) Response to complaints.--
                        (A) In general.--Upon the filing of a complaint
                    under this subsection, the following procedures shall
                    apply:
                                (i) Complainant notice.--The Director shall
                            serve notice upon the complainant acknowledging
                            receipt of such filing and advising the
                            complainant of the time limits and procedures
                            provided under this section.
                                (ii) Respondent notice.--The Director
                            shall, not later than 30 days after receipt of
                            such filing--
                                        (I) serve on the respondent a
                                    notice of the complaint, together with
                                    a copy of the original complaint; and
                                        (II) advise the respondent of the
                                    procedural rights and obligations of
                                    respondents under this section.
                                (iii) Answer.--The respondent may file, not
                            later than 60 days after receipt of the notice
                            from the Director, an answer to such complaint.
                                (iv) Investigative duties.--The Director
                            shall--
                                        (I) make an investigation of the
                                    alleged inequitable provision of health
                                    care; and
                                        (II) complete such investigation
                                    within 180 days (unless it is
                                    impracticable to complete such
                                    investigation within 180 days) after
                                    the filing of the complaint.
                        (B) Investigations.--
                                (i) Pattern or practice.--In the course of
                            investigating the complaint, the Director may
                            seek records of care provided to patients other
                            than the complainant if necessary to
                            demonstrate or disprove an allegation of
                            inequitable provision of health care or to
                            determine whether there is a pattern or
                            practice of such care.
                                (ii) Accounting for social determinants of
                            health.--In investigating the complaint and
                            reaching a determination on the validity of the
                            complaint, the Director shall account for
                            social determinants of health and the effect of
                            such social determinants on health care
                            outcomes.
                                (iii) Inability to complete
                            investigation.--If the Director is unable to
                            complete (or finds it is impracticable to
                            complete) the investigation within 180 days
                            after the filing of the complaint (or, if the
                            Secretary takes further action under paragraph
                            (6)(B) with respect to a complaint, within 180
                            days after the commencement of such further
                            action), the Director shall notify the
                            complainant and respondent in writing of the
                            reasons involved.
                                (iv) Report to state licensing
                            authorities.--On concluding each investigation
                            under this subparagraph, the Director shall
                            provide to the State licensing authorities that
                            were notified under subparagraph (A),
                            information specifying the results of the
                            investigation.
                        (C) Report.--
                                (i) Final report.--On completing each
                            investigation under this paragraph, the
                            Director shall prepare a final investigative
                            report.
                                (ii) Modification of report.--A final
                            report under this subparagraph may be modified
                            if additional evidence is later discovered.
                (3) Conciliation.--
                        (A) In general.--During the period beginning on the
                    date on which a complaint is filed under this
                    subsection and ending on the date of final disposition
                    of such complaint (including during an investigation
                    under paragraph (2)(B)), the Director shall, to the
                    extent feasible, engage in conciliation with respect to
                    such complaint.
                        (B) Conciliation agreement.--A conciliation
                    agreement arising out of such conciliation shall be an
                    agreement between the respondent and the complainant,
                    and shall be subject to approval by the Director.
                        (C) Rights protected.--The Director shall approve a
                    conciliation agreement only if the agreement protects
                    the rights of the complainant and other persons
                    similarly situated.
                        (D) Publicly available agreement.--
                                (i) In general.--Subject to clause (ii),
                            the Secretary shall make available to the
                            public a copy of a conciliation agreement
                            entered into pursuant to this subsection unless
                            the complainant and respondent otherwise agree,
                            and the Secretary determines, that disclosure
                            is not required to further the purposes of this
                            subsection.
                                (ii) Limitation.--A conciliation agreement
                            that is made available to the public pursuant
                            to clause (i) may not disclose individually
                            identifiable health information.
                (4) Failure to comply with conciliation agreement.--
            Whenever the Director has reasonable cause to believe that a
            respondent has breached a conciliation agreement, the Director
            shall refer the matter to the Attorney General to consider
            filing a civil action to enforce such agreement.
                (5) Written consent for disclosure of information.--Nothing
            said or done in the course of conciliation under this
            subsection may be made public, or used as evidence in a
            subsequent proceeding under this subsection, without the
            written consent of the parties to the conciliation.
                (6) Prompt judicial action.--
                        (A) In general.--If the Director determines at any
                    time following the filing of a complaint under this
                    subsection that prompt judicial action is necessary to
                    carry out the purposes of this subsection, the Director
                    may recommend that the Attorney General promptly
                    commence a civil action under subsection (d).
                        (B) Immediate suit.--If the Director determines at
                    any time following the filing of a complaint under this
                    subsection that the public interest would be served by
                    allowing the complainant to bring a civil action under
                    subsection (c) in a State or Federal court immediately,
                    the Director shall certify that the administrative
                    process has concluded and that the complainant may file
                    such a suit immediately.
                (7) Annual report.--Not later than 1 year after the date of
            enactment of this Act, and annually thereafter, the Director
            shall make publicly available a report detailing the activities
            of the Office for Civil Rights and Health Equity under this
            subsection, including--
                        (A) the number of complaints filed and the basis on
                    which the complaints were filed;
                        (B) the number of investigations undertaken as a
                    result of such complaints; and
                        (C) the disposition of all such investigations.
        (c) Enforcement by Private Persons.--
                (1) In general.--
                        (A) Civil action.--
                                (i) In suit.--A complainant under
                            subsection (b) may commence a civil action to
                            obtain appropriate relief with respect to an
                            alleged violation of subsection (a), or for
                            breach of a conciliation agreement under
                            subsection (b), in an appropriate district
                            court of the United States or State court--
                                        (I) not sooner than the earliest
                                    of--
                                                (aa) the date a
                                            conciliation agreement is
                                            reached under subsection (b);
                                                (bb) the date of a final
                                            disposition of a complaint
                                            under subsection (b); or
                                                (cc) 180 days after the
                                            first day of the alleged
                                            violation; and
                                        (II) not later than 2 years after
                                    the final day of the alleged violation.
                                (ii) Statute of limitations.--The
                            computation of such 2-year period shall not
                            include any time during which an administrative
                            proceeding (including investigation or
                            conciliation) under subsection (b) was pending
                            with respect to a complaint under such
                            subsection.
                        (B) Barring suit.--If the Director has obtained a
                    conciliation agreement under subsection (b) regarding
                    an alleged violation of subsection (a), no action may
                    be filed under this paragraph by the complainant
                    involved with respect to the alleged violation except
                    for the purpose of enforcing the terms of such an
                    agreement.
                (2) Relief which may be granted.--
                        (A) In general.--In a civil action under paragraph
                    (1), if the court finds that a violation of subsection
                    (a) or breach of a conciliation agreement has occurred,
                    the court may award to the plaintiff actual and
                    punitive damages, and may grant as relief, as the court
                    determines to be appropriate, any permanent or
                    temporary injunction, temporary restraining order, or
                    other order (including an order enjoining the defendant
                    from engaging in a practice violating subsection (a) or
                    ordering such affirmative action as may be
                    appropriate).
                        (B) Fees and costs.--In a civil action under
                    paragraph (1), the court, in its discretion, may allow
                    the prevailing party, other than the United States, a
                    reasonable attorney's fee and costs. The United States
                    shall be liable for such fees and costs to the same
                    extent as a private person.
                (3) Intervention by attorney general.--Upon timely
            application, the Attorney General may intervene in a civil
            action under paragraph (1), if the Attorney General certifies
            that the case is of general public importance.
        (d) Enforcement by the Attorney General.--
                (1) Commencement of actions.--
                        (A) Pattern or practice cases.--The Attorney
                    General may commence a civil action in any appropriate
                    district court of the United States if the Attorney
                    General has reasonable cause to believe that any health
                    care provider covered by subsection (a)--
                                (i) is engaged in a pattern or practice
                            that violates such subsection; or
                                (ii) is engaged in a violation of such
                            subsection that raises an issue of significant
                            public importance.
                        (B) Cases by referral.--The Director may determine,
                    based on a pattern of complaints, a pattern of
                    violations, a review of data reported by a health care
                    provider covered by subsection (a), or any other means,
                    that there is reasonable cause to believe a health care
                    provider is engaged in a pattern or practice that
                    violates subsection (a). If the Director makes such a
                    determination, the Director shall refer the related
                    findings to the Attorney General. If the Attorney
                    General finds that such reasonable cause exists, the
                    Attorney General may commence a civil action in any
                    appropriate district court of the United States.
                (2) Enforcement of subpoenas.--The Attorney General, on
            behalf of the Director, or another party at whose request a
            subpoena is issued under this subsection, may enforce such
            subpoena in appropriate proceedings in the district court of
            the United States for the district in which the person to whom
            the subpoena was addressed resides, was served, or transacts
            business.
                (3) Relief which may be granted in civil actions.--
                        (A) In general.--In a civil action under paragraph
                    (1), the court--
                                (i) may award such preventive relief,
                            including a permanent or temporary injunction,
                            temporary restraining order, or other order
                            against the person responsible for a violation
                            of subsection (a) as is necessary to assure the
                            full enjoyment of the rights granted by this
                            subsection;
                                (ii) may award such other relief as the
                            court determines to be appropriate, including
                            monetary damages, to aggrieved persons; and
                                (iii) may, to vindicate the public
                            interest, assess punitive damages against the
                            respondent--
                                        (I) in an amount not exceeding
                                    $500,000, for a first violation; and
                                        (II) in an amount not exceeding
                                    $1,000,000, for any subsequent
                                    violation.
                        (B) Fees and costs.--In a civil action under this
                    subsection, the court, in its discretion, may allow the
                    prevailing party, other than the United States, a
                    reasonable attorney's fee and costs. The United States
                    shall be liable for such fees and costs to the extent
                    provided by section 2412 of title 28, United States
                    Code.
                (4) Intervention in civil actions.--Upon timely
            application, any person may intervene in a civil action
            commenced by the Attorney General under paragraphs (1) and (2)
            if the action involves an alleged violation of subsection (a)
            with respect to which such person is an aggrieved person
            (including a person who is a complainant under subsection (b))
            or a conciliation agreement to which such person is a party.
        (e) Definitions.--In this section:
                (1) Aggrieved person.--The term ``aggrieved person''
            means--
                        (A) a person who believes that the person was or
                    will be injured in violation of subsection (a); or
                        (B) the personal representative or estate of a
                    deceased person who was injured in violation of
                    subsection (a).
                (2) Director.--The term ``Director'' refers to the Director
            for Civil Rights and Health Equity of the Department of Health
            and Human Services.
                (3) Disability.--The term ``disability'' has the meaning
            given such term in section 3 of the Americans with Disabilities
            Act of 1990 (42 U.S.C. 12102).
                (4) Conciliation.--The term ``conciliation'' means the
            attempted resolution of issues raised by a complaint, or by the
            investigation of such complaint, through informal negotiations
            involving the complainant, the respondent, and the Secretary.
                (5) Conciliation agreement.--The term ``conciliation
            agreement'' means a written agreement setting forth the
            resolution of the issues in conciliation.
                (6) Individually identifiable health information.--The term
            ``individually identifiable health information'' means any
            information, including demographic information collected from
            an individual--
                        (A) that is created or received by a health care
                    provider covered by subsection (a), health plan,
                    employer, or health care clearinghouse;
                        (B) that relates to the past, present, or future
                    physical or mental health or condition of, the
                    provision of health care to, or the past, present, or
                    future payment for the provision of health care to, the
                    individual; and
                        (C)(i) that identifies the individual; or
                        (ii) with respect to which there is a reasonable
                    basis to believe that the information can be used to
                    identify the individual.
                (7) Provision of inequitable health care.--The term
            ``provision of inequitable health care'' means the provision of
            any health care service, by a health care provider in a manner
            that--
                        (A) fails to meet a high-quality care standard,
                    meaning the health care provider fails to--
                                (i) avoid harm to patients as a result of
                            the health services that are intended to help
                            the patient;
                                (ii) provide health services based on
                            scientific knowledge to all and to all patients
                            who benefit;
                                (iii) refrain from providing services to
                            patients not likely to benefit;
                                (iv) provide care that is responsive to
                            patient preferences, needs, and values; and
                                (v) avoids waits or delays in care; and
                        (B) is discriminatory in intent or effect based at
                    least in part on a basis specified in subsection (a).
                (8) Respondent.--The term ``respondent'' means the person
            or other entity accused in a complaint of a violation of
            subsection (a).
                (9) Secretary.--The term ``Secretary'' means the Secretary
            of Health and Human Services.
                (10) Social determinants of health.--The term ``social
            determinants of health'' means conditions in the environments
            in which individuals live, work, attend school, and worship,
            that affect a wide range of health, functioning, and quality-
            of-life outcomes and risks.
        (f) Rule of Construction.--Nothing in this section shall be
    construed as repealing or limiting the effect of title VI of the Civil
    Rights Act of 1964 (42 U.S.C. 2000b et seq.), section 1557 of the
    Patient Protection and Affordable Care Act (42 U.S.C. 18116), section
    504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), or the Age
    Discrimination Act of 1975 (42 U.S.C. 6101 et seq.).

    SEC. 4507. FEDERAL HEALTH EQUITY COMMISSION.

        (a) Establishment of Commission.--
                (1) In general.--There is established the Federal Health
            Equity Commission (in this section referred to as the
            ``Commission'').
                (2) Membership.--
                        (A) In general.--The Commission shall be composed
                    of--
                                (i) 8 voting members appointed under
                            subparagraph (B); and
                                (ii) the nonvoting, ex officio members
                            listed in subparagraph (C).
                        (B) Voting members.--Not more than 4 of the members
                    described in subparagraph (A)(i) shall at any one time
                    be of the same political party. Such members shall have
                    recognized expertise in and personal experience with
                    racial and ethnic health inequities, health care needs
                    of vulnerable and marginalized populations, and health
                    equity as a vehicle for improving health status and
                    health outcomes. Such members shall be appointed to the
                    Commission as follows:
                                (i) 4 members of the Commission shall be
                            appointed by the President.
                                (ii) 2 members of the Commission shall be
                            appointed by the President pro tempore of the
                            Senate, upon the recommendations of the
                            majority leader and the minority leader of the
                            Senate. Each member appointed to the Commission
                            under this clause shall be appointed from a
                            different political party.
                                (iii) 2 members of the Commission shall be
                            appointed by the Speaker of the House of
                            Representatives upon the recommendations of the
                            majority leader and the minority leader of the
                            House of Representatives. Each member appointed
                            to the Commission under this clause shall be
                            appointed from a different political party.
                        (C) Ex officio member.--The Commission shall have
                    the following nonvoting, ex officio members:
                                (i) The Director for Civil Rights and
                            Health Equity of the Department of Health and
                            Human Services.
                                (ii) The Deputy Assistant Secretary for
                            Minority Health of the Department of Health and
                            Human Services.
                                (iii) The Director of the National
                            Institute on Minority Health and Health
                            Disparities.
                                (iv) The Chairperson of the Advisory
                            Committee on Minority Health established under
                            section 1707(c) of the Public Health Service
                            Act (42 U.S.C. 300u-6(c)).
                (3) Terms.--The term of office of each member appointed
            under paragraph (2)(B) of the Commission shall be 6 years.
                (4) Chairperson; vice chairperson.--
                        (A) Chairperson.--The President shall, with the
                    concurrence of a majority of the members of the
                    Commission appointed under paragraph (2)(B), designate
                    a Chairperson from among the members of the Commission
                    appointed under such paragraph.
                        (B) Vice chairperson.--
                                (i) Designation.--The Speaker of the House
                            of Representatives shall, in consultation with
                            the majority leaders and the minority leaders
                            of the Senate and the House of Representatives
                            and with the concurrence of a majority of the
                            members of the Commission appointed under
                            paragraph (2)(B), designate a Vice Chairperson
                            from among the members of the Commission
                            appointed under such paragraph. The Vice
                            Chairperson may not be a member of the same
                            political party as the Chairperson.
                                (ii) Duty.--The Vice Chairperson shall act
                            in place of the Chairperson in the absence of
                            the Chairperson.
                (5) Removal of members.--The President may remove a member
            of the Commission only for neglect of duty or malfeasance in
            office.
                (6) Quorum.--A majority of members of the Commission
            appointed under paragraph (2)(B) shall constitute a quorum of
            the Commission, but a lesser number of members may hold
            hearings.
        (b) Duties of the Commission.--
                (1) In general.--The Commission shall--
                        (A) monitor and report on the implementation of
                    this Act; and
                        (B) investigate, monitor, and report on progress
                    towards health equity and the elimination of health
                    disparities.
                (2) Annual report.--The Commission shall--
                        (A) submit to the President and Congress at least
                    one report annually on health equity and health
                    disparities; and
                        (B) include in such report--
                                (i) a description of actions taken by the
                            Department of Health and Human Services and any
                            other Federal agency related to health equity
                            or health disparities; and
                                (ii) recommendations on ensuring equitable
                            health care and eliminating health disparities.
        (c) Powers.--
                (1) Hearings.--
                        (A) In general.--The Commission or, at the
                    direction of the Commission, any subcommittee or member
                    of the Commission, may, for the purpose of carrying out
                    this section, as the Commission or the subcommittee or
                    member considers advisable--
                                (i) hold such hearings, meet and act at
                            such times and places, take such testimony,
                            receive such evidence, and administer such
                            oaths; and
                                (ii) require, by subpoena or otherwise, the
                            attendance and testimony of such witnesses and
                            the production of such books, records,
                            correspondence, memoranda, papers, documents,
                            tapes, and materials.
                        (B) Limitation on hearings.--The Commission may
                    hold a hearing under subparagraph (A)(i) only if the
                    hearing is approved--
                                (i) by a majority of the members of the
                            Commission appointed under subsection
                            (a)(2)(B); or
                                (ii) by a majority of such members present
                            at a meeting when a quorum is present.
                (2) Issuance and enforcement of subpoenas.--
                        (A) Issuance.--A subpoena issued under paragraph
                    (1) shall--
                                (i) bear the signature of the Chairperson
                            of the Commission; and
                                (ii) be served by any person or class of
                            persons designated by the Chairperson for that
                            purpose.
                        (B) Enforcement.--In the case of contumacy or
                    failure to obey a subpoena issued under paragraph (1),
                    the United States district court for the district in
                    which the subpoenaed person resides, is served, or may
                    be found may issue an order requiring the person to
                    appear at any designated place to testify or to produce
                    documentary or other evidence.
                        (C) Noncompliance.--Any failure to obey the order
                    of the court may be punished by the court as a contempt
                    of court.
                (3) Witness allowances and fees.--
                        (A) In general.--Section 1821 of title 28, United
                    States Code, shall apply to a witness requested or
                    subpoenaed to appear at a hearing of the Commission.
                        (B) Expenses.--The per diem and mileage allowances
                    for a witness shall be paid from funds available to pay
                    the expenses of the Commission.
                (4) Postal services.--The Commission may use the United
            States mails in the same manner and under the same conditions
            as other agencies of the Federal Government.
                (5) Gifts.--The Commission may accept, use, and dispose of
            gifts or donations of services or property.
        (d) Administrative Provisions.--
                (1) Staff.--
                        (A) Director.--There shall be a full-time staff
                    director for the Commission who shall--
                                (i) serve as the administrative head of the
                            Commission; and
                                (ii) be appointed by the Chairperson with
                            the concurrence of the Vice Chairperson.
                        (B) Other personnel.--The Commission may--
                                (i) appoint such other personnel as it
                            considers advisable, subject to the provisions
                            of title 5, United States Code, governing
                            appointments in the competitive service, and
                            the provisions of chapter 51 and subchapter III
                            of chapter 53 of that title relating to
                            classification and General Schedule pay rates;
                            and
                                (ii) may procure temporary and intermittent
                            services under section 3109(b) of title 5,
                            United States Code, at rates for individuals
                            not in excess of the daily equivalent paid for
                            positions at the maximum rate for GS-15 of the
                            General Schedule under section 5332 of title 5,
                            United States Code.
                (2) Compensation of members.--
                        (A) Non-federal employees.--Each member of the
                    Commission who is not an officer or employee of the
                    Federal Government shall be compensated at a rate equal
                    to the daily equivalent of the annual rate of basic pay
                    prescribed for level IV of the Executive Schedule under
                    section 5315 of title 5, United States Code, for each
                    day (including travel time) during which the member is
                    engaged in the performance of the duties of the
                    Commission.
                        (B) Federal employees.--Each member of the
                    Commission who is an officer or employee of the Federal
                    Government shall serve without compensation in addition
                    to the compensation received for the services of the
                    member as an office or employee of the Federal
                    Government.
                        (C) Travel expenses.--A member of the Commission
                    shall be allowed travel expenses, including per diem in
                    lieu of subsistence, at rates authorized for an
                    employee of an agency under subchapter I of chapter 57
                    of title 5, United States Code, while away from the
                    home or regular place of business of the member in the
                    performance of the duties of the Commission.
                (3) Cooperation.--The Commission may secure directly from
            any Federal department or agency such information as the
            Commission considers necessary to carry out this Act. Upon
            request of the Chairman of the Commission, the head of such
            department or agency shall furnish such information to the
            Commission.
        (e) Permanent Commission.--Section 14 of the Federal Advisory
    Committee Act (5 U.S.C. App.) shall not apply to the Commission.
        (f) Authorization of Appropriations.--There are authorized to be
    appropriated for fiscal year 2022 and each fiscal year thereafter such
    sums as may be necessary to carry out the duties of the Commission.

    SEC. 4508. GRANTS FOR HOSPITALS TO PROMOTE EQUITABLE HEALTH CARE AND
                  OUTCOMES.

        (a) In General.--Not later than 180 days after the date of the
    enactment of this Act, the Secretary of Health and Human Services (in
    this section referred to as the ``Secretary'') shall award grants to
    hospitals to promote equitable health care treatment and services, and
    reduce disparities in care and outcomes.
        (b) Consultation.--In establishing the criteria for grants under
    this section and evaluating applications for such grants, the Secretary
    shall consult with the Director for Civil Rights and Health Equity of
    the Department of Health and Human Services.
        (c) Use of Funds.--A hospital shall use funds received from a grant
    under this section to establish or expand programs to provide equitable
    health care to all patients and to ensure equitable health care
    outcomes. Such uses may include--
                (1) providing explicit and implicit bias training to
            medical providers and staff;
                (2) providing translation or interpretation services for
            patients;
                (3) recruiting and training a diverse workforce;
                (4) tracking data related to care and outcomes; and
                (5) training on cultural sensitivity.
        (d) Priority.--In awarding grants under this section, the Secretary
    shall give priority to hospitals that have received disproportionate
    share hospital payments under section 1886(r) of the Social Security
    Act (42 U.S.C. 1395ww(r)) or section 1923 of such Act (42 U.S.C. 1396r-
    4) with respect to fiscal year 2021.
        (e) Supplement, Not Supplant.--Grants awarded under this section
    shall be used to supplement, not supplant, any nongovernment efforts,
    or other Federal, State, or local funds provided to a recipient.
        (f) Equitable Health Care Defined.--The term ``equitable health
    care'' has the meaning given such term in section
    1886(b)(3)(B)(viii)(XIII)(cc) of the Social Security Act (42 U.S.C.
    1395ww(b)(3)(B)(viii)(XIII)(cc)), as added by section 4(a).
        (g) Authorization of Appropriations.--To carry out this section,
    there are authorized to be appropriated such sums as may be necessary
    for each of fiscal years 2022 through 2027.

                        Subtitle G--Investing in Equity

    SEC. 4601. DEFINITIONS.

        In this subtitle:
                (1) Advisory council.--The term ``Advisory Council'' means
            the Pay for Equity Council convened under section 4603.
                (2) Secretary.--The term ``Secretary'' means the Secretary
            of Health and Human Services.
                (3) Strategy.--The term ``Strategy'' means the Pay for
            Equity Strategy set forth under section 4602.

    SEC. 4602. STRATEGY TO INCENTIVIZE HEALTH EQUITY.

        (a) In General.--The Secretary, in consultation with the heads of
    other appropriate Federal agencies, shall develop jointly with the
    Advisory Council and submit to 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, and make publicly available on
    the internet website of the Department of Health and Human Services, a
    Pay for Equity Strategy.
        (b) Contents.--The Strategy shall establish goals for Federal
    programs, including those authorized under titles XVIII and XIX of the
    Social Security Act, to incentivize health equity, which may include at
    least--
                (1) incorporating measures of equity into all payment
            models by 2025;
                (2) tying a percentage of reimbursement in value-based
            payment models to equity measure performance by 2028; and
                (3) increasing the number of safety net providers
            participating in value-based payment by a set percentage by
            2030.
        (c) Duties of the Secretary.--The Secretary, in carrying out
    subsection (a), shall oversee the following:
                (1) Collecting and making publicly available information
            submitted by the Advisory Council.
                (2) Coordinating and assessing existing Federal Government
            programs and activities to assess capacity to meet equity
            goals.
                (3) Providing technical assistance, as appropriate, such as
            disseminating identified best practices and information sharing
            based on reports developed as a result of this subtitle.
        (d) Initial Strategy; Updates.--The Secretary shall--
                (1) not later than 18 months after the date of enactment of
            this Act, develop, publish, and submit to 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 the strategy outlined in subsection (a); and
                (2) biennially update, publish, and submit to Congress an
            updated strategy to--
                        (A) reflect new developments, challenges,
                    opportunities, and solutions; and
                        (B) review progress and, based on the results of
                    such review, recommend priority actions for improving
                    the implementation of such recommendations, as
                    appropriate.
        (e) Process for Public Input.--The Secretary shall establish a
    process for public input to inform the development of, and updates to,
    the Strategy, including a process for the public to submit
    recommendations to the Advisory Council and an opportunity for public
    comment on the proposed Strategy.

    SEC. 4603. PAY FOR EQUITY ADVISORY COUNCIL.

        (a) Convening.--The Secretary shall convene a Pay for Equity
    Advisory Council to advise and provide recommendations, including
    identified best practices, to the Secretary on the Pay for Equity
    Strategy.
        (b) Membership.--
                (1) In general.--The members of the Advisory Council shall
            consist of--
                        (A) the appointed members under paragraph (2); and
                        (B) the Federal members under paragraph (3).
                (2) Appointed members.--In addition to the Federal members
            under paragraph (3), the Secretary shall appoint not more than
            15 voting members of the Advisory Council who are not
            representatives of Federal departments or agencies and who
            shall include at least 1 representative of each of the
            following:
                        (A) Beneficiaries of Medicare and Medicaid.
                        (B) Safety net health care providers.
                        (C) Value-based payment experts.
                        (D) Other members with expertise and lived
                    experience the Secretary deems appropriate.
                (3) Federal members.--The Federal members of the Advisory
            Council, who shall be nonvoting members, shall consist of the
            following:
                        (A) The Administrator of the Centers for Medicare &
                    Medicaid Services (or the Administrator's designee).
                        (B) The Administrator of the Health Resources and
                    Services Administration.
                (4) Diverse representation.--The Secretary shall ensure
            that the membership of the Advisory Council reflects the
            diversity of individuals impacted by Federal health payment
            programs.
        (c) Meetings.--The Advisory Council shall meet quarterly during the
    1-year period beginning on the date of enactment of this Act and at
    least 3 times during each year thereafter. Meetings of the Advisory
    Council shall be open to the public.

      TITLE V--IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES

                             Subtitle A--In General

    SEC. 5001. GRANTS TO PROMOTE HEALTH FOR UNDERSERVED COMMUNITIES.

        Part Q of title III of the Public Health Service Act (42 U.S.C.
    280h 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 medically 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, nonbinary, gender-nonconforming, 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 medically
            underserved communities, and especially among racial and ethnic
            minority women, racial and ethnic minority children,
            adolescents, and lesbian, gay, bisexual, transgender, queer,
            nonbinary, gender-nonconforming, 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 pregnant, birthing, and postpartum
                    people and children, especially among racial and ethnic
                    minority pregnant, birthing, and postpartum people 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 2023 through 2027.''.

                        Subtitle B--Pregnancy Screening

    SEC. 5101. PREGNANCY INTENTION SCREENING INITIATIVE DEMONSTRATION
                  PROGRAM.

        Part P of title III of the Public Health Service Act (42 U.S.C.
    280g et seq.), as amended by section 5203(c)(6), is further amended by
    adding at the end the following:

    ``SEC. 399V-8. PREGNANCY INTENTION SCREENING INITIATIVE DEMONSTRATION
                  PROGRAM.

        ``(a) Program Establishment.--The Secretary, acting through the
    Director of the Centers for Disease Control and Prevention, shall
    establish a demonstration program to facilitate the clinical adoption
    of pregnancy intention screening initiatives by health care and social
    services providers.
        ``(b) Grants.--The Secretary may carry out the demonstration
    program through awarding grants to eligible entities to implement
    pregnancy intention screening initiatives, collect data, and evaluate
    such initiatives.
        ``(c) Eligible Entities.--To be eligible to seek a grant under this
    section, an entity shall--
                ``(1) provide non-directive, comprehensive, medically
            accurate information; and
                ``(2) be a community-based organization, voluntary health
            organization, public health department, community health
            center, or other interested public or private primary,
            behavioral, or other health care or social service provider or
            organization.
        ``(d) Pregnancy Intention Screening Initiative.--For purposes of
    this section, the term `pregnancy intention screening initiative' means
    any initiative by an eligible entity to routinely screen people with
    respect to their pregnancy intentions and goals to either prevent
    unintended pregnancies or improve the likelihood of healthy
    pregnancies, in order to better provide health care that meets the
    contraceptive or pre-pregnancy needs and goals of such people.
        ``(e) Evaluation.--
                ``(1) In general.--The Secretary, acting through the
            Director of the Centers for Disease Control and Prevention,
            shall, by grant or contract, and after consultation as
            described in paragraph (2), conduct an evaluation of the
            demonstration program, with respect to pregnancy intention
            screening initiatives, conducted under this section. Such
            evaluation shall include:
                        ``(A) Assessment of the implementation of pregnancy
                    intention screening protocols among a diverse group of
                    patients and providers, including collecting data on
                    the experiences and outcomes for diverse patient
                    populations in a variety of clinical settings.
                        ``(B) Analysis of outcome measures that will
                    facilitate effective and widespread adoption of such
                    protocols by health care providers for inquiring about
                    and responding to pregnancy goals of people with both
                    contraceptive and pre-pregnancy care.
                        ``(C) Consideration of health inequities among the
                    population served.
                        ``(D) Assessment of the equitable and voluntary
                    application of such initiatives to minority and
                    medically underserved communities.
                        ``(E) Assessment of the training, capacity, and
                    ongoing technical assistance needed for providers to
                    effectively implement such pregnancy intention
                    screening protocols.
                        ``(F) Assessment of whether referral systems for
                    selected protocols follow evidence-based standards that
                    ensure access to comprehensive health services and
                    appropriate follow-up care.
                        ``(G) Measuring through rigorous methods the effect
                    of such initiatives on key health outcomes.
                ``(2) Consultation with independent, expert advisory
            panel.--In conducting the evaluation under paragraph (1), the
            Director of the Centers for Disease Control and Prevention
            shall consult with physicians, physician assistants, advanced
            practice registered nurses, nurse midwives, and other health
            care providers who specialize in women's health, and other
            experts in public health, clinical practice, program
            evaluation, and research.
                ``(3) Report.--Not later than one year after the last day
            of the demonstration program under this section, the Director
            of the Centers for Disease Control and Prevention shall--
                        ``(A) submit to Congress a report on the results of
                    the evaluation conducted under paragraph (1); and
                        ``(B) make the report publicly available.
        ``(f) Funding.--
                ``(1) Authorization of appropriations.--To carry out this
            section, there is authorized to be appropriated $10,000,000 for
            each of fiscal years 2023 through 2027.
                ``(2) Limitation.--Not more than 20 percent of funds
            appropriated to carry out this section pursuant to paragraph
            (1) for a fiscal year may be used for purposes of the
            evaluation under subsection (e).''.

    SEC. 5102. BIRTH DEFECTS PREVENTION, RISK REDUCTION, AND AWARENESS.

        (a) In General.--The Secretary shall establish and implement a
    birth defects prevention and public awareness program, consisting of
    the activities described in subsections (c) and (d).
        (b) Definitions.--In this section:
                (1) Maternal.--The term ``maternal'' refers to people who
            are pregnant or breastfeeding.
                (2) Pregnancy and breastfeeding information services.--The
            term ``pregnancy and breastfeeding information services''
            includes only--
                        (A) information services to provide accurate,
                    evidence-based, clinical information regarding maternal
                    exposures during pregnancy or breastfeeding that may be
                    associated with birth defects, health risks to a
                    breastfed infant, or other health risks, such as
                    exposures to medications, chemicals, infections,
                    foodborne pathogens, illnesses, nutrition, lifestyle,
                    or climate- and weather-related factors;
                        (B) the provision of accurate, evidence-based
                    information weighing risks of exposures during
                    breastfeeding against the benefits of breastfeeding;
                    and
                        (C) the provision of information described in
                    subparagraph (A), (B), or (C) through counselors,
                    websites, fact sheets, telephonic or electronic
                    communication, community outreach efforts, or other
                    appropriate means.
                (3) Secretary.--The term ``Secretary'' means the Secretary
            of Health and Human Services, acting through the Director of
            the Centers for Disease Control and Prevention.
        (c) Nationwide Media Campaign.--In carrying out subsection (a), the
    Secretary shall conduct or support a nationwide media campaign to
    increase awareness among health care providers and at-risk populations
    about pregnancy and breastfeeding information services.
        (d) Grants for Pregnancy and Breastfeeding Information Services.--
                (1) In general.--In carrying out subsection (a), the
            Secretary shall award grants to State or regional agencies or
            organizations for any of the following:
                        (A) Information services.--The provision of, or
                    campaigns to increase awareness about, pregnancy and
                    breastfeeding information services.
                        (B) Surveillance and research.--The conduct or
                    support of--
                                (i) surveillance of or research on--
                                        (I) maternal exposures and maternal
                                    health conditions that may influence
                                    the risk of birth defects, prematurity,
                                    or other adverse pregnancy outcomes;
                                    and
                                        (II) maternal exposures that may
                                    influence health risks to a breastfed
                                    infant; or
                                (ii) networking to facilitate surveillance
                            or research described in this subparagraph.
                (2) Preference for certain states.--The Secretary, in
            making any grant under this subsection, shall give preference
            to States, otherwise equally qualified, that have pregnancy and
            breastfeeding information services in place.
                (3) Matching funds.--The Secretary may only award a grant
            under this subsection to a State or regional agency or
            organization that agrees, with respect to the costs to be
            incurred in carrying out the grant activities, to make
            available (directly or through donations from public or private
            entities) non-Federal funds toward such costs in an amount
            equal to not less than 25 percent of the amount of the grant.
                (4) Coordination.--The Secretary shall ensure that
            activities funded through a grant under this subsection are
            coordinated, to the maximum extent practicable, with other
            birth defects prevention and environmental health activities of
            the Federal Government, including with respect to pediatric
            environmental health specialty units and children's
            environmental health centers.
        (e) Evaluation.--The Secretary shall provide for an evaluation of
    pregnancy and breastfeeding information services carried out by States
    to identify efficient and effective models of--
                (1) providing information;
                (2) raising awareness and increasing knowledge about birth
            defects prevention measures and targeting education to at-risk
            groups;
                (3) modifying risk behaviors; or
                (4) other outcome measures as determined appropriate by the
            Secretary.
        (f) Authorization of Appropriations.--To carry out this section,
    there are authorized to be appropriated--
                (1) $5,000,000 for fiscal year 2023;
                (2) $6,000,000 for fiscal year 2024;
                (3) $7,000,000 for fiscal year 2025;
                (4) $8,000,000 for fiscal year 2026; and
                (5) $9,000,000 for fiscal year 2027.

                       Subtitle C--Pregnancy-Related Care

    SEC. 5201. MOTHERS AND OFFSPRING MORTALITY AND MORBIDITY AWARENESS.

        (a) 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 and factors relating
            to such mortality (including oral and mental health), intimate
            partner violence, 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 paragraph, there is authorized to
                    be appropriated $5,000,000 for each of fiscal years
                    2023 through 2027.
                (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, acting through the Associate
                    Administrator of the Maternal and Child Health Bureau
                    of the Health Resources and Services Administration
                    (referred to in this paragraph as the ``Secretary''),
                    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 subparagraph (A), 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 subparagraph (A) shall use such grant
                    funds--
                                (i) to develop and implement, through a
                            robust, multi-stakeholder process, maternal
                            safety bundles to assist States, perinatal
                            quality collaboratives, 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
                            clause (i), that such maternal safety bundles--
                                        (I) satisfy the quality improvement
                                    needs of a State, perinatal quality
                                    collaborative, 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 which may
                                    include--
                                                (aa) information on
                                            evidence-based practices to
                                            improve the quality and safety
                                            of maternal health care in
                                            hospitals and other health care
                                            settings of a State or health
                                            care system, including by
                                            addressing topics commonly
                                            associated with health
                                            complications or risks related
                                            to prenatal care, labor care,
                                            birthing, and postpartum care;
                                                (bb) best practices for
                                            improving maternal health care
                                            based on data findings and
                                            reviews conducted by a State
                                            maternal mortality review
                                            committee that address topics
                                            of relevance to common
                                            complications or health risks
                                            related to prenatal care, labor
                                            care, birthing, and postpartum
                                            care;
                                                (cc) information on
                                            addressing determinants of
                                            health that impact maternal
                                            health outcomes for people
                                            before, during, and after
                                            pregnancy;
                                                (dd) obstetric hemorrhage;
                                                (ee) obstetric and
                                            postpartum care for people with
                                            substance use disorders,
                                            including opioid use disorder;
                                                (ff) maternal
                                            cardiovascular system;
                                                (gg) maternal mental
                                            health;
                                                (hh) postpartum care basics
                                            for maternal safety;
                                                (ii) reduction of
                                            peripartum racial and ethnic
                                            inequities;
                                                (jj) reduction of primary
                                            caesarean birth;
                                                (kk) severe hypertension in
                                            pregnancy;
                                                (ll) severe maternal
                                            morbidity reviews;
                                                (mm) support after a severe
                                            maternal morbidity event;
                                                (nn) thromboembolism;
                                                (oo) optimization of
                                            support for breastfeeding;
                                                (pp) maternal oral health;
                                            and
                                                (qq) intimate partner
                                            violence; and
                                (iii) to provide ongoing technical
                            assistance at the national and State levels to
                            support implementation of maternal safety
                            bundles under clause (i).
                        (D) Maternal safety bundle defined.--For purposes
                    of this paragraph, the term ``maternal safety bundle''
                    means standardized, evidence-informed processes for
                    maternal health care.
                        (E) Authorization of appropriations.--For purposes
                    of carrying out this paragraph, there is authorized to
                    be appropriated $10,000,000 for each of fiscal years
                    2023 through 2027.
                (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 paragraph 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 people and their
                    infants.
                        (B) Grant amounts.--Grants awarded under this
                    paragraph 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 paragraph, the term
                    ``State-based perinatal quality collaborative'' means a
                    network of teams that--
                                (i) is multidisciplinary in nature and
                            includes the full range of perinatal and
                            maternity care providers;
                                (ii) works to improve measurable outcomes
                            for maternal and infant health by advancing
                            evidence-informed clinical practices using
                            quality improvement principles;
                                (iii) works 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;
                                (iv) employs 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;
                                (v) has the goal of improving population-
                            level outcomes in maternal and infant health;
                            and
                                (vi) has the goal of improving outcomes of
                            all birthing people, through the coordination,
                            integration, and collaboration across birth
                            settings.
                        (D) Authorization of appropriations.--For purposes
                    of carrying out this paragraph, there is authorized to
                    be appropriated $14,000,000 per year for each of fiscal
                    years 2023 through 2027.
                (5) Expansion of medicaid and chip coverage for pregnant
            and postpartum people.--
                        (A) Requiring coverage of oral health services for
                    pregnant and postpartum people.--
                                (i) Medicaid.--Section 1905 of the Social
                            Security Act (42 U.S.C. 1396d) is amended--
                                        (I) in subsection (a)(4)--
                                                (aa) by redesignating
                                            subparagraphs (E) and (F) as
                                            subparagraphs (F) and (G),
                                            respectively;
                                                (bb) by striking ``; and
                                            (F)'' and inserting ``; (F)'';
                                                (cc) by inserting ``; and
                                            (G) oral health services for
                                            pregnant and postpartum people
                                            (as defined in subsection
                                            (ii))'' before the semicolon at
                                            the end; and
                                        (II) by adding at the end the
                                    following new subsection:
        ``(jj) Oral Health Services for Pregnant and Postpartum People.--
                ``(1) In general.--For purposes of this title, the term
            `oral health services for pregnant and postpartum people' 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 person
            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
            people, a State shall 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)(6)(A) of the
                            Social Security Act (42 U.S.C. 1397cc(c)(6)(A))
                            is amended by inserting ``or a targeted low-
                            income pregnant person'' after ``targeted low-
                            income child''.
                        (B) Extending medicaid coverage for pregnant and
                    postpartum people.--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 people (as defined
                                            in section 1905(jj)))'' 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)(i) of the Social
                    Security Act (42 U.S.C. 1396b(v)(4)(A)(i)) is amended
                    by striking ``60-day'' and inserting ``1-year''.
                        (D) Extending chip coverage for pregnant and
                    postpartum people.--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 people 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 people.--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 people on the basis of being
            pregnant (including pregnancy-related assistance provided to
            targeted low-income pregnant people (as defined in section
            2112(d)), pregnancy-related assistance provided to people 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 people on the basis of being
            pregnant) shall not have in effect, with respect to such
            people, 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 people 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 people under
                            such programs;
                                (ii) optional benefits that States may
                            provide to pregnant and postpartum people under
                            such programs; and
                                (iii) the availability of different kinds
                            of benefits for pregnant and postpartum people,
                            including oral health and mental health
                            benefits, under such programs.
                        (G) Federal funding for cost of extended medicaid
                    and chip coverage for postpartum people.--
                                (i) Medicaid.--Section 1905 of the Social
                            Security Act (42 U.S.C. 1396d), as amended by
                            subparagraph (A), is further amended--
                                        (I) in subsection (b), by striking
                                    ``and (ii)'' and inserting ``(ii), and
                                    (kk)''; and
                                        (II) by adding at the end the
                                    following:
        ``(kk) Increased FMAP for Extended Medical Assistance for
    Postpartum People.--Notwithstanding subsection (b), the Federal medical
    assistance percentage for a State, with respect to amounts expended by
    such State for medical assistance for a person who is eligible for such
    assistance on the basis of being pregnant or having been pregnant that
    is provided during the period that begins on the 60th day after the
    last day of their 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:
                ``(13) Enhanced payment for extended assistance provided to
            pregnant people.--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 person who is eligible for such assistance on the basis of
            being pregnant (including pregnancy-related assistance provided
            to a targeted low-income pregnant person (as defined in section
            2112(d)), pregnancy-related assistance provided to a person 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 person 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) Guidance on state options for medicaid coverage
                    of doula services.--Not later than 1 year after the
                    date of the enactment of this Act, the Secretary of
                    Health and Human Services, acting through the
                    Administrator of the Centers for Medicare & Medicaid
                    Services, shall issue guidance for the States
                    concerning options for Medicaid coverage and payment
                    for support services provided by doulas.
                        (I) Effective date.--
                                (i) In general.--Subject to clause (ii),
                            the amendments made by this paragraph 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 paragraph,
                            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 (42 U.S.C. 280g et seq.), as
            amended by section 5101, is further amended by adding at the
            end the following new section:

    ``SEC. 399V-9. 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, cultural competency,
    and respectful care practices 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, school of
            nursing, 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;
                ``(3) demonstrate engagement with groups engaged in the
            implementation of health care professional training in implicit
            bias and delivering culturally competent care, such as
            departments of public health, perinatal quality collaboratives,
            hospital systems, and health care professional groups, in order
            to obtain input on resources needed for effective
            implementation strategies; and
                ``(4) 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 person 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 2023 through 2027.''.
                (7) Special supplemental nutrition program for people,
            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) Pregnant and postpartum people.--
                                        ``(I) Breastfeeding people.--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 people.--A State
                                    may elect to certify a postpartum
                                    person for a period of 2 years.''.
                (8) Definitions.--In this subsection:
                        (A) Maternal mortality.--The term ``maternal
                    mortality'' means death of a person that occurs during
                    pregnancy or within the one-year period following the
                    end of such pregnancy.
                        (B) Pregnancy related death.--The term ``pregnancy
                    related death'' includes the death of a person during
                    pregnancy or within one year of the end of pregnancy
                    from a pregnancy complication, a chain of events
                    initiated by pregnancy, or the aggravation of an
                    unrelated condition by the physiologic effects of
                    pregnancy.
                        (C) 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 person's health.
        (b) Increase in Tax on Certain Tobacco Products and Imposition of
    Tax on Nicotine.--
                (1) Increasing tax on cigarettes.--
                        (A) Small cigarettes.--Section 5701(b)(1) of the
                    Internal Revenue Code of 1986 is amended by striking
                    ``$50.33'' and inserting ``$100.66''.
                        (B) Large cigarettes.--Section 5701(b)(2) of the
                    Internal Revenue Code of 1986 is amended by striking
                    ``$105.69'' and inserting ``$211.39''.
                (2) Tax parity for small cigars.--Section 5701(a)(1) of the
            Internal Revenue Code of 1986 is amended by striking ``$50.33''
            and inserting ``$100.66''.
                (3) Tax parity for large cigars.--Section 5701(a)(2) of the
            Internal Revenue Code of 1986 is amended by striking ``52.75
            percent'' and all that follows through the period and inserting
            ``$49.56 per pound and a proportionate tax at the like rate on
            all fractional parts of a pound but not less than 10.06 cents
            per cigar.''.
                (4) 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 ``$10.70''; and
                                (iii) by adding at the end the following
                            new paragraph:
                ``(3)  Smokeless tobacco sold in discrete single-use
            units.--On discrete single-use units, $100 per thousand.''.
                        (B) Section 5702(m) of the Internal Revenue Code of
                    1986 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 ``and that is not a discrete single-
                            use unit'' before the period at the end of each
                            such paragraph; and
                                (iii) by adding at the end the following
                            new paragraph:
                ``(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.''.
                (5) 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''.
                (6) 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''.
                (7) Tax parity for roll-your-own tobacco and certain
            processed tobacco.--Section 5702(o) 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''.
                (8) Imposition of tax on nicotine for use in vaping, etc.--
                        (A) In general.--Section 5701 of the Internal
                    Revenue Code of 1986 is amended by redesignating
                    subsection (h) as subsection (i) and by inserting after
                    subsection (g) the following new subsection:
        ``(h) Nicotine.--On taxable nicotine, manufactured in or imported
    into the United States, there shall be imposed a tax equal to the
    dollar amount specified in section 5701(b)(1) per 1,810 milligrams of
    nicotine (and a proportionate tax at the like rate on any fractional
    part thereof).''.
                        (B) Taxable nicotine.--Section 5702 of the Internal
                    Revenue Code of 1986 is amended by adding at the end
                    the following new subsection:
        ``(q) Taxable Nicotine.--
                ``(1) In general.--Except as otherwise provided in this
            subsection, the term `taxable nicotine' means any nicotine
            which has been extracted, concentrated, or synthesized.
                ``(2) Exception for products approved by food and drug
            administration.--Such term shall not include any nicotine if
            the manufacturer or importer thereof demonstrates to the
            satisfaction of the Secretary of Health and Human Services that
            such nicotine will be used in--
                        ``(A) a drug--
                                ``(i) that is approved under section 505 of
                            the Federal Food, Drug, and Cosmetic Act or
                            licensed under section 351 of the Public Health
                            Service Act; or
                                ``(ii) for which an investigational use
                            exemption has been authorized under section
                            505(i) of the Federal Food, Drug, and Cosmetic
                            Act or under section 351(a) of the Public
                            Health Service Act; or
                        ``(B) a combination product (as described in
                    section 503(g) of the Federal Food, Drug, and Cosmetic
                    Act), the constituent parts of which were approved or
                    cleared under section 505, 510(k), or 515 of such Act.
                ``(3) Coordination with taxation of other tobacco
            products.--Tobacco products meeting the definition of cigars,
            cigarettes, smokeless tobacco, pipe tobacco, and roll-your-own
            tobacco in this section shall be classified and taxed as such
            despite any concentration of the nicotine inherent in those
            products or any addition of nicotine to those products during
            the manufacturing process.
                ``(4) Regulations.--The Secretary shall prescribe such
            regulations or other guidance as is necessary or appropriate to
            carry out the purposes of this subsection, including
            regulations or other guidance for coordinating the taxation of
            tobacco products and taxable nicotine to protect revenue and
            prevent double taxation.''.
                        (C) Taxable nicotine treated as a tobacco
                    product.--Section 5702(c) of the Internal Revenue Code
                    of 1986 is amended by striking ``and roll-your-own
                    tobacco'' and inserting ``roll-your-own tobacco, and
                    taxable nicotine''.
                        (D) Manufacturer of taxable nicotine.--Section 5702
                    of the Internal Revenue Code of 1986, as amended by
                    subparagraph (B), is amended by adding at the end the
                    following new subsection:
        ``(r) Manufacturer of Taxable Nicotine.--
                ``(1) In general.--Any person who extracts, concentrates,
            or synthesizes nicotine shall be treated as a manufacturer of
            taxable nicotine (and as manufacturing such taxable nicotine).
                ``(2) Application of rules related to manufacturers of
            tobacco products.--Any reference to a manufacturer of tobacco
            products, or to manufacturing tobacco products, shall be
            treated as including a reference to a manufacturer of taxable
            nicotine, or to manufacturing taxable nicotine,
            respectively.''.
                (9) Repeal of special rules for determining price of
            cigars.--Section 5702 of the Internal Revenue Code of 1986 is
            amended by striking subsection (l).
                (10) Floor stocks taxes.--
                        (A) Imposition of tax.--On covered tobacco
                    products, and cigarette papers and tubes, manufactured
                    in or imported into the United States which are removed
                    before the 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) Covered tobacco products.--For purposes of this
                    paragraph, the term ``covered tobacco products'' means
                    any tobacco product other than--
                                (i) cigars described in section 5701(a)(2)
                            of the Internal Revenue Code of 1986;
                                (ii) discrete single-use units (as defined
                            in section 5702(m)(4) of such Code, as amended
                            by this subsection); and
                                (iii) taxable nicotine (as defined in
                            section 5702(q) of such Code, as amended by
                            this subsection).
                        (C) Credit against tax.--Each person shall be
                    allowed as a credit against the taxes imposed by
                    subparagraph (A) an amount equal to the lesser of
                    $1,000 or the amount of such taxes. For purposes of the
                    preceding sentence, all persons treated as a single
                    employer under subsection (b), (c), (m), or (o) of
                    section 414 of the Internal Revenue Code of 1986 shall
                    be treated as 1 person for purposes of this
                    subparagraph.
                        (D) Liability for tax and method of payment.--
                                (i) Liability for tax.--The person referred
                            to in subparagraph (A) shall be liable for the
                            tax imposed by such subparagraph.
                                (ii) Method of payment.--The tax imposed by
                            subparagraph (A) shall be paid in such manner
                            as the Secretary may provide.
                        (E) Articles in foreign trade zones.--
                                (i) In general.--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
                            covered tobacco products, or cigarette papers
                            and tubes, which are located in a foreign trade
                            zone on the tax increase date, shall be subject
                            to the tax imposed by subparagraph (A) 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).
                        (F) Tax increase date.--For purposes of this
                    paragraph, the term ``tax increase date'' means the
                    first day of the first calendar quarter described in
                    paragraph (11)(A).
                        (G) Certain other definitions.--Terms used in this
                    paragraph which are also used in section 5702 of the
                    Internal Revenue Code of 1986 shall have the same
                    meaning as when used in such section.
                (11) Effective date.--
                        (A) In general.--Except as otherwise provided in
                    this paragraph, the amendments made by this subsection
                    shall apply to articles removed in calendar quarters
                    beginning after the date of the enactment of this Act.
                        (B) Delayed effective date for certain products.--
                    The amendments made by paragraphs (3), (4)(A)(iii),
                    (4)(B), and (8) shall apply to articles removed in
                    calendar quarters beginning after the date which is 180
                    days after the date of the enactment of this Act.
                (12) Transition rule for permit and bond requirements.--A
            person which is lawfully engaged in business as a manufacturer
            or importer of taxable nicotine (within the meaning of
            subchapter A of chapter 52 of the Internal Revenue Code of
            1986, as amended by this subsection) on the date of the
            enactment of this Act, first becomes subject to the
            requirements of subchapter B of chapter 52 of such Code by
            reason of the amendments made by this subsection, and submits
            an application under such subchapter B to engage in such
            business not later than 90 days after the date of the enactment
            of this Act, shall not be denied the right to carry on such
            business by reason of such requirements before final action on
            such application.

    SEC. 5202. MOMMIES.

        (a) GAO Study and Report.--
                (1) In general.--Not later than 1 year after the date of
            the enactment of this Act, the Comptroller General of the
            United States shall submit to Congress a report on the gaps in
            coverage with respect to--
                        (A) pregnant individuals enrolled under a State
                    plan (or waiver of such plan) under title XIX of the
                    Social Security Act (42 U.S.C. 1396 et seq.) and the
                    Children's Health Insurance Program under title XXI of
                    the Social Security Act (42 U.S.C. 1397aa et seq.); and
                        (B) postpartum individuals enrolled under a State
                    plan (or waiver of such plan) under title XIX of the
                    Social Security Act (42 U.S.C. 1396 et seq.) and the
                    Children's Health Insurance Program under title XXI of
                    the Social Security Act (42 U.S.C. 1397aa et seq.) who
                    received assistance under either such program during
                    their pregnancy.
                (2) Content of report.--The report required under this
            paragraph shall include the following:
                        (A) Information about the abilities and successes
                    of State Medicaid agencies in determining whether
                    pregnant and postpartum individuals are eligible under
                    another insurance affordability program, and in
                    transitioning any such individuals who are so eligible
                    to coverage under such a program at the end of their
                    period of eligibility for medical assistance, pursuant
                    to section 435.1200 of the title 42, Code of Federal
                    Regulations (as in effect on September 1, 2018).
                        (B) Information on factors contributing to gaps in
                    coverage that disproportionately impact underserved
                    populations, including low-income individuals, Black,
                    Indigenous, and other individuals of color, individuals
                    who reside in a health professional shortage area (as
                    defined in section 332(a)(1)(A) of the Public Health
                    Service Act (42 U.S.C. 254e(a)(1)(A))) or individuals
                    who are members of a medically underserved population
                    (as defined by section 330(b)(3) of such Act (42 U.S.C.
                    254b(b)(3)(A))).
                        (C) Recommendations for addressing and reducing
                    such gaps in coverage.
                        (D) Such other information as the Comptroller
                    General deems necessary.
                (3) Data disaggregation.--To the greatest extent possible,
            the Comptroller General shall disaggregate data presented in
            the report, including by age, gender identity, race, ethnicity,
            income level, and other demographic factors.
        (b) Maternity Care Home Demonstration Project.--Title XIX of the
    Social Security Act (42 U.S.C. 1396 et seq.) is amended by inserting
    the following new section after section 1947:

    ``SEC. 1948. MATERNITY CARE HOME DEMONSTRATION PROJECT.

        ``(a) In General.--Not later than 1 year after the date of the
    enactment of this section, the Secretary shall establish a
    demonstration project (in this section referred to as the
    `demonstration project') under which the Secretary shall provide grants
    to States to enter into arrangements with eligible entities to
    implement or expand a maternity care home model for eligible
    individuals.
        ``(b) Goals of Demonstration Project.--The goals of the
    demonstration project are the following:
                ``(1) To improve--
                        ``(A) maternity and infant care outcomes;
                        ``(B) birth equity;
                        ``(C) health equity for--
                                ``(i) Black, Indigenous, and other people
                            of color;
                                ``(ii) lesbian, gay, bisexual, transgender,
                            queer, non-binary, and gender nonconfirming
                            individuals;
                                ``(iii) people with disabilities; and
                                ``(iv) other underserved populations;
                        ``(D) communication by maternity, infant care, and
                    social services providers;
                        ``(E) integration of perinatal support services,
                    including community health workers, doulas, social
                    workers, public health nurses, peer lactation
                    counselors, lactation consultants, childbirth
                    educators, peer mental health workers, and others, into
                    health care entities and organizations;
                        ``(F) care coordination between maternity, infant
                    care, oral health services, and social services
                    providers within the community;
                        ``(G) the quality and safety of maternity and
                    infant care;
                        ``(H) the experience of individuals receiving
                    maternity care, including by increasing the ability of
                    an individual to develop and follow their own birthing
                    plans; and
                        ``(I) access to adequate prenatal and postpartum
                    care, including--
                                ``(i) prenatal care that is initiated in a
                            timely manner;
                                ``(ii) not fewer than 5 post-pregnancy
                            visits to a maternity care provider; and
                                ``(iii) interpregnancy care.
                ``(2) To provide coordinated, evidence-based, respectful,
            culturally and linguistically appropriate, and person-centered
            maternity care management.
                ``(3) To decrease--
                        ``(A) severe and preventable maternal morbidity and
                    maternal mortality;
                        ``(B) overall health care spending;
                        ``(C) unnecessary emergency department visits;
                        ``(D) inequities in maternal and infant care
                    outcomes, including racial, economic, disability,
                    gender-based, and geographical inequities;
                        ``(E) racial, gender, economic, and other
                    discrimination among health care professionals;
                        ``(F) racism, discrimination, disrespect, and abuse
                    in maternity care settings;
                        ``(G) the rate of cesarean deliveries for low-risk
                    pregnancies;
                        ``(H) the rate of pre-term births and infants born
                    with low birth weight; and
                        ``(I) the rate of avoidable maternal and newborn
                    hospitalizations and admissions to intensive care
                    units.
        ``(c) Consultation.--In designing and implementing the
    demonstration project the Secretary shall consult with stakeholders,
    including--
                ``(1) States;
                ``(2) organizations representing relevant health care
            professionals, including oral health services professionals;
                ``(3) organizations, particularly reproductive justice and
            birth justice organizations led by people of color, that
            represent consumers of maternal health care, including
            consumers of maternal health care who are disproportionately
            impacted by poor maternal health outcomes;
                ``(4) representatives with experience implementing other
            maternity care home models, including representatives from the
            Center for Medicare and Medicaid Innovation;
                ``(5) community-based health care professionals, including
            doulas, lactation consultants, and other stakeholders;
                ``(6) experts in promoting health equity and combating
            racial bias in health care settings; and
                ``(7) Black, Indigenous, and other maternal health care
            consumers of color who have experienced severe maternal
            morbidity.
        ``(d) Application and Selection of States.--
                ``(1) In general.--A State seeking to participate in the
            demonstration project shall submit an application to the
            Secretary at such time and in such manner as the Secretary
            shall require.
                ``(2) Selection of states.--
                        ``(A) In general.--The Secretary shall select at
                    least 10 States to participate in the demonstration
                    project.
                        ``(B) Selection requirements.--In selecting States
                    to participate in the demonstration project, the
                    Secretary shall--
                                ``(i) ensure that there is geographic and
                            regional diversity in the areas in which
                            activities will be carried out under the
                            project;
                                ``(ii) ensure that States with significant
                            inequities in maternal and infant health
                            outcomes, including severe maternal morbidity,
                            and other inequities based on race, income, or
                            access to maternity care, are included; and
                                ``(iii) ensure that at least 1 territory is
                            included.
        ``(e) Grants.--
                ``(1) In general.--From amounts appropriated under
            subsection (l), the Secretary shall award 1 grant for each year
            of the demonstration project to each State that is selected to
            participate in the demonstration project.
                ``(2) Use of grant funds.--A State may use funds received
            under this section to--
                        ``(A) award grants or make payments to eligible
                    entities as part of an arrangement described in
                    subsection (f)(2);
                        ``(B) provide financial incentives to health care
                    professionals, including community-based health care
                    workers and community-based doulas, who participate in
                    the State's maternity care home model;
                        ``(C) provide adequate training for health care
                    professionals, including community-based health care
                    workers, doulas, and care coordinators, who participate
                    in the State's maternity care home model, which may
                    include training for cultural humility and antiracism,
                    racial bias, health equity, reproductive and birth
                    justice, trauma-informed care, home visiting skills,
                    and respectful communication and listening skills,
                    particularly in regards to maternal health;
                        ``(D) pay for personnel and administrative expenses
                    associated with designing, implementing, and operating
                    the State's maternity care home model;
                        ``(E) pay for items and services that are furnished
                    under the State's maternity care home model and for
                    which payment is otherwise unavailable under this
                    title;
                        ``(F) pay for services and materials to ensure
                    culturally and linguistically appropriate
                    communication, including--
                                ``(i) language services such as
                            interpreters and translation of written
                            materials; and
                                ``(ii) development of culturally and
                            linguistically appropriate materials; and
                            auxiliary aids and services; and
                        ``(G) pay for other costs related to the State's
                    maternity care home model, as determined by the
                    Secretary.
                ``(3) Grant for national independent evaluator.--
                        ``(A) In general.--From the amounts appropriated
                    under subsection (l), prior to awarding any grants
                    under paragraph (1), the Secretary shall enter into a
                    contract with a national external entity to create a
                    single, uniform process to--
                                ``(i) ensure that States that receive
                            grants under paragraph (1) comply with the
                            requirements of this section; and
                                ``(ii) evaluate the outcomes of the
                            demonstration project in each participating
                            State.
                        ``(B) Annual report.--The contract described in
                    subparagraph (A) shall require the national external
                    entity to submit to the Secretary--
                                ``(i) a yearly evaluation report for each
                            year of the demonstration project; and
                                ``(ii) a final impact report after the
                            demonstration project has concluded.
                        ``(C) Secretary's authority.--Nothing in this
                    paragraph shall prevent the Secretary from making a
                    determination that a State is not in compliance with
                    the requirements of this section without the national
                    external entity making such a determination.
        ``(f) Partnership With Eligible Entities.--
                ``(1) In general.--As a condition of receiving a grant
            under this section, a State shall enter into an arrangement
            with one or more eligible entities that meets the requirements
            of paragraph (2).
                ``(2) Arrangements with eligible entities.--Under an
            arrangement between a State and an eligible entity under this
            subsection, the eligible entity shall perform the following
            functions, with respect to eligible individuals enrolled with
            the entity under the State's maternity care home model--
                        ``(A) provide culturally and linguistically
                    appropriate congruent care, which may include prenatal
                    care, family planning services, medical care, mental
                    and behavioral care, postpartum care, and oral health
                    services to such eligible individuals through a team of
                    health care professionals, which may include
                    obstetrician-gynecologists, maternal-fetal medicine
                    specialists, family physicians, primary care providers,
                    oral health providers, physician assistants, advanced
                    practice registered nurses such as nurse practitioners
                    and certified nurse midwives, certified midwives,
                    certified professional midwives, physical therapists,
                    social workers, traditional and community-based doulas,
                    lactation consultants, childbirth educators, community
                    health workers, peer mental health supporters, and
                    other health care professionals;
                        ``(B) conduct a risk assessment of each such
                    eligible individual to determine if their pregnancy is
                    high or low risk, and establish a tailored pregnancy
                    care plan, which takes into consideration the
                    individual's own preferences and pregnancy care and
                    birthing plans and determines the appropriate support
                    services to reduce the individual's medical, social,
                    and environmental risk factors, for each such eligible
                    individual based on the results of such risk
                    assessment;
                        ``(C) assign each such eligible individual to a
                    culturally and linguistically appropriate care
                    coordinator, which may be a nurse, social worker,
                    traditional or community-based doula, community health
                    worker, midwife, or other health care provider, who is
                    responsible for ensuring that such eligible individual
                    receives the necessary medical care and connections to
                    essential support services;
                        ``(D) provide, or arrange for the provision of,
                    essential support services, such as services that
                    address--
                                ``(i) food access, nutrition, and exercise;
                                ``(ii) smoking cessation;
                                ``(iii) substance use disorder and
                            addiction treatment;
                                ``(iv) anxiety, depression, trauma, and
                            other mental and behavioral health issues;
                                ``(v) breast feeding, chestfeeding, or
                            other infant feeding options supports,
                            initiation, continuation, and duration;
                                ``(vi) stable, affordable, safe, and
                            healthy housing;
                                ``(vii) transportation;
                                ``(viii) intimate partner violence;
                                ``(ix) community and police violence;
                                ``(x) home visiting services;
                                ``(xi) childbirth and newborn care
                            education;
                                ``(xii) oral health education;
                                ``(xiii) continuous labor support;
                                ``(xiv) group prenatal care;
                                ``(xv) family planning and contraceptive
                            care and supplies; and
                                ``(xvi) affordable child care;
                        ``(E) as appropriate, facilitate connections to a
                    usual primary care provider, which may be a
                    reproductive health care provider;
                        ``(F) refer to guidelines and opinions of medical
                    associations when determining whether an elective
                    delivery should be performed on an eligible individual
                    before 39 weeks of gestation;
                        ``(G) provide such eligible individual with
                    evidence-based and culturally and linguistically
                    appropriate education and resources to identify
                    potential warning signs of pregnancy and postpartum
                    complications and when and how to obtain medical
                    attention;
                        ``(H) provide, or arrange for the provision of,
                    culturally and linguistically appropriate pregnancy and
                    postpartum health services, including family planning
                    counseling and services, to eligible individuals;
                        ``(I) track and report postpartum health and birth
                    outcomes of such eligible individuals and their
                    children;
                        ``(J) ensure that care is person-centered,
                    culturally and linguistically appropriate, and patient-
                    led, including by engaging eligible individuals in
                    their own care, including through communication and
                    education; and
                        ``(K) ensure adequate training for appropriately
                    serving the population of individuals eligible for
                    medical assistance under the State plan (or waiver of
                    such plan), including through reproductive justice,
                    birth justice, birth equity, and anti-racist
                    frameworks, home visiting skills, and knowledge of
                    social services.
        ``(g) Term of Demonstration Project.--The Secretary shall conduct
    the demonstration project for a period of 5 years.
        ``(h) Report.--Not later than 18 months after the date of the
    enactment of this section and annually thereafter for each year of the
    demonstration project term, the Secretary shall submit a report to
    Congress on the results of the demonstration project, including--
                ``(1) the results of the final report of the national
            external entity required under subsection (e)(3)(B)(ii); and
                ``(2) recommendations on whether the model studied in the
            demonstration project should be continued or more widely
            adopted, including by private health plans.
        ``(i) Waiver Authority.--To the extent that the Secretary
    determines necessary in order to carry out the demonstration project,
    the Secretary may waive section 1902(a)(1) (relating to statewideness)
    and section 1902(a)(10)(B) (relating to comparability).
        ``(j) Technical Assistance.--The Secretary shall establish a
    process to provide technical assistance to States that are awarded
    grants under this section and to eligible entities and other providers
    participating in a State maternity care home model funded by such a
    grant.
        ``(k) Definitions.--In this section:
                ``(1) Eligible entity.--The term `eligible entity' means an
            entity or organization that provides medically accurate,
            comprehensive maternity services to individuals who are
            eligible for medical assistance under a State plan under this
            title or a waiver of such a plan, and may include:
                        ``(A) A freestanding birth center.
                        ``(B) An entity or organization receiving
                    assistance under section 330 of the Public Health
                    Service Act.
                        ``(C) A federally qualified health center.
                        ``(D) A rural health clinic.
                        ``(E) A health facility operated by an Indian tribe
                    or tribal organization (as those terms are defined in
                    section 4 of the Indian Health Care Improvement Act).
                ``(2) Eligible individual.--The term `eligible individual'
            means a pregnant individual or a formerly pregnant individual
            during the 1-year period beginning on the last day of the
            pregnancy, or such longer period beginning on such day as a
            State may elect, who is--
                        ``(A) enrolled in a State plan under this title, a
                    waiver of such a plan, or a State child health plan
                    under title XXI; and
                        ``(B) a patient of an eligible entity which has
                    entered into an arrangement with a State under
                    subsection (g).
        ``(l) Authorization of Appropriations.--There are authorized to be
    appropriated to the Secretary, for each of fiscal years 2023 through
    2030, such sums as may be necessary to carry out this section.''.
        (c) Reapplication of Medicare Payment Rate Floor to Primary Care
    Services Furnished Under Medicaid and Inclusion of Additional
    Providers.--
                (1) Reapplication of payment floor; additional providers.--
                        (A) In general.--Section 1902(a)(13) of the Social
                    Security Act (42 U.S.C. 1396a(a)(13)) is amended--
                                (i) in subparagraph (B), by striking ``;
                            and'' and inserting a semicolon;
                                (ii) in subparagraph (C), by striking the
                            semicolon and inserting ``; and''; and
                                (iii) by adding at the end the following
                            new subparagraph:
                        ``(D) payment for primary care services (as defined
                    in subsection (jj)(1)) furnished in the period that
                    begins on the first day of the first month that begins
                    after the date of enactment of this subparagraph by a
                    provider described in subsection (jj)(2)--
                                ``(i) at a rate that is not less than 100
                            percent of the payment rate that applies to
                            such services and the provider of such services
                            under part B of title XVIII (or, if greater,
                            the payment rate that would be applicable under
                            such part if the conversion factor under
                            section 1848(d) for the year were the
                            conversion factor under such section for 2009);
                                ``(ii) in the case of items and services
                            that are not items and services provided under
                            such part, at a rate to be established by the
                            Secretary; and
                                ``(iii) in the case of items and services
                            that are furnished in rural areas (as defined
                            in section 1886(d)(2)(D)), health professional
                            shortage areas (as defined in section
                            332(a)(1)(A) of the Public Health Service Act
                            (42 U.S.C. 254e(a)(1)(A))), or medically
                            underserved areas (according to a designation
                            under section 330(b)(3)(A) of the Public Health
                            Service Act (42 U.S.C. 254b(b)(3)(A))), at the
                            rate otherwise applicable to such items or
                            services under clause (i) or (ii) increased, at
                            the Secretary's discretion, by not more than 25
                            percent;''.
                        (B) Conforming amendments.--
                                (i) Section 1902(a)(13)(C) of the Social
                            Security Act (42 U.S.C. 1396a(a)(13)(C)) is
                            amended by striking ``subsection (jj)'' and
                            inserting ``subsection (jj)(1)''.
                                (ii) Section 1905(dd) of the Social
                            Security Act (42 U.S.C. 1396d(dd)) is amended--
                                        (I) by striking ``Notwithstanding''
                                    and inserting the following:
                ``(1) In general.--Notwithstanding'';
                                        (II) by striking ``section
                                    1902(a)(13)(C)'' and inserting
                                    ``subparagraph (C) of section
                                    1902(a)(13)'';
                                        (III) by inserting ``or for
                                    services described in subparagraph (D)
                                    of section 1902(a)(13) furnished during
                                    an additional period specified in
                                    paragraph (2),'' after ``2015,'';
                                        (IV) by striking ``under such
                                    section'' and inserting ``under
                                    subparagraph (C) or (D) of section
                                    1902(a)(13), as applicable''; and
                                        (V) by adding at the end the
                                    following:
                ``(2) Additional periods.--For purposes of paragraph (1),
            the following are additional periods:
                        ``(A) The period that begins on the first day of
                    the first month that begins after the date of enactment
                    of this paragraph.''.
                (2) Improved targeting of primary care.--Section 1902(jj)
            of the Social Security Act (42 U.S.C. 1396a(jj)) is amended--
                        (A) by redesignating paragraphs (1) and (2) as
                    clauses (i) and (ii), respectively, and realigning the
                    left margins accordingly;
                        (B) by striking ``For purposes of subsection
                    (a)(13)(C)'' and inserting the following:
                ``(1) In general.--
                        ``(A) Definition.--For purposes of subparagraphs
                    (C) and (D) of subsection (a)(13)''; and
                        (C) by inserting after clause (ii) (as so
                    redesignated) the following:
                        ``(B) Exclusions.--Such term does not include any
                    services described in subparagraph (A) or (B) of
                    paragraph (1) if such services are provided in an
                    emergency department of a hospital.
                ``(2) Additional providers.--For purposes of subparagraph
            (D) of subsection (a)(13), a provider described in this
            paragraph is any of the following:
                        ``(A) A physician with a primary specialty
                    designation of family medicine, general internal
                    medicine, or pediatric medicine, or obstetrics and
                    gynecology.
                        ``(B) An advanced practice clinician, as defined by
                    the Secretary, that works under the supervision of--
                                ``(i) a physician that satisfies the
                            criteria specified in subparagraph (A);
                                ``(ii) a nurse practitioner or a physician
                            assistant (as such terms are defined in section
                            1861(aa)(5)(A)) who is working in accordance
                            with State law; or
                                ``(iii) or a certified nurse-midwife (as
                            defined in section 1861(gg)) or a certified
                            professional midwife who is working in
                            accordance with State law.
                        ``(C) A rural health clinic, federally qualified
                    health center, health center that receives funding
                    under title X of the Public Health Service Act, or
                    other health clinic that receives reimbursement on a
                    fee schedule applicable to a physician.
                        ``(D) An advanced practice clinician supervised by
                    a physician described in subparagraph (A), another
                    advanced practice clinician, or a certified nurse-
                    midwife.
                        ``(E) A midwife who is working in accordance with
                    State law.''.
                (3) Ensuring payment by managed care entities.--
                        (A) In general.--Section 1903(m)(2)(A) of the
                    Social Security Act (42 U.S.C. 1396b(m)(2)(A)) is
                    amended--
                                (i) in clause (xii), by striking ``and''
                            after the semicolon;
                                (ii) by realigning the left margin of
                            clause (xiii) so as to align with the left
                            margin of clause (xii) and by striking the
                            period at the end of clause (xiii) and
                            inserting ``; and''; and
                                (iii) by inserting after clause (xiii) the
                            following:
                ``(xiv) such contract provides that (I) payments to
            providers specified in section 1902(a)(13)(D) for primary care
            services (as defined in section 1902(jj)) that are furnished
            during a year or period (as specified in section 1902(a)(13)(D)
            and section 1905(dd)) are at least equal to the amounts set
            forth and required by the Secretary by regulation; (II) the
            entity shall, upon request, provide documentation to the State,
            sufficient to enable the State and the Secretary to ensure
            compliance with subclause (I); and (III) the Secretary shall
            approve payments described in subclause (I) that are furnished
            through an agreed upon capitation, partial capitation, or other
            value-based payment arrangement if the capitation, partial
            capitation, or other value-based payment arrangement is based
            on a reasonable methodology and the entity provides
            documentation to the State sufficient to enable the State and
            the Secretary to ensure compliance with subclause (I).''.
                        (B) Conforming amendment.--Section 1932(f) of the
                    Social Security Act (42 U.S.C. 1396u-2(f)) is amended--
                                (i) by striking ``section 1902(a)(13)(C)''
                            and inserting ``subsections (C) and (D) of
                            section 1902(a)(13)''; and
                                (ii) by inserting ``, and clause (xiv) of
                            section 1903(m)(2)(A)'' before the period.
        (d) MACPAC Report and CMS Guidance on Increasing Access to Doula
    Services for Medicaid Beneficiaries.--
                (1) MACPAC report.--
                        (A) In general.--Not later than 1 year after the
                    date of the enactment of this Act, the Medicaid and
                    CHIP Payment and Access Commission (referred to in this
                    subsection as ``MACPAC'') shall publish a report on the
                    coverage of doula services under State Medicaid
                    programs, which shall at a minimum include the
                    following:
                                (i) Information about coverage for doula
                            services under State Medicaid programs that
                            currently provide coverage for such care,
                            including the type of doula services offered
                            (such as prenatal, labor and delivery,
                            postpartum support, and also community-based
                            and traditional doula services).
                                (ii) An analysis of barriers to covering
                            doula services under State Medicaid programs.
                                (iii) An identification of effective
                            strategies to increase the use of doula
                            services in order to provide better care and
                            achieve better maternal and infant health
                            outcomes, including strategies that States may
                            use to recruit, train, and certify a diverse
                            doula workforce, particularly from underserved
                            communities, communities of color, and
                            communities facing linguistic or cultural
                            barriers.
                                (iv) Recommendations for legislative and
                            administrative actions to increase access to
                            doula services in State Medicaid programs,
                            including actions that ensure doulas may earn a
                            living wage that accounts for their time and
                            costs associated with providing care and
                            community-based doula program administration
                            and operation.
                        (B) Stakeholder consultation.--In developing the
                    report required under subparagraph (A), MACPAC shall
                    consult with relevant stakeholders, including--
                                (i) States;
                                (ii) organizations, especially reproductive
                            justice and birth justice organizations led by
                            people of color, representing consumers of
                            maternal health care, including those that are
                            disproportionately impacted by poor maternal
                            health outcomes;
                                (iii) organizations and individuals
                            representing doulas, including community-based
                            doula programs and those who serve underserved
                            communities, including communities of color,
                            and communities facing linguistic or cultural
                            barriers;
                                (iv) organizations representing health care
                            providers; and
                                (v) Black, Indigenous, and other maternal
                            health care consumers of color who have
                            experienced severe maternal morbidity.
                (2) CMS guidance.--
                        (A) In general.--Not later than 1 year after the
                    date that MACPAC publishes the report required under
                    paragraph (1)(A), the Administrator of the Centers for
                    Medicare & Medicaid Services shall issue guidance to
                    States on increasing access to doula services under
                    Medicaid. Such guidance shall at a minimum include--
                                (i) options for States to provide medical
                            assistance for doula services under State
                            Medicaid programs;
                                (ii) best practices for ensuring that
                            doulas, including community-based doulas,
                            receive reimbursement for doula services
                            provided under a State Medicaid program, at a
                            level that allows doulas to earn a living wage
                            that accounts for their time and costs
                            associated with providing care and community-
                            based doula program administration; and
                                (iii) best practices for increasing access
                            to doula services, including services provided
                            by community-based doulas, under State Medicaid
                            programs.
                        (B) Stakeholder consultation.--In developing the
                    guidance required under subparagraph (A), the
                    Administrator of the Centers for Medicare & Medicaid
                    Services shall consult with MACPAC and other relevant
                    stakeholders, including--
                                (i) State Medicaid officials;
                                (ii) organizations representing consumers
                            of maternal health care, including those that
                            are disproportionately impacted by poor
                            maternal health outcomes;
                                (iii) organizations representing doulas,
                            including community-based doulas and those who
                            serve underserved communities, such as
                            communities of color and communities facing
                            linguistic or cultural barriers; and
                                (iv) organizations representing medical
                            professionals.
        (e) GAO Report on State Medicaid Programs' Use of Telehealth To
    Increase Access to Maternity Care.--Not later than 1 year after the
    date of the enactment of this Act, the Comptroller General of the
    United States shall submit a report to Congress on State Medicaid
    programs' use of telehealth to increase access to maternity care. Such
    report shall include the following:
                (1) The number of State Medicaid programs that utilize
            telehealth that increases access to maternity care.
                (2) With respect to State Medicaid programs that utilize
            telehealth that increases access to maternity care, information
            about--
                        (A) common characteristics of such programs'
                    approaches to utilizing telehealth that increases
                    access to maternity care;
                        (B) differences in States' approaches to utilizing
                    telehealth to improve access to maternity care, and the
                    resulting differences in State maternal health
                    outcomes, as determined by factors described in
                    subsection (C); and
                        (C) when compared to patients who receive maternity
                    care in-person, what is known about--
                                (i) the demographic characteristics, such
                            as race, ethnicity, sex, sexual orientation,
                            gender identity, disability status, age, and
                            preferred language of the individuals enrolled
                            in such programs who use telehealth to access
                            maternity care;
                                (ii) health outcomes for such individuals,
                            including frequency of mortality and severe
                            morbidity, as compared to individuals with
                            similar characteristics who did not use
                            telehealth to access maternity care;
                                (iii) the services provided to individuals
                            through telehealth, including family planning
                            services, mental health care services, and oral
                            health services;
                                (iv) the devices and equipment provided to
                            individuals for remote patient monitoring and
                            telehealth, including blood pressure monitors
                            and blood glucose monitors;
                                (v) the quality of maternity care provided
                            through telehealth, including whether maternity
                            care provided through telehealth is culturally
                            and linguistically appropriate;
                                (vi) the level of patient satisfaction with
                            maternity care provided through telehealth to
                            individuals enrolled in State Medicaid
                            programs;
                                (vii) the impact of utilizing telehealth to
                            increase access to maternity care on spending,
                            cost savings, access to care, and utilization
                            of care under State Medicaid programs; and
                                (viii) the accessibility and effectiveness
                            of telehealth for maternity care during the
                            COVID-19 pandemic.
                (3) An identification and analysis of the barriers to using
            telehealth to increase access to maternity care under State
            Medicaid programs.
                (4) Recommendations for such legislative and administrative
            actions related to increasing access to telehealth maternity
            services under Medicaid as the Comptroller General deems
            appropriate.

    SEC. 5203. JUSTICE FOR INCARCERATED MOMS.

        (a) Sense of Congress.--It is the sense of Congress that--
                (1) the respect and proper care that birthing people
            deserve is inclusive; and
                (2) regardless of race, ethnicity, gender identity, sexual
            orientation, religion, marital status, familial status,
            socioeconomic status, immigration status, incarceration status,
            or disability, all deserve dignity.
        (b) Ending the Shackling of Pregnant Individuals.--
                (1) In general.--Beginning on the date that is 6 months
            after the date of enactment of this Act, and annually
            thereafter, in each State that receives a grant under subpart 1
            of part E of title I of the Omnibus Crime Control and Safe
            Streets Act of 1968 (34 U.S.C. 10151 et seq.) (commonly
            referred to as the ``Edward Byrne Memorial Justice Grant
            Program'') and that does not have in effect throughout the
            State for such fiscal year laws restricting the use of
            restraints on pregnant individuals in prison that are
            substantially similar to the rights, procedures, requirements,
            effects, and penalties set forth in section 4322 of title 18,
            United States Code, the amount of such grant that would
            otherwise be allocated to such State under such subpart for the
            fiscal year shall be decreased by 25 percent.
                (2) Reallocation.--Amounts not allocated to a State for
            failure to comply with paragraph (1) shall be reallocated in
            accordance with subpart 1 of part E of title I of the Omnibus
            Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10151 et
            seq.) to States that have complied with such paragraph.
        (c) Creating Model Programs for the Care of Incarcerated
    Individuals in the Prenatal and Postpartum Periods.--
                (1) In general.--Not later than 1 year after the date of
            enactment of this Act, the Attorney General, acting through the
            Director of the Bureau of Prisons (in this subsection referred
            to as the ``Director''), shall establish, in not fewer than 6
            Bureau of Prisons facilities, programs to optimize maternal
            health outcomes for pregnant and postpartum individuals
            incarcerated in such facilities. The Attorney General shall
            establish such programs in consultation with stakeholders such
            as--
                        (A) relevant community-based organizations,
                    particularly organizations that represent incarcerated
                    and formerly incarcerated individuals and organizations
                    that seek to improve maternal health outcomes for
                    pregnant and postpartum individuals from racial and
                    ethnic minority groups;
                        (B) relevant organizations representing patients,
                    with a particular focus on patients from racial and
                    ethnic minority groups;
                        (C) organizations representing maternity care
                    providers and maternal health care education programs;
                        (D) perinatal health workers; and
                        (E) researchers and policy experts in fields
                    related to maternal health care for incarcerated
                    individuals.
                (2) Start date.--Each selected facility shall begin
            facility programs not later than 18 months after the date of
            enactment of this Act.
                (3) Facility priority.--In carrying out paragraph (1), the
            Director shall give priority to a facility based on--
                        (A) the number of pregnant and postpartum
                    individuals incarcerated in such facility and, among
                    such individuals, the number of pregnant and postpartum
                    individuals from racial and ethnic minority groups; and
                        (B) the extent to which the leaders of such
                    facility have demonstrated a commitment to developing
                    exemplary programs for pregnant and postpartum
                    individuals incarcerated in such facility.
                (4) Program duration.--The programs established under this
            subsection shall be for a 5-year period.
                (5) Programs.--Bureau of Prisons facilities selected by the
            Director shall establish programs for pregnant and postpartum
            incarcerated individuals, and such programs may--
                        (A) provide access to perinatal health workers from
                    pregnancy through the postpartum period;
                        (B) provide access to healthy foods and counseling
                    on nutrition, recommended activity levels, and safety
                    measures throughout pregnancy;
                        (C) train correctional officers to ensure that
                    pregnant incarcerated individuals receive safe and
                    respectful treatment;
                        (D) train medical personnel to ensure that pregnant
                    incarcerated individuals receive trauma-informed,
                    culturally congruent care that promotes the health and
                    safety of the pregnant individuals;
                        (E) provide counseling and treatment for
                    individuals who have suffered from--
                                (i) diagnosed mental or behavioral health
                            conditions, including trauma and substance use
                            disorders;
                                (ii) trauma or violence, including domestic
                            violence;
                                (iii) human immunodeficiency virus;
                                (iv) sexual abuse;
                                (v) pregnancy or infant loss; or
                                (vi) chronic conditions;
                        (F) provide evidence-based pregnancy and childbirth
                    education, parenting support, and other relevant forms
                    of health literacy;
                        (G) provide clinical education opportunities to
                    maternity care providers in training to expand pathways
                    into maternal health care careers serving incarcerated
                    individuals;
                        (H) offer opportunities for postpartum individuals
                    to maintain contact with the individual's newborn child
                    to promote bonding, including enhanced visitation
                    policies, access to prison nursery programs, or
                    breastfeeding support;
                        (I) provide reentry assistance, particularly to--
                                (i) ensure access to health insurance
                            coverage and transfer of health records to
                            community providers if an incarcerated
                            individual exits the criminal justice system
                            during such individual's pregnancy or in the
                            postpartum period; and
                                (ii) connect individuals exiting the
                            criminal justice system during pregnancy or in
                            the postpartum period to community-based
                            resources, such as referrals to health care
                            providers, substance use disorder treatments,
                            and social services that address social
                            determinants of maternal health; or
                        (J) establish partnerships with local public
                    entities, private community entities, community-based
                    organizations, Indian Tribes and tribal organizations
                    (as such terms are defined in section 4 of the Indian
                    Self-Determination and Education Assistance Act (25
                    U.S.C. 5304)), and urban Indian organizations (as such
                    term is defined in section 4 of the Indian Health Care
                    Improvement Act (25 U.S.C. 1603)) to establish or
                    expand pretrial diversion programs as an alternative to
                    incarceration for pregnant and postpartum individuals,
                    including--
                                (i) evidence-based childbirth education or
                            parenting classes;
                                (ii) prenatal health coordination;
                                (iii) family and individual counseling;
                                (iv) evidence-based screenings, education,
                            and, as needed, treatment for mental and
                            behavioral health conditions, including drug
                            and alcohol treatments;
                                (v) family case management services;
                                (vi) domestic violence education and
                            prevention;
                                (vii) physical and sexual abuse counseling;
                            and
                                (viii) programs to address social
                            determinants of health such as employment,
                            housing, education, transportation, and
                            nutrition.
                (6) Implementation and reporting.--A selected facility
            shall be responsible for--
                        (A) implementing programs, which may include the
                    programs described in paragraph (5); and
                        (B) not later than 3 years after the date of
                    enactment of this Act, and 6 years after the date of
                    enactment of this Act, reporting results of the
                    programs to the Director, including information
                    describing--
                                (i) relevant quantitative indicators of
                            success in improving the standard of care and
                            health outcomes for pregnant and postpartum
                            incarcerated individuals in the facility,
                            including data stratified by race, ethnicity,
                            sex, gender, age, geography, disability status,
                            the category of the criminal charge against
                            such individual, rates of pregnancy-related
                            deaths, pregnancy-associated deaths, cases of
                            infant mortality and morbidity, rates of pre-
                            term births and low-birthweight births, cases
                            of severe maternal morbidity, cases of violence
                            against pregnant or postpartum individuals,
                            diagnoses of maternal mental or behavioral
                            health conditions, and other such information
                            as appropriate;
                                (ii) relevant qualitative and quantitative
                            evaluations from pregnant and postpartum
                            incarcerated individuals who participated in
                            such programs, including measures of patient-
                            reported experience of care; and
                                (iii) strategies to sustain such programs
                            after fiscal year 2027 and expand such programs
                            to other facilities.
                (7) Report.--Not later than 6 years after the date of
            enactment of this Act, the Director shall submit to the
            Attorney General and to the Congress a report describing the
            results of the programs funded under this subsection.
                (8) Oversight.--Not later than 1 year after the date of
            enactment of this Act, the Attorney General shall award a
            contract to an independent organization or independent
            organizations to conduct oversight of the programs described in
            paragraph (5).
                (9) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this subsection $10,000,000 for
            each of fiscal years 2023 through 2027.
        (d) Grant Program To Improve Maternal Health Outcomes for
    Individuals in State and Local Prisons and Jails.--
                (1) Establishment.--Not later than 1 year after the date of
            enactment of this section, the Attorney General, acting through
            the Director of the Bureau of Justice Assistance (in this
            subsection referred to as the ``Director''), shall award
            Justice for Incarcerated Moms grants to States to establish or
            expand programs in State and local prisons and jails for
            pregnant and postpartum incarcerated individuals. The Attorney
            General shall award such grants in consultation with
            stakeholders such as--
                        (A) relevant community-based organizations,
                    particularly organizations that represent incarcerated
                    and formerly incarcerated individuals and organizations
                    that seek to improve maternal health outcomes for
                    pregnant and postpartum individuals from racial and
                    ethnic minority groups;
                        (B) relevant organizations representing patients,
                    with a particular focus on patients from racial and
                    ethnic minority groups;
                        (C) organizations representing maternity care
                    providers and maternal health care education programs;
                        (D) perinatal health workers; and
                        (E) researchers and policy experts in fields
                    related to maternal health care for incarcerated
                    individuals.
                (2) Applications.--Each applicant for a grant under this
            subsection shall submit to the Director an application at such
            time, in such manner, and containing such information as the
            Director may require.
                (3) Use of funds.--A State that is awarded a grant under
            this subsection shall use such grant to establish or expand
            programs for pregnant and postpartum incarcerated individuals,
            and such programs may--
                        (A) provide access to perinatal health workers from
                    pregnancy through the postpartum period;
                        (B) provide access to healthy foods and counseling
                    on nutrition, recommended activity levels, and safety
                    measures throughout pregnancy;
                        (C) train correctional officers to ensure that
                    pregnant incarcerated individuals receive safe and
                    respectful treatment;
                        (D) train medical personnel to ensure that pregnant
                    incarcerated individuals receive trauma-informed,
                    culturally congruent care that promotes the health and
                    safety of the pregnant individuals;
                        (E) provide counseling and treatment for
                    individuals who have suffered from--
                                (i) diagnosed mental or behavioral health
                            conditions, including trauma and substance use
                            disorders;
                                (ii) trauma or violence, including domestic
                            violence;
                                (iii) human immunodeficiency virus;
                                (iv) sexual abuse;
                                (v) pregnancy or infant loss; or
                                (vi) chronic conditions;
                        (F) provide evidence-based pregnancy and childbirth
                    education, parenting support, and other relevant forms
                    of health literacy;
                        (G) provide clinical education opportunities to
                    maternity care providers in training to expand pathways
                    into maternal health care careers serving incarcerated
                    individuals;
                        (H) offer opportunities for postpartum individuals
                    to maintain contact with the individual's newborn child
                    to promote bonding, including enhanced visitation
                    policies, access to prison nursery programs, or
                    breastfeeding support;
                        (I) provide reentry assistance, particularly to--
                                (i) ensure access to health insurance
                            coverage and transfer of health records to
                            community providers if an incarcerated
                            individual exits the criminal justice system
                            during such individual's pregnancy or in the
                            postpartum period; and
                                (ii) connect individuals exiting the
                            criminal justice system during pregnancy or in
                            the postpartum period to community-based
                            resources, such as referrals to health care
                            providers, substance use disorder treatments,
                            and social services that address social
                            determinants of maternal health; or
                        (J) establish partnerships with local public
                    entities, private community entities, community-based
                    organizations, Indian Tribes and tribal organizations
                    (as such terms are defined in section 4 of the Indian
                    Self-Determination and Education Assistance Act (25
                    U.S.C. 5304)), and urban Indian organizations (as such
                    term is defined in section 4 of the Indian Health Care
                    Improvement Act (25 U.S.C. 1603)) to establish or
                    expand pretrial diversion programs as an alternative to
                    incarceration for pregnant and postpartum individuals,
                    including--
                                (i) evidence-based childbirth education or
                            parenting classes;
                                (ii) prenatal health coordination;
                                (iii) family and individual counseling;
                                (iv) evidence-based screenings, education,
                            and, as needed, treatment for mental and
                            behavioral health conditions, including drug
                            and alcohol treatments;
                                (v) family case management services;
                                (vi) domestic violence education and
                            prevention;
                                (vii) physical and sexual abuse counseling;
                            and
                                (viii) programs to address social
                            determinants of health such as employment,
                            housing, education, transportation, and
                            nutrition.
                (4) Priority.--In awarding grants under this subsection,
            the Director shall give priority to applicants based on--
                        (A) the number of pregnant and postpartum
                    individuals incarcerated in the State and, among such
                    individuals, the number of pregnant and postpartum
                    individuals from racial and ethnic minority groups; and
                        (B) the extent to which the State has demonstrated
                    a commitment to developing exemplary programs for
                    pregnant and postpartum individuals incarcerated in the
                    prisons and jails in such State.
                (5) Grant duration.--A grant awarded under this subsection
            shall be for a 5-year period.
                (6) Implementing and reporting.--A State that receives a
            grant under this subsection shall be responsible for--
                        (A) implementing the program funded by the grant;
                    and
                        (B) not later than 3 years after the date of
                    enactment of this section, and 6 years after the date
                    of enactment of this section, reporting results of such
                    program to the Attorney General, including information
                    describing--
                                (i) relevant quantitative indicators of the
                            program's success in improving the standard of
                            care and health outcomes for pregnant and
                            postpartum incarcerated individuals in the
                            facility, including data stratified by race,
                            ethnicity, sex, gender, age, geography,
                            disability status, category of the criminal
                            charge against such individual, incidence rates
                            of pregnancy-related deaths, pregnancy-
                            associated deaths, cases of infant mortality
                            and morbidity, rates of pre-term births and
                            low-birthweight births, cases of severe
                            maternal morbidity, cases of violence against
                            pregnant or postpartum individuals, diagnoses
                            of maternal mental or behavioral health
                            conditions, and other such information as
                            appropriate;
                                (ii) relevant qualitative and quantitative
                            evaluations from pregnant and postpartum
                            incarcerated individuals who participated in
                            such programs, including measures of patient-
                            reported experience of care; and
                                (iii) strategies to sustain such programs
                            beyond the duration of the grant and expand
                            such programs to other facilities.
                (7) Report.--Not later than 6 years after the date of
            enactment of this Act, the Attorney General shall submit to the
            Congress a report describing the results of such grant
            programs.
                (8) Oversight.--Not later than 1 year after the date of
            enactment of this Act, the Attorney General shall award a
            contract to an independent organization or independent
            organizations to conduct oversight of the programs described in
            paragraph (3).
                (9) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this subsection $10,000,000 for
            each of fiscal years 2023 through 2027.
        (e) GAO Report.--
                (1) In general.--Not later than 2 years after the date of
            enactment of this section, the Comptroller General of the
            United States shall submit to the Congress a report on adverse
            maternal and infant health outcomes among incarcerated
            individuals and infants born to such individuals, with a
            particular focus on racial and ethnic inequities in maternal
            and infant health outcomes for incarcerated individuals.
                (2) Contents of report.--The report described in this
            subsection shall include--
                        (A) to the extent practicable--
                                (i) the number of pregnant individuals who
                            are incarcerated in Bureau of Prisons
                            facilities;
                                (ii) the number of incarcerated
                            individuals, including those incarcerated in
                            Federal, State, and local correctional
                            facilities, who have experienced a pregnancy-
                            related death, pregnancy-associated death, or
                            the death of an infant in the most recent 10
                            years of available data;
                                (iii) the number of cases of severe
                            maternal morbidity among incarcerated
                            individuals, including those incarcerated in
                            Federal, State, and local detention facilities,
                            in the most recent 10 years of available data;
                                (iv) the number of pre-term and low-
                            birthweight births of infants born to
                            incarcerated individuals, including those
                            incarcerated in Federal, State, and local
                            correctional facilities, in the most recent 10
                            years of available data; and
                                (v) statistics on the racial and ethnic
                            inequities in maternal and infant health
                            outcomes and severe maternal morbidity rates
                            among incarcerated individuals, including those
                            incarcerated in Federal, State, and local
                            detention facilities;
                        (B) in the case that the Comptroller General of the
                    United States is unable determine the information
                    required in clauses (i) through (iii) of subparagraph
                    (A), an assessment of the barriers to determining such
                    information and recommendations for improvements in
                    tracking maternal health outcomes among incarcerated
                    individuals, including those incarcerated in Federal,
                    State, and local detention facilities;
                        (C) causes of adverse maternal health outcomes that
                    are unique to incarcerated individuals, including those
                    incarcerated in Federal, State, and local detention
                    facilities;
                        (D) causes of adverse maternal health outcomes and
                    severe maternal morbidity that are unique to
                    incarcerated individuals from racial and ethnic
                    minority groups;
                        (E) recommendations to reduce maternal mortality
                    and severe maternal morbidity among incarcerated
                    individuals and to address racial and ethnic inequities
                    in maternal health outcomes for incarcerated
                    individuals in Bureau of Prisons facilities and State
                    and local prisons and jails; and
                        (F) such other information as may be appropriate to
                    reduce the occurrence of adverse maternal health
                    outcomes among incarcerated individuals and to address
                    racial and ethnic inequities in maternal health
                    outcomes for such individuals.
        (f) MACPAC Report.--
                (1) In general.--Not later than 2 years after the date of
            enactment of this section, the Medicaid and CHIP Payment and
            Access Commission (referred to in this subsection as
            ``MACPAC'') shall publish a report on the implications of
            pregnant and postpartum incarcerated individuals being
            ineligible for medical assistance under a State plan under
            title XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
            that contains the information described in paragraph (2).
                (2) Information described.--For purposes of paragraph (1),
            the information described in this paragraph includes--
                        (A) information on the effect of ineligibility for
                    medical assistance under a State plan under title XIX
                    of the Social Security Act (42 U.S.C. 1396 et seq.) on
                    maternal health outcomes for pregnant and postpartum
                    incarcerated individuals, concentrating on the effects
                    of such ineligibility for pregnant and postpartum
                    individuals from racial and ethnic minority groups; and
                        (B) the potential implications on maternal health
                    outcomes resulting from suspending eligibility for
                    medical assistance under a State plan under such title
                    of such Act when a pregnant or postpartum individual is
                    incarcerated.
        (g) Definitions.--In this section:
                (1) Culturally congruent.--The term ``culturally
            congruent'', with respect to care or maternity care, means care
            that is in agreement with the preferred cultural values,
            beliefs, worldview, language, and practices of the health care
            consumer and other stakeholders.
                (2) Maternity care provider.--The term ``maternity care
            provider'' means a health care provider who--
                        (A) is a physician, physician assistant, midwife
                    who meets at a minimum the international definition of
                    the midwife and global standards for midwifery
                    education as established by the International
                    Confederation of Midwives, nurse practitioner, or
                    clinical nurse specialist; and
                        (B) has a focus on maternal or perinatal health.
                (3) Maternal mortality.--The term ``maternal mortality''
            means a death occurring during or within a one-year period
            after pregnancy, caused by pregnancy-related or childbirth
            complications, including a suicide, overdose, or other death
            resulting from a mental health or substance use disorder
            attributed to or aggravated by pregnancy-related or childbirth
            complications.
                (4) Perinatal health worker.--The term ``perinatal health
            worker'' means a doula, community health worker, peer
            supporter, breastfeeding and lactation educator or counselor,
            nutritionist or dietitian, childbirth educator, social worker,
            home visitor, language interpreter, or navigator.
                (5) Postpartum and postpartum period.--The terms
            ``postpartum'' and ``postpartum period'' refer to the 1-year
            period beginning on the last day of the pregnancy of an
            individual.
                (6) Pregnancy-associated death.--The term ``pregnancy-
            associated death'' means a death of a pregnant or postpartum
            individual, by any cause, that occurs during, or within 1 year
            following, the individual's pregnancy, regardless of the
            outcome, duration, or site of the pregnancy.
                (7) Pregnancy-related death.--The term ``pregnancy-related
            death'' means a death of a pregnant or postpartum individual
            that occurs during, or within 1 year following, the
            individual's pregnancy, from a pregnancy complication, a chain
            of events initiated by pregnancy, or the aggravation of an
            unrelated condition by the physiologic effects of pregnancy.
                (8) Racial and ethnic minority group.--The term ``racial
            and ethnic minority group'' has the meaning given such term in
            section 1707(g)(1) of the Public Health Service Act (42 U.S.C.
            300u-6(g)(1)).
                (9) Severe maternal morbidity.--The term ``severe maternal
            morbidity'' means a health condition, including mental health
            conditions and substance use disorders, attributed to or
            aggravated by pregnancy or childbirth that results in
            significant short-term or long-term consequences to the health
            of the individual who was pregnant.
                (10) Social determinants of maternal health defined.--The
            term ``social determinants of maternal health'' means non-
            clinical factors that impact maternal health outcomes,
            including--
                        (A) economic factors, which may include poverty,
                    employment, food security, support for and access to
                    lactation and other infant feeding options, housing
                    stability, and related factors;
                        (B) neighborhood factors, which may include quality
                    of housing, access to transportation, access to child
                    care, availability of healthy foods and nutrition
                    counseling, availability of clean water, air and water
                    quality, ambient temperatures, neighborhood crime and
                    violence, access to broadband, and related factors;
                        (C) social and community factors, which may include
                    systemic racism, gender discrimination or
                    discrimination based on other protected classes,
                    workplace conditions, incarceration, and related
                    factors;
                        (D) household factors, which may include ability to
                    conduct lead testing and abatement, car seat
                    installation, indoor air temperatures, and related
                    factors;
                        (E) education access and quality factors, which may
                    include educational attainment, language and literacy,
                    and related factors; and
                        (F) health care access factors, including health
                    insurance coverage, access to culturally congruent
                    health care services, providers, and non-clinical
                    support, access to home visiting services, access to
                    wellness and stress management programs, health
                    literacy, access to telehealth and items required to
                    receive telehealth services, and related factors.

    SEC. 5204. IMPACT TO SAVE MOMS ACT.

        (a) Perinatal Care Alternative Payment Model Demonstration
    Project.--
                (1) In general.--For the period of fiscal years 2023
            through 2027, the Secretary of Health and Human Services
            (referred to in this subsection as the ``Secretary''), acting
            through the Administrator of the Centers for Medicare &
            Medicaid Services, shall establish and implement, in accordance
            with the requirements of this subsection, a demonstration
            project, to be known as the Perinatal Care Alternative Payment
            Model Demonstration Project (referred to in this subsection as
            the ``Demonstration Project''), for purposes of allowing States
            to test payment models under their State plans under title XIX
            of the Social Security Act (42 U.S.C. 1396 et seq.) and State
            child health plans under title XXI of such Act (42 U.S.C.
            1397aa et seq.) with respect to maternity care provided to
            pregnant and postpartum individuals enrolled in such State
            plans and State child health plans.
                (2) Coordination.--In establishing the Demonstration
            Project, the Secretary shall coordinate with stakeholders such
            as--
                        (A) State Medicaid programs;
                        (B) relevant organizations representing maternal
                    health care providers;
                        (C) relevant organizations representing patients,
                    with a particular focus on individuals from demographic
                    groups with disproportionate rates of adverse maternal
                    health outcomes;
                        (D) relevant community-based organizations,
                    particularly organizations that seek to improve
                    maternal health outcomes for individuals from
                    demographic groups with disproportionate rates of
                    adverse maternal health outcomes;
                        (E) non-clinical perinatal health workers such as
                    doulas, community health workers, peer supporters,
                    certified lactation consultants, nutritionists and
                    dieticians, social workers, home visitors, and
                    navigators;
                        (F) relevant health insurance issuers;
                        (G) hospitals, health systems, freestanding birth
                    centers (as such term is defined in paragraph (3)(B) of
                    section 1905(l) of the Social Security Act (42 U.S.C.
                    1396d(l))), Federally-qualified health centers (as such
                    term is defined in paragraph (2)(B) of such section),
                    and rural health clinics (as such term is defined in
                    section 1861(aa) of such Act (42 U.S.C. 1395x(aa)));
                        (H) researchers and policy experts in fields
                    related to maternity care payment models; and
                        (I) any other stakeholders as the Secretary
                    determines appropriate, with a particular focus on
                    stakeholders from demographic groups with
                    disproportionate rates of adverse maternal health
                    outcomes.
                (3) Considerations.--In establishing the Demonstration
            Project, the Secretary shall consider each of the following:
                        (A) Findings from any evaluations of the Strong
                    Start for Mothers and Newborns initiative carried out
                    by the Centers for Medicare & Medicaid Services, the
                    Health Resources and Services Administration, and the
                    Administration on Children and Families.
                        (B) Any alternative payment model that--
                                (i) is designed to improve maternal health
                            outcomes for racial and ethnic groups with
                            disproportionate rates of adverse maternal
                            health outcomes;
                                (ii) includes methods for stratifying
                            patients by pregnancy risk level and, as
                            appropriate, adjusting payments under such
                            model to take into account pregnancy risk
                            level;
                                (iii) establishes evidence-based quality
                            metrics for such payments;
                                (iv) includes consideration of non-hospital
                            birth settings such as freestanding birth
                            centers (as so defined);
                                (v) includes consideration of social
                            determinants of health that are relevant to
                            maternal health outcomes such as housing,
                            transportation, nutrition, and other non-
                            clinical factors that influence maternal health
                            outcomes; or
                                (vi) includes diverse maternity care teams
                            that include--
                                        (I) maternity care providers,
                                    including obstetrician-gynecologists,
                                    family physicians, physician
                                    assistants, midwives who meet, at a
                                    minimum, the international definition
                                    of the term ``midwife'' and global
                                    standards for midwifery education (as
                                    established by the International
                                    Confederation of Midwives), and nurse
                                    practitioners--
                                                (aa) from racially,
                                            ethnically, and professionally
                                            diverse backgrounds;
                                                (bb) with experience
                                            practicing in racially and
                                            ethnically diverse communities;
                                            or
                                                (cc) who have undergone
                                            trainings on racism, implicit
                                            bias, and explicit bias; and
                                        (II) non-clinical perinatal health
                                    workers such as doulas, community
                                    health workers, peer supporters,
                                    certified lactation consultants,
                                    nutritionists and dieticians, social
                                    workers, home visitors, and navigators.
                (4) Eligibility.--To be eligible to participate in the
            Demonstration Project, a State shall submit an application to
            the Secretary at such time, in such manner, and containing such
            information as the Secretary may require.
                (5) Evaluation.--The Secretary shall conduct an evaluation
            of the Demonstration Project to determine the impact of the
            Demonstration Project on--
                        (A) maternal health outcomes, with data stratified
                    by race, ethnicity, socioeconomic indicators, and any
                    other factors as the Secretary determines appropriate;
                        (B) spending on maternity care by States
                    participating in the Demonstration Project;
                        (C) to the extent practicable, subjective measures
                    of patient experience; and
                        (D) any other areas of assessment that the
                    Secretary determines relevant.
                (6) Report.--Not later than one year after the completion
            or termination date of the Demonstration Project, the Secretary
            shall submit to the Committee on Energy and Commerce, the
            Committee on Ways and Means, and the Committee on Education and
            Labor of the House of Representatives and the Committee on
            Finance and the Committee on Health, Education, Labor, and
            Pensions of the Senate, and make publicly available, a report
            containing--
                        (A) the results of any evaluation conducted under
                    paragraph (5); and
                        (B) a recommendation regarding whether the
                    Demonstration Project should be continued after fiscal
                    year 2026 and expanded on a national basis.
                (7) Authorization of appropriations.--There are authorized
            to be appropriated such sums as are necessary to carry out this
            subsection.
                (8) Definitions.--In this subsection:
                        (A) Alternative payment model.--The term
                    ``alternative payment model'' has the meaning given
                    such term in section 1833(z)(3)(C) of the Social
                    Security Act (42 U.S.C. 1395l(z)(3)(C)).
                        (B) Perinatal.--The term ``perinatal'' means the
                    period beginning on the day a person becomes pregnant
                    and ending on the last day of the 1-year period
                    beginning on the last day of such person's pregnancy.
        (b) MACPAC Report.--
                (1) In general.--Not later than two years after the date of
            the enactment of this section, the Medicaid and CHIP Payment
            and Access Commission shall publish a report on issues relating
            to the continuity of coverage under State plans under title XIX
            of the Social Security Act (42 U.S.C. 1396 et seq.) and State
            child health plans under title XXI of such Act (42 U.S.C.
            1397aa et seq.) for pregnant and postpartum individuals. Such
            report shall, at a minimum, include the following:
                        (A) An assessment of any existing policies under
                    such State plans and such State child health plans
                    regarding presumptive eligibility for pregnant
                    individuals while their application for enrollment in
                    such a State plan or such a State child health plan is
                    being processed.
                        (B) An assessment of any existing policies under
                    such State plans and such State child health plans
                    regarding measures to ensure continuity of coverage
                    under such a State plan or such a State child health
                    plan for pregnant and postpartum individuals, including
                    such individuals who need to change their health
                    insurance coverage during their pregnancy or the
                    postpartum period following their pregnancy.
                        (C) An assessment of any existing policies under
                    such State plans and such State child health plans
                    regarding measures to automatically reenroll
                    individuals who are eligible to enroll under such a
                    State plan or such a State child health plan as a
                    parent.
                        (D) If determined appropriate by the Commission,
                    any recommendations for the Department of Health and
                    Human Services, or such State plans and such State
                    child health plans, to ensure continuity of coverage
                    under such a State plan or such a State child health
                    plan for pregnant and postpartum people.
                (2) Postpartum defined.--In this subsection, the term
            ``postpartum'' means the 1-year period beginning on the last
            day of a person's pregnancy.

    SEC. 5205. PROTECTING MOMS AND BABIES AGAINST CLIMATE CHANGE.

        (a) Grant Program To Protect Vulnerable Mothers and Babies From
    Climate Change Risks.--
                (1) In general.--Not later than 180 days after the date of
            the enactment of this section, the Secretary of Health and
            Human Services (in this section referred to as the
            ``Secretary'') shall establish a grant program (in this
            subsection referred to as the ``Program'') to protect
            vulnerable individuals from risks associated with climate
            change.
                (2) Grant authority.--In carrying out the Program, the
            Secretary may award, on a competitive basis, grants to 10
            covered entities.
                (3) Applications.--To be eligible for a grant under the
            Program, a covered entity shall submit to the Secretary an
            application at such time, in such form, and containing such
            information as the Secretary may require, which shall include,
            at a minimum, a description of the following:
                        (A) Plans for the use of grant funds awarded under
                    the Program and how patients and stakeholder
                    organizations were involved in the development of such
                    plans.
                        (B) How such grant funds will be targeted to
                    geographic areas that have disproportionately high
                    levels of risks associated with climate change for
                    vulnerable individuals.
                        (C) How such grant funds will be used to address
                    racial and ethnic inequities in--
                                (i) adverse maternal and infant health
                            outcomes; and
                                (ii) exposure to risks associated with
                            climate change for vulnerable individuals.
                        (D) Strategies to prevent an initiative assisted
                    with such grant funds from causing--
                                (i) adverse environmental impacts;
                                (ii) displacement of residents and
                            businesses;
                                (iii) rent and housing price increases; or
                                (iv) disproportionate adverse impacts on
                            racial and ethnic minority groups and other
                            underserved populations.
                (4) Selection of grant recipients.--
                        (A) Timing.--Not later than 270 days after the date
                    of the enactment of this Act, the Secretary shall
                    select the recipients of grants under the Program.
                        (B) Consultation.--In selecting covered entities
                    for grants under the Program, the Secretary shall
                    consult with--
                                (i) representatives of stakeholder
                            organizations;
                                (ii) the Administrator of the Environmental
                            Protection Agency;
                                (iii) the Administrator of the National
                            Oceanic and Atmospheric Administration; and
                                (iv) from the Department of Health and
                            Human Services--
                                        (I) the Deputy Assistant Secretary
                                    for Minority Health;
                                        (II) the Administrator of the
                                    Centers for Medicare & Medicaid
                                    Services;
                                        (III) the Administrator of the
                                    Health Resources and Services
                                    Administration;
                                        (IV) the Director of the National
                                    Institutes of Health; and
                                        (V) the Director of the Centers for
                                    Disease Control and Prevention.
                        (C) Priority.--In selecting a covered entity to be
                    awarded a grant under the Program, the Secretary shall
                    give priority to covered entities that serve a county--
                                (i) designated, or located in an area
                            designated, as a nonattainment area pursuant to
                            section 107 of the Clean Air Act (42 U.S.C.
                            7407) for any air pollutant for which air
                            quality criteria have been issued under section
                            108(a) of such Act (42 U.S.C. 7408(a));
                                (ii) with a level of vulnerability of
                            moderate-to-high or higher, according to the
                            Social Vulnerability Index of the Centers for
                            Disease Control and Prevention; or
                                (iii) with temperatures that pose a risk to
                            human health, as determined by the Secretary,
                            in consultation with the Administrator of the
                            National Oceanic and Atmospheric Administration
                            and the Chair of the United States Global
                            Change Research Program, based on the best
                            available science.
                        (D) Limitation.--A recipient of grant funds under
                    the Program may not use such grant funds to serve a
                    county that is served by any other recipient of a grant
                    under the Program.
                (5) Use of funds.--A covered entity awarded grant funds
            under the Program may only use such grant funds for the
            following:
                        (A) Initiatives to identify risks associated with
                    climate change for vulnerable individuals and to
                    provide services and support to such individuals that
                    address such risks, which may include--
                                (i) training for health care providers,
                            doulas, and other employees in hospitals, birth
                            centers, midwifery practices, and other health
                            care practices that provide prenatal or labor
                            and delivery services to vulnerable individuals
                            on the identification of, and patient
                            counseling relating to, risks associated with
                            climate change for vulnerable individuals;
                                (ii) hiring, training, or providing
                            resources to community health workers and
                            perinatal health workers who can help identify
                            risks associated with climate change for
                            vulnerable individuals, provide patient
                            counseling about such risks, and carry out the
                            distribution of relevant services and support;
                                (iii) enhancing the monitoring of risks
                            associated with climate change for vulnerable
                            individuals, including by--
                                        (I) collecting data on such risks
                                    in specific census tracts,
                                    neighborhoods, or other geographic
                                    areas; and
                                        (II) sharing such data with local
                                    health care providers, doulas, and
                                    other employees in hospitals, birth
                                    centers, midwifery practices, and other
                                    health care practices that provide
                                    prenatal or labor and delivery services
                                    to local vulnerable individuals; and
                                (iv) providing vulnerable individuals--
                                        (I) air conditioning units,
                                    residential weatherization support,
                                    filtration systems, household
                                    appliances, or related items;
                                        (II) direct financial assistance;
                                    and
                                        (III) services and support,
                                    including housing and transportation
                                    assistance, to prepare for or recover
                                    from extreme weather events, which may
                                    include floods, hurricanes, wildfires,
                                    droughts, and related events.
                        (B) Initiatives to mitigate levels of and exposure
                    to risks associated with climate change for vulnerable
                    individuals, which shall be based on the best available
                    science and which may include initiatives to--
                                (i) develop, maintain, or expand urban or
                            community forestry initiatives and tree canopy
                            coverage initiatives;
                                (ii) improve infrastructure, including
                            buildings and paved surfaces;
                                (iii) develop or improve community outreach
                            networks to provide culturally and
                            linguistically appropriate information and
                            notifications about risks associated with
                            climate change for vulnerable individuals; and
                                (iv) provide enhanced services to racial
                            and ethnic minority groups and other
                            underserved populations.
                (6) Length of award.--A grant under this subsection shall
            be disbursed over 4 fiscal years.
                (7) Technical assistance.--The Secretary shall provide
            technical assistance to a covered entity awarded a grant under
            the Program to support the development, implementation, and
            evaluation of activities funded with such grant.
                (8) Reports to secretary.--
                        (A) Annual report.--For each fiscal year during
                    which a covered entity is disbursed grant funds under
                    the Program, such covered entity shall submit to the
                    Secretary a report that summarizes the activities
                    carried out by such covered entity with such grant
                    funds during such fiscal year, which shall include a
                    description of the following:
                                (i) The involvement of stakeholder
                            organizations in the implementation of
                            initiatives assisted with such grant funds.
                                (ii) Relevant health and environmental
                            data, disaggregated, to the extent practicable,
                            by race, ethnicity, gender, and pregnancy
                            status.
                                (iii) Qualitative feedback received from
                            vulnerable individuals with respect to
                            initiatives assisted with such grant funds.
                                (iv) Criteria used in selecting the
                            geographic areas assisted with such grant
                            funds.
                                (v) Efforts to address racial and ethnic
                            inequities in adverse maternal and infant
                            health outcomes and in exposure to risks
                            associated with climate change for vulnerable
                            individuals.
                                (vi) Any negative and unintended impacts of
                            initiatives assisted with such grant funds,
                            including--
                                        (I) adverse environmental impacts;
                                        (II) displacement of residents and
                                    businesses;
                                        (III) rent and housing price
                                    increases; and
                                        (IV) disproportionate adverse
                                    impacts on racial and ethnic minority
                                    groups and other underserved
                                    populations.
                                (vii) How the covered entity will address
                            and prevent any impacts described in clause
                            (vi).
                        (B) Publication.--Not later than 30 days after the
                    date on which a report is submitted under subparagraph
                    (A), the Secretary shall publish such report on a
                    public website of the Department of Health and Human
                    Services.
                (9) Report to congress.--Not later than the date that is 5
            years after the date on which the Program is established, the
            Secretary shall submit to Congress and publish on a public
            website of the Department of Health and Human Services a report
            on the results of the Program, including the following:
                        (A) Summaries of the annual reports submitted under
                    paragraph (8).
                        (B) Evaluations of the initiatives assisted with
                    grant funds under the Program.
                        (C) An assessment of the effectiveness of the
                    Program in--
                                (i) identifying risks associated with
                            climate change for vulnerable individuals;
                                (ii) providing services and support to such
                            individuals;
                                (iii) mitigating levels of and exposure to
                            such risks; and
                                (iv) addressing racial and ethnic
                            inequities in adverse maternal and infant
                            health outcomes and in exposure to such risks.
                        (D) A description of how the Program could be
                    expanded, including--
                                (i) monitoring efforts or data collection
                            that would be required to identify areas with
                            high levels of risks associated with climate
                            change for vulnerable individuals;
                                (ii) how such areas could be identified
                            using the strategy developed under subsection
                            (d); and
                                (iii) recommendations for additional
                            funding.
                (10) Covered entity defined.--In this subsection, the term
            ``covered entity'' means a consortium of organizations serving
            a county that--
                        (A) shall include a community-based organization;
                    and
                        (B) may include--
                                (i) another stakeholder organization;
                                (ii) the government of such county;
                                (iii) the governments of one or more
                            municipalities within such county;
                                (iv) a State or local public health
                            department or emergency management agency;
                                (v) a local health care practice, which may
                            include a licensed and accredited hospital,
                            birth center, midwifery practice, or other
                            health care practice that provides prenatal or
                            labor and delivery services to vulnerable
                            individuals;
                                (vi) an Indian tribe or tribal organization
                            (as such terms are defined in section 4 of the
                            Indian Self-Determination and Education
                            Assistance Act (25 U.S.C. 5304));
                                (vii) an Urban Indian organization (as
                            defined in section 4 of the Indian Health Care
                            Improvement Act (25 U.S.C. 1603)); and
                                (viii) an institution of higher education.
                (11) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this subsection $100,000,000
            for fiscal years 2023 through 2026.
        (b) Grant Program for Education and Training at Health Profession
    Schools.--
                (1) In general.--Not later than 1 year after the date of
            the enactment of this Act, the Secretary shall establish a
            grant program (in this subsection referred to as the
            ``Program'') to provide funds to health profession schools to
            support the development and integration of education and
            training programs for identifying and addressing risks
            associated with climate change for vulnerable individuals.
                (2) Grant authority.--In carrying out the Program, the
            Secretary may award, on a competitive basis, grants to health
            profession schools.
                (3) Application.--To be eligible for a grant under the
            Program, a health profession school shall submit to the
            Secretary an application at such time, in such form, and
            containing such information as the Secretary may require, which
            shall include, at a minimum, a description of the following:
                        (A) How such health profession school will engage
                    with vulnerable individuals, and stakeholder
                    organizations representing such individuals, in
                    developing and implementing the education and training
                    programs supported by grant funds awarded under the
                    Program.
                        (B) How such health profession school will ensure
                    that such education and training programs will address
                    racial and ethnic inequities in exposure to, and the
                    effects of, risks associated with climate change for
                    vulnerable individuals.
                (4) Use of funds.--A health profession school awarded a
            grant under the Program shall use the grant funds to develop,
            and integrate into the curriculum and continuing education of
            such health profession school, education and training on each
            of the following:
                        (A) Identifying risks associated with climate
                    change for vulnerable individuals and individuals with
                    the intent to become pregnant.
                        (B) How risks associated with climate change affect
                    vulnerable individuals and individuals with the intent
                    to become pregnant.
                        (C) Racial and ethnic inequities in exposure to,
                    and the effects of, risks associated with climate
                    change for vulnerable individuals and individuals with
                    the intent to become pregnant.
                        (D) Patient counseling and mitigation strategies
                    relating to risks associated with climate change for
                    vulnerable individuals.
                        (E) Relevant services and support for vulnerable
                    individuals relating to risks associated with climate
                    change and strategies for ensuring vulnerable
                    individuals have access to such services and support.
                        (F) Implicit and explicit bias, racism, and
                    discrimination.
                        (G) Related topics identified by such health
                    profession school based on the engagement of such
                    health profession school with vulnerable individuals
                    and stakeholder organizations representing such
                    individuals.
                (5) Partnerships.--In carrying out activities with grant
            funds, a health profession school awarded a grant under the
            Program may partner with one or more of the following:
                        (A) A State or local public health department.
                        (B) A health care professional membership
                    organization.
                        (C) A stakeholder organization.
                        (D) A health profession school.
                        (E) An institution of higher education.
                (6) Reports to secretary.--
                        (A) Annual report.--For each fiscal year during
                    which a health profession school is disbursed grant
                    funds under the Program, such health profession school
                    shall submit to the Secretary a report that describes
                    the activities carried out with such grant funds during
                    such fiscal year.
                        (B) Final report.--Not later than the date that is
                    1 year after the end of the last fiscal year during
                    which a health profession school is disbursed grant
                    funds under the Program, the health profession school
                    shall submit to the Secretary a final report that
                    summarizes the activities carried out with such grant
                    funds.
                (7) Report to congress.--Not later than the date that is 6
            years after the date on which the Program is established, the
            Secretary shall submit to Congress and publish on a public
            website of the Department of Health and Human Services a report
            that includes the following:
                        (A) A summary of the reports submitted under
                    paragraph (6).
                        (B) Recommendations to improve education and
                    training programs at health profession schools with
                    respect to identifying and addressing risks associated
                    with climate change for vulnerable individuals.
                (8) Health profession school defined.--In this subsection,
            the term ``health profession school'' means an accredited--
                        (A) medical school;
                        (B) school of nursing;
                        (C) midwifery program;
                        (D) physician assistant education program;
                        (E) teaching hospital;
                        (F) residency or fellowship program; or
                        (G) other school or program determined appropriate
                    by the Secretary.
                (9) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this subsection $5,000,000 for
            fiscal years 2023 through 2026.
        (c) NIH Consortium on Birth and Climate Change Research.--
                (1) Establishment.--Not later than 1 year after the date of
            the enactment of this Act, the Director of the National
            Institutes of Health (in this subsection referred to as the
            ``Director of NIH'') shall establish the Consortium on Birth
            and Climate Change Research (in this subsection referred to as
            the ``Consortium'').
                (2) Duties.--
                        (A) In general.--The Consortium shall coordinate,
                    across the institutes, centers, and offices of the
                    National Institutes of Health, research on the risks
                    associated with climate change for vulnerable
                    individuals.
                        (B) Required activities.--In carrying out
                    subparagraph (A), the Consortium shall--
                                (i) establish research priorities,
                            including by prioritizing research that--
                                        (I) identifies the risks associated
                                    with climate change for vulnerable
                                    individuals with a particular focus on
                                    inequities in such risks among racial
                                    and ethnic minority groups and other
                                    underserved populations; and
                                        (II) identifies strategies to
                                    reduce levels of, and exposure to, such
                                    risks, with a particular focus on risks
                                    among racial and ethnic minority groups
                                    and other underserved populations;
                                (ii) identify gaps in available data
                            related to such risks;
                                (iii) identify gaps in, and opportunities
                            for, research collaborations;
                                (iv) identify funding opportunities for
                            community-based organizations and researchers
                            from racially, ethnically, and geographically
                            diverse backgrounds; and
                                (v) publish annual reports on the work and
                            findings of the Consortium on a public website
                            of the National Institutes of Health.
                (3) Membership.--The Director of NIH shall appoint to the
            Consortium representatives of such institutes, centers, and
            offices of the National Institutes of Health as the Director of
            NIH considers appropriate, including, at a minimum,
            representatives of--
                        (A) the National Institute of Environmental Health
                    Sciences;
                        (B) the National Institute on Minority Health and
                    Health Disparities;
                        (C) the Eunice Kennedy Shriver National Institute
                    of Child Health and Human Development;
                        (D) the National Institute of Nursing Research; and
                        (E) the Office of Research on Women's Health.
                (4) Chairperson.--The Chairperson of the Consortium shall
            be designated by the Director of NIH and selected from among
            the representatives appointed under paragraph (3).
                (5) Consultation.--In carrying out the duties described in
            paragraph (2), the Consortium shall consult with--
                        (A) the heads of relevant Federal agencies,
                    including--
                                (i) the Environmental Protection Agency;
                                (ii) the National Oceanic and Atmospheric
                            Administration;
                                (iii) the Occupational Safety and Health
                            Administration; and
                                (iv) from the Department of Health and
                            Human Services--
                                        (I) the Office of Minority Health
                                    in the Office of the Secretary;
                                        (II) the Centers for Medicare &
                                    Medicaid Services;
                                        (III) the Health Resources and
                                    Services Administration;
                                        (IV) the Centers for Disease
                                    Control and Prevention;
                                        (V) the Indian Health Service; and
                                        (VI) the Administration for
                                    Children and Families; and
                        (B) representatives of--
                                (i) stakeholder organizations;
                                (ii) health care providers and professional
                            membership organizations with expertise in
                            maternal health or environmental justice;
                                (iii) State and local public health
                            departments;
                                (iv) licensed and accredited hospitals,
                            birth centers, midwifery practices, or other
                            health care practices that provide prenatal or
                            labor and delivery services to vulnerable
                            individuals; and
                                (v) institutions of higher education,
                            including such institutions that are minority-
                            serving institutions or have expertise in
                            maternal health or environmental justice.
        (d) Strategy for Identifying Climate Change Risk Zones for
    Vulnerable Mothers and Babies.--
                (1) In general.--The Secretary, acting through the Director
            of the Centers for Disease Control and Prevention, shall
            develop a strategy (in this subsection referred to as the
            ``Strategy'') for designating areas that the Secretary
            determines to have a high risk of adverse maternal and infant
            health outcomes among vulnerable individuals as a result of
            risks associated with climate change.
                (2) Strategy requirements.--
                        (A) In general.--In developing the Strategy, the
                    Secretary shall establish a process to identify areas
                    where vulnerable individuals are exposed to a high risk
                    of adverse maternal and infant health outcomes as a
                    result of risks associated with climate change in
                    conjunction with other factors that can impact such
                    health outcomes, including--
                                (i) the incidence of diseases associated
                            with air pollution, extreme heat, and other
                            environmental factors;
                                (ii) the availability and accessibility of
                            maternal and infant health care providers;
                                (iii) English-language proficiency among
                            people of reproductive age;
                                (iv) the health insurance status of people
                            of reproductive age;
                                (v) the number of people of reproductive
                            age who are members of racial or ethnic groups
                            with disproportionately high rates of adverse
                            maternal and infant health outcomes;
                                (vi) the socioeconomic status of people of
                            reproductive age, including with respect to--
                                        (I) poverty;
                                        (II) unemployment;
                                        (III) household income; and
                                        (IV) educational attainment; and
                                (vii) access to quality housing,
                            transportation, and nutrition.
                        (B) Resources.--In developing the Strategy, the
                    Secretary shall identify, and incorporate a description
                    of, the following:
                                (i) Existing mapping tools or Federal
                            programs that identify--
                                        (I) risks associated with climate
                                    change for vulnerable individuals; and
                                        (II) other factors that can
                                    influence maternal and infant health
                                    outcomes, including the factors
                                    described in subparagraph (A).
                                (ii) Environmental, health, socioeconomic,
                            and demographic data relevant to identifying
                            risks associated with climate change for
                            vulnerable individuals.
                                (iii) Existing monitoring networks that
                            collect data described in clause (ii), and any
                            gaps in such networks.
                                (iv) Federal, State, and local stakeholders
                            involved in maintaining monitoring networks
                            identified under clause (iii), and how such
                            stakeholders are coordinating their monitoring
                            efforts.
                                (v) Additional monitoring networks, and
                            enhancements to existing monitoring networks,
                            that would be required to address gaps
                            identified under clause (iii), including at the
                            subcounty and census tract level.
                                (vi) Funding amounts required to establish
                            the monitoring networks identified under clause
                            (v) and recommendations for Federal, State, and
                            local coordination with respect to such
                            networks.
                                (vii) Potential uses for data collected and
                            generated as a result of the Strategy,
                            including how such data may be used in
                            determining recipients of grants under the
                            program established by subsection (a) or other
                            similar programs.
                                (viii) Other information the Secretary
                            considers relevant for the development of the
                            Strategy.
                (3) Coordination and consultation.--In developing the
            Strategy, the Secretary shall--
                        (A) coordinate with the Administrator of the
                    Environmental Protection Agency and the Administrator
                    of the National Oceanic and Atmospheric Administration;
                    and
                        (B) consult with--
                                (i) stakeholder organizations;
                                (ii) health care providers and professional
                            membership organizations with expertise in
                            maternal health or environmental justice;
                                (iii) State and local public health
                            departments;
                                (iv) licensed and accredited hospitals,
                            birth centers, midwifery practices, or other
                            health care providers that provide prenatal or
                            labor and delivery services to vulnerable
                            individuals; and
                                (v) institutions of higher education,
                            including such institutions that are minority-
                            serving institutions or have expertise in
                            maternal health or environmental justice.
                (4) Notice and comment.--At least 240 days before the date
            on which the Strategy is published in accordance with paragraph
            (5), the Secretary shall provide--
                        (A) notice of the Strategy on a public website of
                    the Department of Health and Human Services; and
                        (B) an opportunity for public comment of at least
                    90 days.
                (5) Publication.--Not later than 18 months after the date
            of the enactment of this Act, the Secretary shall publish on a
            public website of the Department of Health and Human Services--
                        (A) the Strategy;
                        (B) the public comments received under paragraph
                    (4); and
                        (C) the responses of the Secretary to such public
                    comments.
        (e) Definitions.--In this section, the following definitions apply:
                (1) Adverse maternal and infant health outcomes.--The term
            ``adverse maternal and infant health outcomes'' includes the
            outcomes of pre-term birth, low birth weight, stillbirth,
            infant or maternal mortality, and severe maternal morbidity.
                (2) Institution of higher education.--The term
            ``institution of higher education'' has the meaning given such
            term in section 101 of the Higher Education Act of 1965 (20
            U.S.C. 1001).
                (3) Minority-serving institution.--The term ``minority-
            serving institution'' means an entity specified in any of
            paragraphs (1) through (7) of section 371(a) of the Higher
            Education Act of 1965 (20 U.S.C. 1067q(a)).
                (4) Racial and ethnic minority group.--The term ``racial
            and ethnic minority group'' has the meaning given such term in
            section 1707(g) of the Public Health Service Act (42 U.S.C.
            300u-6(g)).
                (5) Risks associated with climate change.--The term ``risks
            associated with climate change'' includes risks associated with
            extreme heat, air pollution, extreme weather events, and other
            environmental issues associated with climate change that can
            result in adverse maternal and infant health outcomes.
                (6) Stakeholder organization.--The term ``stakeholder
            organization'' means--
                        (A) a community-based organization with expertise
                    in providing assistance to vulnerable individuals;
                        (B) a nonprofit organization with expertise in
                    maternal or infant health or environmental justice; and
                        (C) a patient advocacy organization representing
                    vulnerable individuals.
                (7) Vulnerable individual.--The term ``vulnerable
            individual'' means--
                        (A) an individual who is pregnant;
                        (B) an individual who was pregnant during any
                    portion of the preceding 1-year period; and
                        (C) an individual under 3 years of age.

    SEC. 5206. TECH TO SAVE MOMS.

        (a) Definitions.--In this section:
                (1) Postpartum and postpartum period.--The terms
            ``postpartum'' and ``postpartum period'' refer to the 1-year
            period beginning on the last day of the pregnancy of an
            individual.
                (2) Racial and ethnic minority group.--The term ``racial
            and ethnic minority group'' has the meaning given such term in
            section 1707(g)(1) of the Public Health Service Act (42 U.S.C.
            300u-6(g)(1)).
                (3) Severe maternal morbidity.--The term ``severe maternal
            morbidity'' means a health condition, including mental health
            conditions and substance use disorders, attributed to or
            aggravated by pregnancy or childbirth that results in
            significant short-term or long-term consequences to the health
            of the individual who was pregnant.
                (4) Social determinants of maternal health.--The term
            ``social determinants of maternal health'' means non-clinical
            factors that impact maternal health outcomes, including--
                        (A) economic factors, which may include poverty,
                    employment, food security, support for and access to
                    lactation and other infant feeding options, housing
                    stability, and related factors;
                        (B) neighborhood factors, which may include quality
                    of housing, access to transportation, access to child
                    care, availability of healthy foods and nutrition
                    counseling, availability of clean water, air and water
                    quality, ambient temperatures, neighborhood crime and
                    violence, access to broadband, and related factors;
                        (C) social and community factors, which may include
                    systemic racism, gender discrimination or
                    discrimination based on other protected classes,
                    workplace conditions, incarceration, and related
                    factors;
                        (D) household factors, which may include ability to
                    conduct lead testing and abatement, car seat
                    installation, indoor air temperatures, and related
                    factors;
                        (E) education access and quality factors, which may
                    include educational attainment, language and literacy,
                    and related factors; and
                        (F) health care access factors, including health
                    insurance coverage, access to culturally congruent
                    health care services, providers, and non-clinical
                    support, access to home visiting services, access to
                    wellness and stress management programs, health
                    literacy, access to telehealth and items required to
                    receive telehealth services, and related factors.
        (b) Integrated Telehealth Models in Maternity Care Services.--
                (1) In general.--Section 1115A(b)(2)(B) of the Social
            Security Act (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at
            the end the following:
                                ``(xxviii) Focusing on title XIX, providing
                            for the adoption of and use of telehealth tools
                            that allow for screening, monitoring, and
                            management of common health complications with
                            respect to an individual receiving medical
                            assistance during such individual's pregnancy
                            and for not more than a 1-year period beginning
                            on the last day of the pregnancy.''.
                (2) Effective date.--The amendment made by paragraph (1)
            shall take effect 1 year after the date of the enactment of
            this section.
        (c) Grants To Expand the Use of Technology-Enabled Collaborative
    Learning and Capacity Models for Pregnant and Postpartum Individuals.--
    Title III of the Public Health Service Act is amended by inserting
    after section 330N (42 U.S.C. 254c-20) the following new section:

    ``SEC. 330. EXPANDING CAPACITY FOR MATERNAL HEALTH OUTCOMES.

        ``(a) Establishment.--Beginning not later than 1 year after the
    date of enactment of this section, the Secretary shall award grants to
    eligible entities to evaluate, develop, and expand the use of
    technology-enabled collaborative learning and capacity building models
    and improve maternal health outcomes--
                ``(1) in health professional shortage areas;
                ``(2) in areas with high rates of maternal mortality and
            severe maternal morbidity;
                ``(3) in areas with significant racial and ethnic
            inequities in maternal health outcomes; and
                ``(4) for medically underserved populations and American
            Indians and Alaska Natives, including Indian Tribes, Tribal
            organizations, and Urban Indian organizations.
        ``(b) Use of Funds.--
                ``(1) Required uses.--Recipients of grants under this
            section shall use the grants to--
                        ``(A) train maternal health care providers,
                    students, and other similar professionals through
                    models that include--
                                ``(i) methods to increase safety and health
                            care quality;
                                ``(ii) training to increase awareness of,
                            and eliminate implicit bias, racism, and
                            discrimination in the provision of health care;
                                ``(iii) best practices in screening for
                            and, as needed, evaluating and treating
                            maternal mental health conditions and substance
                            use disorders;
                                ``(iv) training on best practices in
                            maternity care for pregnant and postpartum
                            individuals during the COVID-19 public health
                            emergency or future public health emergencies;
                                ``(v) methods to screen for social
                            determinants of maternal health risks in the
                            prenatal and postpartum periods; and
                                ``(vi) the use of remote patient monitoring
                            tools for pregnancy-related complications
                            described in section 1115A(b)(2)(B)(xxviii) of
                            the Social Security Act;
                        ``(B) evaluate and collect information on the
                    effect of such models on--
                                ``(i) access to, and quality of, care;
                                ``(ii) outcomes with respect to the health
                            of an individual; and
                                ``(iii) the experience of individuals who
                            receive pregnancy-related health care;
                        ``(C) develop qualitative and quantitative measures
                    to identify best practices for the expansion and use of
                    such models;
                        ``(D) study the effect of such models on patient
                    outcomes and maternity care providers; and
                        ``(E) conduct any other activity, as determined by
                    the Secretary.
                ``(2) Permissible uses.--Recipients of grants under this
            section may use grants to support--
                        ``(A) the use and expansion of technology-enabled
                    collaborative learning and capacity building models,
                    including hardware and software that--
                                ``(i) enables distance learning and
                            technical support; and
                                ``(ii) supports the secure exchange of
                            electronic health information; and
                        ``(B) maternity care providers, students, and other
                    similar professionals in the provision of maternity
                    care through such models.
        ``(c) Application.--
                ``(1) In general.--An eligible entity seeking a grant under
            subsection (a) shall submit to the Secretary an application, at
            such time, in such manner, and containing such information as
            the Secretary may require.
                ``(2) Assurance.--An application under paragraph (1) shall
            include an assurance that such entity shall collect information
            on, and assess the effect of, the use of technology-enabled
            collaborative learning and capacity building models, including
            with respect to--
                        ``(A) maternal health outcomes;
                        ``(B) access to maternal health care services;
                        ``(C) quality of maternal health care; and
                        ``(D) retention of maternity care providers serving
                    areas and populations described in subsection (a).
        ``(d) Limitations.--
                ``(1) Number.--The Secretary may not award more than 1
            grant under this section to an eligible entity.
                ``(2) Duration.--A grant awarded under this section shall
            be for a 5-year period.
        ``(e) Access to Broadband.--In administering grants under this
    section, the Secretary may coordinate with other agencies to ensure
    that funding opportunities are available to support access to reliable,
    high-speed internet for grantees.
        ``(f) Technical Assistance.--The Secretary shall provide (either
    directly or by contract) technical assistance to eligible entities,
    including recipients of grants under subsection (a), on the
    development, use, and sustainability of technology-enabled
    collaborative learning and capacity building models to expand access to
    maternal health care services provided by such entities, including--
                ``(1) in health professional shortage areas;
                ``(2) in areas with high rates of maternal mortality and
            severe maternal morbidity or significant racial and ethnic
            inequities in maternal health outcomes; and
                ``(3) for medically underserved populations or American
            Indians and Alaska Natives.
        ``(g) Research and Evaluation.--The Secretary, in consultation with
    experts, shall develop a strategic plan to research and evaluate the
    evidence for such models.
        ``(h) Reporting.--
                ``(1) Eligible entities.--An eligible entity that receives
            a grant under subsection (a) shall submit to the Secretary a
            report, at such time, in such manner, and containing such
            information as the Secretary may require.
                ``(2) Secretary.--Not later than 4 years after the date of
            enactment of this section, the Secretary shall submit to the
            Congress, and make available on the website of the Department
            of Health and Human Services, a report that includes--
                        ``(A) a description of grants awarded under
                    subsection (a) and the purpose and amounts of such
                    grants;
                        ``(B) a summary of--
                                ``(i) the evaluations conducted under
                            subsection (b)(1)(B);
                                ``(ii) any technical assistance provided
                            under subsection (g); and
                                ``(iii) the activities conducted under
                            subsection (a); and
                        ``(C) a description of any significant findings
                    with respect to--
                                ``(i) patient outcomes; and
                                ``(ii) best practices for expanding, using,
                            or evaluating technology-enabled collaborative
                            learning and capacity building models.
        ``(i) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section, $6,000,000 for each of fiscal
    years 2023 through 2027.
        ``(j) Definitions.--In this section:
                ``(1) Eligible entity.--
                        ``(A) In general.--The term `eligible entity' means
                    an entity that provides, or supports the provision of,
                    maternal health care services or other evidence-based
                    services for pregnant and postpartum individuals--
                                ``(i) in health professional shortage
                            areas;
                                ``(ii) in areas with high rates of adverse
                            maternal health outcomes or significant racial
                            and ethnic inequities in maternal health
                            outcomes; or
                                ``(iii) who are--
                                        ``(I) members of medically
                                    underserved populations; or
                                        ``(II) American Indians and Alaska
                                    Natives, including Indian Tribes,
                                    Tribal organizations, and Urban Indian
                                    organizations.
                        ``(B) Inclusions.--An eligible entity may include
                    entities that lead, or are capable of leading a
                    technology-enabled collaborative learning and capacity
                    building model.
                ``(2) Health professional shortage area.--The term `health
            professional shortage area' means a health professional
            shortage area designated under section 332.
                ``(3) Indian tribe.--The term `Indian Tribe' has the
            meaning given such term in section 4 of the Indian Self-
            Determination and Education Assistance Act.
                ``(4) Maternal mortality.--The term `maternal mortality'
            means a death occurring during or within 1-year period after
            pregnancy caused by pregnancy-related or childbirth
            complications, including a suicide, overdose, or other death
            resulting from a mental health or substance use disorder
            attributed to or aggravated by pregnancy or childbirth
            complications.
                ``(5) Medically underserved population.--The term
            `medically underserved population' has the meaning given such
            term in section 330(b)(3).
                ``(6) Postpartum.--The term `postpartum' means the 1-year
            period beginning on the last date of an individual's pregnancy.
                ``(7) Severe maternal morbidity.--The term `severe maternal
            morbidity' means a health condition, including a mental health
            or substance use disorder, attributed to or aggravated by
            pregnancy or childbirth that results in significant short-term
            or long-term consequences to the health of the individual who
            was pregnant.
                ``(8) Technology-enabled collaborative learning and
            capacity building model.--The term `technology-enabled
            collaborative learning and capacity building model' means a
            distance health education model that connects health care
            professionals, and other specialists, through simultaneous
            interactive videoconferencing for the purpose of facilitating
            case-based learning, disseminating best practices, and
            evaluating outcomes in the context of maternal health care.
                ``(9) Tribal organization.--The term `Tribal organization'
            has the meaning given such term in section 4 of the Indian
            Self-Determination and Education Assistance Act.
                ``(10) Urban indian organization.--The term `Urban Indian
            organization' has the meaning given such term in section 4 of
            the Indian Health Care Improvement Act.''.
        (d) Grants To Promote Equity in Maternal Health Outcomes Through
    Digital Tools.--
                (1) In general.--Beginning not later than 1 year after the
            date of the enactment of this Act, the Secretary of Health and
            Human Services shall make grants to eligible entities to reduce
            racial and ethnic inequities in maternal health outcomes by
            increasing access to digital tools related to maternal health
            care.
                (2) Applications.--To be eligible to receive a grant under
            this subsection, an eligible entity shall submit to the
            Secretary an application at such time, in such manner, and
            containing such information as the Secretary may require.
                (3) Prioritization.--In awarding grants under this
            subsection, the Secretary shall prioritize an eligible entity--
                        (A) in an area with high rates of adverse maternal
                    health outcomes or significant racial and ethnic
                    inequities in maternal health outcomes;
                        (B) in a health professional shortage area
                    designated under section 332 of the Public Health
                    Service Act (42 U.S.C. 254e); and
                        (C) that promotes technology that addresses racial
                    and ethnic inequities in maternal health outcomes.
                (4) Limitations.--
                        (A) Number.--The Secretary may award not more than
                    1 grant under this subsection to an eligible entity.
                        (B) Duration.--A grant awarded under this
                    subsection shall be for a 5-year period.
                (5) Technical assistance.--The Secretary shall provide
            technical assistance to an eligible entity on the development,
            use, evaluation, and post-grant sustainability of digital tools
            for purposes of promoting equity in maternal health outcomes.
                (6) Reporting.--
                        (A) Eligible entities.--An eligible entity that
                    receives a grant under paragraph (1) shall submit to
                    the Secretary a report, at such time, in such manner,
                    and containing such information as the Secretary may
                    require.
                        (B) Secretary.--Not later than 4 years after the
                    date of the enactment of this Act, the Secretary shall
                    submit to Congress a report that includes--
                                (i) an evaluation on the effectiveness of
                            grants awarded under this subsection to improve
                            health outcomes for pregnant and postpartum
                            individuals from racial and ethnic minority
                            groups;
                                (ii) recommendations on new grant programs
                            that promote the use of technology to improve
                            such maternal health outcomes; and
                                (iii) recommendations with respect to--
                                        (I) technology-based privacy and
                                    security safeguards in maternal health
                                    care;
                                        (II) reimbursement rates for
                                    maternal telehealth services;
                                        (III) the use of digital tools to
                                    analyze large data sets to identify
                                    potential pregnancy-related
                                    complications;
                                        (IV) barriers that prevent
                                    maternity care providers from providing
                                    telehealth services across States;
                                        (V) the use of consumer digital
                                    tools such as mobile phone
                                    applications, patient portals, and
                                    wearable technologies to improve
                                    maternal health outcomes;
                                        (VI) barriers that prevent access
                                    to telehealth services, including a
                                    lack of access to reliable, high-speed
                                    internet or electronic devices;
                                        (VII) barriers to data sharing
                                    between the Special Supplemental
                                    Nutrition Program for Women, Infants,
                                    and Children program and maternity care
                                    providers, and recommendations for
                                    addressing such barriers; and
                                        (VIII) lessons learned from
                                    expanded access to telehealth related
                                    to maternity care during the COVID-19
                                    public health emergency.
                (7) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this subsection $6,000,000 for
            each of fiscal years 2023 through 2027.
        (e) Report on the Use of Technology in Maternity Care.--
                (1) In general.--Not later than 60 days after the date of
            enactment of this Act, the Secretary of Health and Human
            Services shall enter into an agreement with the National
            Academies of Sciences, Engineering, and Medicine (referred to
            in this section as the ``National Academies'') under which the
            National Academies shall conduct a study on the use of
            technology and patient monitoring devices in maternity care.
                (2) Content.--The agreement entered into pursuant to
            paragraph (1) shall provide for the study of the following:
                        (A) The use of innovative technology (including
                    artificial intelligence) in maternal health care,
                    including the extent to which such technology has
                    affected racial or ethnic biases in maternal health
                    care.
                        (B) The use of patient monitoring devices
                    (including pulse oximeter devices) in maternal health
                    care, including the extent to which such devices have
                    affected racial or ethnic biases in maternal health
                    care.
                        (C) Best practices for reducing and preventing
                    racial or ethnic biases in the use of innovative
                    technology and patient monitoring devices in maternity
                    care.
                        (D) Best practices in the use of innovative
                    technology and patient monitoring devices for pregnant
                    and postpartum individuals from racial and ethnic
                    minority groups.
                        (E) Best practices with respect to privacy and
                    security safeguards in such use.
                (3) Report.--Not later than 24 months after the date of
            enactment of this Act, the National Academies shall complete
            the study under this subsection, and transmit a report the
            results of such study to Congress.

    SEC. 5207. SOCIAL DETERMINANTS FOR MOMS.

        (a) Task Force To Develop a Strategy To Address Social Determinants
    of Maternal Health.--
                (1) In general.--The Secretary of Health and Human Services
            shall convene a task force (in this subsection referred to as
            the ``Task Force'') to develop a strategy to coordinate efforts
            between Federal agencies to address social determinants of
            maternal health with respect to pregnant and postpartum
            individuals.
                (2) Ex officio members.--The ex officio members of the Task
            Force shall consist of the following:
                        (A) The Secretary of Health and Human Services (or
                    a designee thereof).
                        (B) The Secretary of Housing and Urban Development
                    (or a designee thereof).
                        (C) The Secretary of Transportation (or a designee
                    thereof).
                        (D) The Secretary of Agriculture (or a designee
                    thereof).
                        (E) The Secretary of Labor (or a designee thereof).
                        (F) The Administrator of the Environmental
                    Protection Agency (or a designee thereof).
                        (G) The Assistant Secretary for the Administration
                    for Children and Families (or a designee thereof).
                        (H) The Administrator of the Centers for Medicare &
                    Medicaid Services (or a designee thereof).
                        (I) The Director of the Indian Health Service (or a
                    designee thereof).
                        (J) The Director of the National Institutes of
                    Health (or a designee thereof).
                        (K) The Administrator of the Health Resources and
                    Services Administration (or a designee thereof).
                        (L) The Deputy Assistant Secretary for Minority
                    Health of the Department of Health and Human Services
                    (or a designee thereof).
                        (M) The Deputy Assistant Secretary for Women's
                    Health of the Department of Health and Human Services
                    (or a designee thereof).
                        (N) The Director of the Centers for Disease Control
                    and Prevention (or a designee thereof).
                        (O) The Director of the Office on Violence Against
                    Women at the Department of Justice (or a designee
                    thereof).
                (3) Appointed members.--In addition to the ex officio
            members of the Task Force, the Secretary of Health and Human
            Services shall appoint the following members of the Task Force:
                        (A) At least two representatives of patients, to
                    include--
                                (i) a representative of patients who have
                            suffered from severe maternal morbidity; or
                                (ii) a representative of patients who is a
                            family member of an individual who suffered a
                            pregnancy-related death.
                        (B) At least two leaders of community-based
                    organizations that address maternal mortality and
                    severe maternal morbidity with a specific focus on
                    racial and ethnic inequities. In appointing such
                    leaders under this subparagraph, the Secretary of
                    Health and Human Services shall give priority to
                    individuals who are leaders of organizations led by
                    individuals from racial and ethnic minority groups.
                        (C) At least two perinatal health workers.
                        (D) A professionally diverse panel of maternity
                    care providers.
                (4) Chair.--The Secretary of Health and Human Services
            shall select the chair of the Task Force from among the members
            of the Task Force.
                (5) Report.--Not later than 2 years after the date of the
            enactment of this Act, the Task Force shall submit to Congress
            a report on--
                        (A) the strategy developed under paragraph (1);
                        (B) recommendations on funding amounts with respect
                    to implementing such strategy; and
                        (C) recommendations for how to expand coverage of
                    social services to address social determinants of
                    maternal health under Medicaid managed care
                    organizations and State Medicaid programs.
                (6) Termination.--Section 14 of the Federal Advisory
            Committee Act (5 U.S.C. App.) shall not apply to the Task Force
            with respect to termination.
        (b) Housing for Moms Grant Program.--
                (1) In general.--The Secretary of Housing and Urban
            Development shall establish a Housing for Moms grant program
            under this subsection to make grants to eligible entities to
            increase access to safe, stable, affordable, and adequate
            housing for pregnant and postpartum individuals and their
            families.
                (2) Application.--To be eligible to receive a grant under
            this subsection, an eligible entity shall submit to the
            Secretary an application at such time, in such manner, and
            containing such information as the Secretary may provide.
                (3) Priority.--In awarding grants under this subsection,
            the Secretary shall give priority to an eligible entity that--
                        (A) is a community-based organization or will
                    partner with a community-based organization to
                    implement initiatives to increase access to safe,
                    stable, affordable, and adequate housing for pregnant
                    and postpartum individuals and their families;
                        (B) is operating in an area with high rates of
                    adverse maternal health outcomes or significant racial
                    or ethnic inequities in maternal health outcomes, to
                    the extent such data are available; and
                        (C) is operating in an area with a high poverty
                    rate or significant number of individuals who lack
                    consistent access to safe, stable, affordable, and
                    adequate housing.
                (4) Use of funds.--An eligible entity that receives a grant
            under this subsection shall use funds under the grant for the
            purposes of--
                        (A) identifying and conducting outreach to pregnant
                    and postpartum individuals who are low-income and lack
                    consistent access to safe, stable, affordable, and
                    adequate housing;
                        (B) providing safe, stable, affordable, and
                    adequate housing options to such individuals;
                        (C) connecting such individuals with local
                    organizations offering safe, stable, affordable, and
                    adequate housing options;
                        (D) providing application assistance to such
                    individuals seeking to enroll in programs offering
                    safe, stable, affordable, and adequate housing options;
                        (E) providing direct financial assistance to such
                    individuals for the purposes of maintaining safe,
                    stable, and adequate housing for the duration of the
                    individual's pregnancy and postpartum periods; and
                        (F) working with relevant stakeholders to ensure
                    that local housing and homeless shelter infrastructure
                    is supportive to pregnant and postpartum individuals,
                    including through--
                                (i) health-promoting housing codes;
                                (ii) enforcement of housing codes;
                                (iii) proactive rental inspection programs;
                                (iv) code enforcement officer training; and
                                (v) partnerships between regional offices
                            of the Department of Housing and Urban
                            Development and community-based organizations
                            to ensure housing laws are understood and
                            violations are discovered.
                (5) Reporting.--
                        (A) Eligible entities.--The Secretary shall require
                    each eligible entity receiving a grant under this
                    subsection to annually submit to the Secretary and make
                    publicly available a report on the status of activities
                    conducted using the grant.
                        (B) Secretary.--Not later than the end of each
                    fiscal year in which grants are made under this
                    subsection, the Secretary shall submit to the Congress
                    and make publicly available a report that--
                                (i) summarizes the reports received under
                            subparagraph (A);
                                (ii) evaluates the effectiveness of grants
                            awarded under this subsection in increasing
                            access to safe, stable, affordable, and
                            adequate housing for pregnant and postpartum
                            individuals and their families; and
                                (iii) makes recommendations with respect to
                            ensuring activities described paragraph (4)
                            continue after grant amounts made available
                            under this subsection are expended.
                (6) Definitions.--In this subsection:
                        (A) Eligible entity.--The term ``eligible entity''
                    means--
                                (i) a community-based organization;
                                (ii) a State or local governmental entity,
                            including a State or local public health
                            department;
                                (iii) an Indian tribe or tribal
                            organization (as such terms are defined in
                            section 4 of the Indian Self-Determination and
                            Education Assistance Act (25 U.S.C. 5304)); or
                                (iv) an Urban Indian organization (as such
                            term is defined in section 4 of the Indian
                            Health Care Improvement Act (25 U.S.C. 1603)).
                        (B) Secretary.--The term ``Secretary'' means the
                    Secretary of Housing and Urban Development.
                (7) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this subsection $10,000,000 for
            fiscal year 2022, which shall remain available until expended.
        (c) Department of Transportation.--
                (1) Report.--Not later than one year after the date of
            enactment of this Act, the Secretary of Transportation shall
            submit to Congress and make publicly available a report
            containing--
                        (A) an assessment of transportation barriers
                    preventing individuals from attending prenatal and
                    postpartum appointments, accessing maternal health care
                    services, or accessing services and resources related
                    to social determinants maternal of health;
                        (B) recommendations on how to overcome the barriers
                    assessed under subparagraph (A); and
                        (C) an assessment of transportation safety risks
                    for pregnant individuals and recommendations on how to
                    mitigate such risks.
                (2) Considerations.--In carrying out paragraph (1), the
            Secretary shall give special consideration to solutions for--
                        (A) pregnant and postpartum individuals living in a
                    health professional shortage area designated under
                    section 332 of the Public Health Service Act (42 U.S.C.
                    254e);
                        (B) pregnant and postpartum individuals living in
                    areas with high maternal mortality or severe morbidity
                    rates or significant racial or ethnic inequities in
                    maternal health outcomes; and
                        (C) pregnant and postpartum individuals with a
                    disability that impacts mobility.
        (d) Department of Agriculture.--
                (1) Special supplemental nutrition program.--
                        (A) Extension of postpartum period.--Section
                    17(b)(10) of the Child Nutrition Act of 1966 (42 U.S.C.
                    1786(b)(10)) is amended by striking ``six months'' and
                    inserting ``24 months''.
                        (B) Report.--Not later than 2 years after the date
                    of the enactment of this subsection, the Secretary
                    shall submit to Congress a report that includes an
                    evaluation of the effect of each of the amendments made
                    by this paragraph on--
                                (i) maternal and infant health outcomes,
                            including racial and ethnic inequities with
                            respect to such outcomes;
                                (ii) breastfeeding rates among postpartum
                            individuals;
                                (iii) qualitative evaluations of family
                            experiences under the special supplemental
                            nutrition program under section 17 of the Child
                            Nutrition Act of 1966 (42 U.S.C. 1786); and
                                (iv) other relevant information as
                            determined by the Secretary.
                (2) Grant program for healthy food and clean water for
            pregnant and postpartum individuals.--
                        (A) In general.--The Secretary shall establish a
                    program to award grants, on a competitive basis, to
                    eligible entities to carry out the activities described
                    in subparagraph (D).
                        (B) Application.--To be eligible for a grant under
                    this paragraph, an eligible entity shall submit to the
                    Secretary an application at such time, in such manner,
                    and containing such information as the Secretary
                    determines appropriate.
                        (C) Priority.--In awarding grants under this
                    paragraph, the Secretary shall give priority to an
                    eligible entity that--
                                (i) is, or will partner with, a community-
                            based organization; and
                                (ii) is operating in an area with high
                            rates of--
                                        (I) adverse maternal health
                                    outcomes; or
                                        (II) significant racial or ethnic
                                    inequities in maternal health outcomes.
                        (D) Use of funds.--An eligible entity shall use
                    grant funds awarded under this paragraph to deliver
                    healthy food, infant formula, clean water, or diapers
                    to pregnant and postpartum individuals located in areas
                    that are food deserts, as determined by the Secretary
                    using data from the Food Access Research Atlas of the
                    Department of Agriculture.
                        (E) Reports.--
                                (i) Eligible entity.--Not later than 1 year
                            after an eligible entity first receives a grant
                            under this paragraph, and annually thereafter,
                            an eligible entity shall submit to the
                            Secretary a report on the status of activities
                            conducted using the grant, which shall contain
                            such information as the Secretary may require.
                                (ii) Secretary.--
                                        (I) In general.--Not later than 2
                                    years after the date on which the first
                                    grant is awarded under this paragraph,
                                    the Secretary shall submit to Congress
                                    a report that includes--
                                                (aa) a summary of the
                                            reports submitted under clause
                                            (i);
                                                (bb) an assessment of the
                                            extent to which food
                                            distributed through the grant
                                            program was purchased from
                                            local and regional food
                                            systems;
                                                (cc) an evaluation of the
                                            effect of the grant program
                                            under this paragraph on
                                            maternal and infant health
                                            outcomes, including racial and
                                            ethnic inequities with respect
                                            to such outcomes; and
                                                (dd) recommendations with
                                            respect to ensuring the
                                            activities described in
                                            subparagraph (D) continue after
                                            the grant period funding such
                                            activities expires.
                                        (II) Publication.--The Secretary
                                    shall make the report submitted under
                                    subclause (I) publicly available on the
                                    website of the Department of
                                    Agriculture.
                        (F) Authorization of appropriations.--There are
                    authorized to be appropriated $5,000,000 to carry out
                    this paragraph for fiscal years 2022 through 2024.
                (3) Definitions.--In this subsection:
                        (A) Eligible entity.--The term ``eligible entity''
                    means--
                                (i) a community-based organization;
                                (ii) a State or local governmental entity,
                            including a State or local public health
                            department;
                                (iii) an Indian Tribe or Tribal
                            organization (as such terms are defined in
                            section 4 of the Indian Self-Determination and
                            Education Assistance Act (25 U.S.C. 5304)); or
                                (iv) an Urban Indian organization (as such
                            term is defined in section 4 of the Indian
                            Health Care Improvement Act (25 U.S.C. 1603)).
                        (B) Secretary.--The term ``Secretary'' means the
                    Secretary of Agriculture.
        (e) Environmental Study Through National Academies.--
                (1) In general.--The Administrator of the Environmental
            Protection Agency shall seek to enter an agreement, not later
            than 60 days after the date of enactment of this Act, with the
            National Academies of Sciences, Engineering, and Medicine
            (referred to in this subsection as the ``National Academies'')
            under which the National Academies agree to conduct a study on
            the impacts of water and air quality, exposure to extreme
            temperatures, environmental chemicals, environmental risks in
            the workplace and the home, and pollution levels, on maternal
            and infant health outcomes.
                (2) Study requirements.--The agreement under paragraph (1)
            shall direct the National Academies to make recommendations
            for--
                        (A) improving environmental conditions to improve
                    maternal and infant health outcomes; and
                        (B) reducing or eliminating racial and ethnic
                    inequities in such outcomes.
                (3) Report.--The agreement under paragraph (1) shall direct
            the National Academies to complete the study under this
            subsection, and transmit to the Congress and make publicly
            available a report on the results of the study, not later than
            12 months after the date of enactment of this Act.
        (f) Child Care Access.--
                (1) Grant program.--The Secretary of Health and Human
            Services (in this subsection referred to as the ``Secretary'')
            shall award grants to eligible organizations to provide
            pregnant and postpartum individuals with free and accessible
            drop-in child care services during prenatal and postpartum
            appointments.
                (2) Application.--To be eligible to receive a grant under
            this subsection, an eligible entity shall submit to the
            Secretary an application at such time, in such manner, and
            containing such information as the Secretary may require.
                (3) Eligible organizations.--
                        (A) Eligibility.--To be eligible to receive a grant
                    under this subsection, an organization shall be an
                    organization that--
                                (i) provides child care services; and
                                (ii) can carry out programs providing
                            pregnant and postpartum individuals with free
                            and accessible drop-in child care services
                            during prenatal and postpartum appointments.
                        (B) Prioritization.--In selecting grant recipients
                    under this subsection, the Secretary shall give
                    priority to eligible organizations that operate in an
                    area, to the extent data with respect to such an area
                    are available--
                                (i) with high rates of adverse maternal
                            health outcomes; or
                                (ii) significant racial or ethnic
                            inequities in maternal health outcomes.
                (4) Timing.--The Secretary shall commence the grant program
            under paragraph (1) not later than 1 year after the date of
            enactment of this Act.
                (5) Reporting.--
                        (A) Grantees.--Each recipient of a grant under this
                    subsection shall annually submit to the Secretary and
                    make publicly available a report on the status of
                    activities conducted using the grant. Each such report
                    shall include--
                                (i) an analysis of the effect of the funded
                            program on prenatal and postpartum appointment
                            attendance rates;
                                (ii) summaries of qualitative assessments
                            of the funded program from--
                                        (I) pregnant and postpartum
                                    individuals participating in the
                                    program; and
                                        (II) the families of such
                                    individuals; and
                                (iii) such additional information as the
                            Secretary may require.
                        (B) Secretary.--Not later than the end of fiscal
                    year 2024, the Secretary shall submit to the Congress,
                    and make publicly available, a report containing the
                    following:
                                (i) A summary of the reports received under
                            subparagraph (A).
                                (ii) An assessment of the effects, if any,
                            of the funded programs on maternal health
                            outcomes, with a specific focus on racial and
                            ethnic inequities in such outcomes.
                                (iii) A description of actions the
                            Secretary can take to ensure that pregnant and
                            postpartum individuals eligible for medical
                            assistance under a State plan under title XIX
                            of the Social Security Act (42 U.S.C. 1936 et
                            seq.) have access to free and accessible drop-
                            in child care services during prenatal and
                            postpartum appointments, including
                            identification of the funding necessary to
                            carry out such actions.
                (6) Drop-in child care services defined.--In this
            subsection, the term ``drop-in child care services'' means
            child care and early childhood education services that are--
                        (A) delivered at a facility that meets the
                    requirements of all applicable laws and regulations of
                    the State or local government in which it is located,
                    including the licensing of the facility as a child care
                    facility; and
                        (B) provided in single encounters without requiring
                    full-time enrollment of a person in a child care
                    program.
                (7) Authorization of appropriations.--To carry out this
            subsection, there is authorized to be appropriated $5,000,000
            for the period of fiscal years 2023 through 2025.
        (g) Grants to Local Entities Addressing Social Determinants of
    Maternal Health.--
                (1) In general.--The Secretary of Health and Human Services
            (in this subsection referred to as the ``Secretary'') shall
            award grants to eligible entities to--
                        (A) address social determinants of maternal health
                    for pregnant and postpartum individuals; and
                        (B) eliminate racial and ethnic inequities in
                    maternal health outcomes.
                (2) Application.--To be eligible to receive a grant under
            this subsection an eligible entity shall submit to the
            Secretary an application at such time, in such manner, and
            containing such information as the Secretary may provide.
                (3) Prioritization.--In awarding grants under paragraph
            (1), the Secretary shall give priority to an eligible entity
            that--
                        (A) is, or will partner with, a community-based
                    organization to carrying out the activities under
                    paragraph (4);
                        (B) is operating in an area with high rates of
                    adverse maternal health outcomes or significant racial
                    or ethnic inequities in maternal health outcomes; and
                        (C) is operating in an area with a high poverty
                    rate.
                (4) Activities.--An eligible entity that receives a grant
            under this subsection may use funds received through the grant
            to--
                        (A) hire and retain staff;
                        (B) develop and distribute a list of available
                    resources with respect to social service programs in a
                    community;
                        (C) establish a resource center that provides
                    multiple social service programs in a single location;
                        (D) offer programs and resources in the communities
                    in which the respective eligible entities are located
                    to address social determinants of health for pregnant
                    and postpartum individuals; and
                        (E) consult with such pregnant and postpartum
                    individuals to conduct an assessment of the activities
                    under this paragraph.
                (5) Technical assistance.--The Secretary shall provide to
            grant recipients under this subsection technical assistance to
            plan for sustaining programs to address social determinants of
            maternal health among pregnant and postpartum individuals after
            the period of the grant.
                (6) Reporting.--
                        (A) Grantees.--Not later than 1 year after the date
                    on which an eligible entity first receives a grant
                    under this subsection, and annually thereafter, an
                    eligible entity shall submit to the Secretary, and make
                    publicly available, a report on the status of
                    activities conducted using the grant. Each such report
                    shall include data on the effects of such activities,
                    disaggregated by race, ethnicity, gender, and other
                    relevant factors.
                        (B) Secretary.--Not later than the end of fiscal
                    year 2026, the Secretary shall submit to Congress a
                    report that includes--
                                (i) a summary of the reports received under
                            subparagraph (A); and
                                (ii) recommendations for--
                                        (I) improving maternal health
                                    outcomes; and
                                        (II) reducing or eliminating racial
                                    and ethnic inequities in maternal
                                    health outcomes.
                (7) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this subsection $15,000,000 for
            each of fiscal years 2023 through 2027.
        (h) Definitions.--In this section:
                (1) Culturally congruent.--The term ``culturally
            congruent'', with respect to care or maternity care provided to
            a health care consumer, means care that is in agreement with
            the preferred cultural values, beliefs, worldview, language,
            and practices of the health care consumer and other relevant
            stakeholders.
                (2) Maternity care provider.--The term ``maternity care
            provider'' means a health care provider who--
                        (A) is a physician, physician assistant, midwife
                    who meets at a minimum the international definition of
                    the midwife and global standards for midwifery
                    education as established by the International
                    Confederation of Midwives, nurse practitioner, or
                    clinical nurse specialist; and
                        (B) has a focus on maternal or perinatal health.
                (3) Maternal mortality.--The term ``maternal mortality''
            means a death occurring during or within a one-year period
            after pregnancy, caused by pregnancy-related or childbirth
            complications, including a suicide, overdose, or other death
            resulting from a mental health or substance use disorder
            attributed to or aggravated by pregnancy-related or childbirth
            complications.
                (4) Perinatal health worker.--The term ``perinatal health
            worker'' means a doula, community health worker, peer
            supporter, breastfeeding and lactation educator or counselor,
            nutritionist or dietitian, childbirth educator, social worker,
            home visitor, language interpreter, or navigator.
                (5) Postpartum and postpartum period.--The terms
            ``postpartum'' and ``postpartum period'' refer to the 1-year
            period beginning on the last day of the pregnancy of an
            individual.
                (6) Racial and ethnic minority group.--The term ``racial
            and ethnic minority group'' has the meaning given such term in
            section 1707(g)(1) of the Public Health Service Act (42 U.S.C.
            300u-6(g)(1)).
                (7) Severe maternal morbidity.--The term ``severe maternal
            morbidity'' means a health condition, including mental health
            conditions and substance use disorders, attributed to or
            aggravated by pregnancy or childbirth that results in
            significant short-term or long-term consequences to the health
            of the individual who was pregnant.
                (8) Social determinants of maternal health defined.--The
            term ``social determinants of maternal health'' means non-
            clinical factors that impact maternal health outcomes,
            including--
                        (A) economic factors, which may include poverty,
                    employment, food security, support for and access to
                    lactation and other infant feeding options, housing
                    stability, and related factors;
                        (B) neighborhood factors, which may include quality
                    of housing, access to transportation, access to child
                    care, availability of healthy foods and nutrition
                    counseling, availability of clean water, air and water
                    quality, ambient temperatures, neighborhood crime and
                    violence, access to broadband, and related factors;
                        (C) social and community factors, which may include
                    systemic racism, gender discrimination or
                    discrimination based on other protected classes,
                    workplace conditions, incarceration, and related
                    factors;
                        (D) household factors, which may include ability to
                    conduct lead testing and abatement, car seat
                    installation, indoor air temperatures, and related
                    factors;
                        (E) education access and quality factors, which may
                    include educational attainment, language and literacy,
                    and related factors; and
                        (F) health care access factors, including health
                    insurance coverage, access to culturally congruent
                    health care services, providers, and non-clinical
                    support, access to home visiting services, access to
                    wellness and stress management programs, health
                    literacy, access to telehealth and items required to
                    receive telehealth services, and related factors.

    SEC. 5208. DATA TO SAVE MOMS.

        (a) Short Title.--This section may be cited as the ``Data to Save
    Moms Act''.
        (b) Funding for Maternal Mortality Review Committees To Promote
    Representative Community Engagement.--
                (1) In general.--Section 317K(d) of the Public Health
            Service Act (42 U.S.C. 247b-12(d)) is amended by adding at the
            end the following:
                ``(9) Grants to promote representative community engagement
            in maternal mortality review committees.--
                        ``(A) In general.--The Secretary may, using funds
                    made available pursuant to subparagraph (C), provide
                    assistance to an applicable maternal mortality review
                    committee of a State, Indian tribe, tribal
                    organization, or Urban Indian organization (as such
                    term is defined in section 4 of the Indian Health Care
                    Improvement Act (25 U.S.C. 1603))--
                                ``(i) to select for inclusion in the
                            membership of such a committee community
                            members from the State, Indian tribe, tribal
                            organization, or Urban Indian organization by--
                                        ``(I) prioritizing community
                                    members who can increase the diversity
                                    of the committee's membership with
                                    respect to race and ethnicity,
                                    location, and professional background,
                                    including members with non-clinical
                                    experiences; and
                                        ``(II) to the extent applicable,
                                    using funds reserved under subsection
                                    (f), to address barriers to maternal
                                    mortality review committee
                                    participation for community members,
                                    including through providing required
                                    training, reducing transportation
                                    barriers, providing compensation, and
                                    providing other supports as may be
                                    necessary;
                                ``(ii) to establish initiatives to conduct
                            outreach and community engagement efforts
                            within communities throughout the State or
                            Tribe to seek input from community members on
                            the work of such maternal mortality review
                            committee, with a particular focus on outreach
                            to people who are members of minority groups;
                            and
                                ``(iii) to release public reports
                            assessing--
                                        ``(I) the pregnancy-related death
                                    and pregnancy-associated death review
                                    processes of the maternal mortality
                                    review committee, with a particular
                                    focus on the maternal mortality review
                                    committee's sensitivity to the unique
                                    circumstances of pregnant and
                                    postpartum individuals from racial and
                                    ethnic minority groups (as such term is
                                    defined in section 1707(g)(1)) who have
                                    suffered pregnancy-related deaths; and
                                        ``(II) the impact of the use of
                                    funds made available pursuant to
                                    paragraph (C) on increasing the
                                    diversity of the maternal mortality
                                    review committee membership and
                                    promoting community engagement efforts
                                    throughout the State or Tribe.
                        ``(B) Technical assistance.--The Secretary shall
                    provide (either directly through the Department of
                    Health and Human Services or by contract) technical
                    assistance to any maternal mortality review committee
                    receiving a grant under this paragraph on best
                    practices for increasing the diversity of the maternal
                    mortality review committee's membership and for
                    conducting effective community engagement throughout
                    the State or Tribe.
                        ``(C) Authorization of appropriations.--In addition
                    to any funds made available under subsection (f), there
                    are authorized to be appropriated to carry out this
                    paragraph $10,000,000 for each of fiscal years 2023
                    through 2027.''.
                (2) Reservation of funds.--Section 317K(f) of the Public
            Health Service Act (42 U.S.C. 247b-12(f)) is amended by adding
            at the end the following: ``Of the amount made available under
            the preceding sentence for a fiscal year, not less than
            $1,500,000 shall be reserved for grants awarded under
            subsection (d)(9) to Indian tribes, tribal organizations, or
            Urban Indian organizations (as those terms are defined in
            section 4 of the Indian Health Care Improvement Act (25 U.S.C.
            1603)).''.
        (c) Data Collection and Review.--Section 317K(d)(3)(A)(i) of the
    Public Health Service Act (42 U.S.C. 247b-12(d)(3)(A)(i)) is amended--
                (1) by redesignating subclauses (II) and (III) as
            subclauses (V) and (VI), respectively; and
                (2) by inserting after subclause (I) the following:
                                        ``(II) to the extent practicable,
                                    reviewing cases of severe maternal
                                    morbidity, according to the most up-to-
                                    date indicators;
                                        ``(III) to the extent practicable,
                                    reviewing deaths during pregnancy or up
                                    to 1 year after the end of a pregnancy
                                    from suicide, overdose, or other death
                                    from a mental health condition or
                                    substance use disorder attributed to,
                                    or aggravated by, pregnancy or
                                    childbirth complications;
                                        ``(IV) to the extent practicable,
                                    consulting with local community-based
                                    organizations representing pregnant and
                                    postpartum individuals from demographic
                                    groups disproportionately impacted by
                                    poor maternal health outcomes to ensure
                                    that, in addition to clinical factors,
                                    non-clinical factors that might have
                                    contributed to a pregnancy-related
                                    death are appropriately considered;''.
        (d) Review of Maternal Health Data Collection Processes and Quality
    Measures.--
                (1) In general.--The Secretary of Health and Human
            Services, acting through the Administrator for Centers for
            Medicare & Medicaid Serves and the Director of the Agency for
            Healthcare Research and Quality, shall consult with relevant
            stakeholders--
                        (A) to review existing maternal health data
                    collection processes and quality measures; and
                        (B) make recommendations to improve such processes
                    and measures, including topics described under
                    paragraph (3).
                (2) Collaboration.--In carrying out this subsection, the
            Secretary shall consult with a diverse group of maternal health
            stakeholders, which may include--
                        (A) pregnant and postpartum individuals and their
                    family members, and nonprofit organizations
                    representing such individuals, with a particular focus
                    on patients from racial and ethnic minority groups;
                        (B) community-based organizations that provide
                    support for pregnant and postpartum individuals, with a
                    particular focus on patients from racial and ethnic
                    minority groups;
                        (C) membership organizations for maternity care
                    providers;
                        (D) organizations representing perinatal health
                    workers;
                        (E) organizations that focus on maternal mental or
                    behavioral health;
                        (F) organizations that focus on intimate partner
                    violence;
                        (G) institutions of higher education, with a
                    particular focus on minority-serving institutions;
                        (H) licensed and accredited hospitals, birth
                    centers, midwifery practices, or other medical
                    practices that provide maternal health care services to
                    pregnant and postpartum patients;
                        (I) relevant State and local public agencies,
                    including State maternal mortality review committees;
                    and
                        (J) the National Quality Forum, or such other
                    standard-setting organizations specified by the
                    Secretary.
                (3) Topics.--The review of maternal health data collection
            processes and recommendations to improve such processes and
            measures required under paragraph (1) shall assess all
            available relevant information, including information from
            State-level sources, and shall consider at least the following:
                        (A) Current State and Tribal practices for maternal
                    health, maternal mortality, and severe maternal
                    morbidity data collection and dissemination, including
                    consideration of--
                                (i) the timeliness of processes for
                            amending a death certificate when new
                            information pertaining to the death becomes
                            available to reflect whether the death was a
                            pregnancy-related death;
                                (ii) relevant data collected with
                            electronic health records, including data on
                            race, ethnicity, socioeconomic status,
                            insurance type, and other relevant demographic
                            information;
                                (iii) maternal health data collected and
                            publicly reported by hospitals, health systems,
                            midwifery practices, and birth centers;
                                (iv) the barriers preventing States from
                            correlating maternal outcome data with race and
                            ethnicity data;
                                (v) processes for determining the cause of
                            a pregnancy-associated death in States that do
                            not have a maternal mortality review committee;
                                (vi) whether maternal mortality review
                            committees include multidisciplinary and
                            diverse membership (as described in section
                            317K(d)(1)(A) of the Public Health Service Act
                            (42 U.S.C. 247b-12(d)(1)(A)));
                                (vii) whether members of maternal mortality
                            review committees participate in trainings on
                            bias, racism, or discrimination, and the
                            quality of such trainings;
                                (viii) the extent to which States have
                            implemented systematic processes of listening
                            to the stories of pregnant and postpartum
                            individuals and their family members, with a
                            particular focus on pregnant and postpartum
                            individuals from racial and ethnic minority
                            groups (as such term is defined in section
                            1707(g)(1) of the Public Health Service Act (42
                            U.S.C. 300u-6(g)(1))) and their family members,
                            to fully understand the causes of, and inform
                            potential solutions to, the maternal mortality
                            and severe maternal morbidity crisis within
                            their respective States;
                                (ix) the extent to which maternal mortality
                            review committees are considering social
                            determinants of maternal health when examining
                            the causes of pregnancy-associated and
                            pregnancy-related deaths;
                                (x) the extent to which maternal mortality
                            review committees are making actionable
                            recommendations based on their reviews of
                            adverse maternal health outcomes and the extent
                            to which such recommendations are being
                            implemented by appropriate stakeholders;
                                (xi) the legal and administrative barriers
                            preventing the collection, collation, and
                            dissemination of State maternity care data;
                                (xii) the effectiveness of data collection
                            and reporting processes in separating
                            pregnancy-associated deaths from pregnancy-
                            related deaths; and
                                (xiii) the current Federal, State, local,
                            and Tribal funding support for the activities
                            referred to in clauses (i) through (xii).
                        (B) Whether the funding support referred to in
                    subparagraph (A)(xiii) is adequate for States to carry
                    out optimal data collection and dissemination processes
                    with respect to maternal health, maternal mortality,
                    and severe maternal morbidity.
                        (C) Current quality measures for maternity care,
                    including prenatal measures, labor and delivery
                    measures, and postpartum measures, including topics
                    such as--
                                (i) effective quality measures for
                            maternity care used by hospitals, health
                            systems, midwifery practices, birth centers,
                            health plans, and other relevant entities;
                                (ii) the sufficiency of current outcome
                            measures used to evaluate maternity care for
                            driving improved care, experiences, and
                            outcomes in maternity care payment and delivery
                            system models;
                                (iii) maternal health quality measures that
                            other countries effectively use;
                                (iv) validated measures that have been used
                            for research purposes that could be tested,
                            refined, and submitted for national
                            endorsement;
                                (v) barriers preventing maternity care
                            providers and insurers from implementing
                            quality measures that are aligned with best
                            practices;
                                (vi) the frequency with which maternity
                            care quality measures are reviewed and revised;
                                (vii) the strengths and weaknesses of the
                            Prenatal and Postpartum Care measures of the
                            Health Plan Employer Data and Information Set
                            measures established by the National Committee
                            for Quality Assurance;
                                (viii) the strengths and weaknesses of
                            maternity care quality measures under the
                            Medicaid program under title XIX of the Social
                            Security Act (42 U.S.C. 1396 et seq.) and the
                            Children's Health Insurance Program under title
                            XXI of such Act (42 U.S.C. 1397 et seq.),
                            including the extent to which States
                            voluntarily report relevant measures;
                                (ix) the extent to which maternity care
                            quality measures are informed by patient
                            experiences that include measures of patient-
                            reported experience of care;
                                (x) the current processes for collecting
                            stratified data on the race and ethnicity of
                            pregnant and postpartum individuals in
                            hospitals, health systems, midwifery practices,
                            and birth centers, and for incorporating such
                            racially and ethnically stratified data in
                            maternity care quality measures;
                                (xi) the extent to which maternity care
                            quality measures account for the unique
                            experiences of pregnant and postpartum
                            individuals from racial and ethnic minority
                            groups (as such term is defined in section
                            1707(g)(1) of the Public Health Service Act (42
                            U.S.C. 300u-6(g)(1))); and
                                (xii) the extent to which hospitals, health
                            systems, midwifery practices, and birth centers
                            are implementing existing maternity care
                            quality measures.
                        (D) Recommendations on authorizing additional funds
                    and providing additional technical assistance to
                    improve maternal mortality review committees and State
                    and Tribal maternal health data collection and
                    reporting processes.
                        (E) Recommendations for new authorities that may be
                    granted to maternal mortality review committees to be
                    able to--
                                (i) access records from other Federal and
                            State agencies and departments that may be
                            necessary to identify causes of pregnancy-
                            associated and pregnancy-related deaths that
                            are unique to pregnant and postpartum
                            individuals from specific populations, such as
                            veterans and individuals who are incarcerated;
                            and
                                (ii) work with relevant experts who are not
                            members of the maternal mortality review
                            committee to assist in the review of pregnancy-
                            associated deaths of pregnant and postpartum
                            individuals from specific populations, such as
                            veterans and individuals who are incarcerated.
                        (F) Recommendations to improve and standardize
                    current quality measures for maternity care, with a
                    particular focus on racial and ethnic inequities in
                    maternal health outcomes.
                        (G) Recommendations to improve the coordination by
                    the Department of Health and Human Services of the
                    efforts undertaken by the agencies and organizations
                    within the Department related to maternal health data
                    and quality measures.
                (4) Report.--Not later than 1 year after the date of the
            enactment of this Act, the Secretary shall submit to the
            Congress, and make publicly available, a report on the results
            of the review of maternal health data collection processes and
            quality measures and recommendations to improve such processes
            and measures required under paragraph (1).
                (5) Definitions.--In this subsection:
                        (A) Maternal mortality review committee.--The term
                    ``maternal mortality review committee'' means a
                    maternal mortality review committee duly authorized by
                    a State and receiving funding under section
                    317k(a)(2)(D) of the Public Health Service Act (42
                    U.S.C. 247b-12(a)(2)(D)).
                        (B) Pregnancy-associated death.--The term
                    ``pregnancy-associated'', with respect to a death,
                    means a death of a pregnant or postpartum individual,
                    by any cause, that occurs during, or within 1 year
                    following, the individual's pregnancy, regardless of
                    the outcome, duration, or site of the pregnancy.
                        (C) Pregnancy-related death.--The term ``pregnancy-
                    related'', with respect to a death, means a death of a
                    pregnant or postpartum individual that occurs during,
                    or within 1 year following, the individual's pregnancy,
                    from a pregnancy complication, a chain of events
                    initiated by pregnancy, or the aggravation of an
                    unrelated condition by the physiologic effects of
                    pregnancy.
                (6) Authorization of appropriations.--There are authorized
            to be appropriated such sums as may be necessary to carry out
            this subsection for each of fiscal years 2023 through 2027.
        (e) Indian Health Service Study on Maternal Mortality and Severe
    Maternal Morbidity.--
                (1) In general.--The Director of the Indian Health Service
            (referred to in this subsection as the ``Director'') shall, in
            coordination with entities described in paragraph (2)--
                        (A) not later than 90 days after the enactment of
                    this Act, enter into a contract with an independent
                    research organization or Tribal Epidemiology Center to
                    conduct a comprehensive study on maternal mortality and
                    severe maternal morbidity in the populations of
                    American Indian and Alaska Native individuals; and
                        (B) not later than 3 years after the date of the
                    enactment of this Act, submit to Congress a report on
                    such study that contains recommendations for policies
                    and practices that can be adopted to improve maternal
                    health outcomes for pregnant and postpartum American
                    Indian and Alaska Native individuals.
                (2) Participating entities.--The entities described in this
            paragraph shall consist of 12 members, selected by the Director
            from among individuals nominated by Indian Tribes and Tribal
            organizations (as such terms are defined in section 4 of the
            Indian Self-Determination and Education Assistance Act (25
            U.S.C. 5304)), and Urban Indian organizations (as such term is
            defined in section 4 of the Indian Health Care Improvement Act
            (25 U.S.C. 1603)). In selecting such members, the Director
            shall ensure that each of the 12 service areas of the Indian
            Health Service is represented.
                (3) Contents of study.--The study conducted pursuant to
            paragraph (1) shall--
                        (A) examine the causes of maternal mortality and
                    severe maternal morbidity that are unique to American
                    Indian and Alaska Native individuals;
                        (B) include a systematic process of listening to
                    the stories of American Indian and Alaska Native
                    pregnant and postpartum individuals to fully understand
                    the causes of, and inform potential solutions to, the
                    maternal mortality and severe maternal morbidity crisis
                    within their respective communities;
                        (C) distinguish between the causes of, landscape of
                    maternity care at, and recommendations to improve
                    maternal health outcomes within, the different settings
                    in which American Indian and Alaska Native pregnant and
                    postpartum individuals receive maternity care, such
                    as--
                                (i) facilities operated by the Indian
                            Health Service;
                                (ii) an Indian health program operated by
                            an Indian Tribe or Tribal organization pursuant
                            to a contract, grant, cooperative agreement, or
                            compact with the Indian Health Service pursuant
                            to the Indian Self-Determination Act; and
                                (iii) an Urban Indian health program
                            operated by an Urban Indian organization
                            pursuant to a grant or contract with the Indian
                            Health Service pursuant to title V of the
                            Indian Health Care Improvement Act;
                        (D) review processes for coordinating programs of
                    the Indian Health Service with social services provided
                    through other programs administered by the Secretary of
                    Health and Human Services (other than the Medicare
                    program under title XVIII of the Social Security Act
                    (42 U.S.C. 1395 et seq.), the Medicaid program under
                    title XIX of such Act (42 U.S.C. 1396 et seq.), and the
                    Children's Health Insurance Program under title XXI of
                    such Act (42 U.S.C. 1397aa et seq.));
                        (E) review current data collection and quality
                    measurement processes and practices;
                        (F) assess causes and frequency of maternal mental
                    health conditions and substance use disorders;
                        (G) consider social determinants of health,
                    including poverty, lack of health insurance,
                    unemployment, sexual violence, and environmental
                    conditions in Tribal areas;
                        (H) consider the role that historical mistreatment
                    of American Indian and Alaska Native people has played
                    in causing currently high rates of maternal mortality
                    and severe maternal morbidity;
                        (I) consider how current funding of the Indian
                    Health Service affects the ability of the Service to
                    deliver quality maternity care;
                        (J) consider the extent to which the delivery of
                    maternity care services is culturally appropriate for
                    American Indian and Alaska Native pregnant and
                    postpartum individuals;
                        (K) make recommendations to reduce
                    misclassification of American Indian and Alaska Native
                    pregnant and postpartum individuals, including
                    consideration of best practices in training for
                    maternal mortality review committee members to be able
                    to correctly classify American Indian and Alaska Native
                    individuals; and
                        (L) make recommendations informed by the stories
                    shared by American Indian and Alaska Native pregnant
                    and postpartum individuals pursuant to subparagraph (B)
                    to improve maternal health outcomes for such
                    individuals.
                (4) Report.--The agreement entered into under paragraph (1)
            with an independent research organization or Tribal
            Epidemiology Center shall require that the organization or
            center transmit to Congress a report on the results of the
            study conducted pursuant to that agreement not later than 36
            months after the date of the enactment of this Act.
                (5) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this subsection $2,000,000 for
            each of fiscal years 2023 through 2025.
        (f) Grants to Minority-Serving Institutions To Study Maternal
    Mortality, Severe Maternal Morbidity, and Other Adverse Maternal Health
    Outcomes.--
                (1) In general.--The Secretary of Health and Human Services
            shall establish a program under which the Secretary shall award
            grants to research centers, health professions schools and
            programs, and other entities at minority-serving institutions
            to study specific aspects of the maternal health crisis among
            pregnant and postpartum individuals from racial and ethnic
            minority groups. Such research may--
                        (A) include the development and implementation of
                    systematic processes of listening to the stories of
                    pregnant and postpartum individuals from racial and
                    ethnic minority groups, and perinatal health workers
                    supporting such individuals, to fully understand the
                    causes of, and inform potential solutions to, the
                    maternal mortality and severe maternal morbidity crisis
                    within their respective communities;
                        (B) assess the potential causes of relatively low
                    rates of maternal mortality among Hispanic individuals,
                    including potential racial misclassification and other
                    data collection and reporting issues that might be
                    misrepresenting maternal mortality rates among Hispanic
                    individuals in the United States; and
                        (C) assess differences in rates of adverse maternal
                    health outcomes among subgroups identifying as
                    Hispanic.
                (2) Application.--To be eligible to receive a grant under
            paragraph (1), an entity described in such paragraph shall
            submit to the Secretary an application at such time, in such
            manner, and containing such information as the Secretary may
            require.
                (3) Technical assistance.--The Secretary may use not more
            than 10 percent of the funds made available under paragraph
            (7)--
                        (A) to conduct outreach to minority-serving
                    institutions to raise awareness of the availability of
                    grants under this paragraph (1);
                        (B) to provide technical assistance in the
                    application process for such a grant; and
                        (C) to promote capacity building, as needed to
                    enable entities described in such paragraph to submit
                    such an application.
                (4) Reporting requirement.--Each entity awarded a grant
            under this subsection shall periodically submit to the
            Secretary a report on the status of activities conducted using
            the grant.
                (5) Evaluation.--Beginning one year after the date on which
            the first grant is awarded under this subsection, the Secretary
            shall submit to Congress an annual report summarizing the
            findings of research conducted using funds made available under
            this subsection.
                (6) Minority-serving institutions defined.--In this
            subsection, the term ``minority-serving institution'' has the
            meaning given the term in section 371(a) of the Higher
            Education Act of 1965 (20 U.S.C. 1067q(a)).
                (7) Authorization of appropriations.--There are authorized
            to be appropriated to carry out this subsection $10,000,000 for
            each of fiscal years 2023 through 2027.
        (g) Definitions.--In this section:
                (1) Culturally congruent.--The term ``culturally
            congruent'', with respect to care or maternity care, means care
            that is in agreement with the preferred cultural values,
            beliefs, worldview, language, and practices of the health care
            consumer and other stakeholders.
                (2) Maternity care provider.--The term ``maternity care
            provider'' means a health care provider who--
                        (A) is a physician, physician assistant, midwife
                    who meets at a minimum the international definition of
                    the midwife and global standards for midwifery
                    education as established by the International
                    Confederation of Midwives, nurse practitioner, or
                    clinical nurse specialist; and
                        (B) has a focus on maternal or perinatal health.
                (3) Maternal mortality.--The term ``maternal mortality''
            means a death occurring during or within a one-year period
            after pregnancy, caused by pregnancy-related or childbirth
            complications, including a suicide, overdose, or other death
            resulting from a mental health or substance use disorder
            attributed to or aggravated by pregnancy-related or childbirth
            complications.
                (4) Perinatal health worker.--The term ``perinatal health
            worker'' means a doula, community health worker, peer
            supporter, breastfeeding and lactation educator or counselor,
            nutritionist or dietitian, childbirth educator, social worker,
            home visitor, language interpreter, or navigator.
                (5) Postpartum and postpartum period.--The terms
            ``postpartum'' and ``postpartum period'' refer to the 1-year
            period beginning on the last day of the pregnancy of an
            individual.
                (6) Pregnancy-associated death.--The term ``pregnancy-
            associated death'' means a death of a pregnant or postpartum
            individual, by any cause, that occurs during, or within 1 year
            following, the individual's pregnancy, regardless of the
            outcome, duration, or site of the pregnancy.
                (7) Pregnancy-related death.--The term ``pregnancy-related
            death'' means a death of a pregnant or postpartum individual
            that occurs during, or within 1 year following, the
            individual's pregnancy, from a pregnancy complication, a chain
            of events initiated by pregnancy, or the aggravation of an
            unrelated condition by the physiologic effects of pregnancy.
                (8) Racial and ethnic minority group.--The term ``racial
            and ethnic minority group'' has the meaning given such term in
            section 1707(g)(1) of the Public Health Service Act (42 U.S.C.
            300u-6(g)(1)).
                (9) Severe maternal morbidity.--The term ``severe maternal
            morbidity'' means a health condition, including mental health
            conditions and substance use disorders, attributed to or
            aggravated by pregnancy or childbirth that results in
            significant short-term or long-term consequences to the health
            of the individual who was pregnant.
                (10) Social determinants of maternal health defined.--The
            term ``social determinants of maternal health'' means non-
            clinical factors that impact maternal health outcomes,
            including--
                        (A) economic factors, which may include poverty,
                    employment, food security, support for and access to
                    lactation and other infant feeding options, housing
                    stability, and related factors;
                        (B) neighborhood factors, which may include quality
                    of housing, access to transportation, access to child
                    care, availability of healthy foods and nutrition
                    counseling, availability of clean water, air and water
                    quality, ambient temperatures, neighborhood crime and
                    violence, access to broadband, and related factors;
                        (C) social and community factors, which may include
                    systemic racism, gender discrimination or
                    discrimination based on other protected classes,
                    workplace conditions, incarceration, and related
                    factors;
                        (D) household factors, which may include ability to
                    conduct lead testing and abatement, car seat
                    installation, indoor air temperatures, and related
                    factors;
                        (E) education access and quality factors, which may
                    include educational attainment, language and literacy,
                    and related factors; and
                        (F) health care access factors, including health
                    insurance coverage, access to culturally congruent
                    health care services, providers, and non-clinical
                    support, access to home visiting services, access to
                    wellness and stress management programs, health
                    literacy, access to telehealth and items required to
                    receive telehealth services, and related factors.

    SEC. 5209. KIRA JOHNSON ACT.

        (a) Investments in Community-Based Organizations To Improve Black
    Maternal Health Outcomes.--
                (1) Awards.--Following the 1-year period described in
            paragraph (3), the Secretary of Health and Human Services (in
            this subsection referred to as the ``Secretary'') shall award
            grants to eligible entities to establish or expand programs to
            prevent maternal mortality and severe maternal morbidity among
            Black pregnant and postpartum individuals.
                (2) Eligibility.--To be eligible to seek a grant under this
            subsection, an entity shall be a community-based organization
            offering programs and resources aligned with evidence-based
            practices for improving maternal health outcomes for Black
            pregnant and postpartum individuals.
                (3) Outreach and technical assistance period.--During the
            1-year period beginning on the date of enactment of this Act,
            the Secretary shall--
                        (A) conduct outreach to encourage eligible entities
                    to apply for grants under this subsection; and
                        (B) provide technical assistance to eligible
                    entities on best practices for applying for grants
                    under this subsection.
                (4) Special consideration.--
                        (A) Outreach.--In conducting outreach under
                    paragraph (3), the Secretary shall give special
                    consideration to eligible entities that--
                                (i) are based in, and provide support for,
                            communities with high rates of adverse maternal
                            health outcomes or significant racial and
                            ethnic inequities in maternal health outcomes,
                            to the extent such data are available;
                                (ii) are led by Black people; and
                                (iii) offer programs and resources that are
                            aligned with evidence-based practices for
                            improving maternal health outcomes for Black
                            pregnant and postpartum individuals.
                        (B) Awards.--In awarding grants under this
                    subsection, the Secretary shall give special
                    consideration to eligible entities that--
                                (i) are described in clauses (i), (ii), and
                            (iii) of subparagraph (A);
                                (ii) offer programs and resources designed
                            in consultation with and intended for Black
                            pregnant and postpartum individuals; and
                                (iii) offer programs and resources in the
                            communities in which the respective eligible
                            entities are located that--
                                        (I) promote maternal mental health
                                    and maternal substance use disorder
                                    treatments and supports that are
                                    aligned with evidence-based practices
                                    for improving maternal mental and
                                    behavioral health outcomes for Black
                                    pregnant and postpartum individuals;
                                        (II) address social determinants of
                                    maternal health for pregnant and
                                    postpartum individuals;
                                        (III) promote evidence-based health
                                    literacy and pregnancy, childbirth, and
                                    parenting education for pregnant and
                                    postpartum individuals;
                                        (IV) provide support from perinatal
                                    health workers to pregnant and
                                    postpartum individuals;
                                        (V) provide culturally congruent
                                    training to perinatal health workers;
                                        (VI) conduct or support research on
                                    maternal health issues
                                    disproportionately impacting Black
                                    pregnant and postpartum individuals;
                                        (VII) provide support to family
                                    members of individuals who suffered a
                                    pregnancy-associated death or
                                    pregnancy-related death; or
                                        (VIII) operate midwifery practices
                                    that provide culturally congruent
                                    maternal health care and support,
                                    including for the purposes of--
                                                (aa) supporting additional
                                            education, training, and
                                            certification programs,
                                            including support for distance
                                            learning;
                                                (bb) providing financial
                                            support to current and future
                                            midwives to address education
                                            costs, debts, and other needs;
                                                (cc) clinical site
                                            investments;
                                                (dd) supporting preceptor
                                            development trainings;
                                                (ee) expanding the
                                            midwifery practice; or
                                                (ff) related needs
                                            identified by the midwifery
                                            practice and described in the
                                            practice's application; or
                                        (IX) have developed other programs
                                    and resources that address community-
                                    specific needs for pregnant and
                                    postpartum individuals and are aligned
                                    with evidence-based practices for
                                    improving maternal health outcomes for
                                    Black pregnant and postpartum
                                    individuals.
                (5) Technical assistance.--The Secretary shall provide to
            grant recipients under this subsection technical assistance
            on--
                        (A) capacity building to establish or expand
                    programs to prevent adverse maternal health outcomes
                    among Black pregnant and postpartum individuals;
                        (B) best practices in data collection, measurement,
                    evaluation, and reporting; and
                        (C) planning for sustaining programs to prevent
                    maternal mortality and severe maternal morbidity among
                    Black pregnant and postpartum individuals after the
                    period of the grant.
                (6) Evaluation.--Not later than the end of fiscal year
            2026, the Secretary shall submit to the Congress an evaluation
            of the grant program under this subsection that--
                        (A) assesses the effectiveness of outreach efforts
                    during the application process in diversifying the pool
                    of grant recipients;
                        (B) makes recommendations for future outreach
                    efforts to diversify the pool of grant recipients for
                    Department of Health and Human Services grant programs
                    and funding opportunities related to maternal health;
                        (C) assesses the effectiveness of programs funded
                    by grants under this subsection in improving maternal
                    health outcomes for Black pregnant and postpartum
                    individuals, to the extent practicable; and
                        (D) makes recommendations for future Department of
                    Health and Human Services grant programs and funding
                    opportunities that deliver funding to community-based
                    organizations that provide programs and resources that
                    are aligned with evidence-based practices for improving
                    maternal health outcomes for Black pregnant and
                    postpartum individuals.
                (7) Authorization of appropriations.--To carry out this
            subsection, there is authorized to be appropriated $10,000,000
            for each of fiscal years 2023 through 2027.
        (b) Investments in Community-Based Organizations To Improve
    Maternal Health Outcomes in Underserved Communities.--
                (1) Awards.--Following the 1-year period described in
            paragraph (3), the Secretary of Health and Human Services (in
            this subsection referred to as the ``Secretary'') shall award
            grants to eligible entities to establish or expand programs to
            prevent maternal mortality and severe maternal morbidity among
            underserved groups.
                (2) Eligibility.--To be eligible to seek a grant under this
            subsection, an entity shall be a community-based organization
            offering programs and resources aligned with evidence-based
            practices for improving maternal health outcomes for pregnant
            and postpartum individuals.
                (3) Outreach and technical assistance period.--During the
            1-year period beginning on the date of enactment of this Act,
            the Secretary shall--
                        (A) conduct outreach to encourage eligible entities
                    to apply for grants under this subsection; and
                        (B) provide technical assistance to eligible
                    entities on best practices for applying for grants
                    under this subsection.
                (4) Special consideration.--
                        (A) Outreach.--In conducting outreach under
                    paragraph (3), the Secretary shall give special
                    consideration to eligible entities that--
                                (i) are based in, and provide support for,
                            communities with high rates of adverse maternal
                            health outcomes or significant racial and
                            ethnic inequities in maternal health outcomes,
                            to the extent such data are available;
                                (ii) are led by individuals from racially,
                            ethnically, and geographically diverse
                            backgrounds; and
                                (iii) offer programs and resources that are
                            aligned with evidence-based practices for
                            improving maternal health outcomes for pregnant
                            and postpartum individuals.
                        (B) Awards.--In awarding grants under this
                    subsection, the Secretary shall give special
                    consideration to eligible entities that--
                                (i) are described in clauses (i), (ii), and
                            (iii) of subparagraph (A);
                                (ii) offer programs and resources designed
                            in consultation with and intended for pregnant
                            and postpartum individuals from underserved
                            groups; and
                                (iii) offer programs and resources in the
                            communities in which the respective eligible
                            entities are located that--
                                        (I) promote maternal mental health
                                    and maternal substance use disorder
                                    treatments and support that are aligned
                                    with evidence-based practices for
                                    improving maternal mental and
                                    behavioral health outcomes for pregnant
                                    and postpartum individuals;
                                        (II) address social determinants of
                                    maternal health for pregnant and
                                    postpartum individuals;
                                        (III) promote evidence-based health
                                    literacy and pregnancy, childbirth, and
                                    parenting education for pregnant and
                                    postpartum individuals;
                                        (IV) provide support from perinatal
                                    health workers to pregnant and
                                    postpartum individuals;
                                        (V) provide culturally congruent
                                    training to perinatal health workers;
                                        (VI) conduct or support research on
                                    maternal health outcomes and
                                    inequities;
                                        (VII) provide support to family
                                    members of individuals who suffered a
                                    pregnancy-associated death or
                                    pregnancy-related death; or
                                        (VIII) operate midwifery practices
                                    that provide culturally congruent
                                    maternal health care and support,
                                    including for the purposes of--
                                                (aa) supporting additional
                                            education, training, and
                                            certification programs,
                                            including support for distance
                                            learning;
                                                (bb) providing financial
                                            support to current and future
                                            midwives to address education
                                            costs, debts, and other needs;
                                                (cc) clinical site
                                            investments;
                                                (dd) supporting preceptor
                                            development trainings;
                                                (ee) expanding the
                                            midwifery practice; or
                                                (ff) related needs
                                            identified by the midwifery
                                            practice and described in the
                                            practice's application; or
                                (iv) have developed other programs and
                            resources that address community-specific needs
                            for pregnant and postpartum individuals and are
                            aligned with evidence-based practices for
                            improving maternal health outcomes for pregnant
                            and postpartum individuals.
                (5) Technical assistance.--The Secretary shall provide to
            grant recipients under this subsection technical assistance
            on--
                        (A) capacity building to establish or expand
                    programs to prevent adverse maternal health outcomes
                    among pregnant and postpartum individuals from
                    underserved groups;
                        (B) best practices in data collection, measurement,
                    evaluation, and reporting; and
                        (C) planning for sustaining programs to prevent
                    maternal mortality and severe maternal morbidity among
                    pregnant and postpartum individuals from underserved
                    groups after the period of the grant.
                (6) Evaluation.--Not later than the end of fiscal year
            2026, the Secretary shall submit to the Congress an evaluation
            of the grant program under this subsection that--
                        (A) assesses the effectiveness of outreach efforts
                    during the application process in diversifying the pool
                    of grant recipients;
                        (B) makes recommendations for future outreach
                    efforts to diversify the pool of grant recipients for
                    Department of Health and Human Services grant programs
                    and funding opportunities related to maternal health;
                        (C) assesses the effectiveness of programs funded
                    by grants under this subsection in improving maternal
                    health outcomes for pregnant and postpartum individuals
                    from underserved groups, to the extent practicable; and
                        (D) makes recommendations for future Department of
                    Health and Human Services grant programs and funding
                    opportunities that deliver funding to community-based
                    organizations that provide programs and resources that
                    are aligned with evidence-based practices for improving
                    maternal health outcomes for pregnant and postpartum
                    individuals.
                (7) Definition.--In this subsection, the term ``underserved
            groups'' refers to pregnant and postpartum individuals--
                        (A) from racial and ethnic minority groups (as such
                    term is defined in section 1707(g)(1) of the Public
                    Health Service Act (42 U.S.C. 300u-6(g)(1)));
                        (B) whose household income is equal to or less than
                    150 percent of the Federal poverty line;
                        (C) who live in health professional shortage areas
                    (as such term is defined in section 332 of the Public
                    Health Service Act (42 U.S.C. 254e));
                        (D) who live in counties with no hospital offering
                    obstetric care, no birth center, and no obstetric
                    provider; or
                        (E) who live in counties with a level of
                    vulnerability of moderate-to-high or higher, according
                    to the Social Vulnerability Index of the Centers for
                    Disease Control and Prevention.
                (8) Authorization of appropriations.--To carry out this
            subsection, there is authorized to be appropriated $10,000,000
            for each of fiscal years 2023 through 2027.
        (c) Respectful Maternity Care Training for All Employees in
    Maternity Care Settings.--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 new section:

    ``SEC. 742. RESPECTFUL MATERNITY CARE TRAINING FOR ALL EMPLOYEES IN
                  MATERNITY CARE SETTINGS.

        ``(a) Grants.--The Secretary shall award grants for programs to
    reduce and prevent bias, racism, and discrimination in maternity care
    settings and to advance respectful, culturally congruent, trauma-
    informed care.
        ``(b) Special Consideration.--In awarding grants under subsection
    (a), the Secretary shall give special consideration to applications for
    programs that would--
                ``(1) apply to all maternity care providers and any
            employees who interact with pregnant and postpartum individuals
            in the provider setting, including front desk employees,
            sonographers, schedulers, health care professionals, hospital
            or health system administrators, security staff, and other
            employees;
                ``(2) emphasize periodic, as opposed to one-time, trainings
            for all birthing professionals and employees described in
            paragraph (1);
                ``(3) address implicit bias, racism, and cultural humility;
                ``(4) be delivered in ongoing education settings for
            providers maintaining their licenses, with a preference for
            trainings that provide continuing education units;
                ``(5) include trauma-informed care best practices and an
            emphasis on shared decision making between providers and
            patients;
                ``(6) include antiracism training and programs;
                ``(7) be delivered in undergraduate programs that funnel
            into health professions schools;
                ``(8) be delivered in settings that apply to providers of
            the special supplemental nutrition program for women, infants,
            and children under section 17 of the Child Nutrition Act of
            1966;
                ``(9) integrate bias training in obstetric emergency
            simulation trainings or related trainings;
                ``(10) include training for emergency department employees
            and emergency medical technicians on recognizing warning signs
            for severe pregnancy-related complications;
                ``(11) offer training to all maternity care providers on
            the value of racially, ethnically, and professionally diverse
            maternity care teams to provide culturally congruent care; or
                ``(12) be based on one or more programs designed by a
            historically Black college or university or other minority-
            serving institution.
        ``(c) Application.--To seek a grant under subsection (a), an entity
    shall submit an application at such time, in such manner, and
    containing such information as the Secretary may require.
        ``(d) Reporting to Secretary.--Each recipient of a grant under this
    section shall annually submit to the Secretary a report on the status
    of activities conducted using the grant, including, as applicable, a
    description of the impact of training provided through the grant on
    patient outcomes and patient experience for pregnant and postpartum
    individuals from racial and ethnic minority groups and their families.
        ``(e) Dissemination of Findings.--Based on the annual reports
    submitted pursuant to subsection (d), the Secretary--
                ``(1) shall produce an annual report on the findings
            resulting from programs funded through this section;
                ``(2) shall disseminate such report to all recipients of
            grants under this section and to the public; and
                ``(3) may include in such report findings on best practices
            for improving patient outcomes and patient experience for
            pregnant and postpartum individuals from racial and ethnic
            minority groups and their families in maternity care settings.
        ``(f) Definitions.--In this section:
                ``(1) The term `postpartum' means the one-year period
            beginning on the last day of an individual's pregnancy.
                ``(2) The term `culturally congruent' means in agreement
            with the preferred cultural values, beliefs, world view,
            language, and practices of the health care consumer and other
            stakeholders.
                ``(3) The term `maternity care provider' means a health
            care provider who--
                        ``(A) is a physician, physician assistant, midwife
                    who meets at a minimum the international definition of
                    the midwife and global standards for midwifery
                    education as established by the International
                    Confederation of Midwives, nurse practitioner, or
                    clinical nurse specialist; and
                        ``(B) has a focus on maternal or perinatal health.
                ``(4) The term `racial and ethnic minority group' has the
            meaning given such term in section 1707(g)(1).
        ``(g) Authorization of Appropriations.--To carry out this section,
    there is authorized to be appropriated $5,000,000 for each of fiscal
    years 2023 through 2027.''.
        (d) Study on Reducing and Preventing Bias, Racism, and
    Discrimination in Maternity Care Settings.--
                (1) In general.--The Secretary of Health and Human Services
            shall seek to enter into an agreement, not later than 90 days
            after the date of enactment of this Act, with the National
            Academies of Sciences, Engineering, and Medicine (referred to
            in this subsection as the ``National Academies'') under which
            the National Academies agree to--
                        (A) conduct a study on the design and
                    implementation of programs to reduce and prevent bias,
                    racism, and discrimination in maternity care settings
                    and to advance respectful, culturally congruent,
                    trauma-informed care; and
                        (B) not later than 24 months after the date of the
                    enactment of this Act--
                                (i) complete the study; and
                                (ii) transmit a report on the results of
                            the study to the Congress.
                (2) Possible topics.--The agreement entered into pursuant
            to paragraph (1) may provide for the study of any of the
            following:
                        (A) The development of a scorecard or other
                    evaluation standards for programs designed to reduce
                    and prevent bias, racism, and discrimination in
                    maternity care settings to assess the effectiveness of
                    such programs in improving patient outcomes and patient
                    experience for pregnant and postpartum individuals from
                    racial and ethnic minority groups and their families.
                        (B) Determination of the types and frequency of
                    training to reduce and prevent bias, racism, and
                    discrimination in maternity care settings that are
                    demonstrated to improve patient outcomes or patient
                    experience for pregnant and postpartum individuals from
                    racial and ethnic minority groups and their families.
        (e) Respectful Maternity Care Compliance Program.--
                (1) In general.--The Secretary of Health and Human Services
            (referred to in this subsection as the ``Secretary'') shall
            award grants to accredited hospitals, health systems, and other
            maternity care settings to establish as an integral part of
            quality implementation initiatives within one or more hospitals
            or other birth settings a respectful maternity care compliance
            program.
                (2) Program requirements.--A respectful maternity care
            compliance program funded through a grant under this subsection
            shall--
                        (A) institutionalize mechanisms to allow patients
                    receiving maternity care services, the families of such
                    patients, or perinatal health workers supporting such
                    patients to report instances of racism or evidence of
                    bias on the basis of race, ethnicity, or another
                    protected class;
                        (B) institutionalize response mechanisms through
                    which representatives of the program can directly
                    follow up with the patient, if possible, and the
                    patient's family in a timely manner;
                        (C) prepare, and make publicly available, a
                    hospital- or health system-wide strategy to reduce bias
                    on the basis of race, ethnicity, or another protected
                    class in the delivery of maternity care that includes--
                                (i) information on the training programs to
                            reduce and prevent bias, racism, and
                            discrimination on the basis of race, ethnicity,
                            or another protected class for all employees in
                            maternity care settings;
                                (ii) information on the number of cases
                            reported to the compliance program; and
                                (iii) the development of methods to
                            routinely assess the extent to which bias,
                            racism, or discrimination on the basis of race,
                            ethnicity, or another protected class are
                            present in the delivery of maternity care to
                            patients from racial and ethnic minority
                            groups; and
                        (D) develop mechanisms to routinely collect and
                    publicly report hospital-level data related to patient-
                    reported experience of care; and
                        (E) provide annual reports to the Secretary with
                    information about each case reported to the compliance
                    program over the course of the year containing such
                    information as the Secretary may require, such as--
                                (i) de-identified demographic information
                            on the patient in the case, such as race,
                            ethnicity, gender identity, and primary
                            language;
                                (ii) the content of the report from the
                            patient or the family of the patient to the
                            compliance program;
                                (iii) the response from the compliance
                            program; and
                                (iv) to the extent applicable,
                            institutional changes made as a result of the
                            case.
                (3) Secretary requirements.--
                        (A) Processes.--Not later than 180 days after the
                    date of the enactment of this Act, the Secretary shall
                    establish processes for--
                                (i) disseminating best practices for
                            establishing and implementing a respectful
                            maternity care compliance program within a
                            hospital or other birth setting;
                                (ii) promoting coordination and
                            collaboration between hospitals, health
                            systems, and other maternity care delivery
                            settings on the establishment and
                            implementation of respectful maternity care
                            compliance programs; and
                                (iii) evaluating the effectiveness of
                            respectful maternity care compliance programs
                            on maternal health outcomes and patient and
                            family experiences, especially for patients
                            from racial and ethnic minority groups and
                            their families.
                        (B) Study.--
                                (i) In general.--Not later than 2 years
                            after the date of the enactment of this Act,
                            the Secretary shall, through a contract with an
                            independent research organization, conduct a
                            study on strategies to address--
                                        (I) racism or bias on the basis of
                                    race, ethnicity, or another protected
                                    class in the delivery of maternity care
                                    services; and
                                        (II) successful implementation of
                                    respectful care initiatives.
                                (ii) Components of study.--The study shall
                            include the following:
                                        (I) An assessment of the reports
                                    submitted to the Secretary from the
                                    respectful maternity care compliance
                                    programs pursuant to paragraph (2)(E).
                                        (II) Based on such assessment,
                                    recommendations for potential
                                    accountability mechanisms related to
                                    cases of racism or bias on the basis of
                                    race, ethnicity, or another protected
                                    class in the delivery of maternity care
                                    services at hospitals and other birth
                                    settings. Such recommendations shall
                                    take into consideration medical and
                                    non-medical factors that contribute to
                                    adverse patient experiences and
                                    maternal health outcomes.
                                (iii) Report.--The Secretary shall submit
                            to the Congress, and make publicly available, a
                            report on the results of the study under this
                            subparagraph.
                (4) Authorization of appropriations.--To carry out this
            subsection, there is authorized to be appropriated such sums as
            may be necessary for fiscal years 2023 through 2028.
        (f) GAO Report.--
                (1) In general.--Not later than 2 years after the date of
            enactment of this Act and annually thereafter, the Comptroller
            General of the United States shall submit to the Congress, and
            make publicly available, a report on the establishment of
            respectful maternity care compliance programs within hospitals,
            health systems, and other maternity care settings.
                (2) Matters included.--The report under paragraph (1) shall
            include the following:
                        (A) Information regarding the extent to which
                    hospitals, health systems, and other maternity care
                    settings have elected to establish respectful maternity
                    care compliance programs, including--
                                (i) which hospitals and other birth
                            settings elect to establish compliance programs
                            and when such programs are established;
                                (ii) to the extent practicable, impacts of
                            the establishment of such programs on maternal
                            health outcomes and patient and family
                            experiences in the hospitals and other birth
                            settings that have established such programs,
                            especially for patients from racial and ethnic
                            minority groups and their families;
                                (iii) information on geographic areas, and
                            types of hospitals or other birth settings,
                            where respectful maternity care compliance
                            programs are not being established and
                            information on factors contributing to
                            decisions to not establish such programs; and
                                (iv) recommendations for establishing
                            respectful maternity care compliance programs
                            in geographic areas, and types of hospitals or
                            other birth settings, where such programs are
                            not being established.
                        (B) Whether the funding made available to carry out
                    this subsection has been sufficient and, if applicable,
                    recommendations for additional appropriations to carry
                    out this subsection.
                        (C) Such other information as the Comptroller
                    General determines appropriate.
        (g) Definitions.--In this section:
                (1) Culturally congruent.--The term ``culturally
            congruent'', with respect to care or maternity care, means care
            that is in agreement with the preferred cultural values,
            beliefs, worldview, language, and practices of the health care
            consumer and other stakeholders.
                (2) Maternity care provider.--The term ``maternity care
            provider'' means a health care provider who--
                        (A) is a physician, physician assistant, midwife
                    who meets at a minimum the international definition of
                    the midwife and global standards for midwifery
                    education as established by the International
                    Confederation of Midwives, nurse practitioner, or
                    clinical nurse specialist; and
                        (B) has a focus on maternal or perinatal health.
                (3) Maternal mortality.--The term ``maternal mortality''
            means a death occurring during or within a one-year period
            after pregnancy, caused by pregnancy-related or childbirth
            complications, including a suicide, overdose, or other death
            resulting from a mental health or substance use disorder
            attributed to or aggravated by pregnancy-related or childbirth
            complications.
                (4) Perinatal health worker.--The term ``perinatal health
            worker'' means a doula, community health worker, peer
            supporter, breastfeeding and lactation educator or counselor,
            nutritionist or dietitian, childbirth educator, social worker,
            home visitor, language interpreter, or navigator.
                (5) Postpartum and postpartum period.--The terms
            ``postpartum'' and ``postpartum period'' refer to the 1-year
            period beginning on the last day of the pregnancy of an
            individual.
                (6) Pregnancy-associated death.--The term ``pregnancy-
            associated death'' means a death of a pregnant or postpartum
            individual, by any cause, that occurs during, or within 1 year
            following, the individual's pregnancy, regardless of the
            outcome, duration, or site of the pregnancy.
                (7) Pregnancy-related death.--The term ``pregnancy-related
            death'' means a death of a pregnant or postpartum individual
            that occurs during, or within 1 year following, the
            individual's pregnancy, from a pregnancy complication, a chain
            of events initiated by pregnancy, or the aggravation of an
            unrelated condition by the physiologic effects of pregnancy.
                (8) Racial and ethnic minority group.--The term ``racial
            and ethnic minority group'' has the meaning given such term in
            section 1707(g)(1) of the Public Health Service Act (42 U.S.C.
            300u-6(g)(1)).
                (9) Severe maternal morbidity.--The term ``severe maternal
            morbidity'' means a health condition, including mental health
            conditions and substance use disorders, attributed to or
            aggravated by pregnancy or childbirth that results in
            significant short-term or long-term consequences to the health
            of the individual who was pregnant.
                (10) Social determinants of maternal health defined.--The
            term ``social determinants of maternal health'' means non-
            clinical factors that impact maternal health outcomes,
            including--
                        (A) economic factors, which may include poverty,
                    employment, food security, support for and access to
                    lactation and other infant feeding options, housing
                    stability, and related factors;
                        (B) neighborhood factors, which may include quality
                    of housing, access to transportation, access to child
                    care, availability of healthy foods and nutrition
                    counseling, availability of clean water, air and water
                    quality, ambient temperatures, neighborhood crime and
                    violence, access to broadband, and related factors;
                        (C) social and community factors, which may include
                    systemic racism, gender discrimination or
                    discrimination based on other protected classes,
                    workplace conditions, incarceration, and related
                    factors;
                        (D) household factors, which may include ability to
                    conduct lead testing and abatement, car seat
                    installation, indoor air temperatures, and related
                    factors;
                        (E) education access and quality factors, which may
                    include educational attainment, language and literacy,
                    and related factors; and
                        (F) health care access factors, including health
                    insurance coverage, access to culturally congruent
                    health care services, providers, and non-clinical
                    support, access to home visiting services, access to
                    wellness and stress management programs, health
                    literacy, access to telehealth and items required to
                    receive telehealth services, and related factors.

    SEC. 5210. MOMS MATTER.

        (a) Maternal Mental Health Equity Grant Program.--
                (1) In general.--The Secretary of Health and Human
            Services, acting through the Assistant Secretary for Mental
            Health and Substance Use, shall establish a program to award
            grants to eligible entities to address maternal mental health
            conditions and substance use disorders with respect to pregnant
            and postpartum individuals, with a focus on racial and ethnic
            minority groups.
                (2) Application.--To be eligible to receive a grant under
            this subsection, an eligible entity shall submit to the
            Secretary an application at such time, in such manner, and
            containing such information as the Secretary may provide,
            including how such entity will use funds for activities
            described in paragraph (4) that are culturally congruent.
                (3) Priority.--In awarding grants under this subsection,
            the Secretary shall give priority to an eligible entity that--
                        (A) is, or will partner with, a community-based
                    organization to address maternal mental health
                    conditions and substance use disorders described in
                    paragraph (1);
                        (B) is operating in an area with high rates of--
                                (i) adverse maternal health outcomes; or
                                (ii) significant racial or ethnic
                            inequities in maternal health outcomes; and
                        (C) is operating in a health professional shortage
                    area designated under section 332 of the Public Health
                    Service Act (42 U.S.C. 254e).
                (4) Use of funds.--An eligible entity that receives a grant
            under this subsection shall use funds for the following:
                        (A) Establishing or expanding maternity care
                    programs to improve the integration of maternal health
                    and behavioral health care services into primary care
                    settings where pregnant individuals regularly receive
                    health care services.
                        (B) Establishing or expanding group prenatal care
                    programs or postpartum care programs.
                        (C) Expanding existing programs that improve
                    maternal mental and behavioral health during the
                    prenatal and postpartum periods, with a focus on
                    individuals from racial and ethnic minority groups.
                        (D) Providing services and support for pregnant and
                    postpartum individuals with maternal mental health
                    conditions and substance use disorders, including
                    referrals to addiction treatment centers that offer
                    evidence-based treatment options.
                        (E) Addressing stigma associated with maternal
                    mental health conditions and substance use disorders,
                    with a focus on racial and ethnic minority groups.
                        (F) Raising awareness of warning signs of maternal
                    mental health conditions and substance use disorders,
                    with a focus on pregnant and postpartum individuals
                    from racial and ethnic minority groups.
                        (G) Establishing or expanding programs to prevent
                    suicide or self-harm among pregnant and postpartum
                    individuals.
                        (H) Offering evidence-aligned programs at
                    freestanding birth centers that provide maternal mental
                    and behavioral health care education, treatments, and
                    services, and other services for individuals throughout
                    the prenatal and postpartum period.
                        (I) Establishing or expanding programs to provide
                    education and training to maternity care providers with
                    respect to--
                                (i) identifying potential warning signs for
                            maternal mental health conditions or substance
                            use disorders in pregnant and postpartum
                            individuals, with a focus on individuals from
                            racial and ethnic minority groups; and
                                (ii) in the case where such providers
                            identify such warning signs, offering referrals
                            to mental and behavioral health care
                            professionals.
                        (J) Developing a website, or other source, that
                    includes information on health care providers who treat
                    maternal mental health conditions and substance use
                    disorders.
                        (K) Establishing or expanding programs in
                    communities to improve coordination between maternity
                    care providers and mental and behavioral health care
                    providers who treat maternal mental health conditions
                    and substance use disorders, including through the use
                    of toll-free hotlines.
                        (L) Carrying out other programs aligned with
                    evidence-based practices for addressing maternal mental
                    health conditions and substance use disorders for
                    pregnant and postpartum individuals from racial and
                    ethnic minority groups.
                (5) Reporting.--
                        (A) Eligible entities.--An eligible entity that
                    receives a grant under paragraph (1) shall submit
                    annually to the Secretary, and make publicly available,
                    a report on the activities conducted using funds
                    received through a grant under this subsection. Such
                    reports shall include quantitative and qualitative
                    evaluations of such activities, including the
                    experience of individuals who received health care
                    through such grant.
                        (B) Secretary.--Not later than the end of fiscal
                    year 2024, the Secretary shall submit to Congress a
                    report that includes--
                                (i) a summary of the reports received under
                            subparagraph (A);
                                (ii) an evaluation of the effectiveness of
                            grants awarded under this subsection;
                                (iii) recommendations with respect to
                            expanding coverage of evidence-based screenings
                            and treatments for maternal mental health
                            conditions and substance use disorders; and
                                (iv) recommendations with respect to
                            ensuring activities described under paragraph
                            (4) continue after the end of a grant period.
                (6) Definitions.--In this subsection:
                        (A) Eligible entity.--The term ``eligible entity''
                    means--
                                (i) a community-based organization serving
                            pregnant and postpartum individuals, including
                            such organizations serving individuals from
                            racial and ethnic minority groups and other
                            underserved populations;
                                (ii) a nonprofit or patient advocacy
                            organization with expertise in maternal mental
                            and behavioral health;
                                (iii) a maternity care provider;
                                (iv) a mental or behavioral health care
                            provider who treats maternal mental health
                            conditions or substance use disorders;
                                (v) a State or local governmental entity,
                            including a State or local public health
                            department;
                                (vi) an Indian Tribe or Tribal organization
                            (as such terms are defined in section 4 of the
                            Indian Self-Determination and Education
                            Assistance Act (25 U.S.C. 5304)); and
                                (vii) an Urban Indian organization (as such
                            term is defined in section 4 of the Indian
                            Health Care Improvement Act (25 U.S.C. 1603)).
                        (B) Culturally congruent.--The term ``culturally
                    congruent'', with respect to care or maternity care,
                    means care that is in agreement with the preferred
                    cultural values, beliefs, worldview, language, and
                    practices of the health care consumer and other
                    stakeholders.
                        (C) Freestanding birth center.--The term
                    ``freestanding birth center'' has the meaning given
                    that term under section 1905(l) of the Social Security
                    Act (42 U.S.C. 1396d(1)).
                        (D) Maternity care provider.--The term ``maternity
                    care provider'' means a health care provider who--
                                (i) is a physician, physician assistant,
                            midwife who meets at a minimum the
                            international definition of the midwife and
                            global standards for midwifery education as
                            established by the International Confederation
                            of Midwives, nurse practitioner, or clinical
                            nurse specialist; and
                                (ii) has a focus on maternal or perinatal
                            health.
                        (E) Secretary.--The term ``Secretary'' means the
                    Secretary of Health and Human Services.
                (7) Authorization of appropriations.--To carry out this
            subsection, there is authorized to be appropriated $25,000,000
            for each of fiscal years 2023 through 2026.
        (b) Grants To Grow and Diversify the Maternal Mental and Behavioral
    Health Care Workforce.--Title VII of the Public Health Service Act is
    amended by inserting after section 757 of such Act (42 U.S.C. 294f) the
    following new section:

    ``SEC. 758. MATERNAL MENTAL AND BEHAVIORAL HEALTH CARE WORKFORCE
                  GRANTS.

        ``(a) In General.--The Secretary may award grants to entities to
    establish or expand programs described in subsection (b) to grow and
    diversify the maternal mental and behavioral health care workforce.
        ``(b) Use of Funds.--Recipients of grants under this section shall
    use the grants to grow and diversify the maternal mental and behavioral
    health care workforce by--
                ``(1) establishing schools or programs that provide
            education and training to individuals seeking appropriate
            licensing or certification as mental or behavioral health care
            providers who will specialize in maternal mental health
            conditions or substance use disorders; or
                ``(2) expanding the capacity of existing schools or
            programs described in paragraph (1), for the purposes of
            increasing the number of students enrolled in such schools or
            programs, including by awarding scholarships for students.
        ``(c) Prioritization.--In awarding grants under this section, the
    Secretary shall give priority to any entity that--
                ``(1) has demonstrated a commitment to recruiting and
            retaining students and faculty from racial and ethnic minority
            groups;
                ``(2) has developed a strategy to recruit and retain a
            diverse pool of students into the maternal mental or behavioral
            health care workforce program or school supported by funds
            received through the grant, particularly from racial and ethnic
            minority groups and other underserved populations;
                ``(3) has developed a strategy to recruit and retain
            students who plan to practice in a health professional shortage
            area designated under section 332;
                ``(4) has developed a strategy to recruit and retain
            students who plan to practice in an area with significant
            racial and ethnic inequities in maternal health outcomes, to
            the extent practicable; and
                ``(5) includes in the standard curriculum for all students
            within the maternal mental or behavioral health care workforce
            program or school a bias, racism, or discrimination training
            program that includes training on implicit bias and racism.
        ``(d) Reporting.--As a condition on receipt of a grant under this
    section for a maternal mental or behavioral health care workforce
    program or school, an entity shall agree to submit to the Secretary an
    annual report on the activities conducted through the grant,
    including--
                ``(1) the number and demographics of students participating
            in the program or school;
                ``(2) the extent to which students in the program or school
            are entering careers in--
                        ``(A) health professional shortage areas designated
                    under section 332; and
                        ``(B) areas with significant racial and ethnic
                    inequities in maternal health outcomes, to the extent
                    such data are available; and
                ``(3) whether the program or school has included in the
            standard curriculum for all students a bias, racism, or
            discrimination training program that includes training on
            implicit bias and racism, and if so the effectiveness of such
            training program.
        ``(e) Period of Grants.--The period of a grant under this section
    shall be up to 5 years.
        ``(f) Application.--To seek a grant under this section, an entity
    shall submit to the Secretary an application at such time, in such
    manner, and containing such information as the Secretary may require,
    including any information necessary for prioritization under subsection
    (c).
        ``(g) Technical Assistance.--The Secretary shall provide, directly
    or by contract, technical assistance to entities seeking or receiving a
    grant under this section on the development, use, evaluation, and post-
    grant period sustainability of the maternal mental or behavioral health
    care workforce programs or schools proposed to be, or being,
    established or expanded through the grant.
        ``(h) Report by the Secretary.--Not later than 4 years after the
    date of enactment of this section, the Secretary shall prepare and
    submit to the Congress, and post on the internet website of the
    Department of Health and Human Services, a report on the effectiveness
    of the grant program under this section at--
                ``(1) recruiting students from racial and ethnic minority
            groups and other underserved populations;
                ``(2) increasing the number of mental or behavioral health
            care providers specializing in maternal mental health
            conditions or substance use disorders from racial and ethnic
            minority groups and other underserved populations;
                ``(3) increasing the number of mental or behavioral health
            care providers specializing in maternal mental health
            conditions or substance use disorders working in health
            professional shortage areas designated under section 332; and
                ``(4) increasing the number of mental or behavioral health
            care providers specializing in maternal mental health
            conditions or substance use disorders working in areas with
            significant racial and ethnic inequities in maternal health
            outcomes, to the extent such data are available.
        ``(i) Definitions.--In this section:
                ``(1) Racial and ethnic minority group.--The term `racial
            and ethnic minority group' has the meaning given such term in
            section 1707(g)(1).
                ``(2) Mental or behavioral health care provider.--The term
            `mental or behavioral health care provider' refers to a health
            care provider in the field of mental and behavioral health,
            including substance use disorders, acting in accordance with
            State law.
        ``(j) Authorization of Appropriations.--To carry out this section,
    there is authorized to be appropriated $15,000,000 for each of fiscal
    years 2023 through 2027.''.

    SEC. 5211. TASKFORCE RECOMMENDING IMPROVEMENTS FOR UNADDRESSED MENTAL
                  PERINATAL & POSTPARTUM HEALTH (TRIUMPH) FOR NEW MOMS.

        Part B of title III of the Public Health Service Act (42 U.S.C. 243
    et seq.) is amended by inserting after section 317L-1 (42 U.S.C. 247b-
    13a) the following:

    ``SEC. 317L-2. TASK FORCE ON MATERNAL MENTAL HEALTH.

        ``(a) Establishment.--Not later than 90 days after the date of
    enactment of this section, the Secretary shall establish a task force,
    to be known as the Task Force on Maternal Mental Health (in this
    section referred to as the `Task Force') to identify, evaluate, and
    make recommendations to coordinate and improve, Federal responses to
    maternal mental health conditions.
        ``(b) Membership.--
                ``(1) Composition.--The Task Force shall be composed of--
                        ``(A) the Assistant Secretary for Health of the
                    Department of Health and Human Services (or the
                    Assistant Secretary's designee) who shall serve as the
                    Chair of the Task Force;
                        ``(B) the Federal members under paragraph (2); and
                        ``(C) the non-Federal members under paragraph (3).
                ``(2) Federal members.--In addition to the Assistant
            Secretary for Health, the Federal members of the Task Force
            shall consist of the heads of the following Federal departments
            and agencies (or their designees):
                        ``(A) The Administration for Children and Families.
                        ``(B) The Agency for Healthcare Research and
                    Quality.
                        ``(C) The Centers for Disease Control and
                    Prevention.
                        ``(D) The Centers for Medicare & Medicaid Services.
                        ``(E) The Health Resources and Services
                    Administration.
                        ``(F) The Food and Drug Administration.
                        ``(G) The Indian Health Service.
                        ``(H) The Office of the Assistant Secretary for
                    Planning and Evaluation of the Department of Health and
                    Human Services.
                        ``(I) The Office of Minority Health of the
                    Department of Health and Human Services.
                        ``(J) The Office of the Surgeon General of the
                    Department of Health and Human Services.
                        ``(K) The Office of Women's Health of the
                    Department of Health and Human Services.
                        ``(L) The National Institutes of Health.
                        ``(M) The Substance Abuse and Mental Health
                    Services Administration.
                        ``(N) Such other Federal departments and agencies
                    as the Secretary determines that serve individuals with
                    maternal mental health conditions, such as the
                    Department of Veterans Affairs, the Department of
                    Justice, the Department of Labor, the Department of
                    Housing and Urban Development, and the Department of
                    Defense.
                ``(3) Non-federal members.--The non-Federal members of the
            Task Force shall--
                        ``(A) compose not more than one-half, and not less
                    than one-third, of the total membership of the Task
                    Force;
                        ``(B) be appointed by the Secretary; and
                        ``(C) include--
                                ``(i) representatives of medical societies
                            with expertise in maternal or mental health;
                                ``(ii) representatives of nonprofit
                            organizations with expertise in maternal or
                            mental health;
                                ``(iii) relevant industry representatives;
                            and
                                ``(iv) other representatives, as
                            appropriate.
                ``(4) Deadline for designating designees.--If the Assistant
            Secretary for Health, or the head of a Federal department or
            agency serving as a member of the Task Force under paragraph
            (2), chooses to be represented on the Task Force by a designee,
            the Assistant Secretary or head shall designate such designee
            not later than 90 days after the date of the enactment of this
            section.
        ``(c) Duties.--The Task Force shall--
                ``(1) create and regularly update a report that identifies,
            analyzes, and evaluates the state of national maternal mental
            health policy and programs at the Federal, State, and local
            levels, and identifies best practices including--
                        ``(A) a set of evidence-based, evidence-informed,
                    and promising practices with respect to--
                                ``(i) prevention strategies for individuals
                            at risk of experiencing a maternal mental
                            health condition, including strategies and
                            recommendations to address social determinants
                            of health;
                                ``(ii) the identification, screening,
                            diagnosis, intervention, and treatment of
                            individuals and families affected by a maternal
                            mental health condition;
                                ``(iii) the expeditious referral to, and
                            implementation of, practices and supports that
                            prevent and mitigate the effects of a maternal
                            mental health condition, including strategies
                            and recommendations to eliminate the racial and
                            ethnic inequities that exist in maternal mental
                            health; and
                                ``(iv) community-based or multigenerational
                            practices that support individuals and families
                            affected by a maternal mental health condition;
                            and
                        ``(B) Federal and State programs and activities to
                    prevent, screen, diagnose, intervene, and treat
                    maternal mental health conditions;
                ``(2) develop and regularly update a national strategy for
            maternal mental health, taking into consideration the findings
            of the reports under paragraph (1), on how the Task Force and
            Federal departments and agencies represented on the Task Force
            will prioritize options for, and implement a coordinated
            approach to, addressing maternal mental health conditions,
            including by--
                        ``(A) increasing prevention, screening, diagnosis,
                    intervention, treatment, and access to care, including
                    clinical and nonclinical care such as peer-support and
                    community health workers, through the public and
                    private sectors;
                        ``(B) providing support for pregnant or postpartum
                    individuals who are at risk for or experiencing a
                    maternal mental health condition, and their families as
                    appropriate;
                        ``(C) reducing racial, ethnic, geographic, and
                    other health inequities for prevention, diagnosis,
                    intervention, treatment, and access to care;
                        ``(D) identifying opportunities for local- and
                    State-level partnerships;
                        ``(E) identifying options for modifying,
                    strengthening, and coordinating Federal programs and
                    activities, including existing infant and maternity
                    programs, such as the Medicaid program under title XIX
                    of the Social Security Act and the State Children's
                    Health Insurance Program under title XXI of such Act,
                    in order to increase research, prevention,
                    identification, intervention, and treatment with
                    respect to maternal mental health;
                        ``(F) providing recommendations to ensure research,
                    services, supports, and prevention activities are not
                    unnecessarily duplicative; and
                        ``(G) planning, data sharing, and communication
                    within and across Federal departments, agencies,
                    offices, and programs;
                ``(3) solicit public comments from stakeholders for the
            report under paragraph (1) and the national strategy under
            paragraph (2), including comments from frontline service
            providers, mental health professionals, researchers, experts in
            maternal mental health, institutions of higher education,
            public health agencies (including maternal and child health
            programs), and industry representatives, in order to inform the
            activities and reports of the Task Force; and
                ``(4) disaggregate any data collected under this section by
            race, ethnicity, geographical location, age, marital status,
            socioeconomic level, and other factors as determined
            appropriate by the Secretary.
        ``(d) Meetings.--The Task Force shall--
                ``(1) meet not less than two times each year; and
                ``(2) convene public meetings, as appropriate, to fulfill
            its duties under this section.
        ``(e) Reports to Public and Federal Leaders.--The Task Force shall
    make publicly available and submit to the heads of relevant Federal
    departments and agencies, the Committee on Energy and Commerce of the
    House of Representatives, the Committee on Health, Education, Labor,
    and Pensions of the Senate, and other relevant congressional
    committees, the following:
                ``(1) Not later than 1 year after the first meeting of the
            Task Force, an initial report under subsection (c)(1).
                ``(2) Not later than 2 years after the first meeting of the
            Task Force, an initial national strategy under subsection
            (c)(2).
                ``(3) Each year thereafter--
                        ``(A) an updated report under subsection (c)(1);
                        ``(B) an updated national strategy under subsection
                    (c)(2); or
                        ``(C) if no such update is made, a report
                    summarizing the activities of the Task Force.
        ``(f) Reports to Governors.--Upon finalizing the initial national
    strategy under subsection (c)(2), and upon making relevant updates to
    such strategy, the Task Force shall submit a report to the Governors of
    all States describing opportunities for local- and State-level
    partnerships identified under subsection (c)(2)(D).
        ``(g) Sunset.--The Task Force shall terminate on the date that is 6
    years after the date on which the Task Force is established under
    subsection (a).''.

    SEC. 5212. PROTECT MOMS FROM DOMESTIC VIOLENCE.

        (a) Study by Department of Health and Human Services.--
                (1) Study.--The Secretary, in collaboration with the Health
            Resources and Services Administration, the Substance Abuse and
            Mental Health Services Administration, and the Administration
            for Children and Families, and in consultation with the
            Attorney General of the United States, the Director of the
            Indian Health Service, and stakeholders (including community-
            based organizations, culturally specific organizations, and
            Tribal public health authorities), shall conduct a study on the
            extent to which individuals are more at risk of maternal
            mortality or severe maternal morbidity as a result of being a
            victim of domestic violence, dating violence, sexual assault,
            stalking, human trafficking, sex trafficking, child sexual
            abuse, or forced marriage.
                (2) Reports.--Not later than 2 years after the date of
            enactment of this Act, the Secretary shall complete the study
            under paragraph (1) and submit a report to the Congress on the
            results of such study. Such report shall include--
                        (A) an analysis of the extent to which domestic
                    violence, dating violence, sexual assault, stalking,
                    human trafficking, sex trafficking, child sexual abuse,
                    and forced marriage contribute to, or result in,
                    maternal mortality;
                        (B) an analysis of the impact of domestic violence,
                    dating violence, sexual assault, stalking, human
                    trafficking, sex trafficking, child sexual abuse, and
                    forced marriage on access to health care (including
                    mental health care) and substance use disorder
                    treatment and recovery support;
                        (C) a breakdown (including by race and ethnicity)
                    of categories of individuals who are disproportionately
                    victims of domestic violence, dating violence, sexual
                    assault, stalking, human trafficking, sex trafficking,
                    child sexual abuse, or forced marriage that contributes
                    to, or results in, pregnancy-related death;
                        (D) an analysis of the impact on health, mental
                    health, and substance use resulting from domestic
                    violence, dating violence, sexual assault, stalking,
                    human trafficking, sex trafficking, child sexual abuse,
                    and forced marriage among Alaskan Natives, Native
                    Hawaiians, and American Indians during the prenatal and
                    postpartum period;
                        (E) an assessment of the factors that increase or
                    decrease risks for maternal mortality or severe
                    maternal morbidity among victims of domestic violence,
                    dating violence, sexual assault, stalking, human
                    trafficking, sex trafficking, child sexual abuse, or
                    forced marriage;
                        (F) an assessment of increased risk of maternal
                    mortality or severe maternal morbidity stemming from
                    suicide, substance use disorders, or drug overdose due
                    to domestic violence, dating violence, sexual assault,
                    stalking, human trafficking, sex trafficking, child
                    sexual abuse, or forced marriage;
                        (G) recommendations for legislative or policy
                    changes--
                                (i) to reduce maternal mortality rates; and
                                (ii) to address health inequities that
                            contribute to inequities in such rates and
                            deaths;
                        (H) best practices to reduce maternal mortality and
                    severe maternal morbidity among victims of domestic
                    violence, dating violence, sexual assault, stalking,
                    human trafficking, sex trafficking, child sexual abuse,
                    and forced marriage, including--
                                (i) reducing reproductive coercion, mental
                            health conditions, and substance use coercion;
                            and
                                (ii) routinely assessing pregnant people
                            for domestic violence and other forms of
                            reproductive violence; and
                        (I) any other information on maternal mortality or
                    severe maternal morbidity the Secretary determines
                    appropriate to include in the report.
        (b) Study by National Academy of Medicine.--
                (1) In general.--The Secretary shall seek to enter into an
            arrangement with the National Academy of Medicine (or, if the
            Academy declines to enter into such arrangement, another
            appropriate entity) to study--
                        (A) the impact of domestic violence, dating
                    violence, sexual assault, stalking, human trafficking,
                    sex trafficking, child sexual abuse, and forced
                    marriage on an individual's health; relative to
                        (B) maternal mortality and severe maternal
                    morbidity.
                (2) Topics.--The study under paragraph (1) shall--
                        (A) examine--
                                (i) whether domestic violence, dating
                            violence, sexual assault, stalking, human
                            trafficking, sex trafficking, child sexual
                            abuse, or forced marriage, or generational
                            intimate partner violence, trauma, and
                            psychiatric disorders, increase the risk of
                            suicide, substance use, and drug overdose among
                            pregnant and postpartum persons; and
                                (ii) the intersection of domestic violence,
                            dating violence, sexual assault, stalking,
                            human trafficking, sex trafficking, child
                            sexual abuse, and forced marriage as a social
                            determinant of health; and
                        (B) give particular focus to impacts among African
                    American, American Indian, Native Hawaiian, Alaskan
                    Native, and LGBTQ birthing persons.
        (c) Grants for Innovative Approaches.--
                (1) In general.--The Secretary, acting through the
            Administrator of the Health Resources and Services
            Administration, and in collaboration with the Administration
            for Children and Families, the Indian Health Service, and the
            Substance Abuse and Mental Health Services Administration,
            shall award grants to eligible entities for developing and
            implementing innovative approaches to improve maternal and
            child health outcomes of victims of domestic violence, dating
            violence, sexual assault, stalking, human trafficking, sex
            trafficking, child sexual abuse, or forced marriage.
                (2) Eligible entity.--To seek a grant under this
            subsection, an entity shall be--
                        (A) a State, local, or federally recognized Tribal
                    government;
                        (B) a nonprofit organization or community-based
                    organization that provides prevention or intervention
                    services related to domestic violence, dating violence,
                    sexual assault, stalking, human trafficking, sex
                    trafficking, child sexual abuse, or forced marriage;
                        (C) a tribal organization or Urban Indian
                    organization (as such terms are defined in section 4 of
                    the Indian Health Care Improvement Act (25 U.S.C.
                    1603));
                        (D) an entity, the principal purpose of which is to
                    provide health care, such as a hospital, clinic, health
                    department, freestanding birthing center, perinatal
                    health worker, or maternity care provider;
                        (E) an institution of higher education; or
                        (F) a comprehensive substance use disorder
                    parenting program.
                (3) Priority.--In awarding grants under this subsection,
            the Secretary of Health and Human Services shall give priority
            to applicants proposing to address--
                        (A) mental health and substance use disorders among
                    pregnant persons; or
                        (B) pregnant and postpartum persons experiencing
                    intimate partner violence.
                (4) Freestanding birth center defined.--In this subsection,
            the term ``freestanding birth center'' has the meaning given
            that term in section 1905(l) of the Social Security Act (42
            U.S.C. 1396d(1)).
                (5) Authorization of appropriations.--To carry out this
            subsection, there is authorized to be appropriated $25,000,000
            for the period of fiscal years 2023 through 2025.
        (d) Guidance.--Not later than 2 years after the date of enactment
    of this Act, the Secretary shall issue and disseminate guidance to
    States, Tribes, Territories, maternity care providers, and managed care
    entities on--
                (1) providing universal education on healthy relationships
            and intimate partner violence;
                (2) developing protocols on--
                        (A) routine assessment of intimate partner
                    violence; and
                        (B) health promotion and strategies for trauma-
                    informed care plans; and
                (3) creating sustainable partnerships with community-based
            organizations that address domestic violence, dating violence,
            sexual assault, stalking, human trafficking, sex trafficking,
            child sexual abuse, or forced marriage.
        (e) Definitions.--In this section:
                (1) The term ``maternal mortality''--
                        (A) means death that--
                                (i) occurs during, or within the 1-year
                            period after, pregnancy; and
                                (ii) is attributed to or aggravated by
                            pregnancy-related or childbirth complications;
                            and
                        (B) includes a suicide, drug overdose death,
                    homicide (including a domestic violence-related
                    homicide), or other death resulting from a mental
                    health or substance use disorder attributed to or
                    aggravated by pregnancy-related or childbirth
                    complications.
                (2) The term ``maternity care provider'' means a health
            care provider who--
                        (A) is a physician, physician assistant, nurse,
                    midwife who meets at a minimum the international
                    definition of the midwife and global standards for
                    midwifery education as established by the International
                    Confederation of Midwives, nurse practitioner, or
                    clinical nurse specialist; and
                        (B) has a focus on maternal or perinatal health.
                (3) The term ``perinatal health worker'' means a worker
            who--
                        (A) is a doula, community health worker, peer
                    supporter, breastfeeding and lactation educator or
                    counselor, nutritionist or dietitian, childbirth
                    educator, social worker, home visitor, language
                    interpreter, or navigator; and
                        (B) provides assistance with perinatal health.
                (4) The term ``postpartum'' refers to the 12-month period
            following childbirth.
                (5) The term ``Secretary'' means the Secretary of Health
            and Human Services.
                (6) The term ``severe maternal morbidity'' means a health
            condition, including a mental health condition or substance use
            disorder, that--
                        (A) is attributed to or aggravated by pregnancy or
                    childbirth; and
                        (B) results in significant short-term or long-term
                    consequences to the health of the individual who was
                    pregnant.

    SEC. 5213. PERINATAL WORKFORCE.

        (a) HHS Agency Directives.--
                (1) Guidance to states.--
                        (A) In general.--Not later than 2 years after the
                    date of enactment of this Act, the Secretary of Health
                    and Human Services shall issue and disseminate guidance
                    to States to educate providers, managed care entities,
                    and other insurers about the value and process of
                    delivering respectful maternal health care through
                    diverse and multidisciplinary care provider models.
                        (B) Contents.--The guidance required by
                    subparagraph (A) shall address how States can encourage
                    and incentivize hospitals, health systems, midwifery
                    practices, freestanding birth centers, other maternity
                    care provider groups, managed care entities, and other
                    insurers--
                                (i) to recruit and retain maternity care
                            providers, mental and behavioral health care
                            providers acting in accordance with State law,
                            registered dietitians or nutrition
                            professionals (as such term is defined in
                            section 1861(vv)(2) of the Social Security Act
                            (42 U.S.C. 1395x(vv)(2))), and lactation
                            consultants certified by the International
                            Board of Lactation Consultants Examiners--
                                        (I) from racially, ethnically, and
                                    linguistically diverse backgrounds;
                                        (II) with experience practicing in
                                    racially and ethnically diverse
                                    communities; and
                                        (III) who have undergone training
                                    on implicit bias and racism;
                                (ii) to incorporate into maternity care
                            teams--
                                        (I) midwives who meet, at a
                                    minimum, the international definition
                                    of the midwife and global standards for
                                    midwifery education, as established by
                                    the International Confederation of
                                    Midwives; and
                                        (II) perinatal health workers;
                                (iii) to provide collaborative, culturally
                            congruent care; and
                                (iv) to provide opportunities for
                            individuals enrolled in accredited midwifery
                            education programs to participate in job
                            shadowing with maternity care teams in
                            hospitals, health systems, midwifery practices,
                            and freestanding birth centers.
                (2) Study on respectful and culturally congruent maternity
            care.--
                        (A) Study.--The Secretary of Health and Human
                    Services, acting through the Director of the National
                    Institutes of Health (in this paragraph referred to as
                    the ``Secretary''), shall conduct a study on best
                    practices in respectful and culturally congruent
                    maternity care.
                        (B) Report.--Not later than 2 years after the date
                    of enactment of this Act, the Secretary shall--
                                (i) complete the study required by
                            subparagraph (A);
                                (ii) submit to the Congress, and make
                            publicly available, a report on the results of
                            such study; and
                                (iii) include in such report--
                                        (I) a compendium of examples of
                                    hospitals, health systems, midwifery
                                    practices, freestanding birth centers,
                                    other maternity care provider groups,
                                    managed care entities, and other
                                    insurers that are delivering respectful
                                    and culturally congruent maternal
                                    health care;
                                        (II) a compendium of examples of
                                    hospitals, health systems, midwifery
                                    practices, freestanding birth centers,
                                    other maternity care provider groups,
                                    managed care entities, and other
                                    insurers that have made progress in
                                    reducing inequities in maternal health
                                    outcomes and improving birthing
                                    experiences for pregnant and postpartum
                                    individuals from racial and ethnic
                                    minority groups; and
                                        (III) recommendations to hospitals,
                                    health systems, midwifery practices,
                                    freestanding birth centers, other
                                    maternity care provider groups, managed
                                    care entities, and other insurers, for
                                    best practices in respectful and
                                    culturally congruent maternity care.
        (b) Grants To Grow and Diversify the Perinatal Workforce.--Title
    VII of the Public Health Service Act is amended by inserting after
    section 758, as added by section 5210(b), the following new section:

    ``SEC. 758A. PERINATAL WORKFORCE GRANTS.

        ``(a) In General.--The Secretary shall award grants to entities to
    establish or expand programs described in subsection (b) to grow and
    diversify the perinatal workforce.
        ``(b) Use of Funds.--Recipients of grants under this section shall
    use the grants to grow and diversify the perinatal workforce by--
                ``(1) establishing schools or programs that provide
            education and training to individuals seeking appropriate
            licensing or certification as--
                        ``(A) physician assistants who will complete
                    clinical training in the field of maternal and
                    perinatal health; or
                        ``(B) perinatal health workers; and
                ``(2) expanding the capacity of existing schools or
            programs described in paragraph (1), for the purposes of
            increasing the number of students enrolled in such schools or
            programs, including by awarding scholarships for students.
        ``(c) Prioritization.--In awarding grants under this section, the
    Secretary shall give priority to any entity that--
                ``(1) has demonstrated a commitment to recruiting and
            retaining students and faculty from racial and ethnic minority
            groups;
                ``(2) has developed a strategy to recruit and retain a
            diverse pool of students into the perinatal workforce program
            or school supported by funds received through the grant,
            particularly from racial and ethnic minority groups and other
            underserved populations;
                ``(3) has developed a strategy to recruit and retain
            students who plan to practice in a health professional shortage
            area designated under section 332;
                ``(4) has developed a strategy to recruit and retain
            students who plan to practice in an area with significant
            racial and ethnic inequities in maternal health outcomes, to
            the extent practicable; and
                ``(5) includes in the standard curriculum for all students
            within the perinatal workforce program or school a bias,
            racism, or discrimination training program that includes
            training on implicit bias and racism.
        ``(d) Reporting.--As a condition on receipt of a grant under this
    section for a perinatal workforce program or school, an entity shall
    agree to submit to the Secretary an annual report on the activities
    conducted through the grant, including--
                ``(1) the number and demographics of students participating
            in the program or school;
                ``(2) the extent to which students in the program or school
            are entering careers in--
                        ``(A) health professional shortage areas designated
                    under section 332; and
                        ``(B) areas with significant racial and ethnic
                    inequities in maternal health outcomes, to the extent
                    such data are available; and
                ``(3) whether the program or school has included in the
            standard curriculum for all students a bias, racism, or
            discrimination training program that includes explicit and
            implicit bias, and if so the effectiveness of such training
            program.
        ``(e) Period of Grants.--The period of a grant under this section
    shall not exceed 5 years.
        ``(f) Application.--To seek a grant under this section, an entity
    shall submit to the Secretary an application at such time, in such
    manner, and containing such information as the Secretary may require,
    including any information necessary for prioritization under subsection
    (c).
        ``(g) Technical Assistance.--The Secretary shall provide, directly
    or by contract, technical assistance to entities seeking or receiving a
    grant under this section on the development, use, evaluation, and post-
    grant period sustainability of the perinatal workforce programs or
    schools proposed to be, or being, established or expanded through the
    grant.
        ``(h) Report by the Secretary.--Not later than 4 years after the
    date of enactment of this section, the Secretary shall prepare and
    submit to the Congress, and post on the internet website of the
    Department of Health and Human Services, a report on the effectiveness
    of the grant program under this section at--
                ``(1) recruiting students from racial and ethnic minority
            groups;
                ``(2) increasing the number of physician assistants who
            will complete clinical training in the field of maternal and
            perinatal health, and perinatal health workers, from racial and
            ethnic minority groups and other underserved populations;
                ``(3) increasing the number of physician assistants who
            will complete clinical training in the field of maternal and
            perinatal health, and perinatal health workers, working in
            health professional shortage areas designated under section
            332; and
                ``(4) increasing the number of physician assistants who
            will complete clinical training in the field of maternal and
            perinatal health, and perinatal health workers, working in
            areas with significant racial and ethnic inequities in maternal
            health outcomes, to the extent such data are available.
        ``(i) Definition.--In this section, the term `racial and ethnic
    minority group' has the meaning given such term in section 1707(g).
        ``(j) Authorization of Appropriations.--To carry out this section,
    there is authorized to be appropriated $15,000,000 for each of fiscal
    years 2023 through 2027.''.
        (c) Grants To Grow and Diversify the Nursing Workforce in Maternal
    and Perinatal Health.--Title VIII of the Public Health Service Act is
    amended by inserting after section 811 of that Act (42 U.S.C. 296j) the
    following:

    ``SEC. 812. PERINATAL NURSING WORKFORCE GRANTS.

        ``(a) In General.--The Secretary shall award grants to schools of
    nursing to grow and diversify the perinatal nursing workforce.
        ``(b) Use of Funds.--Recipients of grants under this section shall
    use the grants to grow and diversify the perinatal nursing workforce by
    providing scholarships to students seeking to become--
                ``(1) nurse practitioners whose education includes a focus
            on maternal and perinatal health; or
                ``(2) clinical nurse specialists whose education includes a
            focus on maternal and perinatal health.
        ``(c) Prioritization.--In awarding grants under this section, the
    Secretary shall give priority to any school of nursing that--
                ``(1) has developed a strategy to recruit and retain a
            diverse pool of students seeking to enter careers focused on
            maternal and perinatal health, particularly students from
            racial and ethnic minority groups and other underserved
            populations;
                ``(2) has developed a partnership with a practice setting
            in a health professional shortage area designated under section
            332 for the clinical placements of the school's students;
                ``(3) has developed a strategy to recruit and retain
            students who plan to practice in an area with significant
            racial and ethnic inequities in maternal health outcomes, to
            the extent practicable; and
                ``(4) includes in the standard curriculum for all students
            seeking to enter careers focused on maternal and perinatal
            health a bias, racism, or discrimination training program that
            includes education on implicit bias and racism.
        ``(d) Reporting.--As a condition on receipt of a grant under this
    section, a school of nursing shall agree to submit to the Secretary an
    annual report on the activities conducted through the grant, including,
    to the extent practicable--
                ``(1) the number and demographics of students in the school
            of nursing seeking to enter careers focused on maternal and
            perinatal health;
                ``(2) the extent to which such students are preparing to
            enter careers in--
                        ``(A) health professional shortage areas designated
                    under section 332; and
                        ``(B) areas with significant racial and ethnic
                    inequities in maternal health outcomes, to the extent
                    such data are available; and
                ``(3) whether the standard curriculum for all students
            seeking to enter careers focused on maternal and perinatal
            health includes a bias, racism, or discrimination training
            program that includes education on implicit bias and racism.
        ``(e) Period of Grants.--The period of a grant under this section
    shall be up to 5 years.
        ``(f) Application.--To seek a grant under this section, an entity
    shall submit to the Secretary an application, at such time, in such
    manner, and containing such information as the Secretary may require,
    including any information necessary for prioritization under subsection
    (c).
        ``(g) Technical Assistance.--The Secretary shall provide, directly
    or by contract, technical assistance to schools of nursing seeking or
    receiving a grant under this section on the processes of awarding and
    evaluating scholarships through the grant.
        ``(h) Report by the Secretary.--Not later than 4 years after the
    date of enactment of this section, the Secretary shall prepare and
    submit to the Congress, and post on the internet website of the
    Department of Health and Human Services, a report on the effectiveness
    of the grant program under this section at--
                ``(1) recruiting students from racial and ethnic minority
            groups and other underserved populations;
                ``(2) increasing the number of nurse practitioners and
            clinical nurse specialists entering careers focused on maternal
            and perinatal health from racial and ethnic minority groups and
            other underserved populations;
                ``(3) increasing the number of nurse practitioners and
            clinical nurse specialists entering careers focused on maternal
            and perinatal health working in health professional shortage
            areas designated under section 332; and
                ``(4) increasing the number of nurse practitioners and
            clinical nurse specialists entering careers focused on maternal
            and perinatal health working in areas with significant racial
            and ethnic inequities in maternal health outcomes, to the
            extent such data are available.
        ``(i) Authorization of Appropriations.--To carry out this section,
    there is authorized to be appropriated $15,000,000 for each of fiscal
    years 2023 through 2027.''.
        (d) GAO Report.--
                (1) In general.--Not later than 2 years after the date of
            enactment of this Act, and every 5 years thereafter, the
            Comptroller General of the United States shall submit to
            Congress a report on barriers to maternal health education and
            access to care in the United States. Such report shall include
            the information and recommendations described in paragraph (2).
                (2) Content of report.--The report under paragraph (1)
            shall include--
                        (A) an assessment of current barriers to entering
                    accredited midwifery education programs, and
                    recommendations for addressing such barriers,
                    particularly for low-income people and people from
                    racial and ethnic minority groups;
                        (B) an assessment of current barriers to entering
                    and successfully completing accredited education
                    programs for other health professional careers related
                    to maternity care, including maternity care providers,
                    mental and behavioral health care providers acting in
                    accordance with State law, registered dietitians or
                    nutrition professionals (as such term is defined in
                    section 1861(vv)(2) of the Social Security Act (42
                    U.S.C. 1395x(vv)(2))), and lactation consultants
                    certified by the International Board of Lactation
                    Consultants Examiners, particularly for low-income
                    people and people from racial and ethnic minority
                    groups;
                        (C) an assessment of current barriers that prevent
                    midwives from meeting the international definition of
                    the midwife and global standards for midwifery
                    education as established by the International
                    Confederation of Midwives, and recommendations for
                    addressing such barriers, particularly for low-income
                    people and people from racial and ethnic minority
                    groups;
                        (D) an assessment of inequities in access to
                    maternity care providers, mental or behavioral health
                    care providers acting in accordance with State law,
                    registered dietitians or nutrition professionals (as
                    such term is defined in section 1861(vv)(2) of the
                    Social Security Act (42 U.S.C. 1395x(vv)(2))),
                    lactation consultants certified by the International
                    Board of Lactation Consultants Examiners, and perinatal
                    health workers, stratified by race, ethnicity, gender
                    identity, geographic location, and insurance type and
                    recommendations to promote greater access equity; and
                        (E) recommendations to promote greater equity in
                    compensation for perinatal health workers under public
                    and private insurers, particularly for such individuals
                    from racially and ethnically diverse backgrounds.
        (e) Definitions.--In this section:
                (1) Culturally congruent.--The term ``culturally
            congruent'', with respect to care or maternity care, means care
            that is in agreement with the preferred cultural values,
            beliefs, worldview, language, and practices of the health care
            consumer and other stakeholders.
                (2) Maternity care provider.--The term ``maternity care
            provider'' means a health care provider who--
                        (A) is a physician, physician assistant, midwife
                    who meets at a minimum the international definition of
                    the midwife and global standards for midwifery
                    education as established by the International
                    Confederation of Midwives, nurse practitioner, or
                    clinical nurse specialist; and
                        (B) has a focus on maternal or perinatal health.
                (3) Perinatal health worker.--The term ``perinatal health
            worker'' means a doula, community health worker, peer
            supporter, breastfeeding and lactation educator or counselor,
            nutritionist or dietitian, childbirth educator, social worker,
            home visitor, language interpreter, or navigator.
                (4) Postpartum and postpartum period.--The terms
            ``postpartum'' and ``postpartum period'' refer to the 1-year
            period beginning on the last day of the pregnancy of an
            individual.
                (5) Racial and ethnic minority group.--The term ``racial
            and ethnic minority group'' has the meaning given such term in
            section 1707(g)(1) of the Public Health Service Act (42 U.S.C.
            300u-6(g)(1)).

    SEC. 5214. MIDWIVES SCHOOLS AND PROGRAMS EXPANSION.

        (a) Midwifery Schools and Programs.--
                (1) In general.--Title VII of the Public Health Service Act
            is amended by inserting after section 760 of such Act (42
            U.S.C. 294k) the following:

    ``SEC. 760A. MIDWIFERY SCHOOLS AND PROGRAMS.

        ``(a) In General.--The Secretary may award grants to institutions
    of higher education (as defined in subsections (a) and (b) of section
    101 of the Higher Education Act of 1965) for the following:
                ``(1) Direct support of students in an accredited midwifery
            school or program.
                ``(2) Establishment or expansion of an accredited midwifery
            school or program.
                ``(3) Securing, preparing, or providing support for
            increasing the number of, qualified preceptors for training the
            students of an accredited midwifery school or program.
        ``(b) Special Considerations.--In awarding grants under subsection
    (a), the Secretary shall give special consideration to any institution
    of higher education that--
                ``(1) agrees to prioritize students who plan to practice in
            a health professional shortage area designated under section
            332; and
                ``(2) demonstrates a focus on increasing racial and ethnic
            minority representation in midwifery education.
        ``(c) Restriction.--The Secretary shall not provide any assistance
    under this section to be used with respect to a midwifery school or
    program within a school of nursing (as defined in section 801).
        ``(d) Authorization of Appropriations.--
                ``(1) In general.--There is authorized to be appropriated
            to carry out this section $15,000,000 for the period of fiscal
            years 2023 through 2027.
                ``(2) Allocation.--Of the amounts made available to carry
            out this section for any fiscal year, the Secretary shall use--
                        ``(A) 50 percent to award grants for purposes
                    specified in subsection (a)(1);
                        ``(B) 25 percent to award grants for purposes
                    specified in subsection (a)(2); and
                        ``(C) 25 percent to award grants for purposes
                    specified in subsection (a)(3).''.
                (2) Definitions.--
                        (A) Midwifery school or program.--Section
                    799B(1)(A) of the Public Health Service Act (42 U.S.C.
                    295p(1)(A)) is amended--
                                (i) by inserting ```midwifery school or
                            program','' before ``and `school of
                            chiropractic''';
                                (ii) by inserting ``a degree or certificate
                            in midwifery or an equivalent degree or
                            certificate,'' before ``and a degree of doctor
                            of chiropractic or an equivalent degree''; and
                                (iii) by striking ``any such school'' and
                            inserting ``any such school or program''.
                        (B) Accredited.--Section 799B(1)(E) of the Public
                    Health Service Act (42 U.S.C. 295p(1)(E)) is amended by
                    inserting ``or a midwifery school or program,'' before
                    ``or a graduate program in health administration''.
        (b) Nurse-Midwives.--Title VIII of the Public Health Service Act,
    as amended by section 5213, is further amended by inserting after
    section 812 of that Act, as added by section 5213, the following:

    ``SEC. 812A. MIDWIFERY EXPANSION PROGRAM.

        ``(a) In General.--The Secretary may award grants to schools of
    nursing for the following:
                ``(1) Direct support of students in an accredited nurse-
            midwifery school or program.
                ``(2) Establishment or expansion of an accredited nurse-
            midwifery school or program.
                ``(3) Securing, preparing, or providing support for
            increasing the numbers of, preceptors at clinical training
            sites to precept students training to become certified nurse-
            midwives.
        ``(b) Special Considerations.--In awarding grants under subsection
    (a), the Secretary shall give special consideration to any school of
    nursing that--
                ``(1) agrees to prioritize students who choose to pursue an
            advanced education degree in nurse-midwifery to practice in a
            health professional shortage area designated under section 332;
            and
                ``(2) demonstrates a focus on increasing racial and ethnic
            minority representation in nurse-midwifery education.
        ``(c) Authorization of Appropriations.--
                ``(1) In general.--To carry out this section, there is
            authorized to be appropriated $20,000,000 for the period of
            fiscal years 2023 through 2027.
                ``(2) Allocation.--Of the amounts made available to carry
            out this section for any fiscal year, the Secretary shall use--
                        ``(A) 50 percent to award grants for purposes
                    specified in subsection (a)(1);
                        ``(B) 25 percent to award grants for purposes
                    specified in subsection (a)(2); and
                        ``(C) 25 percent to award grants for purposes
                    specified in subsection (a)(3).''.

    SEC. 5215. GESTATIONAL DIABETES.

        Part B of title III of the Public Health Service Act (42 U.S.C. 243
    et seq.) is amended by adding after section 317H the following:

    ``SEC. 317H-1. GESTATIONAL DIABETES.

        ``(a) Understanding and Monitoring Gestational Diabetes.--
                ``(1) In general.--The Secretary, acting through the
            Director of the Centers for Disease Control and Prevention, in
            consultation with the Diabetes Mellitus Interagency
            Coordinating Committee established under section 429 and
            representatives of appropriate national health organizations,
            shall develop a multisite gestational diabetes research project
            within the diabetes program of the Centers for Disease Control
            and Prevention to expand and enhance surveillance data and
            public health research on gestational diabetes.
                ``(2) Areas to be addressed.--The research project
            developed under paragraph (1) shall address--
                        ``(A) procedures to establish accurate and
                    efficient systems for the collection of gestational
                    diabetes data within each State and commonwealth,
                    territory, or possession of the United States;
                        ``(B) the progress of collaborative activities with
                    the National Vital Statistics System, the National
                    Center for Health Statistics, and State health
                    departments with respect to the standard birth
                    certificate, in order to improve surveillance of
                    gestational diabetes;
                        ``(C) postpartum methods of tracking individuals
                    with gestational diabetes after delivery as well as
                    targeted interventions proven to lower the incidence of
                    type 2 diabetes in that population;
                        ``(D) variations in the distribution of diagnosed
                    and undiagnosed gestational diabetes, and of impaired
                    fasting glucose tolerance and impaired fasting glucose,
                    within and among groups of pregnant individuals; and
                        ``(E) factors and culturally sensitive
                    interventions that influence risks and reduce the
                    incidence of gestational diabetes and related
                    complications during childbirth, including cultural,
                    behavioral, racial, ethnic, geographic, demographic,
                    socioeconomic, and genetic factors.
                ``(3) Report.--Not later than 2 years after the date of the
            enactment of this section, and annually thereafter, the
            Secretary shall generate a report on the findings and
            recommendations of the research project including prevalence of
            gestational diabetes in the multisite area and disseminate the
            report to the appropriate Federal and non-Federal agencies.
        ``(b) Expansion of Gestational Diabetes Research.--
                ``(1) In general.--The Secretary shall expand and intensify
            public health research regarding gestational diabetes. Such
            research may include--
                        ``(A) developing and testing novel approaches for
                    improving postpartum diabetes testing or screening and
                    for preventing type 2 diabetes in individuals who can
                    become pregnant with a history of gestational diabetes;
                    and
                        ``(B) conducting public health research to further
                    understanding of the epidemiologic, socioenvironmental,
                    behavioral, translation, and biomedical factors and
                    health systems that influence the risk of gestational
                    diabetes and the development of type 2 diabetes in
                    individuals who can become pregnant with a history of
                    gestational diabetes.
                ``(2) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this subsection $5,000,000 for
            each of fiscal years 2023 through 2027.
        ``(c) Demonstration Grants To Lower the Rate of Gestational
    Diabetes.--
                ``(1) In general.--The Secretary, acting through the
            Director of the Centers for Disease Control and Prevention,
            shall award grants, on a competitive basis, to eligible
            entities for demonstration projects that implement evidence-
            based interventions to reduce the incidence of gestational
            diabetes, the recurrence of gestational diabetes in subsequent
            pregnancies, and the development of type 2 diabetes in
            individuals who can become pregnant with a history of
            gestational diabetes.
                ``(2) Priority.--In making grants under this subsection,
            the Secretary shall give priority to projects focusing on--
                        ``(A) helping individuals who can become pregnant
                    who have 1 or more risk factors for developing
                    gestational diabetes;
                        ``(B) working with individuals who can become
                    pregnant with a history of gestational diabetes during
                    a previous pregnancy;
                        ``(C) providing postpartum care for individuals who
                    can become pregnant with gestational diabetes;
                        ``(D) tracking cases where individuals who can
                    become pregnant with a history of gestational diabetes
                    developed type 2 diabetes;
                        ``(E) educating mothers with a history of
                    gestational diabetes about the increased risk of their
                    child developing diabetes;
                        ``(F) working to prevent gestational diabetes and
                    prevent or delay the development of type 2 diabetes in
                    individuals who can become pregnant with a history of
                    gestational diabetes; and
                        ``(G) achieving outcomes designed to assess the
                    efficacy and cost-effectiveness of interventions that
                    can inform decisions on long-term sustainability,
                    including third-party reimbursement.
                ``(3) Application.--An eligible entity desiring to receive
            a grant under this subsection shall submit to the Secretary--
                        ``(A) an application at such time, in such manner,
                    and containing such information as the Secretary may
                    require; and
                        ``(B) a plan to--
                                ``(i) lower the rate of gestational
                            diabetes during pregnancy; or
                                ``(ii) develop methods of tracking
                            individuals who can become pregnant with a
                            history of gestational diabetes and develop
                            effective interventions to lower the incidence
                            of the recurrence of gestational diabetes in
                            subsequent pregnancies and the development of
                            type 2 diabetes.
                ``(4) Uses of funds.--An eligible entity receiving a grant
            under this subsection shall use the grant funds to carry out
            demonstration projects described in paragraph (1), including--
                        ``(A) expanding community-based health promotion
                    education, activities, and incentives focused on the
                    prevention of gestational diabetes and development of
                    type 2 diabetes in individuals who can become pregnant
                    with a history of gestational diabetes;
                        ``(B) aiding State- and Tribal-based diabetes
                    prevention and control programs to collect, analyze,
                    disseminate, and report surveillance data on
                    individuals who can become pregnant with, and at risk
                    for, gestational diabetes, the recurrence of
                    gestational diabetes in subsequent pregnancies, and,
                    for individuals who can become pregnant with a history
                    of gestational diabetes, the development of type 2
                    diabetes; and
                        ``(C) training and encouraging health care
                    providers--
                                ``(i) to promote risk assessment, high-
                            quality care, and self-management for
                            gestational diabetes and the recurrence of
                            gestational diabetes in subsequent pregnancies;
                            and
                                ``(ii) to prevent the development of type 2
                            diabetes in individuals who can become pregnant
                            with a history of gestational diabetes, and its
                            complications in the practice settings of the
                            health care providers.
                ``(5) Report.--Not later than 4 years after the date of the
            enactment of this section, the Secretary shall prepare and
            submit to the Congress a report concerning the results of the
            demonstration projects conducted through the grants awarded
            under this subsection.
                ``(6) Definition of eligible entity.--In this subsection,
            the term `eligible entity' means a nonprofit organization (such
            as a nonprofit academic center or community health center) or a
            State, Tribal, or local health agency.
                ``(7) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this subsection $5,000,000 for
            each of fiscal years 2023 through 2027.
        ``(d) Postpartum Followup Regarding Gestational Diabetes.--The
    Secretary, acting through the Director of the Centers for Disease
    Control and Prevention, shall work with the State- and Tribal-based
    diabetes prevention and control programs assisted by the Centers to
    encourage postpartum followup after gestational diabetes, as medically
    appropriate, for the purpose of reducing the incidence of gestational
    diabetes, the recurrence of gestational diabetes in subsequent
    pregnancies, the development of type 2 diabetes in individuals with a
    history of gestational diabetes, and related complications.''.

    SEC. 5216. CONSUMER EDUCATION CAMPAIGN.

        Section 229(b) of the Public Health Service Act (42 U.S.C.
    237a(b)), as amended--
                (1) in paragraph (6), at the end, by striking ``and'';
                (2) in paragraph (7), at the end, by striking the period
            and inserting a semicolon; and
                (3) by adding at the end the following:
                ``(8) not later than one year after the date of the
            enactment of this paragraph, develop and implement a 4-year
            culturally and linguistically appropriate multimedia consumer
            education campaign that is designed to promote understanding
            and acceptance of evidence-based maternity practices and models
            of care for optimal maternity outcomes among individuals of
            childbearing ages and families of such individuals and that--
                        ``(A) highlights the importance of protecting,
                    promoting, and supporting the innate capacities of
                    childbearing individuals and their newborns for
                    childbirth, breastfeeding, and attachment;
                        ``(B) promotes understanding of the importance of
                    using obstetric interventions when medically necessary
                    and when supported by strong, high-quality evidence;
                        ``(C) highlights the widespread overuse of
                    maternity practices that have been shown to have
                    benefit when used appropriately in situations of
                    medical necessity, but which can expose pregnant
                    individuals, infants, or both to risk of harm if used
                    routinely and indiscriminately;
                        ``(D) emphasizes the noninvasive maternity
                    practices that have proven correlation or may be
                    associated with improvement in outcomes with no
                    detrimental side effects, and are significantly
                    underused in the United States, including smoking
                    cessation programs in pregnancy, group model prenatal
                    care, continuous labor support, nonsupine positions for
                    birth, and external version to turn breech babies at
                    term;
                        ``(E) educates consumers about--
                                ``(i) the qualifications of licensed
                            providers of maternity care, including
                            obstetrician-gynecologists, family physicians,
                            certified nurse-midwives, certified midwives,
                            and certified professional midwives; and
                                ``(ii) the best evidence about the safety,
                            satisfaction, outcomes, and costs of such
                            providers;
                        ``(F) informs consumers about the best available
                    research comparing birth center births, planned home
                    births, and hospital births, including information
                    about each setting's safety, satisfaction, outcomes,
                    and costs;
                        ``(G) fosters participation in high-quality,
                    evidence-based childbirth education that promotes a
                    healthy and safe approach to pregnancy, childbirth, and
                    early parenting; is taught by certified educators, peer
                    counselors, and health professionals; and promotes
                    informed decision making by childbearing individuals;
                        ``(H) informs consumers about--
                                ``(i) the effects of systemic,
                            institutional, and interpersonal racism on the
                            health, well-being, and outcomes of birthing
                            people;
                                ``(ii) the importance of respectful,
                            culturally and linguistically appropriate, and
                            culturally congruent care; and
                                ``(iii) the value of community-based and
                            community-led maternal care and support; and
                        ``(I) is pilot tested for consumer comprehension,
                    cultural sensitivity, and acceptance of the messages
                    across geographically, racially, ethnically, and
                    linguistically diverse populations;''.

    SEC. 5217. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC REVIEWS FOR CARE OF
                  CHILDBEARING INDIVIDUALS AND NEWBORNS.

        (a) In General.--Not later than one year after the date of the
    enactment of this Act, the Secretary of Health and Human Services,
    acting through the Director of the Agency for Healthcare Research and
    Quality, shall--
                (1) make publicly available an online bibliographic
            database identifying systematic reviews, including an
            explanation of the level and quality of evidence, for care of
            childbearing individuals and newborns; and
                (2) initiate regular updates that incorporate newly issued
            and updated systematic reviews.
        (b) Sources.--To aim for a comprehensive inventory of systematic
    reviews relevant to maternal and newborn care, the database shall
    identify reviews from diverse sources, including--
                (1) scientific peer-reviewed journals;
                (2) databases, including the Cochrane Database of
            Systematic Reviews; and
                (3) internet websites of agencies and organizations
            throughout the world that produce such systematic reviews.
        (c) Features.--The database shall--
                (1) provide bibliographic citations for each record within
            the database, and for each such citation include an explanation
            of the level and quality of evidence;
                (2) include abstracts, as available;
                (3) provide reference to companion documents as may exist
            for each review, such as evidence tables and guidelines or
            consumer educational materials developed from the review;
                (4) provide links to the source of the full review and to
            any companion documents;
                (5) provide links to the source of a previous version or
            update of the review;
                (6) be searchable by intervention or other topic of the
            review, reported outcomes, author, title, and source; and
                (7) offer to users periodic electronic notification of
            database updates relating to users' topics of interest.
        (d) Outreach.--Not later than the first date the database is made
    publicly available and periodically thereafter, the Secretary of Health
    and Human Services shall publicize the availability, features, and uses
    of the database under this section to the stakeholders described in
    subsection (e).
        (e) Consultation.--For purposes of developing the database under
    this section and maintaining and updating such database, the Secretary
    of Health and Human Services shall convene and consult with an advisory
    committee composed of relevant stakeholders, including--
                (1) Federal Medicaid administrators and State agencies
            administrating State plans under title XIX of the Social
            Security Act pursuant to section 1902(a)(5) of such Act (42
            U.S.C. 1396a(a)(5));
                (2) providers of maternity and newborn care from both
            academic and community-based settings, including obstetrician-
            gynecologists, family physicians, certified nurse midwives,
            certified midwives, certified professional midwives, physician
            assistants, perinatal nurses, pediatricians, and nurse
            practitioners;
                (3) maternal-fetal medicine specialists;
                (4) neonatologists;
                (5) childbearing individuals and advocates for such
            individuals, including childbirth educators certified by a
            nationally accredited program, representing communities that
            are diverse in terms of race, ethnicity, indigenous status, and
            geographic area;
                (6) employers and purchasers;
                (7) health facility and system leaders, including both
            hospital and birth center facilities;
                (8) journalists; and
                (9) bibliographic informatics specialists.
        (f) Authorization of Appropriations.--There is authorized to be
    appropriated $2,500,000 for each of the fiscal years 2023 through 2025
    for the purpose of developing the database and such sums as may be
    necessary for each subsequent fiscal year for updating the database and
    providing outreach and notification to users, as described in this
    section.

    SEC. 5218. DEVELOPMENT OF INTERPROFESSIONAL MATERNITY CARE EDUCATIONAL
                  MODELS AND TOOLS.

        (a) In General.--Not later than 6 months after the date of the
    enactment of this Act, the Secretary of Health and Human Services,
    acting in conjunction with the Administrator of Health Resources and
    Services Administration, shall convene, for a 1-year period, an
    Interprofessional Maternity Provider Education Commission (referred to
    in this section as the ``Commission'') to discuss and make
    recommendations for--
                (1) a consensus standard physiologic maternity care
            curriculum that takes into account the core competencies for
            basic midwifery practice such as those developed by the
            American College of Nurse Midwives and the North American
            Registry of Midwives, and the educational objectives for
            physicians practicing in obstetrics and gynecology as
            determined by the Council on Resident Education in Obstetrics
            and Gynecology;
                (2) suggestions for multidisciplinary use of the consensus
            physiologic curriculum;
                (3) strategies to integrate and coordinate education across
            maternity care disciplines, including recommendations to
            increase medical and midwifery student exposure to out-of-
            hospital birth;
                (4) curriculum and strategies for continuing education of
            practicing perinatal professionals who have completed their
            undergraduate and graduate education; and
                (5) pilot demonstrations of interprofessional educational
            models.
        (b) Participants.--
                (1) Professions.--The Commission shall include maternity
            care educators, curriculum developers, service leaders,
            certification leaders, and accreditation leaders from the
            various professions that provide or support maternity care in
            the United States. Such professions shall include obstetrician
            gynecologists, certified nurse midwives or certified midwives,
            family practice physicians, nurse practitioners, physician
            assistants, certified professional midwives, perinatal nurses,
            doulas, lactation personnel, and community health workers.
                (2) Consumer advocates.--The Commission shall also include
            representation from maternity care consumer advocates.
        (c) Curriculum.--The consensus standard physiologic maternity care
    curriculum described in subsection (a)(1) shall--
                (1) have a public health focus with a foundation in health
            promotion and disease prevention;
                (2) foster physiologic childbearing and person and family
            centered care;
                (3) reflect the extensive, growing research evidence
            about--
                        (A) the innate abilities and processes of the
                    birthing person and the fetus or newborn for labor,
                    birth, postpartum transition, breastfeeding, and
                    attachment, when promoted, supported, and protected;
                    and
                        (B) the effects of factors that disturb and disrupt
                    these processes;
                (4) integrate strategies to reduce maternal and infant
            morbidity and mortality;
                (5) incorporate recommendations to ensure respectful, safe,
            and seamless consultation, referral, transport, and transfer of
            care when necessary;
                (6) include cultural sensitivity and strategies to decrease
            inequities in maternity outcomes; and
                (7) include implicit bias training.
        (d) Report.--Not later than 6 months after the final meeting of the
    Commission, the Secretary of Health and Human Services shall--
                (1) submit to Congress a report containing the
            recommendations made by the Commission under this section; and
                (2) make such report publicly available.
        (e) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section $1,000,000 for each of the
    fiscal years 2023 and 2024, and such sums as are necessary for each of
    the fiscal years 2025 through 2027.

    SEC. 5219. DISSEMINATION OF THE QUALITY FAMILY PLANNING GUIDELINES.

        (a) In General.--Not later than 180 days after the date of
    enactment of this Act, the Secretary of Health and Human Services and
    the Director of the Centers for Disease Control and Prevention shall--
                (1) develop a plan for outreach to publicly funded health
            care providers, including federally qualified health centers
            (as defined in section 1861(aa)(4) of the Social Security Act
            (42 U.S.C. 1395x(aa)(4))) and branches of the Indian Health
            Service, about the quality family planning guidelines referred
            to in section 5304; and
                (2) award grants to eligible entities to implement such
            guidelines for all patients seeking family planning services.
        (b) Definition.--In this section, the term ``eligible entity''
    means a publicly funded health care provider that serves persons of
    reproductive age.

           Subtitle D--Federal Agency Coordination on Maternal Health

    SEC. 5301. INTERAGENCY COORDINATING COMMITTEE ON THE PROMOTION OF
                  OPTIMAL MATERNITY OUTCOMES.

        (a) In General.--Part A of title II of the Public Health Service
    Act (42 U.S.C. 202 et seq.) is amended by adding at the end the
    following:

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

        ``(a) In General.--The Secretary, acting through the Deputy
    Assistant Secretary for Women's Health under section 229 and in
    collaboration with the Federal officials specified in subsection (b),
    shall establish the Interagency Coordinating Committee on the Promotion
    of Optimal Maternity Outcomes (referred to in this section as the
    `ICCPOM').
        ``(b) Other Agencies.--The officials specified in this subsection
    are the Secretary of Labor, the Secretary of Defense, the Secretary of
    Veterans Affairs, the Surgeon General, the Director of the Centers for
    Disease Control and Prevention, the Administrator of the Health
    Resources and Services Administration, the Administrator of the Centers
    for Medicare & Medicaid Services, the Director of the Indian Health
    Service, the Administrator of the Substance Abuse and Mental Health
    Services Administration, the Director of the National Institute of
    Child Health and Human Development, the Director of the Agency for
    Healthcare Research and Quality, the Assistant Secretary for Children
    and Families, the Deputy Assistant Secretary for Minority Health, the
    Director of the Office of Personnel Management, and such other Federal
    officials as the Secretary of Health and Human Services determines to
    be appropriate.
        ``(c) Chair.--The Deputy Assistant Secretary for Women's Health
    shall serve as the chair of the ICCPOM.
        ``(d) Duties.--The ICCPOM shall guide policy and program
    development across the Federal Government with respect to promotion of
    optimal maternity care, provided, however, that nothing in this section
    shall be construed as transferring regulatory or program authority from
    an agency to the ICCPOM.
        ``(e) Consultations.--The ICCPOM shall actively seek the input of,
    and shall consult with, all appropriate and interested stakeholders,
    including State health departments, public health research and interest
    groups, foundations, childbearing individuals and their advocates, and
    maternity care professional associations and organizations, reflecting
    racially, ethnically, demographically, and geographically diverse
    communities.
        ``(f) Annual Report.--
                ``(1) In general.--The Secretary, on behalf of the ICCPOM,
            shall annually submit to Congress a report that summarizes--
                        ``(A) all programs and policies of Federal agencies
                    (including the Medicare Program under title XVIII of
                    the Social Security Act and the Medicaid program under
                    title XIX of such Act) designed to promote optimal
                    maternity care, focusing particularly on programs and
                    policies that support the adoption of evidence-based
                    maternity care, as defined by timely, scientifically
                    sound systematic reviews;
                        ``(B) all programs and policies of Federal agencies
                    (including the Medicare Program under title XVIII of
                    the Social Security Act and the Medicaid program under
                    title XIX of such Act) designed to address the problems
                    of maternal mortality and morbidity, infant mortality,
                    prematurity, and low birth weight, including such
                    programs and policies designed to address racial and
                    ethnic inequities with respect to each of such
                    problems;
                        ``(C) the extent of progress in reducing maternal
                    mortality and infant mortality, low birth weight, and
                    prematurity at State and national levels; and
                        ``(D) such other information regarding optimal
                    maternity care (such as quality and performance
                    measures) as the Secretary determines to be
                    appropriate.
                ``(2) Reducing inequities with respect to indigenous
            status.--The information specified in paragraph (1)(C) shall be
            included in each such report in a manner that disaggregates
            such information by race, ethnicity, and indigenous status in
            order to determine the extent of progress in reducing racial
            and ethnic inequities and inequities related to indigenous
            status.
                ``(3) Certain information.--Each report under paragraph (1)
            shall include information (disaggregated by race, ethnicity,
            and indigenous status, as applicable) on the following rates,
            trends, and costs by State:
                        ``(A) The rate and trend of primary cesarean
                    deliveries and repeat cesarean deliveries.
                        ``(B) The rate and trend of vaginal births after
                    cesarean.
                        ``(C) The rate and trend of vaginal breech births.
                        ``(D) The rate and trend of induction of labor.
                        ``(E) The rate and trend of freestanding birth
                    center births.
                        ``(F) The rate and trend of planned and unplanned
                    home birth.
                        ``(G) The rate and trends of attended births by
                    different types of maternity care providers, including
                    by an obstetrician-gynecologist, family practice
                    physician, obstetrician-gynecologist physician
                    assistant, certified nurse-midwife, certified midwife,
                    and certified professional midwife.
                        ``(H) The rate and trend of severe maternal
                    morbidity.
                        ``(I) The rates and trends of prenatal and
                    postpartum anxiety and depression.
                        ``(J) The rate and trend of pre-term birth.
                        ``(K) The rate and trend of low birth weight.
                        ``(L) The cost of maternity care disaggregated by
                    place of birth and provider of care, including--
                                ``(i) uncomplicated vaginal birth;
                                ``(ii) complicated vaginal birth;
                                ``(iii) uncomplicated cesarean birth; and
                                ``(iv) complicated cesarean birth.
        ``(g) Authorization of Appropriations.--There is authorized to be
    appropriated, in addition to amounts authorized to be appropriated
    under section 229(e), to carry out this section $1,000,000 for each of
    the fiscal years 2023 through 2027.''.
        (b) Conforming Amendments.--
                (1) Inclusion as duty of hhs office on women's health.--
            Section 229(b) of such Act (42 U.S.C. 237a(b)), as amended by
            section 5216, is further amended by adding at the end the
            following new paragraph:
                ``(9) establish the Interagency Coordinating Committee on
            the Promotion of Optimal Maternity Outcomes in accordance with
            section 229A; and''.
                (2) Treatment of biennial reports.--Section 229(d) of such
            Act (42 U.S.C. 237a(d)) is amended by inserting ``(other than
            under subsection (b)(9))'' after ``under this section''.

    SEC. 5302. EXPANSION OF CDC PREVENTION RESEARCH CENTERS PROGRAM TO
                  INCLUDE CENTERS ON OPTIMAL MATERNITY OUTCOMES.

        (a) In General.--Not later than one year after the date of the
    enactment of this Act, the Secretary of Health and Human Services shall
    support the establishment of additional Prevention Research Centers
    under the Prevention Research Center Program administered by the
    Centers for Disease Control and Prevention. Such additional centers
    shall each be known as a Center for Excellence on Optimal Maternity
    Outcomes.
        (b) Research.--Each Center for Excellence on Optimal Maternity
    Outcomes shall--
                (1) conduct at least one focused program of research to
            improve maternity outcomes, including the reduction of cesarean
            birth rates, early elective inductions, prematurity rates, and
            low birth weight rates within an underserved population that
            has a disproportionately large burden of suboptimal maternity
            outcomes, including maternal mortality and morbidity, infant
            mortality, prematurity, or low birth weight, which such program
            shall include developing performance and quality measures for
            accountability;
                (2) work with partners on special interest projects, as
            specified by the Centers for Disease Control and Prevention and
            other relevant agencies within the Department of Health and
            Human Services, and on projects funded by other sources; and
                (3) involve a minimum of two distinct birth setting models,
            such as--
                        (A) a hospital labor and delivery model and
                    freestanding birth center model; or
                        (B) a hospital labor and delivery model and planned
                    home birth model.
        (c) Interdisciplinary Providers.--Each Center for Excellence on
    Optimal Maternity Outcomes shall include the following
    interdisciplinary providers of maternity care:
                (1) Obstetrician-gynecologists.
                (2) At least two of the following providers:
                        (A) Family practice physicians.
                        (B) Nurse practitioners.
                        (C) Physician assistants.
                        (D) Certified professional midwives, certified
                    nurse-midwives, or certified midwives.
        (d) Services.--Research conducted by each Center for Excellence on
    Optimal Maternity Outcomes shall include at least 2 (and preferably
    more) of the following supportive provider services:
                (1) Mental health.
                (2) Doula labor support.
                (3) Nutrition education.
                (4) Childbirth education.
                (5) Social work.
                (6) Physical therapy or occupation therapy.
                (7) Substance use disorder services.
                (8) Home visiting.
        (e) Coordination.--The programs of research at each of the Centers
    of Excellence on Optimal Maternity Outcomes shall complement and not
    replicate the work of the other.
        (f) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section $2,000,000 for each of the
    fiscal years 2023 through 2027.

    SEC. 5303. EXPANDING MODELS TO BE TESTED BY CENTER FOR MEDICARE AND
                  MEDICAID INNOVATION TO EXPLICITLY INCLUDE MATERNITY CARE
                  AND CHILDREN'S HEALTH MODELS.

        Section 1115A(b)(2) of the Social Security Act (42 U.S.C.
    1315a(b)(2)) is amended--
                (1) in subparagraph (B), by adding at the end the
            following:
                                ``(xxviii) Promoting evidence-based models
                            of care that have been associated with
                            reductions in pregnancy-related and infant
                            health inequities, including incorporating the
                            use of and payment for doulas, particularly
                            community-based doulas, and promoting support
                            for people during pregnancy and for the one-
                            year period after the last day of such person's
                            pregnancy, through evidence-based models of
                            antepartum, birth, postpartum care, and two-
                            generation birthing person and newborn care
                            models, and supporting the risk-appropriate use
                            of out-of-hospital birth models, including
                            births at home and in freestanding birth
                            centers. Such models shall be selected and
                            evaluated based on their impact on quality,
                            equity, and developmental outcomes,
                            notwithstanding any other provision of this
                            section.'';
                (2) in subparagraph (C), by adding at the end the
            following:
                                ``(ix) Whether the model includes a regular
                            process for ensuring the provision of
                            culturally and linguistically appropriate
                            services.
                                ``(x) Whether health care services and
                            supportive services included in the model are
                            tailored to community health and health-related
                            social needs and provided by community-based
                            and community-led providers.
                                ``(xi) Whether the model is designed to
                            mitigate harmful effects of discrimination on
                            the basis of race, sex, disability, ethnicity,
                            language, and age.''; and
                (3) by adding at the end the following:
                        ``(D) Mandatory health equity models to be
                    tested.--The Secretary shall select--
                                ``(i) Medicaid global and episode-based
                            payment models for culturally and
                            linguistically appropriate antepartum, labor
                            and delivery, and postpartum doula services,
                            including community-based doula services, that
                            are--
                                        ``(I) structured to provide payment
                                    to doulas as individuals, health care
                                    entity staff, or members of a doula
                                    group or collective, or through a
                                    third-party administrator;
                                        ``(II) designed to reduce racial
                                    and intersecting health inequities;
                                        ``(III) designed to provide doulas
                                    providing support with an equitable and
                                    sustainable reimbursement rate;
                                        ``(IV) designed to reduce barriers
                                    to workforce entry for culturally and
                                    linguistically competent and racially
                                    congruent doulas to provide services to
                                    Medicaid enrollees; and
                                        ``(V) designed with input from
                                    community-based doulas, maternal health
                                    advocates, reproductive justice
                                    advocates, and Medicaid beneficiaries;
                                ``(ii) a Medicaid episode-based payment
                            model for pregnancy-related services, including
                            health care services and supportive services to
                            address health-related socials needs, during
                            the prenatal, intrapartum, and postpartum
                            periods, to improve health outcomes and reduce
                            racial health inequities, and to be designed
                            with input from maternity care providers,
                            maternal health advocates, reproductive justice
                            advocates, and Medicaid beneficiaries;
                                ``(iii) a Medicaid alternative payment
                            model for a pregnancy-related health home to
                            improve health outcomes during and for one year
                            after pregnancy and during the newborn period,
                            and to reduce racial health inequities,
                            designed with input from maternity care
                            providers, maternal health advocates,
                            reproductive justice advocates, and Medicaid
                            beneficiaries;
                                ``(iv) a Medicaid perinatal health worker
                            service delivery model for culturally and
                            linguistically appropriate and respectful
                            health care and supportive services that are
                            tailored to community health and health-related
                            social needs, designed to improve health
                            outcomes and mitigate harmful effects of racism
                            and other forms of discrimination, and provided
                            by community-based and community-led providers;
                            and
                                ``(v) one or more models exclusively
                            focused on early intervention and prevention
                            for children enrolled in a State plan (or
                            waiver of such plan) under title XIX or a State
                            child health plan under title XXI using
                            evidence-based interventions including
                            parenting support programs, home-visiting
                            services, and dyadic therapy treatment for
                            children and adolescents at-risk.
                    Such models shall be selected and evaluated based on
                    their impact on quality, equity, and developmental
                    outcomes, notwithstanding any other provision of this
                    section.''.

    SEC. 5304. INTERAGENCY UPDATE TO THE QUALITY FAMILY PLANNING
                  GUIDELINES.

        (a) In General.--Not later than six months after the date of
    enactment of this Act, the Director of the Centers for Disease Control
    and Prevention and the Office of Population Affairs shall review and
    expand the 2014 Quality Family Planning Guidelines to address--
                (1) health inequities; and
                (2) the importance of patient-directed contraceptive
            decision making.
        (b) Consultation.--In carrying out subsection (a), the Director of
    the Centers for Disease Control and Prevention and the Office of
    Population Affairs shall convene a meeting, and solicit the views of,
    stakeholders including experts on health inequities, experts on
    reproductive coercion, representatives of provider organizations,
    patient advocates, reproductive justice organizations, organizations
    that represent racial and ethnic minority communities, organizations
    that represent people with disabilities, organizations that represent
    LGBTQ persons, and organizations that represent people with limited
    English proficiency.

                   Subtitle E--Reproductive and Sexual Health

    SEC. 5401. FINDINGS; SENSE OF CONGRESS ON URGENT BARRIERS TO ABORTION
                  ACCESS AND VITAL SOLUTIONS.

        (a) Findings.--Congress finds the following:
                (1) Affordable, comprehensive health insurance that
            includes coverage for a full range of pregnancy-related care,
            including abortion, is critical to the health of every person
            regardless of actual or perceived race, color, national origin,
            immigration status, sex (including sexual orientation, gender
            identity, pregnancy, childbirth, a medical condition relating
            to pregnancy or childbirth, or sex stereotyping), age, or
            disability status.
                (2) Abortion services are essential to health care and
            access to those services is central to people's ability to
            participate equally in the economic and social life of the
            United States. Abortion access allows people who are pregnant
            to make their own decisions about their pregnancies, their
            families, and their lives.
                (3) Reproductive justice seeks to address restrictions on
            reproductive health, including abortion, that perpetuate
            systems of oppression, lack of bodily autonomy, White
            supremacy, and anti-Black racism. The violent legacy of these
            systems of oppression has manifested in policies including
            enslavement, rape, and experimentation on Black people, forced
            sterilizations, medical experimentation on low-income people's
            reproductive systems, and the forcible removal of Indigenous
            children. Access to equitable reproductive health care,
            including abortion services, has always been deficient in the
            United States for Black, Indigenous, and other People of Color
            (BIPOC) and their families. Transgender, nonbinary, and gender-
            expansive individuals, and specifically those who are Black,
            disabled, and at the intersections of multiple forms of
            oppression, also experience inequitable access to abortion
            services due to systemic violence. Centering abortion rights
            and access as a ``women's health'' issue restricts access to
            those with reproductive needs who do not identify as cisgender
            women. In order to work towards reproductive justice for all
            communities, transgender, nonbinary, and gender expansive must
            be centered in conversations of abortion access. Improving
            abortion access for this community requires a gender-neutral
            approach to abortion care, rights, and justice policy.
                (4) The legacy of restrictions on reproductive health,
            rights, and justice is not a dated vestige of a dark history.
            Access to abortion services is obstructed across the United
            States in various ways, including blockades of health care
            facilities and associated violence, prohibitions of, and
            restrictions on, insurance coverage, parental involvement laws
            (notification and consent), restrictions that shame and
            stigmatize people seeking abortion services, and medically
            unnecessary regulations that neither confer any health benefit
            nor further the safety of abortion services, but which harm
            people by delaying, complicating access to, and reducing the
            availability of, abortion services. As of December 2, 2021, 19
            States have enacted 106 restrictions, including 12 new abortion
            bans, making 2021 the year with the highest number of
            restrictions passed since Roe v. Wade was decided in 1973.
            Additionally, 21 States are poised to immediately ban or
            significantly restrict access to abortion services if the
            Supreme Court chooses to overturn or weaken Roe v. Wade. These
            unprecedented attacks on abortion rights and access fall
            especially heavily on people with low incomes, BIPOC,
            immigrants, young people, people with disabilities, those
            living in rural and other medically underserved areas, and
            transgender, nonbinary, and gender expansive individuals.
                (5) Since 1976, the Federal Government has withheld funds
            for abortion coverage in most circumstances through the Hyde
            amendment and similar coverage restrictions, affecting
            individuals of reproductive age in the United States who are
            insured through the Medicaid program, as well as individuals
            who receive insurance or care through other Federal health
            plans and programs. Of women aged 15 to 44 enrolled in Medicaid
            in 2017, 55 percent lived in the 35 States and the District of
            Columbia that do not cover abortion, except in limited
            circumstances. This amounts to roughly 7,300,000 women of
            reproductive age, including 3,100,000 women living below the
            Federal poverty level. Women of color are disproportionately
            likely to be insured by the Medicaid program, and nationwide,
            32 percent of Black women and 27 percent of Hispanic women aged
            15 to 44 were enrolled in Medicaid in 2017, compared with 16
            percent of White women.
                (6) Abortion-specific restrictions are even more compounded
            by the ongoing criminalization of people who are pregnant,
            including those who are incarcerated, living with HIV, or with
            substance-use disorders. These communities already experience
            health inequities due to social, political, and environmental
            inequities, and restrictions on abortion services exacerbate
            these harms. Removing medically unjustified restrictions on
            abortion services would constitute one important step on the
            path toward realizing reproductive justice by ensuring that the
            full range of reproductive health care is accessible to all who
            need it.
                (7) Abortion-specific restrictions are a tool of gender
            oppression, as they target health care services that are used
            primarily by individuals with reproductive needs. These
            paternalistic restrictions rely on and reinforce harmful
            stereotypes about gender roles, people's decision making, and
            people's need for protection instead of support, undermining
            their ability to control their own lives and well-being. These
            restrictions harm the basic autonomy, dignity, and equality of
            individuals with reproductive health needs, and their ability
            to participate in the social and economic life of the Nation.
                (8) Many abortion-specific restrictions do not confer any
            health or safety benefits on the patient. Instead, these
            restrictions have the purpose and effect of unduly burdening
            people's personal and private medical decisions to end their
            pregnancies by making access to abortion services more
            difficult, invasive, and costly, often forcing people to travel
            significant distances and make multiple unnecessary visits to
            the provider, and in some cases, foreclosing the option
            altogether.
                (9) Congress has used its authority in the past to protect
            access to abortion services and health care providers' ability
            to provide abortion services. In the early 1990s, protests and
            blockades at health care facilities where abortion services
            were provided, and associated violence, increased dramatically
            and reached crisis level, requiring congressional action.
            Congress passed the Freedom of Access to Clinic Entrances Act
            (Public Law 103-259; 108 Stat. 694) to address that situation
            and protect physical access to abortion services.
                (10) Congressional action is necessary to put an end to
            harmful restrictions, to federally protect access to abortion
            services for everyone regardless of where they live, and to
            protect the ability of health care providers to provide these
            services in a safe and accessible manner.
                (11) The Equal Access to Abortion Coverage in Health
            Insurance Act of 2021 or the EACH Act of 2021 (H.R. 2234, S.
            1021) introduced in the 117th Congress, would reverse the Hyde
            amendment and related abortion coverage restrictions. It would
            create an enforceable statutory right for people who receive
            health coverage or care through enumerated Federal programs
            (including Medicaid, the Children's Health Insurance Program,
            Medicare, the Indian Health Service, among others) and plans
            (including government-sponsored health insurance due to a
            current or former employment relationship) to receive abortion
            coverage. It would require the Federal government to facilitate
            abortion access for individuals eligible to receive health care
            in Federal facilities or in facilitates with which it contracts
            to provide health care, such as immigration detention centers.
            It also prohibits the Federal Government from prohibiting,
            restricting, or otherwise inhibiting State or local governments
            or private health insurance issuers from providing abortion
            coverage.
                (12) The Women's Health Protection Act of 2021 (H.R. 3755,
            S. 1975) introduced in the 117th Congress, would establish an
            enforceable statutory right for health care providers to
            provide, and abortion patients to receive, abortions free from
            medically unnecessary restrictions, limitations, and bans that
            delay, and at times, completely obstruct, access to abortion.
        (b) Sense of Congress.--It is the sense of Congress that
    eliminating the Hyde amendment, enacting the Equal Access to Abortion
    Coverage in Health Insurance Act of 2021, and enacting the Women's
    Health Protection Act of 2021, are critical to--
                (1) promoting equitable abortion access, including
            coverage, for all who seek care;
                (2) creating enforceable rights to receive, and receive
            coverage for, such care;
                (3) advancing equitable access to comprehensive health
            coverage, which cannot be achieved without abortion coverage;
            and
                (4) alleviating urgent racial, gender, and other inequities
            in health and health care and corresponding reproductive
            injustices.

    SEC. 5402. EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION PROGRAMS.

        (a) Emergency Contraception Public Education Program.--
                (1) In general.--The Secretary, acting through the Director
            of the Centers for Disease Control and Prevention, shall
            develop and disseminate to the public medically accurate and
            complete information on emergency contraceptives.
                (2) Dissemination.--The Secretary may disseminate medically
            accurate and complete information under paragraph (1) directly
            or through arrangements with nonprofit organizations, community
            health workers, including promotores, consumer groups,
            institutions of higher education, clinics, the media, and
            Federal, State, and local agencies.
                (3) Information.--The information disseminated under
            paragraph (1) shall--
                        (A) include, at a minimum, a description of
                    emergency contraceptives and an explanation of the use,
                    safety, efficacy, affordability, and availability,
                    including over-the-counter access, of such
                    contraceptives and options for access to such
                    contraceptives without cost-sharing through insurance
                    and other programs; and
                        (B) be pilot tested for consumer comprehension,
                    cultural and linguistic appropriateness, and acceptance
                    of the messages across geographically, racially,
                    ethnically, and linguistically diverse populations.
        (b) Emergency Contraception Information Program for Health Care
    Providers.--
                (1) In general.--The Secretary, acting through the
            Administrator of the Health Resources and Services
            Administration and in consultation with major medical and
            public health organizations, shall develop and disseminate to
            health care providers, including pharmacists, information on
            emergency contraceptives.
                (2) Information.--The information disseminated under
            paragraph (1) shall include, at a minimum--
                        (A) information describing the use, safety,
                    efficacy, and availability of emergency contraceptives,
                    and options for access without cost-sharing through
                    insurance and other programs;
                        (B) a recommendation regarding the use of such
                    contraceptives; and
                        (C) information explaining how to obtain copies of
                    the information developed under subsection (a) for
                    distribution to the patients of the providers.
        (c) Definitions.--In this section:
                (1) Health care provider.--The term ``health care
            provider'' means an individual who is licensed or certified
            under State law to provide health care services and who is
            operating within the scope of such license. Such term shall
            include a pharmacist.
                (2) Institution of higher education.--The term
            ``institution of higher education'' has the same meaning given
            such term in section 101(a) of the Higher Education Act of 1965
            (20 U.S.C. 1001(a)).
                (3) Secretary.--The term ``Secretary'' means the Secretary
            of Health and Human Services.
        (d) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section such sums as may be necessary
    for each of the fiscal years 2023 through 2027.

    SEC. 5403. ACCESS TO BIRTH CONTROL DUTIES OF PHARMACIES TO ENSURE
                  PROVISION OF FDA-APPROVED CONTRACEPTION.

        Part B of title II of the Public Health Service Act (42 U.S.C. 238
    et seq.) is amended by adding at the end the following:

    ``SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION OF FDA-APPROVED
                  CONTRACEPTION.

        ``(a) In General.--Subject to subsection (c), a pharmacy that
    receives Food and Drug Administration-approved drugs or devices in
    interstate commerce shall maintain compliance with the following:
                ``(1) If a customer requests a contraceptive or a
            medication related to a contraceptive, including emergency
            contraception, that is in stock, the pharmacy shall ensure that
            the contraceptive is provided to the customer without delay.
                ``(2) If a customer requests a contraceptive or a
            medication related to a contraceptive that is not in stock and
            the pharmacy in the normal course of business stocks
            contraception, the pharmacy shall immediately inform the
            customer that the contraceptive is not in stock and without
            delay offer the customer the following options:
                        ``(A) If the customer prefers to obtain the
                    contraceptive or a medication related to a
                    contraceptive through a referral or transfer, the
                    pharmacy shall--
                                ``(i) locate a pharmacy of the customer's
                            choice or the closest pharmacy confirmed to
                            have the contraceptive or a medication related
                            to a contraceptive in stock; and
                                ``(ii) refer the customer or transfer the
                            prescription to that pharmacy.
                        ``(B) If the customer prefers for the pharmacy to
                    order the contraceptive or a medication related to a
                    contraceptive, the pharmacy shall obtain the
                    contraceptive or medication under the pharmacy's
                    standard procedure for expedited ordering of medication
                    and notify the customer when the contraceptive or
                    medication arrives.
                ``(3) The pharmacy shall ensure that--
                        ``(A) the pharmacy does not operate an environment
                    in which customers are intimidated, threatened, or
                    harassed in the delivery of services relating to a
                    request for contraception or a medication related to a
                    contraceptive;
                        ``(B) the pharmacy's employees do not interfere
                    with or obstruct the delivery of services relating to a
                    request for contraception or a medication related to a
                    contraceptive;
                        ``(C) the pharmacy's employees do not intentionally
                    misrepresent or deceive customers about the
                    availability of a contraceptive or a medication related
                    to a contraceptive, or the mechanism of action of such
                    contraceptive or medication;
                        ``(D) the pharmacy's employees do not breach
                    medical confidentiality with respect to a request for a
                    contraceptive or a medication related to a
                    contraceptive or threaten to breach such
                    confidentiality; or
                        ``(E) the pharmacy's employees do not refuse to
                    return a valid, lawful prescription for a contraceptive
                    or a medication related to a contraceptive upon
                    customer request.
        ``(b) Contraceptives Not Ordinarily Stocked.--Nothing in subsection
    (a)(2) shall be construed to require any pharmacy to comply with such
    subsection if the pharmacy does not ordinarily stock contraceptives or
    a medication related to a contraceptive in the normal course of
    business.
        ``(c) Refusals Pursuant to Standard Pharmacy Practice.--This
    section does not prohibit a pharmacy from refusing to provide a
    contraceptive or a medication related to a contraceptive to a customer
    in accordance with any of the following:
                ``(1) If it is unlawful to dispense the contraceptive or a
            medication related to a contraceptive to the customer without a
            valid, lawful prescription and no such prescription is
            presented.
                ``(2) If the customer is unable to pay for the
            contraceptive or the medication related to a contraceptive.
                ``(3) If the employee of the pharmacy refuses to provide
            the contraceptive or a medication related to a contraceptive on
            the basis of a professional clinical judgment.
        ``(d) Relation to Other Law.--
                ``(1) Rule of construction.--Nothing in this section shall
            be construed to invalidate or limit rights, remedies,
            procedures, or legal standards under title VII of the Civil
            Rights Act of 1964.
                ``(2) Certain claims.--The Religious Freedom Restoration
            Act of 1993 shall not provide a basis for a claim concerning,
            or a defense to a claim under, this section, or provide a basis
            for challenging the application or enforcement of this section.
        ``(e) Preemption.--This section does not preempt any provision of
    State law or any professional obligation made applicable by a State
    board or other entity responsible for licensing or discipline of
    pharmacies or pharmacists, to the extent that such State law or
    professional obligation provides protections for customers that are
    greater than the protections provided by this section.
        ``(f) Enforcement.--
                ``(1) Civil penalty.--A pharmacy that violates a
            requirement of subsection (a) is liable to the United States
            for a civil penalty in an amount not exceeding $1,000 per day
            of violation, not to exceed $100,000 for all violations
            adjudicated in a single proceeding.
                ``(2) Private cause of action.--Any person aggrieved as a
            result of a violation of a requirement of subsection (a) may,
            in any court of competent jurisdiction, commence a civil action
            against the pharmacy involved to obtain appropriate relief,
            including actual and punitive damages, injunctive relief, and a
            reasonable attorney's fee and cost.
                ``(3) Limitations.--A civil action under paragraph (1) or
            (2) may not be commenced against a pharmacy after the
            expiration of the 5-year period beginning on the date on which
            the pharmacy allegedly engaged in the violation involved.
        ``(g) Definitions.--In this section:
                ``(1) Contraception.--The term `contraception' or
            `contraceptive' means any drug or device approved by the Food
            and Drug Administration to prevent pregnancy.
                ``(2) Employee.--The term `employee' means a person hired,
            by contract or any other form of an agreement, by a pharmacy.
                ``(3) Medication related to a contraceptive.--The term
            `medication related to a contraceptive' means any drug or
            device approved by the Food and Drug Administration that a
            medical professional determines necessary to use before or in
            conjunction with a contraceptive.
                ``(4) Pharmacy.--The term `pharmacy' means an entity that--
                        ``(A) is authorized by a State to engage in the
                    business of selling prescription drugs at retail; and
                        ``(B) employs one or more employees.
                ``(5) Product.--The term `product' means a Food and Drug
            Administration-approved drug or device.
                ``(6) Professional clinical judgment.--The term
            `professional clinical judgment' means the use of professional
            knowledge and skills to form a clinical judgment, in accordance
            with prevailing medical standards.
                ``(7) Without delay.--The term `without delay', with
            respect to a pharmacy providing, providing a referral for, or
            ordering contraception, or transferring the prescription for
            contraception, means within the usual and customary timeframe
            at the pharmacy for providing, providing a referral for, or
            ordering other products, or transferring the prescription for
            other products, respectively.
        ``(h) Effective Date.--This section shall take effect on the 31st
    day after the date of the enactment of this section, without regard to
    whether the Secretary has issued any guidance or final rule regarding
    this section.''.

    SEC. 5404. REAL EDUCATION AND ACCESS FOR HEALTHY YOUTH.

        (a) Purpose.--The purpose of this section is to provide young
    people with sex education and sexual health services that--
                (1) promote and uphold the rights of young people to
            information and services that empower them to make decisions
            about their bodies, health, sexuality, families, and
            communities in all areas of life;
                (2) are evidence-informed, comprehensive in scope,
            confidential, equitable, accessible, medically accurate and
            complete, age and developmentally appropriate, culturally
            responsive, and trauma-informed and resilience-oriented;
                (3) provide information about the prevention, treatment,
            and care of pregnancy, sexually transmitted infections, and
            interpersonal violence;
                (4) provide information about the importance of consent as
            a basis for healthy relationships and for autonomy in health
            care;
                (5) provide information on gender roles and gender
            discrimination;
                (6) provide information on the historical and current
            condition in which education and health systems, policies,
            programs, services, and practices have uniquely and adversely
            impacted Black, Indigenous, Latinx, Asian, Asian American and
            Pacific Islander, and other People of Color; and
                (7) redress inequities in the delivery of sex education and
            sexual health services to marginalized young people.
        (b) Definitions.--In this section:
                (1) Age and developmentally appropriate.--The term ``age
            and developmentally appropriate'' means topics, messages, and
            teaching methods suitable to particular ages, age groups, or
            developmental levels, based on cognitive, emotional, social,
            and behavioral capacity of most young people at that age level.
                (2) Characteristics of effective programs.--The term
            ``characteristics of effective programs'' means the aspects of
            evidence-informed programs, including development, content, and
            implementation of such programs, that--
                        (A) have been shown to be effective in terms of
                    increasing knowledge, clarifying values and attitudes,
                    increasing skills, and impacting behavior; and
                        (B) are widely recognized by leading medical and
                    public health agencies to be effective in changing
                    sexual behaviors that lead to sexually transmitted
                    infections, unintended pregnancy, and interpersonal
                    violence among young people.
                (3) Consent.--The term ``consent'' means affirmative,
            conscious, and voluntary agreement to engage in interpersonal,
            physical, or sexual activity.
                (4) Culturally responsive.--The term ``culturally
            responsive'' means education and services that--
                        (A) embrace and actively engage and adjust to young
                    people and their various cultural identities;
                        (B) recognize the ways in which many marginalized
                    young people face unique barriers in our society that
                    result in increased adverse health outcomes and
                    associated stereotypes; and
                        (C) may address the ways in which racism has shaped
                    national health care policy, the lasting historical
                    trauma associated with reproductive health experiments
                    and forced sterilizations of Black, Latinx, and
                    Indigenous communities, or sexual stereotypes assigned
                    to young People of Color or LGBTQ+ people.
                (5) Evidence-informed.--The term ``evidence-informed''
            means incorporates characteristics, content, or skills that
            have been proven to be effective through evaluation in changing
            sexual behavior.
                (6) Gender expression.--The term ``gender expression''
            means the expression of one's gender, such as through behavior,
            clothing, haircut, or voice, and which may or may not conform
            to socially defined behaviors and characteristics typically
            associated with being either masculine or feminine.
                (7) Gender identity.--The term ``gender identity'' means
            the gender-related identity, appearance, mannerisms, or other
            gender-related characteristics of an individual, regardless of
            the individual's designated sex at birth.
                (8) Inclusive.--The term ``inclusive'' means content and
            skills that ensure marginalized young people are valued,
            respected, centered, and supported in sex education instruction
            and materials.
                (9) Institution of higher education.--The term
            ``institution of higher education'' has the meaning given the
            term in section 101 of the Higher Education Act of 1965 (20
            U.S.C. 1001).
                (10) Interpersonal violence.--The term ``interpersonal
            violence'' means abuse, assault, bullying, dating violence,
            domestic violence, harassment, intimate partner violence, or
            stalking.
                (11) Marginalized young people.--The term ``marginalized
            young people'' means young people who are disadvantaged by
            underlying structural barriers and social inequities, including
            young people who are--
                        (A) Black, Indigenous, and other People of Color;
                        (B) immigrants;
                        (C) in contact with the foster care system;
                        (D) in contact with the juvenile justice system;
                        (E) experiencing homelessness;
                        (F) pregnant or parenting;
                        (G) lesbian, gay, bisexual, transgender, or queer;
                        (H) living with HIV;
                        (I) living with disabilities;
                        (J) from families with low-incomes; or
                        (K) living in rural areas.
                (12) Medically accurate and complete.--The term ``medically
            accurate and complete'' means that--
                        (A) the information provided through the education
                    is verified or supported by the weight of research
                    conducted in compliance with accepted scientific
                    methods and is published in peer-reviewed journals,
                    where applicable; or
                        (B) the education contains information that leading
                    professional organizations and agencies with relevant
                    expertise in the field recognize as accurate,
                    objective, and complete.
                (13) Resilience.--The term ``resilience'' means the ability
            to adapt to trauma and tragedy.
                (14) Secretary.--The term ``Secretary'' means the Secretary
            of Health and Human Services.
                (15) Sex education.--The term ``sex education'' means high
            quality teaching and learning that--
                        (A) is delivered, to the maximum extent
                    practicable, following the National Sexuality Education
                    Standards of the Future of Sex Ed Initiative;
                        (B) is about a broad variety of topics related to
                    sex and sexuality, including--
                                (i) puberty and adolescent development;
                                (ii) sexual and reproductive anatomy and
                            physiology;
                                (iii) sexual orientation, gender identity,
                            and gender expression;
                                (iv) contraception, pregnancy, and
                            reproduction;
                                (v) HIV and other STIs;
                                (vi) consent and healthy relationships; and
                                (vii) interpersonal violence;
                        (C) explores values and beliefs about such topics;
                    and
                        (D) helps young people in gaining the skills that
                    are needed to navigate relationships and manage one's
                    own sexual health.
                (16) Sexual development.--The term ``sexual development''
            means the lifelong process of physical, behavioral, cognitive,
            and emotional growth and change as it relates to an
            individual's sexuality and sexual maturation, including
            puberty, identity development, socio-cultural influences, and
            sexual behaviors.
                (17) Sexual health services.--The term ``sexual health
            services'' includes--
                        (A) sexual health information, education, and
                    counseling;
                        (B) all methods of contraception approved by the
                    Food and Drug Administration;
                        (C) routine gynecological care, including human
                    papillomavirus (HPV) vaccines and cancer screenings;
                        (D) pre-exposure prophylaxis or post-exposure
                    prophylaxis;
                        (E) substance use and mental health services;
                        (F) interpersonal violence survivor services; and
                        (G) other prevention, care, or treatment services.
                (18) Sexual orientation.--The term ``sexual orientation''
            means an individual's romantic, emotional, or sexual attraction
            to other people.
                (19) Trauma.--The term ``trauma'' means a response to an
            event, series of events, or set of circumstances that is
            experienced or witnessed by an individual or group of people as
            physically or emotionally harmful or life-threatening with
            lasting adverse effects on their functioning and mental,
            physical, social, emotional, or spiritual well-being.
                (20) Trauma-informed and resilience-oriented.--The term
            ``trauma-informed and resilience-oriented'' means an approach
            that realizes the prevalence of trauma, recognizes the various
            ways individuals, organizations, and communities may respond to
            trauma differently, recognizes that resilience can be built,
            and responds by putting this knowledge into practice.
                (21) Young people.--The term ``young people'' means
            individuals who are ages 10 through 29 at the time of
            commencement of participation in a project supported under this
            section.
                (22) Youth-friendly sexual health services.--The term
            ``youth-friendly sexual health services'' means sexual health
            services that are provided in a confidential, equitable, and
            accessible manner that makes it easy and comfortable for young
            people to seek out and receive services.
        (c) Grants for Sex Education at Elementary and Secondary Schools
    and Youth-Serving Organizations.--
                (1) Program authorized.--The Secretary, in coordination
            with the Secretary of Education, shall award grants, on a
            competitive basis, to eligible entities to enable such eligible
            entities to carry out projects that provide young people with
            sex education.
                (2) Duration.--Grants awarded under this subsection shall
            be for a period of 5 years.
                (3) Eligible entity.--In this subsection, the term
            ``eligible entity'' means a public or private entity that
            delivers health education to young people.
                (4) Applications.--An eligible entity desiring a grant
            under this subsection shall submit an application to the
            Secretary at such time, in such manner, and containing such
            information as the Secretary may require.
                (5) Priority.--In awarding grants under this subsection,
            the Secretary shall give priority to eligible entities that
            are--
                        (A) State educational agencies or local educational
                    agencies; or
                        (B) Indian Tribes or Tribal organizations, as
                    defined in section 4 of the Indian Self-Determination
                    and Education Assistance Act (25 U.S.C. 5304).
                (6) Use of funds.--Each eligible entity that receives a
            grant under this subsection shall use the grant funds to carry
            out a project that provides young people with sex education.
        (d) Grants for Sex Education at Institutions of Higher Education.--
                (1) Program authorized.--The Secretary, in coordination
            with the Secretary of Education, shall award grants, on a
            competitive basis, to institutions of higher education or
            consortia of such institutions to enable such institutions to
            provide students with age and developmentally appropriate sex
            education.
                (2) Duration.--Grants awarded under this subsection shall
            be for a period of 5 years.
                (3) Applications.--An institution of higher education or
            consortium of such institutions desiring a grant under this
            subsection shall submit an application to the Secretary at such
            time, in such manner, and containing such information as the
            Secretary may require.
                (4) Priority.--In awarding grants under this subsection,
            the Secretary shall give priority to an institution of higher
            education that--
                        (A) has an enrollment of needy students, as defined
                    in section 318(b) of the Higher Education Act of 1965
                    (20 U.S.C. 1059e(b));
                        (B) is a Hispanic-serving institution, as defined
                    in section 502(a) of such Act (20 U.S.C. 1101a(a));
                        (C) is a Tribal College or University, as defined
                    in section 316(b) of such Act (20 U.S.C. 1059c(b));
                        (D) is an Alaska Native-serving institution, as
                    defined in section 317(b) of such Act (20 U.S.C.
                    1059d(b));
                        (E) is a Native Hawaiian-serving institution, as
                    defined in section 317(b) of such Act (20 U.S.C.
                    1059d(b));
                        (F) is a Predominantly Black Institution, as
                    defined in section 318(b) of such Act (20 U.S.C.
                    1059e(b));
                        (G) is a Native American-serving, nontribal
                    institution, as defined in section 319(b) of such Act
                    (20 U.S.C. 1059f(b));
                        (H) is an Asian American and Native American
                    Pacific Islander-serving institution, as defined in
                    section 320(b) of such Act (20 U.S.C. 1059g(b)); or
                        (I) is a minority institution, as defined in
                    section 365 of such Act (20 U.S.C. 1067k), with an
                    enrollment of needy students, as defined in section 312
                    of such Act (20 U.S.C. 1058).
                (5) Uses of funds.--An institution of higher education or
            consortium of such institutions receiving a grant under this
            subsection shall use grant funds to develop and implement a
            project to integrate sex education into the institution of
            higher education in order to reach a large number of students,
            by carrying out 1 or more of the following activities:
                        (A) Adopting and incorporating age and
                    developmentally appropriate sex education into student
                    orientation, general education, or courses.
                        (B) Developing or adopting and implementing
                    educational programming outside of class that delivers
                    age and developmentally appropriate sex education to
                    students.
                        (C) Developing or adopting and implementing
                    innovative technology-based approaches to deliver age
                    and developmentally appropriate sex education to
                    students.
                        (D) Developing or adopting and implementing peer-
                    led activities to generate discussion, educate, and
                    raise awareness among students about age and
                    developmentally appropriate sex education.
                        (E) Developing or adopting and implementing
                    policies and practices to link students to sexual
                    health services.
        (e) Grants for Educator Training.--
                (1) Program authorized.--The Secretary, in coordination
            with the Secretary of Education, shall award grants, on a
            competitive basis, to eligible entities to enable such eligible
            entities to carry out the activities described in paragraph
            (5).
                (2) Duration.--Grants awarded under this subsection shall
            be for a period of 5 years.
                (3) Eligible entity.--In this subsection, the term
            ``eligible entity'' means--
                        (A) a State educational agency or local educational
                    agency;
                        (B) an Indian Tribe or Tribal organization, as
                    defined in section 4 of the Indian Self-Determination
                    and Education Assistance Act (25 U.S.C. 5304);
                        (C) a State or local department of health;
                        (D) an educational service agency;
                        (E) a nonprofit institution of higher education or
                    a consortium of such institutions; or
                        (F) a national or statewide nonprofit organization
                    or consortium of nonprofit organizations that has as
                    its primary purpose the improvement of provision of sex
                    education through training and effective teaching of
                    sex education.
                (4) Application.--An eligible entity desiring a grant under
            this subsection shall submit an application to the Secretary at
            such time, in such manner, and containing such information as
            the Secretary may require.
                (5) Authorized activities.--
                        (A) Required activity.--Each eligible entity
                    receiving a grant under this subsection shall use grant
                    funds for professional development and training of
                    relevant teachers, health educators, faculty,
                    administrators, and staff, in order to increase
                    effective teaching of sex education to young people.
                        (B) Permissible activities.--Each eligible entity
                    receiving a grant under this subsection may use grant
                    funds to--
                                (i) provide training and support for
                            educators about the content, skills, and
                            professional disposition needed to implement
                            sex education effectively;
                                (ii) develop and provide training and
                            support to educators on incorporating anti-
                            racist and gender inclusive policies and
                            practices in sex education;
                                (iii) support the dissemination of
                            information on effective practices and research
                            findings concerning the teaching of sex
                            education;
                                (iv) support research on--
                                        (I) effective sex education
                                    teaching practices; and
                                        (II) the development of assessment
                                    instruments and strategies to
                                    document--
                                                (aa) young people's
                                            understanding of sex education;
                                            and
                                                (bb) the effects of sex
                                            education;
                                (v) convene conferences on sex education,
                            in order to effectively train educators in the
                            provision of sex education; and
                                (vi) develop and disseminate appropriate
                            research-based materials to foster sex
                            education.
                        (C) Subgrants.--Each eligible entity receiving a
                    grant under this subsection may award subgrants to
                    nonprofit organizations that possess a demonstrated
                    record of providing training to teachers, health
                    educators, faculty, administrators, and staff on sex
                    education to--
                                (i) train educators in sex education;
                                (ii) support internet or distance learning
                            related to sex education;
                                (iii) promote rigorous academic standards
                            and assessment techniques to guide and measure
                            student performance in sex education;
                                (iv) encourage replication of best
                            practices and model programs to promote sex
                            education;
                                (v) develop and disseminate effective,
                            research-based sex education learning
                            materials; or
                                (vi) develop academic courses on the
                            pedagogy of sex education at institutions of
                            higher education.
        (f) Authorization of Grants To Support the Delivery of Sexual
    Health Services to Marginalized Young People.--
                (1) Program authorized.--The Secretary shall award grants,
            on a competitive basis, to eligible entities to enable such
            entities to provide youth-friendly sexual health services to
            marginalized young people.
                (2) Duration.--Grants awarded under this subsection shall
            be for a period of 5 years.
                (3) Eligible entity.--In this subsection, the term
            ``eligible entity'' means--
                        (A) a public or private youth-serving organization;
                    or
                        (B) a covered entity, as defined in section 340B of
                    the Public Health Service Act (42 U.S.C. 256b).
                (4) Applications.--An eligible entity desiring a grant
            under this subsection shall submit an application to the
            Secretary at such time, in such manner, and containing such
            information as the Secretary may require.
                (5) Uses of funds.--Each eligible entity that receives a
            grant under this subsection may use the grant funds to--
                        (A) develop and implement an evidence-informed
                    project to deliver sexual health services to
                    marginalized young people;
                        (B) establish, alter, or modify staff positions,
                    service delivery policies and practices, service
                    delivery locations, service delivery environments,
                    service delivery schedules, or other services
                    components in order to increase youth-friendly sexual
                    health services to marginalized young people;
                        (C) conduct outreach to marginalized young people
                    to invite them to participate in the eligible entity's
                    sexual health services and to provide feedback to
                    inform improvements in the delivery of such services;
                        (D) establish and refine systems of referral to
                    connect marginalized young people to other sexual
                    health services and supportive services;
                        (E) establish partnerships and collaborations with
                    entities providing services to marginalized young
                    people to link such young people to sexual health
                    services, such as by delivering health services at
                    locations where they congregate, providing
                    transportation to locations where sexual health
                    services are provided, or other linkages to services
                    approaches;
                        (F) provide evidence-informed, comprehensive in
                    scope, confidential, equitable, accessible, medically
                    accurate and complete, age and developmentally
                    appropriate, culturally responsive, and trauma-informed
                    and resilience-oriented sexual health information to
                    marginalized young people in the languages and cultural
                    contexts that are most appropriate for the marginalized
                    young people to be served by the eligible entity;
                        (G) promote effective communication regarding
                    sexual health among marginalized young people; and
                        (H) provide training and support for eligible
                    entity personnel and community members who work with
                    marginalized young people about the content, skills,
                    and professional disposition needed to provide youth-
                    friendly sex education and youth-friendly sexual health
                    services.
        (g) Reporting and Impact Evaluation.--
                (1) Grantee report to secretary.--For each year an eligible
            entity receives grant funds under subsection (d), (e), (f), or
            (g), the eligible entity shall submit to the Secretary a report
            that includes--
                        (A) the use of grant funds by the eligible entity;
                        (B) how the use of grant funds has increased the
                    access of young people to sex education or sexual
                    health services; and
                        (C) such other information as the Secretary may
                    require.
                (2) Secretary's report to congress.--Not later than 1 year
            after the date of the enactment of this Act, and annually
            thereafter for a period of 5 years, the Secretary shall prepare
            and submit to Congress a report on the activities funded under
            this section. The Secretary's report to Congress shall
            include--
                        (A) a statement of how grants awarded by the
                    Secretary meet the purposes described in subsection
                    (b)(1); and
                        (B) information about--
                                (i) the number of eligible entities that
                            are receiving grant funds under subsections
                            (d), (e), (f), and (g);
                                (ii) the specific activities supported by
                            grant funds awarded under subsections (d), (e),
                            (f), and (g);
                                (iii) the number of young people served by
                            projects funded under subsections (d), (e),
                            (f), and (g), in the aggregate and
                            disaggregated and cross-tabulated by grant
                            program, race and ethnicity, sex, sexual
                            orientation, gender identity, and other
                            characteristics determined by the Secretary
                            (except that such disaggregation or cross-
                            tabulation shall not be required in a case in
                            which the results would reveal personally
                            identifiable information about an individual
                            young person);
                                (iv) the number of teachers, health
                            educators, faculty, school administrators, and
                            staff trained under subsection (f); and
                                (v) the status of the evaluation required
                            under paragraph (3).
                (3) Multi-year evaluation.--
                        (A) In general.--Not later than 6 months after the
                    date of the enactment of this Act, the Secretary shall
                    enter into a contract with a nonprofit organization
                    with experience in conducting impact evaluations to
                    conduct a multi-year evaluation on the impact of the
                    projects funded under subsections (d), (e), (f), and
                    (g) and to report to Congress and the Secretary on the
                    findings of such evaluation.
                        (B) Evaluation.--The evaluation conducted under
                    this paragraph shall--
                                (i) be conducted in a manner consistent
                            with relevant, nationally recognized
                            professional and technical evaluation
                            standards;
                                (ii) use sound statistical methods and
                            techniques relating to the behavioral sciences,
                            including quasi-experimental designs,
                            inferential statistics, and other methodologies
                            and techniques that allow for conclusions to be
                            reached;
                                (iii) be carried out by an independent
                            organization that has not received a grant
                            under subsection (d), (e), (f), or (g); and
                                (iv) be designed to provide information on
                            output measures and outcome measures to be
                            determined by the Secretary.
                        (C) Report.--Not later than 6 years after the date
                    of enactment of this Act, the organization conducting
                    the evaluation under this paragraph shall prepare and
                    submit to the appropriate committees of Congress and
                    the Secretary a report on such evaluation. Such report
                    shall be made publicly available, including on the
                    website of the Department of Health and Human Services.
        (h) Nondiscrimination.--Activities funded under this section shall
    not discriminate on the basis of actual or perceived sex (including
    sexual orientation and gender identity), age, parental status, race,
    color, ethnicity, national origin, disability, or religion. Nothing in
    this section shall be construed to invalidate or limit rights,
    remedies, procedures, or legal standards available under any other
    Federal law or any law of a State or a political subdivision of a
    State, including the Civil Rights Act of 1964 (42 U.S.C. 2000a et
    seq.), title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et
    seq.), section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794),
    the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.),
    and section 1557 of the Patient Protection and Affordable Care Act (42
    U.S.C. 18116).
        (i) Limitation.--No Federal funds provided under this section may
    be used for sex education or sexual health services that--
                (1) withhold health-promoting or life-saving information
            about sexuality-related topics, including HIV;
                (2) are medically inaccurate or incomplete;
                (3) promote gender or racial stereotypes or are
            unresponsive to gender or racial inequities;
                (4) fail to address the needs of sexually active young
            people;
                (5) fail to address the needs of pregnant or parenting
            young people;
                (6) fail to address the needs of survivors of interpersonal
            violence;
                (7) fail to address the needs of young people of all
            physical, developmental, or mental abilities;
                (8) fail to be inclusive of individuals with varying gender
            identities, gender expressions, and sexual orientations; or
                (9) are inconsistent with the ethical imperatives of
            medicine and public health.
        (j) Amendments to Other Laws.--
                (1) Amendment to the public health service act.--Section
            2500 of the Public Health Service Act (42 U.S.C. 300ee) is
            amended by striking subsections (b) through (d) and inserting
            the following:
        ``(b) Contents of Programs.--All programs of education and
    information receiving funds under this subchapter shall include
    information about the potential effects of intravenous substance
    use.''.
                (2) Amendments to the elementary and secondary education
            act of 1965.--Section 8526 of the Elementary and Secondary
            Education Act of 1965 (20 U.S.C. 7906) is amended--
                        (A) by striking paragraphs (3), (5), and (6);
                        (B) in paragraph (2), by inserting ``or'' after the
                    semicolon;
                        (C) by redesignating paragraph (4) as paragraph
                    (3); and
                        (D) in paragraph (3), as redesignated by
                    subparagraph (C), by striking the semicolon and
                    inserting a period.
        (k) Funding.--
                (1) Authorization.--For the purpose of carrying out this
            section, there is authorized to be appropriated $100,000,000
            for each of fiscal years 2022 through 2027. Amounts
            appropriated under this paragraph shall remain available until
            expended.
                (2) Reservations of funds.--
                        (A) In general.--Of the amount authorized under
                    paragraph (1), the Secretary shall reserve--
                                (i) not more than 30 percent for the
                            purposes of awarding grants for sex education
                            at elementary and secondary schools and youth-
                            serving organizations under subsection (d);
                                (ii) not more than 10 percent for the
                            purpose of awarding grants for sex education at
                            institutions of higher education under
                            subsection (e);
                                (iii) not more than 15 percent for the
                            purpose of awarding grants for educator
                            training under subsection (f);
                                (iv) not more than 30 percent for the
                            purpose of awarding grants for sexual health
                            services for marginalized youth under
                            subsection (g); and
                                (v) not less than 5 percent for the purpose
                            of carrying out the reporting and impact
                            evaluation required under subsection (h).
                        (B) Research, training and technical assistance.--
                    The Secretary shall reserve not less than 10 percent of
                    the amount authorized under paragraph (1) for
                    expenditures by the Secretary to provide, directly or
                    through a competitive grant process, research,
                    training, and technical assistance, including
                    dissemination of research and information regarding
                    effective and promising practices, providing
                    consultation and resources, and developing resources
                    and materials to support the activities of recipients
                    of grants. In carrying out such functions, the
                    Secretary shall collaborate with a variety of entities
                    that have expertise in sex education and sexual health
                    services standards setting, design, development,
                    delivery, research, monitoring, and evaluation.
                (3) Reprogramming of abstinence only until marriage program
            funding.--The unobligated balance of funds made available to
            carry out section 510 of the Social Security Act (42 U.S.C.
            710) (as in effect on the day before the date of enactment of
            this Act) are hereby transferred and shall be used by the
            Secretary to carry out this section. The amounts transferred
            and made available to carry out this section shall remain
            available until expended.
                (4) Repeal of abstinence only until marriage program.--
            Section 510 of the Social Security Act (42 U.S.C. 710 et seq.)
            is repealed.

    SEC. 5405. COMPASSIONATE ASSISTANCE FOR RAPE EMERGENCIES.

        (a) Medicare.--
                (1) Limitation on payment.--Section 1866(a)(1) of the
            Social Security Act (42 U.S.C. 1395cc(a)(1)) is amended--
                        (A) by moving the indentation of subparagraph (W) 2
                    ems to the left;
                        (B) in subparagraph (X)--
                                (i) by moving the indentation 2 ems to the
                            left; and
                                (ii) by striking ``and'' at the end;
                        (C) in subparagraph (Y)--
                                (i) by striking ``and'' at the end of item
                            (bb); and
                                (ii) by striking the period at the end and
                            inserting ``; and''; and
                        (D) by inserting after subparagraph (Y) the
                    following new subparagraph:
                ``(Z) in the case of a hospital or critical access
            hospital, to adopt and enforce a policy to ensure compliance
            with the requirements of subsection (l) and to meet the
            requirements of such subsection.''.
                (2) Assistance to victims.--Section 1866 of the Social
            Security Act (42 U.S.C. 1395cc) is amended by adding at the end
            the following new subsection:
        ``(l) Compassionate Assistance for Rape Emergencies.--
                ``(1) In general.--For purposes of subsection (a)(1)(Z), a
            hospital meets the requirements of this subsection if the
            hospital provides each of the services described in paragraph
            (2) to each individual, whether or not eligible for benefits
            under this title or under any other form of health insurance,
            who comes to the hospital on or after January 1, 2021, and--
                        ``(A) who states to hospital personnel that they
                    are victims of sexual assault;
                        ``(B) who is accompanied by an individual who
                    states to hospital personnel that the individual is a
                    victim of sexual assault; or
                        ``(C) whom hospital personnel, during the course of
                    treatment and care for the individual, have reason to
                    believe is a victim of sexual assault.
                ``(2) Required services described.--For purposes of
            paragraph (1), the services described in this subparagraph are
            the following:
                        ``(A) Provision of medically and factually accurate
                    and unbiased written and oral information about
                    emergency contraception that--
                                ``(i) is written in clear and concise
                            language;
                                ``(ii) is readily comprehensible;
                                ``(iii) includes an explanation that
                            emergency contraceptives--
                                        ``(I) have been approved by the
                                    Food and Drug Administration for
                                    individuals and are a safe and
                                    effective way to prevent pregnancy
                                    after unprotected intercourse or
                                    contraceptive failure if taken in a
                                    timely manner;
                                        ``(II) are more effective the
                                    sooner it is taken; and
                                        ``(III) do not cause an abortion
                                    and cannot interrupt an established
                                    pregnancy;
                                ``(iv) meet such conditions regarding the
                            provision of such information in languages
                            other than English as the Secretary may
                            establish; and
                                ``(v) are provided without regard to the
                            ability of the individual or their family to
                            pay costs associated with the provision of such
                            information to the individual.
                        ``(B) Immediate offer to provide emergency
                    contraception to the individual at the hospital and, in
                    the case that such individual accepts such offer,
                    immediate provision to such individual of such
                    contraception on the same day it is requested without
                    regard to the inability of the individual or their
                    family to pay costs associated with the offer and
                    provision of such contraception.
                        ``(C) Development and implementation of a written
                    policy to ensure that an individual is present at the
                    hospital, or on-call, who--
                                ``(i) has authority to dispense or
                            prescribe emergency contraception,
                            independently, or under a protocol prepared by
                            a physician for the administration of emergency
                            contraception at the hospital to a victim of
                            sexual assault; and
                                ``(ii) is trained to comply with the
                            requirements of this section.
                        ``(D) Provision of medically and factually accurate
                    and unbiased written and oral information and
                    counseling about post-exposure prophylaxis (PEP)
                    protocol for the prevention of HIV.
                        ``(E) Immediate offer to begin PEP to the
                    individual at the hospital except in cases where the
                    medical professional's best judgement is that further
                    evaluation is required or that such a regimen will be
                    substantially detrimental to the health of such
                    individual. Such provision shall be offered regardless
                    of the individual's ability to pay. Hospitals shall be
                    responsible for ensuring adequate supply of PEP
                    medications to provide to patients.
                ``(3) Hospital defined.--For purposes of this paragraph,
            the term `hospital' includes a critical access hospital, as
            defined in section 1861(mm)(1).''.
        (b) Limitation on Payment Under Medicaid.--Section 1903(i) of the
    Social Security Act (42 U.S.C. 1396b(i)) is amended by inserting after
    paragraph (8) the following new paragraph:
                ``(9) with respect to any amount expended for care or
            services furnished under the plan by a hospital on or after
            January 1, 2021, unless such hospital meets the requirements
            specified in section 1866(l) for purposes of title XVIII;''.

    SEC. 5406. MENSTRUAL EQUITY FOR ALL ACT OF 2021.

        (a) Short Title.--This section may be cited as the ``Menstrual
    Equity For All Act of 2021''.
        (b) Menstrual Products for Students at Elementary and Secondary
    Schools.--
                (1) In general.--Section 4108(5)(C) of the Elementary and
            Secondary Education Act of 1965 (20 U.S.C. 7118(5)(C)) is
            amended--
                        (A) in clause (vi), by striking ``or'' after the
                    semicolon;
                        (B) in clause (vii), by inserting ``or'' after the
                    semicolon; and
                        (C) by adding at the end the following:
                                ``(viii) provide free menstrual products to
                            students who use menstrual products;''.
                (2) Definitions.--Section 4102 of the Elementary and
            Secondary Education Act of 1965 (20 U.S.C. 7112) is amended--
                        (A) by redesignating paragraphs (6) through (8) as
                    paragraphs (7) through (9), respectively; and
                        (B) by inserting after paragraph (5) the following:
                ``(6) Menstrual products.--The term `menstrual products'
            means sanitary napkins and tampons that conform to applicable
            industry standards.''.
                (3) Rulemaking.--Not later than 1 year after the date of
            enactment of this section, the Secretary of Education, in
            consultation with the Secretary of Health and Human Services,
            shall promulgate rules with respect to the definition of
            ``menstrual products'' in paragraph (6) of section 4102 of the
            Elementary and Secondary Education Act of 1965 (20 U.S.C.
            7112), as amended by section 3(b).
        (c) Menstrual Products for Students at Institutions of Higher
    Education.--
                (1) Purpose.--The purpose of this section is to alleviate--
                        (A) the barriers to academic success faced by many
                    college and graduate students due to the inability of
                    such students to afford to purchase menstrual products;
                    and
                        (B) the unique set of burdens that college and
                    graduate students experiencing period poverty face that
                    can be compounded by lack of access to basic needs such
                    as housing, food, transportation, and access to
                    physical and mental health services.
                (2) In general.--The Secretary of Education shall establish
            a program to award grants, on a competitive basis, to at least
            4 institutions of higher education, to--
                        (A) support programs that provide free menstrual
                    products to students; and
                        (B) report on best practices of such programs.
                (3) Application.--To apply for a grant under this
            subsection, an institution of higher education shall submit to
            the Secretary an application in such form, at such time, and
            containing such information as the Secretary determines
            appropriate, including an assurance that such grant will be
            used to carry out the activities described in paragraph (5).
                (4) Community colleges.--At least 50 percent of the grants
            awarded under this subsection shall be awarded to community
            colleges.
                (5) Grant uses.--A grant awarded under this subsection may
            only be used to--
                        (A) carry out or expand activities that fund
                    programs that support direct provision of free
                    menstrual products to students in appropriate campus
                    locations, including--
                                (i) campus restroom facilities;
                                (ii) wellness centers; and
                                (iii) on-campus residential buildings;
                        (B) report on best practices of such programs;
                        (C) conduct outreach to students to encourage
                    participation in menstrual equity programs and
                    services;
                        (D) help eligible students apply for and enroll in
                    local, State, and Federal public assistance programs;
                    and
                        (E) coordinate and collaborate with government or
                    community-based organizations to carry out the
                    activities described in subparagraphs (A) through (D).
                (6) Priority.--In awarding grants under this subsection,
            the Secretary shall prioritize--
                        (A) institutions with Federal Pell Grant enrollment
                    that is at least 25 percent of the total enrollment of
                    such institution; and
                        (B) historically Black colleges and universities,
                    Hispanic-serving institutions, Asian American and
                    Native American Pacific Islander-serving institutions,
                    and other minority serving institutions.
                (7) Menstrual product defined.--In this subsection, the
            term ``menstrual product'' means a sanitary napkin or tampon
            that conforms to industry standards.
                (8) Authorization of appropriations.--There are authorized
            to be appropriated, out of funds appropriated for a fiscal year
            to the Fund for the Improvement of Postsecondary Education
            under section 741 of the Higher Education Act of 1965 (20
            U.S.C. 1138), $5,000,000 to carry out the grant program under
            this subsection.
        (d) Menstrual Products for Incarcerated Individuals and
    Detainees.--
                (1) Requirement for states.--Beginning on the date that is
            180 days after the date of the enactment of this section, and
            annually thereafter, the chief executive officer of each State
            that receives a grant under subpart 1 of part E of title I of
            the Omnibus Crime Control and Safe Streets Act of 1968 (42
            U.S.C. 3750 et seq.) (commonly referred to as the ``Edward
            Byrne Memorial Justice Assistance Grant Program'') shall submit
            to the Attorney General a certification, in such form and
            containing such information as the Attorney General may
            require, that--
                        (A) all incarcerated individuals and detainees in
                    that State have access to menstrual products--
                                (i) on demand; and
                                (ii) at no cost to such individuals and
                            detainees; and
                        (B) no visitor is prohibited from visiting an
                    incarcerated individual due to the visitor's use of
                    menstrual products.
                (2) Reduction in grant funding.--In the case of a State
            whose chief executive officer fails to submit a certification
            required under paragraph (1) in a fiscal year, the Attorney
            General shall reduce the amount that the State would have
            otherwise received under section 505 of title I of the Omnibus
            Crime Control and Safe Streets Act of 1968 (42 U.S.C. 3755) by
            20 percent for the following fiscal year.
                (3) Reallocation.--Amounts not allocated to a State under
            section 505 of title I of the Omnibus Crime Control and Safe
            Streets Act of 1968 (42 U.S.C. 3755) for a fiscal year pursuant
            to paragraph (2) shall be reallocated under such section to
            States that submit such certifications.
                (4) Menstrual products.--For the purposes of paragraph (1),
            the term ``menstrual products'' means sanitary napkins and
            tampons that conform to applicable industry standards.
                (5) Availability for federal prisoners.--The Attorney
            General shall make rules requiring, and the Director of the
            Bureau of Prisons shall take such actions as may be necessary
            to ensure, the distribution and accessibility (without charge)
            of menstrual products to prisoners in the custody of the Bureau
            of Prisons, including any prisoner in a Federal penal or
            correctional institution, any Federal prisoner in a State penal
            or correctional institution, and any Federal prisoner in a
            facility administered by a private detention entity, and that
            each prisoner who requires these products may receive them in
            sufficient quantity.
                (6) Availability for detainees.--The Secretary of Homeland
            Security shall take such actions as may be necessary to ensure
            that menstrual products are distributed and made accessible to
            each alien detained by the Secretary of Homeland Security,
            including any alien in a facility administered by a private
            detention entity, at no expense to the alien.
        (e) Menstrual Products Availability for Homeless Individuals Under
    Emergency Food and Shelter Grant Program.--Subsection (a) of section
    316 of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11346(a))
    is amended--
                (1) in paragraph (5), by striking ``and'' at the end;
                (2) in paragraph (6), by striking the period at the end and
            inserting ``; and''; and
                (3) by adding at the end the following new paragraph:
                ``(7) guidelines that ensure that amounts provided under
            the program to private nonprofit organizations and local
            governments may be used to provide sanitary napkins and tampons
            that conform to applicable industry standards.''.
        (f) Menstrual Products Covered by Medicaid.--
                (1) In general.--Section 1905 of the Social Security Act
            (42 U.S.C. 1396d) is amended--
                        (A) in subsection (a)--
                                (i) by redesignating paragraphs (30) and
                            (31) as paragraphs (31) and (32), respectively;
                            and
                                (ii) by inserting after paragraph (29) the
                            following new paragraph:
                ``(30) menstrual products (as defined in subsection
            (hh));''; and
                        (B) by adding at the end the following:
        ``(jj) Menstrual Products.--For purposes of subsection (a)(30), the
    term `menstrual products' means sanitary napkins, tampons, liners,
    cups, and similar items used by individuals with respect to
    menstruation and that conform to industry standards.''.
                (2) Effective date.--
                        (A) In general.--Subject to subparagraph (B), the
                    amendments made by this subsection shall apply with
                    respect to medical assistance furnished during or after
                    the first calendar quarter beginning on or after the
                    date that is 1 year after the date of the enactment of
                    this section.
                        (B) Exception for state legislation.--In the case
                    of a State plan under title XIX of the Social Security
                    Act (42 U.S.C. 1396 et seq.) 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
                    section, 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 the enactment of this section.
                    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.
        (g) Menstrual Products for Employees.--Section 6 of the
    Occupational Safety and Health Act of 1970 (29 U.S.C. 655) is amended
    by adding at the end the following:
        ``(h) The Secretary shall by rule promulgate a requirement that
    each employer with not less than 100 employees provide menstrual
    products free of charge for employees of the employer. For purposes of
    the preceding sentence, `menstrual products' means sanitary napkins and
    tampons that conform to applicable industry standards.''.
        (h) Menstrual Products in Federal Buildings.--
                (1) Requirement.--Each appropriate authority shall ensure
            that menstrual products are stocked in, and available free of
            charge in, each covered restroom in each covered public
            building under the jurisdiction of such authority.
                (2) Definitions.--In this section:
                        (A) Appropriate authority.--The term ``appropriate
                    authority'' means the head of a Federal agency, the
                    Architect of the Capitol, or other official authority
                    responsible for the operation of a covered public
                    building.
                        (B) Covered public building.--The term ``covered
                    public building'' means a public building, as defined
                    in section 3301 of title 40, United States Code, that
                    is open to the public and contains a public restroom,
                    and includes a building listed in section 6301 or 5101
                    of such title.
                        (C) Covered restroom.--The term ``covered
                    restroom'' means a restroom in a covered public
                    building.
                        (D) Menstrual products.--The term ``menstrual
                    products'' means sanitary napkins and tampons that
                    conform to applicable industry standards.

    SEC. 5407. ADDITIONAL FOCUS AREA FOR THE OFFICE ON WOMEN'S HEALTH.

        Section 229(b) of the Public Health Service Act (42 U.S.C.
    237a(b)), as amended by sections 5217 and 5301, is further amended by
    adding at the end the following:
                ``(10) facilitate policymakers, health system leaders and
            providers, consumers, and other stakeholders in understanding
            optimal maternity care and support for the provision of such
            care, including the priorities of--
                        ``(A) protecting, promoting, and supporting the
                    innate capacities of childbearing individuals and their
                    newborns for childbirth, breastfeeding, and attachment;
                        ``(B) using obstetric interventions only when such
                    interventions are supported by strong, high-quality
                    evidence, and minimizing overuse of maternity practices
                    that have been shown to have benefit in limited
                    situations and that can expose people, infants, or both
                    to risk of harm if used routinely and indiscriminately,
                    including continuous electronic fetal monitoring, labor
                    induction, epidural analgesia, primary cesarean
                    section, and routine repeat cesarean birth;
                        ``(C) reliably incorporating noninvasive, evidence-
                    based practices that have a documented correlation with
                    considerable improvement in outcomes with no
                    detrimental side effects, such as smoking cessation
                    programs in pregnancy, maternal immunizations, and
                    proven models (including group prenatal care, midwifery
                    care, and doula support) that integrate health
                    assessment, education, and support into a unified
                    program and supporting evidence-based breastfeeding
                    promotion efforts with respect for a breastfeeding
                    individual's personal decision making;
                        ``(D) a shared understanding of the qualifications
                    of licensed providers of maternity care and the best
                    evidence about the safety, satisfaction, outcomes, and
                    costs of maternity care, and appropriate deployment of
                    such caregivers within the maternity care workforce to
                    address the needs of childbearing individuals and
                    newborns and the growing shortage of maternity
                    caregivers;
                        ``(E) a shared understanding of the results of the
                    best available research comparing hospital, birth
                    center, and planned home births, including information
                    about each setting's safety, satisfaction, outcomes,
                    and costs;
                        ``(F) a shared understanding of the importance for
                    the safety and choices of birthing families of an
                    integrated maternity care system with seamless
                    processes for consultation, shared care, transfer and
                    transport across maternity care settings, and providers
                    when birthing people and their newborns require a
                    higher level of care;
                        ``(G) high-quality, evidence-based childbirth
                    education that--
                                ``(i) promotes a healthy and safe approach
                            to pregnancy, childbirth, and early parenting;
                                ``(ii) is taught by certified educators,
                            peer counselors, and health professionals; and
                                ``(iii) promotes informed decision making
                            by childbearing individuals; and
                        ``(H) developing measures that enable a more
                    robust, balanced set of standardized maternity care
                    measures, including performance and quality
                    measures.''.

    SEC. 5408. INCLUDING SERVICES FURNISHED BY CERTAIN STUDENTS, INTERNS,
                  AND RESIDENTS SUPERVISED BY CERTIFIED NURSE MIDWIVES OR
                  CERTIFIED MIDWIVES WITHIN INPATIENT HOSPITAL SERVICES
                  UNDER MEDICARE.

        (a) In General.--Section 1861(b) of the Social Security Act (42
    U.S.C. 1395x(b)) is amended--
                (1) in paragraph (6), by striking ``; or'' at the end and
            inserting ``, or in the case of services in a hospital or
            osteopathic hospital by a student midwife or an intern or
            resident-in-training under a teaching program previously
            described in this paragraph who is in the field of obstetrics
            and gynecology, if such student midwife, intern, or resident-
            in-training is supervised by a certified nurse-midwife or
            certified midwife to the extent permitted under applicable
            State law and as may be authorized by the hospital;'';
                (2) in paragraph (7), by striking the period at the end and
            inserting ``; or''; and
                (3) by adding at the end the following new paragraph:
                ``(8) a certified nurse-midwife or certified midwife where
            the hospital has a teaching program approved as specified in
            paragraph (6), if--
                        ``(A) the hospital elects to receive any payment
                    due under this title for reasonable costs of such
                    services; and
                        ``(B) all certified nurse-midwives or certified
                    midwives in such hospital agree not to bill charges for
                    professional services rendered in such hospital to
                    individuals covered under the insurance program
                    established by this title.''.
        (b) Effective Date.--The amendments made by subsection (a) shall
    apply to services furnished on or after the date of the enactment of
    this Act.

    SEC. 5409. GRANTS TO PROFESSIONAL ORGANIZATIONS AND MINORITY-SERVING
                  INSTITUTIONS TO INCREASE DIVERSITY IN MATERNAL,
                  REPRODUCTIVE, AND SEXUAL HEALTH PROFESSIONALS.

        (a) Grants to Health Professional Organizations.--
                (1) In general.--The Secretary of Health and Human
            Services, acting through the Administrator of the Health
            Resources and Services Administration, shall carry out a grant
            program under which the Secretary may make to eligible
            organizations--
                        (A) for fiscal year 2023, planning grants described
                    in paragraph (2); and
                        (B) for the subsequent 4-year period,
                    implementation grants described in paragraph (3).
                (2) Planning grants.--
                        (A) In general.--Planning grants described in this
                    paragraph are grants for the following purposes:
                                (i) To collect data and identify any
                            workforce inequalities, with respect to a
                            health profession, at each of the following
                            areas along the health professional continuum:
                                        (I) Pipeline availability, with
                                    respect to students at the high school
                                    and college or university levels
                                    considering, and working toward,
                                    entrance in the profession, including
                                    barriers triggered by criminal records.
                                        (II) Entrance into the training
                                    program for the profession.
                                        (III) Graduation from such training
                                    program.
                                        (IV) Entrance into practice,
                                    including barriers triggered by
                                    criminal records.
                                        (V) Retention in practice for more
                                    than a 5-year period.
                                (ii) To develop one or more strategies to
                            address the workforce inequalities within the
                            health profession, as identified under (and in
                            response to the findings pursuant to) clause
                            (i).
                        (B) Application.--To be eligible to receive a grant
                    under this paragraph, an eligible health professional
                    organization shall submit to the Secretary an
                    application in such form and manner and containing such
                    information as specified by the Secretary.
                        (C) Amount.--Each grant awarded under this
                    paragraph shall be for an amount not to exceed
                    $300,000.
                        (D) Report.--Each recipient of a grant under this
                    paragraph shall submit to the Secretary a report
                    containing--
                                (i) information on the extent and
                            distribution of workforce inequities identified
                            through the grant; and
                                (ii) reasonable objectives and strategies
                            developed to address such inequalities within a
                            5-, 10-, and 25-year period.
                (3) Implementation grants.--
                        (A) In general.--Implementation grants described in
                    this paragraph are grants to implement one or more of
                    the strategies developed pursuant to a planning grant
                    awarded under paragraph (2).
                        (B) Application.--To be eligible to receive a grant
                    under this paragraph, an eligible health professional
                    organization shall submit to the Secretary an
                    application in such form and manner as specified by the
                    Secretary. Each such application shall contain
                    information on--
                                (i) the capability of the organization to
                            carry out a strategy described in subparagraph
                            (A);
                                (ii) the involvement of partners or
                            coalitions;
                                (iii) the organization's plans for
                            developing sustainability of the efforts after
                            the culmination of the grant cycle, and any
                            other information specified by the Secretary.
                        (C) Amount; duration.--Each grant awarded under
                    this paragraph shall be for an amount not to exceed
                    $500,000 each year of the grant. The term of a grant
                    under this subsection shall not exceed 4 years.
                        (D) Reports.--For each of the first 3 years for
                    which an eligible health professional organization is
                    awarded a grant under this paragraph, the organization
                    shall submit to the Secretary of Health and Human
                    Services a report on the activities carried out by such
                    organization through the grant during such year and
                    objectives for the subsequent year. For the fourth year
                    for which an eligible health professional organization
                    is awarded a grant under this paragraph, the
                    organization shall submit to the Secretary a report
                    that includes an analysis of all the activities carried
                    out by the organization through the grant and a
                    detailed plan for the continuation of the
                    organization's outreach efforts.
                (4) Eligible health professional organization defined.--For
            purposes of this subsection, the term ``eligible health
            professional organization'' means a professional organization
            representing obstetrician-gynecologists, certified nurse
            midwives, certified midwives, family practice physicians, nurse
            practitioners whose scope of practice includes maternity or
            sexual and reproductive health care, physician assistants whose
            scope of practice includes obstetrical or sexual and
            reproductive health care, or certified professional midwives,
            adolescent medicine specialists, and pediatricians who provide
            sexual and reproductive health care.
        (b) Grants to Minority-Serving Institutions.--
                (1) In general.--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 carry out a grant program
            under which the Secretary may make to eligible organizations--
                        (A) for fiscal years 2023 and 2024, planning grants
                    described in paragraph (2); and
                        (B) for the subsequent ten-year period,
                    implementation grants described in paragraph (3).
                (2) Planning grants.--
                        (A) In general.--Planning grants described in this
                    paragraph are grants for plans the following purposes:
                                (i) To develop or expand academic programs
                            to educate maternity care clinicians and
                            maternity care support personnel, including--
                                        (I) nurses with the intention of
                                    providing maternity, newborn, or sexual
                                    and reproductive health care;
                                        (II) nurse-practitioners whose
                                    scope of practice includes maternity,
                                    newborn, or sexual and reproductive
                                    health care; and
                                        (III) maternity care support
                                    personnel, such as doulas and lactation
                                    counselors.
                                (ii) To develop or expand academic programs
                            to educate obstetrician-gynecologists.
                        (B) Application.--To be eligible to receive a grant
                    under this paragraph, an eligible minority serving
                    institution shall submit to the Secretary an
                    application in such form and manner and containing such
                    information as specified by the Secretary.
                        (C) Amount.--Each grant awarded under this
                    paragraph shall be for an amount not to exceed $400,000
                    for each of two years.
                        (D) Report.--Each recipient of a grant under this
                    paragraph shall submit to the Secretary an annual
                    report describing the planned development or expansion
                    of educational programs, including--
                                (i) the types of clinical or support
                            personnel and the degrees or certificates to be
                            conferred;
                                (ii) the associated curricula;
                                (iii) the faculty and their capabilities
                            and commitments, including any plans for
                            recruitment;
                                (iv) the anticipated number of students to
                            be enrolled and plans for their recruitment and
                            social, emotional, and financial support; and
                                (v) the objectives and strategies for
                            addressing inequities and preparing students to
                            provide high-quality culturally congruent care.
                (3) Implementation grants.--
                        (A) In general.--Implementation grants described in
                    this paragraph are grants to implement the strategies
                    developed under paragraph (2).
                        (B) Application.--To be eligible to receive a grant
                    under this paragraph, an eligible minority serving
                    institution shall submit to the Secretary of Health and
                    Human Services an application in such form and manner
                    as specified by the Secretary. Each such application
                    shall contain information on the capability of the
                    institution to carry out a strategy described in
                    paragraph (2), plans for sustainability of the program
                    after the culmination of the grant cycle, and any other
                    information specified by the Secretary.
                        (C) Amount.--Each grant under this paragraph shall
                    be for an amount not to exceed $1,000,000 each year
                    during the 10-year period of the grant.
                        (D) Reports.--
                                (i) Initial period.--For each of the first
                            9 years for which an eligible minority-serving
                            institution is awarded a grant under this
                            paragraph, the institution shall submit a
                            report to the Secretary on the activities
                            carried out by such institution through the
                            grant during such year and objectives for the
                            subsequent year.
                                (ii) Final year.--For the tenth year for
                            which an eligible minority-serving institution
                            is awarded a grant under this paragraph, the
                            organization shall submit to the Secretary a
                            report that includes an analysis of all the
                            activities carried out by the institution
                            through the grant and a detailed plan for
                            continuation of the educational program.
                (4) Eligible minority-serving institutions defined.--For
            the purposes of this subsection, the term ``minority-serving
            institution'' means a historically Black college or university,
            Tribal college or university, Latino-serving institution, Asian
            American and Pacific Islander serving institution, or other
            minority serving institution of higher education.
        (c) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out--
                (1) subsection (a), $2,000,000 for fiscal year 2023 and
            $3,000,000 for each of the fiscal years 2024 through 2027; and
                (2) subsection (b), $4,000,000 for each of fiscal years
            2023 and 2024 and $10,000,000 for each of fiscal years 2025
            through 2034.

                         Subtitle F--Children's Health

    SEC. 5501. CARING FOR KIDS ACT.

        (a) Permanent Extension of Children's Health Insurance Program.--
                (1) In general.--Section 2104(a)(28) of the Social Security
            Act (42 U.S.C. 1397dd(a)(28)) is amended to read as follows:
                ``(28) for fiscal year 2027 and each subsequent year, such
            sums as are necessary to fund allotments to States under
            subsections (c) and (m).''.
                (2) Allotments.--
                        (A) In general.--Section 2104(m) of the Social
                    Security Act (42 U.S.C. 1397dd(m)) is amended--
                                (i) in paragraph (2)(B)(i), by striking
                            ``,, 2023, and 2027'' and inserting ``and
                            2023'';
                                (ii) in paragraph (7)--
                                        (I) in subparagraph (A), by
                                    striking ``and ending with fiscal year
                                    2027,''; and
                                        (II) in the flush left matter at
                                    the end, by striking ``or fiscal year
                                    2026'' and inserting ``fiscal year
                                    2026, or a subsequent even-numbered
                                    fiscal year'';
                                (iii) in paragraph (9)--
                                        (I) by striking ``(10), or (11)''
                                    and inserting ``or (10)''; and
                                        (II) by striking ``2023, or 2027,''
                                    and inserting ``or 2023''; and
                                (iv) by striking paragraph (11).
                        (B) Conforming amendment.--Section 50101(b)(2) of
                    the Bipartisan Budget Act of 2018 (Public Law 115-123)
                    is repealed.
        (b) Permanent Extensions of Other Programs and Demonstration
    Projects.--
                (1) Pediatric quality measures program.--Section
            1139A(i)(1) of the Social Security Act (42 U.S.C. 1320b-
            9a(i)(1)) is amended--
                        (A) in subparagraph (C), by striking at the end
                    ``and'';
                        (B) in subparagraph (D), by striking the period at
                    the end and insert a semicolon; and
                        (C) by adding at the end the following new
                    subparagraphs:
                        ``(E) for fiscal year 2028, $15,000,000 for the
                    purpose of carrying out this section (other than
                    subsections (e), (f), and (g)); and
                        ``(F) for a subsequent fiscal year, the amount
                    appropriated under this paragraph for the previous
                    fiscal year, increased by the percentage increase in
                    the consumer price index for all urban consumers (all
                    items; United States city average) over such previous
                    fiscal year, for the purpose of carrying out this
                    section (other than subsections (e), (f), and (g)).''.
                (2) Express lane eligibility option.--Section 1902(e)(13)
            of the Social Security Act (42 U.S.C. 1396a(e)(13)) is amended
            by striking subparagraph (I).
                (3) Assurance of affordability standard for children and
            families.--
                        (A) In general.--Section 2105(d)(3) of the Social
                    Security Act (42 U.S.C. 1397ee(d)(3)) is amended--
                                (i) in the paragraph heading, by striking
                            ``through september 30, 2027''; and
                                (ii) in subparagraph (A), in the matter
                            preceding clause (i)--
                                        (I) by striking ``During the period
                                    that begins on the date of enactment of
                                    the Patient Protection and Affordable
                                    Care Act and ends on September 30,
                                    2027'' and inserting ``Beginning on the
                                    date of the enactment of the Patient
                                    Protection and Affordable Care Act'';
                                        (II) by striking ``During the
                                    period that begins on October 1, 2019,
                                    and ends on September 30, 2027'' and
                                    inserting ``Beginning on October 1,
                                    2019''; and
                                        (III) by striking ``The preceding
                                    sentences shall not be construed as
                                    preventing a State during any such
                                    periods from'' and inserting ``The
                                    preceding sentences shall not be
                                    construed as preventing a State from''.
                        (B) Conforming amendments.--Section 1902(gg)(2) of
                    the Social Security Act (42 U.S.C. 1396a(gg)(2)) is
                    amended--
                                (i) in the paragraph heading, by striking
                            ``through september 30, 2027''; and
                                (ii) by striking ``through September 30''
                            and all that follows through ``ends on
                            September 30, 2027'' and inserting ``(but
                            beginning on October 1, 2019,''.
                (4) Qualifying states option.--Section 2105(g)(4) of the
            Social Security Act (42 U.S.C. 1397ee(g)(4)) is amended--
                        (A) in the paragraph heading, by striking ``for
                    fiscal years 2009 through 2027'' and inserting ``after
                    fiscal year 2008''; and
                        (B) in subparagraph (A), by striking ``for any of
                    fiscal years 2009 through 2027'' and inserting ``for
                    any fiscal year after fiscal year 2008''.
                (5) Outreach and enrollment program.--Section 2113 of the
            Social Security Act (42 U.S.C. 1397mm) is amended--
                        (A) in subsection (a)--
                                (i) in paragraph (1), by striking ``during
                            the period of fiscal years 2009 through 2027''
                            and inserting ``, beginning with fiscal year
                            2009,'';
                                (ii) in paragraph (2)--
                                        (I) by striking ``10 percent of
                                    such amounts'' and inserting ``10
                                    percent of such amounts for the period
                                    or the fiscal year for which such
                                    amounts are appropriated''; and
                                        (II) by striking ``during such
                                    period'' and inserting ``, during such
                                    period or such fiscal year,''; and
                                (iii) in paragraph (3), by striking ``For
                            the period of fiscal years 2024 through 2027,
                            an amount equal to 10 percent of such amounts''
                            and inserting ``Beginning with fiscal year
                            2024, an amount equal to 10 percent of such
                            amounts for the period or the fiscal year for
                            which such amounts are appropriated''; and
                        (B) in subsection (g)--
                                (i) by striking ``2017,,'' and inserting
                            ``2017,'';
                                (ii) by striking ``and $48,000,000'' and
                            inserting ``$48,000,000''; and
                                (iii) by inserting after ``through 2027''
                            the following: ``, $12,000,000 for fiscal year
                            2028, and, for each fiscal year after fiscal
                            year 2028, the amount appropriated under this
                            subsection for the previous fiscal year,
                            increased by the percentage increase in the
                            consumer price index for all urban consumers
                            (all items; United States city average) over
                            such previous fiscal year''.
                (6) Child enrollment contingency fund.--Section 2104(n) of
            the Social Security Act (42 U.S.C. 1397dd(n)) is amended--
                        (A) in paragraph (2)--
                                (i) in subparagraph (A)(ii)--
                                        (I) by striking ``and 2024 through
                                    2026'' and inserting ``beginning with
                                    fiscal year 2024''; and
                                        (II) by striking ``2023, and 2027''
                                    and inserting ``, and 2023''; and
                                (ii) in subparagraph (B)--
                                        (I) by striking ``2024 through
                                    2026'' and inserting ``beginning with
                                    fiscal year 2024''; and
                                        (II) by striking ``2023, and 2027''
                                    and inserting ``, and 2023''; and
                        (B) in paragraph (3)(A)--
                                (i) by striking ``fiscal years 2024 through
                            2026'' and inserting ``beginning with fiscal
                            year 2024''; and
                                (ii) by striking ``2023, or 2027'' and
                            inserting ``, or 2023''.

    SEC. 5502. END DIAPER NEED ACT OF 2021.

        (a) Targeted Funding for Diaper Assistance (Including Diapering
    Supplies and Adult Incontinence Materials and Supplies) Through the
    Social Services Block Grant Program.--
                (1) Increase in funding for social services block grant
            program.--
                        (A) In general.--The amount specified in subsection
                    (c) of section 2003 of the Social Security Act (42
                    U.S.C. 1397b) for purposes of subsections (a) and (b)
                    of such section is deemed to be $1,900,000,000 for each
                    of fiscal years 2023 through 2026, of which, the amount
                    equal to $200,000,000, reduced by the amounts reserved
                    under subparagraph (B)(ii) for each such fiscal year,
                    shall be obligated by States in accordance with
                    paragraph (2).
                        (B) Appropriation.--
                                (i) In general.--Out of any money in the
                            Treasury of the United States not otherwise
                            appropriated, there is appropriated
                            $200,000,000 for each of fiscal years 2023
                            through 2026, to carry out this subsection.
                                (ii) Reservations.--
                                        (I) Purposes.--The Secretary shall
                                    reserve, from the amount appropriated
                                    under clause (i) to carry out this
                                    subsection--
                                                (aa) for each of fiscal
                                            years 2023 through 2026, not
                                            more than 2 percent of the
                                            amount appropriated for the
                                            fiscal year for purposes of
                                            entering into an agreement with
                                            a national entity described in
                                            clause (iii) to assist in
                                            providing technical assistance
                                            and training, to support
                                            effective policy, practice,
                                            research, and cross-system
                                            collaboration among grantees
                                            and subgrantees, and to assist
                                            in the administration of the
                                            program described in this
                                            subsection; and
                                                (bb) for fiscal year 2023,
                                            an amount, not to exceed
                                            $2,000,000, for purposes of
                                            conducting an evaluation under
                                            paragraph (4).
                                        (II) No state entitlement to
                                    reserved funds.--The State entitlement
                                    under section 2002(a) of the Social
                                    Security Act (42 U.S.C. 1397a(a)) shall
                                    not apply to the amounts reserved under
                                    subclause (I).
                                (iii) National entity described.--A
                            national entity described in this clause is a
                            nonprofit organization described in section
                            501(c)(3) of the Internal Revenue Code of 1986
                            and exempt from taxation under section 501(a)
                            of such Code, that--
                                        (I) has experience in more than 1
                                    State in the area of--
                                                (aa) community
                                            distributions of basic need
                                            services, including experience
                                            collecting, warehousing, and
                                            distributing basic necessities
                                            such as diapers, food, or
                                            menstrual products;
                                                (bb) child care;
                                                (cc) child development
                                            activities in low-income
                                            communities; or
                                                (dd) motherhood,
                                            fatherhood, or parent education
                                            efforts serving low-income
                                            parents of young children;
                                        (II) demonstrates competency to
                                    implement a project, provide fiscal
                                    accountability, collect data, and
                                    prepare reports and other necessary
                                    documentation; and
                                        (III) demonstrates a willingness to
                                    share information with researchers,
                                    practitioners, and other interested
                                    parties.
                (2) Rules governing use of additional funds.--
                        (A) In general.--Funds are used in accordance with
                    this paragraph if--
                                (i) the State, in consultation with
                            relevant stakeholders, including agencies,
                            professional associations, and nonprofit
                            organizations, distributes the funds to
                            eligible entities to--
                                        (I) decrease the need for diapers
                                    and diapering supplies and adult
                                    incontinence materials and supplies in
                                    low-income families and meet such unmet
                                    needs of infants and toddlers,
                                    medically complex children, and low-
                                    income adults and adults with
                                    disabilities in such families through--
                                                (aa) the distribution of
                                            free diapers and diapering
                                            supplies, medically necessary
                                            diapers, and adult incontinence
                                            materials and supplies;
                                                (bb) community outreach to
                                            assist in participation in
                                            existing diaper distribution
                                            programs or programs that
                                            distribute medically necessary
                                            diapers or adult incontinence
                                            materials and supplies; or
                                                (cc) improving access to
                                            diapers and diapering supplies,
                                            medically necessary diapers,
                                            and adult incontinence
                                            materials and supplies; and
                                        (II) increase the ability of
                                    communities and low-income families in
                                    such communities to provide for the
                                    need for diapers and diapering
                                    supplies, medically necessary diapers,
                                    and adult continence materials and
                                    supplies, of infants and toddlers,
                                    medically complex children, and low-
                                    income adults and adults with
                                    disabilities;
                                (ii) the funds are used subject to the
                            limitations in section 2005 of the Social
                            Security Act (42 U.S.C. 1397d);
                                (iii) the funds are used to supplement, not
                            supplant, State general revenue funds provided
                            for the purposes described in clause (i); and
                                (iv) the funds are not used for costs that
                            are reimbursable by the Federal Emergency
                            Management Agency, under a contract for
                            insurance, or by self-insurance.
                        (B) Allowable uses by eligible entities.--An
                    eligible entity receiving funds made available under
                    paragraph (1) shall use the funds for any of the
                    following:
                                (i) To pay for the purchase and
                            distribution of diapers and diapering supplies,
                            medically necessary diapers, and funding diaper
                            (including medically necessary diapers)
                            distribution that serves low-income families
                            with--
                                        (I) 1 or more children 3 years of
                                    age or younger; or
                                        (II) 1 or more medically complex
                                    children.
                                (ii) To pay for the purchase and
                            distribution of adult incontinence materials
                            and supplies and funding distribution of such
                            materials and supplies that serves low-income
                            families with 1 or more low-income adults or
                            adults with disabilities who rely on adult
                            incontinence materials and supplies.
                                (iii) To integrate activities carried out
                            under clause (i) with other basic needs
                            assistance programs serving eligible children
                            and their families, including the following:
                                        (I) Programs funded by 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.), including the State maintenance
                                    of effort provisions of such program.
                                        (II) Programs designed to support
                                    the health of eligible children, such
                                    as the Children's Health Insurance
                                    Program under title XXI of the Social
                                    Security Act, the Medicaid program
                                    under title XIX of such Act, or State
                                    funded health care programs.
                                        (III) Programs funded through the
                                    special supplemental nutrition program
                                    for women, infants, and children under
                                    section 17 of the Child Nutrition Act
                                    of 1966.
                                        (IV) Programs that offer early home
                                    visiting services, including the
                                    maternal, infant, and early childhood
                                    home visiting program (including the
                                    Tribal home visiting program) under
                                    section 511 of the Social Security Act
                                    (42 U.S.C. 711).
                                        (V) Programs to provide improved
                                    and affordable access to child care,
                                    including programs funded through the
                                    Child Care and Development Fund, 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.), or a State-funded program.
                        (C) Availability of funds.--
                                (i) Funds distributed to eligible
                            entities.--Funds made available under paragraph
                            (1) that are distributed to an eligible entity
                            by a State for a fiscal year may be expended by
                            the eligible entity only in such fiscal year or
                            the succeeding fiscal year.
                                (ii) Evaluation.--Funds reserved under
                            paragraph (1)(B)(ii)(I)(aa) to carry out the
                            evaluation under paragraph (4) shall be
                            available for expenditure during the 3-year
                            period that begins on the date of enactment of
                            this Act.
                        (D) No effect on other programs.--Any assistance or
                    benefits received by a family through funds made
                    available under paragraph (1) shall be disregarded for
                    purposes of determining the family's eligibility for,
                    or amount of, benefits under any other Federal needs-
                    based programs.
                (3) Annual reports.--A State shall include in the annual
            report required under section 2006 of the Social Security Act
            (42 U.S.C. 1397e) covering each of fiscal years 2022 through
            2025, information detailing how eligible entities, including
            subgrantees, used funds made available under paragraph (1) to
            distribute diapers and diapering supplies and adult
            incontinence materials and supplies to families in need. Each
            such report shall include the following:
                        (A) The number and age of infants, toddlers,
                    medically complex children, and low-income adults and
                    adults with disabilities who received assistance or
                    benefits through such funds.
                        (B) The number of families that have received
                    assistance or benefits through such funds.
                        (C) The number of diapers, medically necessary
                    diapers, or adult incontinence materials and supplies
                    (such as adult diapers, briefs, protective underwear,
                    pull-ons, pull-ups, liners, shields, guards, pads,
                    undergarments), and the number of each type of
                    diapering or adult incontinence supply, distributed
                    through the use of such funds.
                        (D) The ZIP Code or ZIP Codes where the eligible
                    entity (or subgrantee) distributed diapers and
                    diapering supplies and adult incontinence materials and
                    supplies.
                        (E) The method or methods the eligible entity (or
                    subgrantee) uses to distribute diapers and diapering
                    supplies and, adult incontinence materials and
                    supplies.
                        (F) Such other information as the Secretary may
                    specify.
                (4) Evaluation.--The Secretary, in consultation with
            States, the national entity described in paragraph (1)(B)(iii),
            and eligible entities receiving funds made available under this
            subsection, shall--
                        (A) not later than 2 years after the date of
                    enactment of this Act--
                                (i) complete an evaluation of the
                            effectiveness of the assistance program carried
                            out pursuant to this subsection, such as the
                            effect of activities carried out under this
                            section on mitigating the health and
                            developmental risks of unmet diaper need among
                            infants, toddlers, medically complex children,
                            and other family members in low-income
                            families, including the risks of diaper
                            dermatitis, urinary tract infections, and
                            parental and child depression and anxiety;
                                (ii) submit to the relevant congressional
                            committees a report on the results of such
                            evaluation; and
                                (iii) publish the results of the evaluation
                            on the internet website of the Department of
                            Health and Human Services;
                        (B) not later than 3 years after the date of
                    enactment of this Act, update the evaluation required
                    by subparagraph (A)(i); and
                        (C) not later than 90 days after completion of the
                    updated evaluation under subparagraph (B)--
                                (i) submit to the relevant congressional
                            committees a report describing the results of
                            such updated evaluation; and
                                (ii) publish the results of such evaluation
                            on the internet website of the Department of
                            Health and Human Services.
                (5) Guidance.--Not later than 180 days after enactment of
            this Act, the Secretary shall issue guidance regarding how the
            provisions of this subsection should be carried out, including
            information regarding eligible entities, allowable use of
            funds, and reporting requirements.
                (6) Definitions.--In this subsection:
                        (A) Adult incontinence materials and supplies.--The
                    term ``adult incontinence materials and supplies''
                    means those supplies that are used to assist low-income
                    adults or adults with disabilities and includes adult
                    diapers, briefs, protective underwear, pull-ons, pull-
                    ups, liners, shields, guards, pads, undergarments,
                    disposable wipes, over-the-counter adult diaper rash
                    cream products, intermittent catheterization,
                    indwelling catheters, condom catheters, urinary
                    drainage bags, external collection devices, wearable
                    urinals, and penile clamps.
                        (B) Adults with disabilities.--The term ``adults
                    with disabilities'' means individuals who--
                                (i) have attained age 18; and
                                (ii) have a disability (as such term is
                            defined, with respect to an individual, in
                            section 3 of the Americans with Disabilities
                            Act of 1990 (42 U.S.C. 12102)).
                        (C) Diaper.--The term ``diaper'' means an absorbent
                    garment that--
                                (i) is washable or disposable that may be
                            worn by an infant or toddler who is not toilet-
                            trained; and
                                (ii) if disposable--
                                        (I) does not use any latex or
                                    common allergens; and
                                        (II) meets or exceeds the quality
                                    standards for diapers commercially
                                    available through retail sale in the
                                    following categories:
                                                (aa) Absorbency (with
                                            acceptable rates for first and
                                            second wetting).
                                                (bb) Waterproof outer
                                            cover.
                                                (cc) Flexible leg openings.
                                                (dd) Refastening closures.
                        (D) Diapering supplies.--The term ``diapering
                    supplies'' means items, including diaper wipes and
                    diaper cream, necessary to ensure that--
                                (i) an eligible child using a diaper is
                            properly cleaned and protected from diaper
                            rash; or
                                (ii) a medically complex child who uses a
                            medically necessary diaper is properly cleaned
                            and protected from diaper rash.
                        (E) Eligible child.--The term ``eligible child''
                    means a child who--
                                (i) has not attained 4 years of age; and
                                (ii) is a member of a low-income family.
                        (F) Eligible entities.--The term ``eligible
                    entity'' means a State or local governmental entity, an
                    Indian tribe or tribal organization (as defined in
                    section 4 of the Indian Self-Determination and
                    Education Assistance Act), or a nonprofit organization
                    described in section 501(c)(3) of the Internal Revenue
                    Code of 1986 and exempt from taxation under section
                    501(a) of such Code that--
                                (i) has experience in the area of--
                                        (I) community distributions of
                                    basic need services, including
                                    experience collecting, warehousing, and
                                    distributing basic necessities such as
                                    diapers, food, or menstrual products;
                                        (II) child care;
                                        (III) child development activities
                                    in low-income communities; or
                                        (IV) motherhood, fatherhood, or
                                    parent education efforts serving low-
                                    income parents of young children;
                                (ii) demonstrates competency to implement a
                            project, provide fiscal accountability, collect
                            data, and prepare reports and other necessary
                            documentation; and
                                (iii) demonstrates a willingness to share
                            information with researchers, practitioners,
                            and other interested parties.
                        (G) Federal poverty line.--The term ``Federal
                    poverty line'' means the Federal poverty line as
                    defined by the Office of Management and Budget and
                    revised annually in accordance with section 673(2) of
                    the Omnibus Budget Reconciliation Act of 1981
                    applicable to a family of the size involved.
                        (H) Low-income.--The term ``low-income'', with
                    respect to a family, means a family whose self-
                    certified income is not more than 200 percent of the
                    Federal poverty line.
                        (I) Medically complex child.--The term ``medically
                    complex child'' means an individual who has attained
                    age 3 and for whom a licensed health care provider has
                    provided a diagnosis of bowel or bladder incontinence,
                    a bowel or bladder condition that causes excess urine
                    or stool (such as short gut syndrome or diabetes
                    insipidus), or a severe skin condition that causes skin
                    erosions (such as epidermolysis bullosa).
                        (J) Medically necessary diaper.--The term
                    ``medically necessary diaper'' means an absorbent
                    garment that is--
                                (i) washable or disposable;
                                (ii) worn by a medically complex child who
                            has been diagnosed with bowel or bladder
                            incontinence, a bowel or bladder condition that
                            causes excess urine or stool (such as short gut
                            syndrome or diabetes insipidus), or a severe
                            skin condition that causes skin erosions (such
                            as epidermolysis bullosa) and needs such
                            garment to correct or ameliorate such
                            condition; and
                                (iii) if disposable--
                                        (I) does not use any latex or
                                    common allergens; and
                                        (II) meets or exceeds the quality
                                    standards for diapers commercially
                                    available through retail sale in the
                                    following categories:
                                                (aa) Absorbency (with
                                            acceptable rates for first and
                                            second wetting).
                                                (bb) Waterproof outer
                                            cover.
                                                (cc) Flexible leg openings.
                                                (dd) Refastening closures.
                (7) Exemption of program from sequestration.--
                        (A) In general.--Section 255(h) of the Balanced
                    Budget and Emergency Deficit Control Act of 1985 (2
                    U.S.C. 905(h)) is amended by inserting after
                    ``Supplemental Security Income Program (28-0406-0-1-
                    609).'' the following:
                ``Targeted funding for States for diaper assistance
            (including diapering supplies and adult incontinence materials
            and supplies) through the Social Services Block Grant
            Program.''.
                        (B) Applicability.--The amendment made by this
                    paragraph shall apply to any sequestration order issued
                    under the Balanced Budget and Emergency Deficit Control
                    Act of 1985 (2 U.S.C. 900 et seq.) on or after the date
                    of enactment of this Act.
        (b) Improving Access to Diapers for Medically Complex Children.--
    Section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)) is
    amended by adding at the end the following new paragraph:
        ``(11)(A) In the case of any waiver under this subsection that
    provides medical assistance to a medically complex child who has been
    diagnosed with bowel or bladder incontinence, a bowel or bladder
    condition that causes excess urine or stool (such as short gut syndrome
    or diabetes insipidus), or a severe skin condition that causes skin
    erosions (such as epidermolysis bullosa), such medical assistance shall
    include, for the duration of the waiver, the provision of 200 medically
    necessary diapers per month and diapering supplies. Such medical
    assistance may include the provision of medically necessary diapers in
    amounts greater than 200 if a licensed health care provider (such as a
    physician, nurse practitioner, or physician assistant) specifies that
    such greater amounts are necessary for such medically complex child.
        ``(B) For purposes of this paragraph:
                ``(i) The term `medically complex child' means an
            individual who has attained age 3 and for whom a licensed
            health care provider has provided a diagnosis of 1 or more
            significant chronic conditions.
                ``(ii) The term `medically necessary diaper' means an
            absorbent garment that is--
                        ``(I) washable or disposable;
                        ``(II) worn by a medically complex child who has
                    been diagnosed with a condition described in
                    subparagraph (A) and needs such garment to correct or
                    ameliorate such condition; and
                        ``(III) if disposable--
                                ``(aa) does not use any latex or common
                            allergens; and
                                ``(bb) meets or exceeds the quality
                            standards for diapers commercially available
                            through retail sale in the following
                            categories:
                                        ``(AA) Absorbency (with acceptable
                                    rates for first and second wetting).
                                        ``(BB) Waterproof outer cover.
                                        ``(CC) Flexible leg openings.
                                        ``(DD) Refastening closures.
                ``(iii) The term `diapering supplies' means items,
            including diaper wipes and diaper creams, necessary to ensure
            that a medically complex child who has been diagnosed with a
            condition described in subparagraph (A) and uses a medically
            necessary diaper is properly cleaned and protected from diaper
            rash.''.
        (c) Inclusion of Diapers and Diapering Supplies as Qualified
    Medical Expenses.--
                (1) Health savings accounts.--Section 223(d)(2) of the
            Internal Revenue Code of 1986 is amended--
                        (A) by inserting ``, medically necessary diapers,
                    and diapering supplies'' after ``menstrual care
                    products'' in the last sentence of subparagraph (A);
                    and
                        (B) by adding at the end the following new
                    subparagraph:
                        ``(E) Medically necessary diapers and diapering
                    supplies.--For purposes of this paragraph--
                                ``(i) Medically necessary diapers.--The
                            term `medically necessary diaper' means an
                            absorbent garment which is washable or
                            disposable and which is worn by an individual
                            who has attained 3 years of age because of
                            medical necessity, such as someone who has been
                            diagnosed with bowel or bladder incontinence, a
                            bowel or bladder condition that causes excess
                            urine or stool (such as short gut syndrome or
                            diabetes insipidus), or a severe skin condition
                            that causes skin erosions (such as
                            epidermolysis bullosa) and needs such garment
                            to correct or ameliorate such condition, to
                            serve a preventative medical purpose, or to
                            correct or ameliorate defects or physical or
                            mental illnesses or conditions diagnosed by a
                            licensed health care provider, and, if
                            disposable--
                                        ``(I) does not use any latex or
                                    common allergens; and
                                        ``(II) meets or exceeds the quality
                                    standards for diapers commercially
                                    available through retail sale in the
                                    following categories:
                                                ``(aa) Absorbency (with
                                            acceptable rates for first and
                                            second wetting).
                                                ``(bb) Waterproof outer
                                            cover.
                                                ``(cc) Flexible leg
                                            openings.
                                                ``(dd) Refastening
                                            closures.
                                ``(ii) Diapering supplies.--The term
                            `diapering supplies' means items, including
                            diaper wipes and diaper creams, necessary to
                            ensure that an individual wearing medically
                            necessary diapers is properly cleaned and
                            protected from diaper rash.''.
                (2) Archer msas.--The last sentence of section 220(d)(2)(A)
            of such Code is amended by inserting ``, medically necessary
            diapers (as defined in section 223(d)(2)(E)), and diapering
            supplies (as defined in section 223(d)(2)(E))'' after
            ``menstrual care products (as defined in section
            223(d)(2)(D))''.
                (3) Health flexible spending arrangements and health
            reimbursement arrangements.--Section 106(f) of such Code is
            amended--
                        (A) by inserting ``, medically necessary diapers
                    (as defined in section 223(d)(2)(E)), and diapering
                    supplies (as defined in section 223(d)(2)(E))'' after
                    ``menstrual care products (as defined in section
                    223(d)(2)(D))''; and
                        (B) in the heading, by inserting ``, Medically
                    Necessary Diapers, and Diapering Supplies'' after
                    ``Menstrual Care Products''.
                (4) Effective dates.--
                        (A) Distributions from certain accounts.--The
                    amendments made by paragraphs (1) and (2) shall apply
                    to amounts paid after December 31, 2023.
                        (B) Reimbursements.--The amendment made by
                    paragraph (3) shall apply to expenses incurred after
                    December 31, 2023.

    SEC. 5503. DECREASING THE RISK FACTORS FOR SUDDEN UNEXPECTED INFANT
                  DEATH AND SUDDEN UNEXPLAINED DEATH IN CHILDHOOD.

        (a) Establishment.--The Secretary of Health and Human Services,
    acting through the Administrator of the Health Resources and Services
    Administration and in consultation with the Director of the Centers for
    Disease Control and Prevention and the Director of the National
    Institutes of Health (in this section referred to as the
    ``Secretary''), shall establish and implement a culturally and
    linguistically competent public health awareness and education campaign
    to provide information that is focused on decreasing the risk factors
    for sudden unexpected infant death and sudden unexplained death in
    childhood, including educating individuals about safe sleep
    environments, sleep positions, and reducing exposure to smoking during
    pregnancy and after birth.
        (b) Targeted Populations.--The campaign under subsection (a) shall
    be designed to reduce health inequities through the targeting of
    populations with high rates of sudden unexpected infant death and
    sudden unexplained death in childhood.
        (c) Consultation.--In establishing and implementing the campaign
    under subsection (a), the Secretary shall consult with national
    organizations representing health care providers, including nurses and
    physicians, parents, child care providers, children's advocacy and
    safety organizations, maternal and child health programs, nutrition
    professionals focusing on people, infants, and children, and other
    individuals and groups determined necessary by the Secretary for such
    establishment and implementation.
        (d) Grants.--
                (1) In general.--In carrying out the campaign under
            subsection (a), the Secretary shall award grants to national
            organizations, State and local health departments, and
            community-based organizations for the conduct of education and
            outreach programs for nurses, parents, child care providers,
            public health agencies, and community organizations.
                (2) Application.--To be eligible to receive a grant under
            paragraph (1), an entity shall submit to the Secretary an
            application at such time, in such manner, and containing such
            information as the Secretary may require.
        (e) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section such sums as may be necessary
    for each of fiscal years 2023 through 2027.

              Subtitle G--Nutrition for Women, Children, Families

    SEC. 5601. REMOVING BARRIERS TO HEALTH CARE AND NUTRITION ASSISTANCE
                  FOR CHILDREN, PREGNANT PERSONS, AND LAWFULLY PRESENT
                  INDIVIDUALS.

        (a) Medicaid.--Paragraph (4) of section 1903(v) of the Social
    Security Act (42 U.S.C. 1396b(v)) is amended to read as follows:
        ``(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) CHIP.--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 for Lawfully Present
    Individuals.--
                (1) In general.--Section 402(a)(2)(J) of the Personal
            Responsibility and Work Opportunity Reconciliation Act of 1996
            (8 U.S.C. 1612(a)(2)(J)) is amended--
                        (A) in the subparagraph heading, by striking
                    ``certain children'' inserting ``children and lawfully
                    present individuals''; and
                        (B) by striking ``who is under 18 years of age.''
                    and inserting ``who is--
                                ``(i) under 21 years of age; or
                                ``(ii) lawfully present in the United
                            States.''.
                (2) Conforming amendments.--
                        (A) Section 402(a)(3) of such Act (8 U.S.C.
                    1612(a)(3)) is amended by striking subparagraph (B) and
                    inserting the following:
                        ``(B) SNAP (food stamp program).--The supplemental
                    nutrition assistance program established under the Food
                    and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.)
                    (referred to in this title as `SNAP' or the `food stamp
                    program').''.
                        (B) Section 403(c)(2)(L) of such Act (42 U.S.C.
                    1613(c)(2)(L)) is amended by striking ``18'' and all
                    that follows through the period and inserting ``21, or
                    to individuals who are lawfully present in the United
                    States, under the supplemental nutrition assistance
                    program established under the Food and Nutrition Act of
                    2008 (7 U.S.C. 2011 et seq.).''.
                        (C) Section 5(i)(2)(E) of the Food and Nutrition
                    Act of 2008 (7 U.S.C. 2014(i)(2)(E)) is amended by
                    striking ``18 years of age.'' and inserting ``21 years
                    of age, or who is lawfully present in the United
                    States.''.
        (d) Nonapplication of Sponsor Deeming; Assuring Eligibility for
    Families.--Section 421(d) of the Personal Responsibility and Work
    Opportunity Reconciliation Act of 1996 (8 U.S.C. 1631(d)) is amended by
    striking paragraph (3) and inserting the following:
                ``(3) This section shall not apply to assistance or
            benefits under the supplemental nutrition assistance program
            established under the Food and Nutrition Act of 2008 (7 U.S.C.
            2011 et seq.) for a qualified alien who is eligible under
            section 402(a)(2)(J) and for any member of the household of
            such qualified alien.''.
        (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), respectively; 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 applicants who may be exempt from that
                            provision;''.

    SEC. 5602. CLOSING THE MEAL GAP.

        (a) Elimination of Time Limit.--
                (1) In general.--Section 6 of the Food and Nutrition Act of
            2008 (7 U.S.C. 2015) is amended--
                        (A) by striking subsection (o); and
                        (B) by redesignating subsections (p) through (s) as
                    subsections (o) through (r), respectively.
                (2) Additional allocations for states that ensure
            availability of work opportunities.--Section 16(h) of the Food
            and Nutrition Act of 2008 (7 U.S.C. 2025(h)) is amended--
                        (A) in paragraph (1)--
                                (i) in subparagraph (C)(iv)(I)--
                                        (I) by striking ``(F)(viii)'' each
                                    place it appears and inserting
                                    ``(E)(viii)'';
                                        (II) by striking ``(F)(vii)(I)''
                                    each place it appears and inserting
                                    ``(E)(vii)(I)'';
                                        (III) in item (bb)(BB), by striking
                                    ``(F)(vii)(II)'' and inserting
                                    ``(E)(vii)(II)''; and
                                        (IV) in item (cc), by striking
                                    ``(F)(vii)'' and inserting
                                    ``(E)(vii)'';
                                (ii) by striking subparagraph (E); and
                                (iii) by redesignating subparagraph (F) as
                            subparagraph (E);
                        (B) in paragraphs (3) and (4), by striking
                    ``(1)(F)'' each place it appears and inserting
                    ``(1)(E)''; and
                        (C) in paragraph (5)(C)--
                                (i) in clause (ii), by adding ``and'' at
                            the end;
                                (ii) in clause (iii), by striking ``; and''
                            and inserting a period; and
                                (iii) by striking clause (iv).
                (3) Conforming amendments.--
                        (A) Section 5(a) of the Food and Nutrition Act of
                    2008 (7 U.S.C. 2014(a)) is amended in the second
                    sentence, by striking ``(r)'' and inserting ``(q)''.
                        (B) Section 6(d)(4) of the Food and Nutrition Act
                    of 2008 (7 U.S.C. 2015(d)(4)) is amended--
                                (i) in subparagraph (B)(ii)(I)(bb)(DD), by
                            striking ``or subsection (o)''; and
                                (ii) in subparagraph (N), by striking ``or
                            subsection (o)'' each place it appears.
                        (C) Section 7(i)(1) of the Food and Nutrition Act
                    of 2008 (7 U.S.C. 2016(i)(1)) is amended by striking
                    ``section 6(o)(2) of this Act or''.
                        (D) Section 16(h)(1) of the Food and Nutrition Act
                    of 2008 (7 U.S.C. 2025(h)) is amended--
                                (i) in subparagraph (B), in the matter
                            preceding clause (i), by striking ``that--''
                            and all that follows through the period at the
                            end of clause (ii) and inserting ``that is
                            determined and adjusted by the Secretary.'';
                            and
                                (ii) in clause (ii)(III)(ee)(AA) of
                            subparagraph (E) (as redesignated by paragraph
                            (2)(A)(iii)), by striking ``, individuals
                            subject to the requirements under section
                            6(o),''.
                        (E) Section 51(d)(8)(A)(ii) of the Internal Revenue
                    Code of 1986 is amended--
                                (i) in subclause (I), by striking ``, or''
                            at the end and inserting a period;
                                (ii) in the matter preceding subclause (I),
                            by striking ``family--'' and all that follows
                            through ``receiving'' in subclause (I) and
                            inserting ``family receiving''; and
                                (iii) by striking subclause (II).
                        (F) Section 103(a)(2) of the Workforce Innovation
                    and Opportunity Act (29 U.S.C. 3113) is amended--
                                (i) by striking subparagraph (D); and
                                (ii) by redesignating subparagraphs (E)
                            through (K) as subparagraphs (D) through (J),
                            respectively.
                        (G) Section 121(b)(2)(B) of the Workforce
                    Innovation and Opportunity Act (29 U.S.C. 3151) is
                    amended--
                                (i) by striking clause (iv); and
                                (ii) by redesignating clauses (v) through
                            (vii) as clauses (iv) through (vi),
                            respectively.
        (b) Participation of Puerto Rico, American Samoa, and the Northern
    Mariana Islands in Supplemental Nutrition Assistance Program.--
                (1) Definition of state.--Subsection (r) of section 3 of
            the Food and Nutrition Act of 2008 (7 U.S.C. 2012) is amended
            by inserting ``the Commonwealth of Puerto Rico, American Samoa,
            the Commonwealth of the Northern Mariana Islands,'' after
            ``Guam,''.
                (2) Eligible households.--Section 5 of the Food and
            Nutrition Act of 2008 (7 U.S.C. 2014) is amended--
                        (A) in subsection (c), in the undesignated matter
                    at the end, by striking ``States or Guam'' and
                    inserting ``States, Guam, the Commonwealth of Puerto
                    Rico, American Samoa, or the Commonwealth of the
                    Northern Mariana Islands''; and
                        (B) by adding at the end the following:
        ``(o) Puerto Rico, American Samoa, and the Northern Mariana
    Islands.--Notwithstanding any other provision of this Act, including
    the requirements under this section, the Commonwealth of Puerto Rico,
    American Samoa, and the Commonwealth of the Northern Mariana Islands
    shall each establish their own standards of eligibility for
    participation by households in the supplemental nutrition assistance
    program.''.
                (3) Effective date.--
                        (A) In general.--The amendments made by paragraphs
                    (1) and (2) shall be effective with respect to the
                    Commonwealth of Puerto Rico, American Samoa, and the
                    Commonwealth of the Northern Mariana Islands, as
                    applicable, on the date described in subparagraph (B)
                    if the Secretary of Agriculture submits to Congress a
                    certification under subsection (f)(2)(B) of section 19
                    of the Food and Nutrition Act of 2008 (7 U.S.C. 2028).
                        (B) Date described.--The date referred to in
                    subparagraph (A) is, with respect to the Commonwealth
                    of Puerto Rico, American Samoa, and the Commonwealth of
                    the Northern Mariana Islands, the date established by
                    the Commonwealth of Puerto Rico, American Samoa, or the
                    Commonwealth of the Northern Mariana Islands,
                    respectively, in the applicable plan of operation
                    submitted to the Secretary of Agriculture under
                    subsection (f)(1)(A) of section 19 of the Food and
                    Nutrition Act of 2008 (7 U.S.C. 2028).
        (c) Transition of Puerto Rico, American Samoa, and the Northern
    Mariana Islands to Supplemental Nutrition Assistance Program.--Section
    19 of the Food and Nutrition Act of 2008 (7 U.S.C. 2028) is amended--
                (1) in subsection (a)(1)--
                        (A) in subparagraph (A), by striking ``and'' at the
                    end;
                        (B) in subparagraph (B), by striking the period at
                    the end and inserting ``; and''; and
                        (C) by adding at the end the following:
                        ``(C) the Commonwealth of the Northern Mariana
                    Islands.''; and
                (2) by adding at the end the following:
        ``(f) Transition of Puerto Rico, American Samoa, and the Northern
    Mariana Islands to Supplemental Nutrition Assistance Program.--
                ``(1) Request for participation.--A governmental entity may
            submit to the Secretary a request to participate in the
            supplemental nutrition assistance program, which shall include
            a plan of operation described in section 11(d), which shall
            include the date on which the governmental entity intends to
            begin participation in the program.
                ``(2) Certification by secretary.--
                        ``(A) In general.--The Secretary shall certify a
                    governmental entity that submits a request under
                    paragraph (1) as qualified to participate in the
                    supplemental nutrition assistance program if the
                    Secretary--
                                ``(i) approves the plan of operation
                            submitted with the request, in accordance with
                            this subsection; and
                                ``(ii) approves the applications described
                            in paragraph (4) in accordance with that
                            paragraph.
                        ``(B) Submission of certification to congress.--The
                    Secretary shall submit each certification under
                    subparagraph (A) to Congress.
                ``(3) Determination of plan of operation.--
                        ``(A) Approval.--The Secretary shall approve a plan
                    of operation submitted with a request under paragraph
                    (1) if the plan satisfies the requirements under this
                    Act for a plan of operation.
                        ``(B) Disapproval.--If the Secretary does not
                    approve a plan of operation submitted with a request
                    under paragraph (1), the Secretary shall provide to the
                    governmental entity a statement that describes each
                    requirement under this Act that is not satisfied by the
                    plan.
                ``(4) Approval of retail food stores.--
                        ``(A) Solicitation of applications.--If the
                    Secretary approves a plan of operation under paragraph
                    (3)(A) for a governmental entity, the Secretary shall
                    accept applications from retail food stores located in
                    that governmental entity to be authorized under section
                    9 to participate in the supplemental nutrition
                    assistance program.
                        ``(B) Determination.--The Secretary shall authorize
                    a retail food store applying to participate in the
                    supplemental nutrition assistance program under
                    subparagraph (A) if the application satisfies the
                    requirements under this Act for authorization of a
                    retail food store.
                ``(5) Puerto rico.--In the case of a request under
            paragraph (1) by the Commonwealth of Puerto Rico,
            notwithstanding subsection (g), the Secretary shall allow the
            Commonwealth of Puerto Rico to continue to carry out under the
            supplemental nutrition assistance program the Family Market
            Program established pursuant to this section.
                ``(6) Authorization of appropriations.--There are
            authorized to be appropriated to the Secretary to carry out
            this subsection such sums as are necessary for fiscal year
            2023, to remain available until expended.
        ``(g) Termination of Effectiveness.--
                ``(1) In general.--Subsections (a) through (e) shall cease
            to be effective with respect to the Commonwealth of Puerto
            Rico, American Samoa, and the Commonwealth of the Northern
            Mariana Islands, as applicable, on the date described in
            paragraph (2) if the Secretary submits to Congress a
            certification under subsection (f)(2)(B) for that governmental
            entity.
                ``(2) Date described.--The date referred to in paragraph
            (1) is, with respect to the Commonwealth of Puerto Rico,
            American Samoa, and the Commonwealth of the Northern Mariana
            Islands, the date established by the Commonwealth of Puerto
            Rico, American Samoa, or the Commonwealth of the Northern
            Mariana Islands, respectively, in the applicable plan of
            operation submitted to the Secretary under subsection
            (f)(1)(A).''.

    SEC. 5603. REPEAL OF DENIAL OF SUPPLEMENTAL NUTRITION ASSISTANCE
                  PROGRAM BENEFITS.

        Section 115 of the Personal Responsibility and Work Opportunity
    Reconciliation Act of 1996 (21 U.S.C. 862a) is amended--
                (1) in subsection (a), by striking ``for--'' and all that
            follows and inserting ``for assistance under any State program
            funded under part A of title IV of the Social Security Act (42
            U.S.C. 601 et seq.).'';
                (2) in subsection (b)--
                        (A) by striking ``Others.--'' and all that follows
                    through ``families.--The'' and insert ``Others.--The''
                        (B) by striking paragraph (2); and
                (3) in subsection (e), by striking ``it--'' and all that
            follows and inserting ``the term in section 419(5) of the
            Social Security Act (42 U.S.C. 619(5)) when referring to
            assistance provided under a State program funded under
            paragraph A of title IV of the Social Security Act (42 U.S.C.
            601 et seq.).''.

                   Subtitle H--Universal School Meals Program

    SEC. 5701. SHORT TITLE.

        This subtitle may be cited as the ``Universal School Meals Program
    Act of 2022''.

    SEC. 5702. EFFECTIVE DATE.

        Unless otherwise provided, this subtitle, and the amendments made
    by this subtitle, shall take effect 1 year after the date of enactment
    of this section.

    SEC. 5703. FREE SCHOOL BREAKFAST PROGRAM.

        (a) In General.--Section 4(a) of the Child Nutrition Act of 1966
    (42 U.S.C. 1773(a)) is amended, in the first sentence--
                (1) by striking ``is hereby'' and inserting ``are''; and
                (2) by inserting ``to provide free breakfast to all
            children enrolled at those schools'' before ``in accordance''.
        (b) Apportionment to States.--Section 4(b) of the Child Nutrition
    Act of 1966 (42 U.S.C. 1773(b)) is amended--
                (1) in paragraph (1)--
                        (A) in subparagraph (A)(i), by striking subclause
                    (II) and inserting the following:
                                        ``(II) the national average payment
                                    for free breakfasts, as specified in
                                    subparagraph (B).'';
                        (B) by striking subparagraph (B) and inserting the
                    following:
                        ``(B) Payment amounts.--
                                ``(i) In general.--The national average
                            payment for each free breakfast shall be $2.72,
                            adjusted annually for inflation in accordance
                            with clause (ii) and rounded in accordance with
                            clause (iii).
                                ``(ii) Inflation adjustment.--
                                        ``(I) In general.--The annual
                                    inflation adjustment under clause (i)
                                    shall reflect changes in the cost of
                                    operating the free breakfast program
                                    under this section, as indicated by the
                                    change in the Consumer Price Index for
                                    food away from home for all urban
                                    consumers.
                                        ``(II) Basis.--Each inflation
                                    annual adjustment under clause (i)
                                    shall reflect the changes in the
                                    Consumer Price Index for food away from
                                    home for the most recent 12-month
                                    period for which that data is
                                    available.
                                ``(iii) Rounding.--On July 1, 2021, and
                            annually thereafter, the national average
                            payment rate for free breakfast shall be--
                                        ``(I) adjusted to the nearest
                                    lower-cent increment; and
                                        ``(II) based on the unrounded
                                    amounts for the preceding 12-month
                                    period.'';
                        (C) by striking subparagraphs (C) and (E); and
                        (D) by redesignating subparagraph (D) as
                    subparagraph (C);
                (2) by striking paragraphs (2) and (3);
                (3) by redesignating paragraphs (4) and (5) as paragraphs
            (2) and (3), respectively; and
                (4) in paragraph (3) (as so redesignated), by striking
            ``paragraph (3) or (4)'' and inserting ``paragraph (2)''.
        (c) State Disbursement to Schools.--Section 4 of the Child
    Nutrition Act of 1966 (42 U.S.C. 1773) is amended by striking
    subsection (c) and inserting the following:
        ``(c) State Disbursement to Schools.--Funds apportioned and paid to
    any State for the purpose of this section shall be disbursed by the
    State educational agency to schools selected by the State educational
    agency to assist those schools in operating a breakfast program.''.
        (d) No Collection of Debt.--
                (1) In general.--Notwithstanding any other provision of the
            Child Nutrition Act of 1966 (42 U.S.C. 1771 et seq.) or any
            other provision of law, effective beginning on the date of
            enactment of this Act, as a condition of participation in the
            breakfast program under section 4 of that Act (42 U.S.C. 1773),
            a school--
                        (A) shall not collect any debt owed to the school
                    for unpaid meal charges; and
                        (B) shall continue to accrue debt for unpaid meal
                    charges--
                                (i) for the purpose of receiving
                            reimbursement under section 5715; and
                                (ii) until the effective date specified in
                            section 5702.
                (2) Child nutrition act of 1966.--
                        (A) In general.--Section 4 of the Child Nutrition
                    Act of 1966 (42 U.S.C. 1773) is amended by striking
                    subsection (d) and inserting the following:
        ``(d) No Collection of Debt.--A school participating in the free
    breakfast program under this section shall not collect any debt owed to
    the school for unpaid meal charges.''.
                        (B) Conforming amendment.--Section 23(a) of the
                    Child Nutrition Act of 1966 (42 U.S.C. 1793(a)) is
                    amended by striking ``school in severe need, as
                    described in section 4(d)(1)'' and inserting the
                    following: ``school--
                ``(1) that has a free breakfast program under section 4 or
            seeks to initiate a free breakfast program under that section;
            and
                ``(2) of which not less than 40 percent of the students are
            identified students (as defined in paragraph (8) of section
            1113(a) of the Elementary and Secondary Education Act of 1965
            (20 U.S.C. 6313(a)))''.
        (e) Nutritional and Other Program Requirements.--Section 4(e) of
    the Child Nutrition Act of 1966 (42 U.S.C. 1773(e)) is amended--
                (1) in paragraph (1)(A), in the second sentence, by
            striking ``free or'' and all that follows through the period at
            the end and inserting ``free to all children enrolled at a
            school participating in the school breakfast program.''; and
                (2) in paragraph (2), in the second sentence, by striking
            ``the full charge to the student for a breakfast meeting the
            requirements of this section or''.
        (f) Prohibition on Breakfast Shaming, Meal Denial.--
                (1) In general.--Effective beginning on the date of
            enactment of this Act, a school or school food authority--
                        (A) shall not--
                                (i) physically segregate or otherwise
                            discriminate against any child participating in
                            the breakfast program under section 4 of the
                            Child Nutrition Act of 1966 (42 U.S.C. 1773);
                            or
                                (ii) overtly identify a child described in
                            clause (i) by a special token or ticket, an
                            announced or published list of names, or any
                            other means; and
                        (B) shall provide the program meal to any child
                    eligible under the program.
                (2) Child nutrition act of 1966.--Section 4 of the Child
            Nutrition Act of 1966 (42 U.S.C. 1773) is amended by adding at
            the end the following:
        ``(f) Prohibition on Breakfast Shaming.--A school or school food
    authority shall not--
                ``(1) physically segregate or otherwise discriminate
            against any child participating in the free breakfast program
            under this section; or
                ``(2) overtly identify a child described in paragraph (1)
            by a special token or ticket, an announced or published list of
            names, or any other means.''.
        (g) Department of Defense Overseas Dependents' Schools.--Section
    20(b) of the Child Nutrition Act of 1966 (42 U.S.C. 1789(b)) is
    amended--
                (1) by striking ``and reduced-price''; and
                (2) by striking ``and shall'' and all that follows through
            ``section''.
        (h) Conforming Amendments.--The Child Nutrition Act of 1966 (42
    U.S.C. 1771 et seq.) is amended--
                (1) by striking ``or reduced price'' each place it appears;
                (2) by striking ``and reduced price'' each place it
            appears; and
                (3) by striking ``a reduced price'' each place it appears.

    SEC. 5704. APPORTIONMENT TO STATES.

        Section 4(b) of the Richard B. Russell National School Lunch Act
    (42 U.S.C. 1753(b)) is amended--
                (1) by striking paragraph (2) and inserting the following:
                ``(2) Payment amounts.--
                        ``(A) In general.--The national average payment for
                    each free lunch shall be $3.81, adjusted annually for
                    inflation in accordance with subparagraph (C) and
                    rounded in accordance with subparagraph (D).
                        ``(B) Additional payment for local food.--
                                ``(i) Definition of locally-sourced farm
                            product.--In this subparagraph, the term
                            `locally-sourced farm product' means a farm
                            product that--
                                        ``(I) is marketed to consumers--
                                                ``(aa) directly; or
                                                ``(bb) through
                                            intermediated channels (such as
                                            food hubs and cooperatives);
                                            and
                                        ``(II) with respect to the school
                                    food authority purchasing the farm
                                    product, is produced and distributed--
                                                ``(aa) in the State in
                                            which the school food authority
                                            is located; or
                                                ``(bb) not more than 250
                                            miles from the location of the
                                            school food authority.
                                ``(ii) Additional payment eligibility.--
                            During a school year, a school food authority
                            shall receive an additional payment described
                            in clause (iii) if the State certifies that the
                            school food authority served meals (including
                            breakfasts, lunches, suppers, and supplements)
                            during the last school year of which not less
                            than 25 percent were made with locally-sourced
                            farm products.
                                ``(iii) Payment amount.--
                                        ``(I) In general.--The additional
                                    payment amount under this subparagraph
                                    shall be--
                                                ``(aa) $0.30 for each free
                                            lunch and supper;
                                                ``(bb) $0.21 for each free
                                            breakfast; and
                                                ``(cc) $0.08 for each free
                                            supplement.
                                        ``(II) Adjustments.--Each
                                    additional payment amount under
                                    subclause (I) shall be adjusted
                                    annually in accordance with
                                    subparagraph (C) and rounded in
                                    accordance with subparagraph (D).
                                ``(iv) Disbursement.--The State agency
                            shall disburse funds made available under this
                            clause to school food authorities eligible to
                            receive additional reimbursement.
                        ``(C) Inflation adjustment.--
                                ``(i) In general.--The annual inflation
                            adjustment under subparagraphs (A) and (B)(iii)
                            shall reflect changes in the cost of operating
                            the free lunch program under this Act, as
                            indicated by the change in the Consumer Price
                            Index for food away from home for all urban
                            consumers.
                                ``(ii) Basis.--Each annual inflation
                            adjustment under subparagraphs (A) and (B)(iii)
                            shall reflect the changes in the Consumer Price
                            Index for food away from home for the most
                            recent 12-month period for which that data is
                            available.
                        ``(D) Rounding.--On July 1, 2021, and annually
                    thereafter, the national average payment rate for free
                    lunch and the additional payment amount for free
                    breakfast, lunch, supper, and supplement under
                    subparagraph (B) shall be--
                                ``(i) adjusted to the nearest lower-cent
                            increment; and
                                ``(ii) based on the unrounded amounts for
                            the preceding 12-month period.''; and
                (2) by striking paragraph (3).

    SEC. 5705. NUTRITIONAL AND OTHER PROGRAM REQUIREMENTS.

        (a) Elimination of Free Lunch Eligibility Requirements.--
                (1) In general.--Section 9 of the Richard B. Russell
            National School Lunch Act (42 U.S.C. 1758) is amended by
            striking subsection (b) and inserting the following:
        ``(b) Eligibility.--All children enrolled in a school that
    participates in the school lunch program under this Act shall be
    eligible to receive free lunch under this Act.''.
                (2) Conforming amendments.--
                        (A) Section 9 of the Richard B. Russell National
                    School Lunch Act (42 U.S.C. 1758) is amended--
                                (i) in subsection (c), in the third
                            sentence, by striking ``or at a reduced cost'';
                            and
                                (ii) in subsection (e), by striking ``,
                            reduced price,''.
                        (B) Section 18 of the Richard B. Russell National
                    School Lunch Act (42 U.S.C. 1769) is amended--
                                (i) by striking subsection (j); and
                                (ii) by redesignating subsection (k) as
                            subsection (j).
                        (C) Section 28(b)(4) of the Richard B. Russell
                    National School Lunch Act (42 U.S.C. 1769i(b)(4)) is
                    amended--
                                (i) by striking subparagraph (B); and
                                (ii) in subparagraph (A), by striking the
                            subparagraph designation and heading and all
                            that follows through ``the Secretary'' and
                            inserting ``The Secretary''.
                        (D) Section 17 of the Child Nutrition Act of 1966
                    (42 U.S.C. 1786) is amended--
                                (i) in subsection (d)(2)(A)--
                                        (I) by striking clause (i); and
                                        (II) by redesignating clauses (ii)
                                    and (iii) as clauses (i) and (ii),
                                    respectively; and
                                (ii) in subsection (f)(17), by striking
                            ``Notwithstanding subsection (d)(2)(A)(i), not
                            later'' and inserting ``Not later''.
                        (E) Section 1902(a) of the Social Security Act (42
                    U.S.C. 1396a(a)) is amended by striking paragraph (7)
                    and inserting the following:
                ``(7) provide safeguards which restrict the use or
            disclosure of information concerning applicants and recipients
            to purposes directly connected with the administration of the
            plan;''.
                        (F) Section 1154(a)(2)(A)(i) of title 10, United
                    States Code, is amended by striking ``in accordance
                    with section 9(b)(1) of the Richard B. Russell National
                    School Lunch Act (42 U.S.C. 1758(b)(1)''.
                        (G) Section 4301 of the Food, Conservation, and
                    Energy Act of 2008 (42 U.S.C. 1758a) is repealed.
        (b) No Collection of Debt.--
                (1) In general.--Notwithstanding any other provision of the
            Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et
            seq.) or any other provision of law, effective beginning on the
            date of enactment of this Act, as a condition of participation
            in the school lunch program under that Act, a school--
                        (A) shall not collect any debt owed to the school
                    for unpaid meal charges; and
                        (B) shall continue to accrue debt for unpaid meal
                    charges--
                                (i) for the purpose of receiving
                            reimbursement under section 5716; and
                                (ii) until the effective date specified in
                            section 5702.
                (2) National school lunch act.--
                        (A) In general.--Section 9 of the Richard B.
                    Russell National School Lunch Act (42 U.S.C. 1758) is
                    amended by striking subsection (d) and inserting the
                    following:
        ``(d) No Collection of Debt.--A school participating in the school
    lunch program under this Act shall not collect any debt owed to the
    school for unpaid meal charges.''.
                        (B) Conforming amendments.--Section 9(b)(8)(A) of
                    the Richard B. Russell National School Lunch Act (42
                    U.S.C. 1758(b)(8)(A)) is amended by striking ``or
                    subsection (d)''.

    SEC. 5706. SPECIAL ASSISTANCE PROGRAM.

        (a) In General.--Section 11 of the Richard B. Russell National
    School Lunch Act (42 U.S.C. 1759a) is repealed.
        (b) Conforming Amendments.--
                (1) Section 6 of the Richard B. Russell National School
            Lunch Act (42 U.S.C. 1755) is amended--
                        (A) in subsection (a)(2), by striking ``sections 11
                    and 13'' and inserting ``section 13''; and
                        (B) in subsection (e)(1), in the matter preceding
                    subparagraph (A), by striking ``section 4, this
                    section, and section 11'' and inserting ``this section
                    and section 4''.
                (2) Section 7(d) of the Richard B. Russell National School
            Lunch Act (42 U.S.C. 1756(d)) is amended by striking ``or 11''.
                (3) Section 8(g) of the Richard B. Russell National School
            Lunch Act (42 U.S.C. 1757(g)) is amended by striking ``and
            under section 11 of this Act''.
                (4) Section 12(f) of the Richard B. Russell National School
            Lunch Act (42 U.S.C. 1760(f)) is amended by striking ``11,''.
                (5) Section 7(a) of the Child Nutrition Act of 1966 (42
            U.S.C. 1766(a)) is amended--
                        (A) in paragraph (1)(A), by striking ``4, 11, and
                    17'' and inserting ``4 and 17''; and
                        (B) in paragraph (2)(A), by striking ``sections 4
                    and 11'' and inserting ``section 4''.

    SEC. 5707. PRICE FOR A PAID LUNCH.

        Section 12 of the Richard B. Russell National School Lunch Act (42
    U.S.C. 1760) is amended--
                (1) by striking subsection (p); and
                (2) by redesignating subsections (q) and (r) as subsections
            (p) and (q), respectively.

    SEC. 5708. SUMMER FOOD SERVICE PROGRAM FOR CHILDREN.

        Section 13 of the Richard B. Russell National School Lunch Act (42
    U.S.C. 1761) is amended--
                (1) in subsection (a)--
                        (A) in paragraph (2), by adding at the end the
                    following:
                        ``(C) Waiver.--If the Secretary determines that a
                    program requirement under this section limits the
                    access of children to meals served under this section,
                    the Secretary may waive that program requirement.
                        ``(D) Eligibility.--All children shall be eligible
                    to participate in the program under this section.'';
                    and
                        (B) in paragraph (5), by striking ``only for'' and
                    all that follows through the period at the end and
                    inserting ``for meals served to all children.'';
                (2) in subsection (b)(2), by striking ``may only serve''
            and all that follows through ``migrant children'';
                (3) by striking subsection (c) and inserting the following:
        ``(c) Payments.--
                ``(1) In general.--Payments shall be made to service
            institutions for meals served--
                        ``(A) during the months of May through September;
                        ``(B) during school vacation at any time during an
                    academic school year;
                        ``(C) during a teacher in-service day; and
                        ``(D) on days that school is closed during the
                    months of October through April due to a natural
                    disaster, building repair, court order, or similar
                    cause, as determined by the Secretary.
                ``(2) Limitation on payments.--A service institution shall
            receive payments under this section for not more than 3 meals
            and 1 supplement per child per day.''; and
                (4) in subsection (f)(3), by striking ``, except that'' and
            all that follows through ``section''.

    SEC. 5709. SUMMER ELECTRONIC BENEFIT TRANSFER FOR CHILDREN PROGRAM.

        Section 13(a) of the Richard B. Russell National School Lunch Act
    (42 U.S.C. 1761(a)) is amended by adding at the end the following:
                ``(13) Summer electronic benefit transfer for children
            program.--
                        ``(A) Definitions.--In this paragraph:
                                ``(i) EBT card.--The term `EBT card' means
                            an electronic benefit transfer card.
                                ``(ii) Eligible household.--The term
                            `eligible household' means a household with--
                                        ``(I) an income that does not
                                    exceed 200 percent of the poverty line
                                    (as defined in section 673 of the
                                    Community Services Block Grant Act (42
                                    U.S.C. 9902)); and
                                        ``(II) 1 or more children.
                                ``(iii) Program.--The term `Program' means
                            the Summer Electronic Benefit Transfer for
                            Children Program established under subparagraph
                            (B).
                        ``(B) Establishment.--The Secretary shall establish
                    a national program, to be known as the `Summer
                    Electronic Benefit Transfer for Children Program',
                    under which the Secretary shall issue EBT cards to
                    eligible households to provide food assistance during
                    the summer months.
                        ``(C) EBT amount.--
                                ``(i) In general.--The value of an EBT card
                            provided under the Program to an eligible
                            household shall be $60 per month per child
                            (adjusted for inflation).
                                ``(ii) Annual limitation.--No eligible
                            household shall receive benefits under the
                            Program for more than 3 months in a calendar
                            year.
                        ``(D) Administration.--
                                ``(i) In general.--Except as provided under
                            this paragraph, the Program shall be based on
                            the summer electronic benefit transfer for
                            children demonstration program carried out
                            pursuant to section 749(g) of the Agriculture,
                            Rural Development, Food and Drug
                            Administration, and Related Agencies
                            Appropriations Act, 2010 (Public Law 111-80;
                            123 Stat. 2132).
                                ``(ii) SNAP or WIC.--
                                        ``(I) In general.--Subject to
                                    subclause (II), a State shall
                                    administer the Program through the
                                    supplemental nutrition assistance
                                    program established under the Food and
                                    Nutrition Act of 2008 (7 U.S.C. 2011 et
                                    seq.).
                                        ``(II) WIC option.--If a State has
                                    participated in the demonstration
                                    program described in clause (i) before
                                    the effective date specified in section
                                    5702 of the Universal School Meals
                                    Program Act of 2022, the State may
                                    elect to administer the Program through
                                    the special supplemental nutrition
                                    program for women, infants, and
                                    children established by section 17 of
                                    the Child Nutrition Act of 1966 (42
                                    U.S.C. 1786).
                        ``(E) Authorization of appropriations.--There are
                    authorized to be appropriated to the Secretary to carry
                    out this paragraph such sums as are necessary for
                    fiscal year 2021 and each fiscal year thereafter.''.

    SEC. 5710. CHILD AND ADULT CARE FOOD PROGRAM.

        Section 17 of the Richard B. Russell National School Lunch Act (42
    U.S.C. 1766) is amended--
                (1) in subsection (a)(2), by striking subparagraph (B) and
            inserting the following:
                        ``(B) any other private organization providing
                    nonresidential child care or day care outside school
                    hours for school children;'';
                (2) by striking subsection (c) and inserting the following:
        ``(c) Free Meals.--Notwithstanding any other provision of law--
                ``(1) all meals and supplements served under the program
            authorized under this section shall be provided for free to
            participants of the program; and
                ``(2) an institution that serves those meals and
            supplements shall be reimbursed--
                        ``(A) in the case of breakfast, at the rate
                    established for free breakfast under section
                    4(b)(1)(B)(i) of the Child Nutrition Act of 1966 (42
                    U.S.C. 1773(b)(1)(B)(i));
                        ``(B) in the case of lunch, at the rate established
                    for free lunch under section 4(b)(2)(A); and
                        ``(C) in the case of a supplemental meal, $0.96,
                    adjusted for inflation in accordance with section
                    4(b)(2)(C).'';
                (3) in subsection (f)--
                        (A) in paragraph (2), by striking subparagraph (B)
                    and inserting the following:
                        ``(B) Limitation to reimbursements.--An institution
                    may claim reimbursement under this paragraph for not
                    more than 3 meals and 1 supplement per day per
                    child.''; and
                        (B) by striking paragraph (3); and
                (4) in subsection (r)--
                        (A) in the subsection heading, by striking
                    ``Program for At-Risk School Children'' and inserting
                    ``Afterschool Meal and Snack Program'';
                        (B) by striking ``at-risk school'' each place it
                    appears and inserting ``eligible'';
                        (C) in paragraph (1)--
                                (i) in the paragraph heading, by striking
                            ``at-risk school'' and inserting ``eligible'';
                            and
                                (ii) in subparagraph (B), by striking
                            ``operated'' and all that follows through the
                            period at the end and inserting a period; and
                        (D) in paragraph (4)(A), by striking ``only for''
                    and all that follows through the period at the end and
                    inserting the following: ``for--
                                ``(i) not more than 1 meal and 1 supplement
                            per child per day served on a regular school
                            day; and
                                ``(ii) not more than 3 meals and 1
                            supplement per child per day served on any day
                            other than a regular school day.''.

    SEC. 5711. MEALS AND SUPPLEMENTS FOR CHILDREN IN AFTERSCHOOL CARE.

        Section 17A of the Richard B. Russell National School Lunch Act (42
    U.S.C. 1766a) is amended--
                (1) in the section heading, by striking ``meal
            supplements'' and inserting ``meals and supplements'';
                (2) in subsection (a)(1), by striking ``meal supplements''
            and inserting ``free meals and supplements'';
                (3) in subsection (b), by inserting ``meals and'' before
            ``supplements''; and
                (4) by striking subsection (c) and inserting the following:
        ``(c) Reimbursement.--
                ``(1) In general.--
                        ``(A) Meals.--A free meal provided under this
                    section to a child shall be reimbursed at a rate of
                    $3.81, adjusted annually for inflation in accordance
                    with paragraph (3)(A) and rounded in accordance with
                    paragraph (3)(B).
                        ``(B) Supplements.--A free supplement provided
                    under this section to a child shall be reimbursed at
                    the rate at which free supplements are reimbursed under
                    section 17(c)(2)(C).
                ``(2) Limitation to reimbursements.--An institution may
            claim reimbursement under this section for not more than 1 meal
            and 1 supplement per day per child served on a regular school
            day.
                ``(3) Inflation; rounding.--
                        ``(A) Inflation adjustment.--
                                ``(i) In general.--The annual inflation
                            adjustment under paragraph (1)(A) shall reflect
                            changes in the cost of operating the program
                            under this section, as indicated by the change
                            in the Consumer Price Index for food away from
                            home for all urban consumers.
                                ``(ii) Basis.--Each inflation annual
                            adjustment under paragraph (1)(A) shall reflect
                            the changes in the Consumer Price Index for
                            food away from home for the most recent 12-
                            month period for which that data is available.
                        ``(B) Rounding.--On July 1, 2021, and annually
                    thereafter, the reimbursement rate for a free meal
                    under this section shall be--
                                ``(i) adjusted to the nearest lower-cent
                            increment; and
                                ``(ii) based on the unrounded amounts for
                            the preceding 12-month period.''.

    SEC. 5712. ACCESS TO LOCAL FOODS: FARM TO SCHOOL PROGRAM.

        Section 18(g)(5) of the Richard B. Russell National School Lunch
    Act (42 U.S.C. 1769(g)(5)) is amended by striking subparagraph (B) and
    inserting the following:
                        ``(B) serve a high proportion of identified
                    students (as defined in paragraph (8) of section
                    1113(a) of the Elementary and Secondary Education Act
                    of 1965 (20 U.S.C. 6313(a)));''.

    SEC. 5713. FRESH FRUIT AND VEGETABLE PROGRAM.

        Section 19(d) of the Richard B. Russell National School Lunch Act
    (42 U.S.C. 1769a(d)) is amended--
                (1) in paragraph (1)--
                        (A) in the matter preceding subparagraph (A), by
                    striking ``paragraph (2) of this subsection and'';
                        (B) in subparagraph (A), in the matter preceding
                    clause (i), by striking ``school--'' and all that
                    follows through ``submits'' in clause (ii) and
                    inserting ``school that submits'';
                        (C) in subparagraph (B), by striking ``schools''
                    and all that follows through ``Act'' and inserting
                    ``high-need schools (as defined in section 2211(b) of
                    the Elementary and Secondary Education Act of 1965 (20
                    U.S.C. 6631(b)))''; and
                        (D) in subparagraph (D)--
                                (i) by striking clause (i); and
                                (ii) by redesignating clauses (ii) through
                            (iv) as clauses (i) through (iii),
                            respectively; and
                (2) by striking paragraphs (2) and (3) and inserting the
            following:
                ``(2) Outreach to high-need schools.--Prior to making
            decisions regarding school participation in the program, a
            State agency shall inform high-need schools (as defined in
            section 2211(b) of the Elementary and Secondary Education Act
            of 1965 (20 U.S.C. 6631(b))), including Tribal schools, of the
            eligibility of the schools for the program.''.

    SEC. 5714. TRAINING, TECHNICAL ASSISTANCE, AND FOOD SERVICE MANAGEMENT
                  INSTITUTE.

        Section 21(a)(1)(B) of the Richard B. Russell National School Lunch
    Act (42 U.S.C. 1769b-1(a)(1)(B)) is amended in the matter preceding
    clause (i) by striking ``certified to receive free or reduced price
    meals'' and inserting ``who are identified students (as defined in
    paragraph (8) of section 1113(a) of the Elementary and Secondary
    Education Act of 1965 (20 U.S.C. 6313(a))''.

    SEC. 5715. REIMBURSEMENT OF SCHOOL MEAL DELINQUENT DEBT PROGRAM.

        (a) Definitions.--In this section:
                (1) Delinquent debt.--The term ``delinquent debt'' means
            the debt owed by a parent or guardian of a child to a school--
                        (A) as of the effective date specified in section
                    5702; and
                        (B) for meals served by the school under--
                                (i) the school breakfast program under
                            section 4 of the Child Nutrition Act of 1966
                            (42 U.S.C. 1773);
                                (ii) the school lunch program established
                            under the Richard B. Russell National School
                            Lunch Act (42 U.S.C. 1751 et seq.); or
                                (iii) both of the programs described in
                            clauses (i) and (ii).
                (2) Program.--The term ``program'' means the program
            established under subsection (b)(1).
                (3) Secretary.--The term ``Secretary'' means the Secretary
            of Agriculture.
        (b) Reimbursement Program.--
                (1) Establishment.--Not later than 60 days after the
            effective date specified in section 5702, the Secretary shall
            establish a program under which the Secretary shall reimburse
            each school participating in a program described in clause (i)
            or (ii) of subsection (a)(1)(B) for all delinquent debt.
                (2) Form for reimbursement.--To carry out the program, the
            Secretary shall design and distribute a form to State agencies
            to collect data on all delinquent debt in applicable schools in
            the State, grouped by school food authority.
                (3) Completion date.--The Secretary shall provide all
            reimbursements under the program not later than 180 days after
            the effective date specified in section 5702.
        (c) Report.--Not later than 2 years after the effective date
    specified in section 5702, the Comptroller General of the United States
    shall submit to Congress and make publicly available a report that
    describes the successes and challenges of the program.

    SEC. 5716. CONFORMING AMENDMENTS.

        The Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et
    seq.) is amended--
                (1) by striking ``or reduced price'' each place it appears;
                (2) by striking ``or a reduced price'' each place it
            appears;
                (3) by striking ``and reduced price'' each place it
            appears; and
                (4) by striking ``a reduced price'' each place it appears.

    SEC. 5717. MEASURE OF POVERTY.

        Section 1113(a) of the Elementary and Secondary Education Act of
    1965 (20 U.S.C. 6313(a)) is amended--
                (1) in paragraph (5)(A), by striking ``the number of
            children eligible for a free or reduced price lunch under the
            Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et
            seq.)'' and inserting ``the number of identified students'';
            and
                (2) by adding at the end the following:
                ``(8) Identified students defined.--
                        ``(A) In general.--In this subsection, the term
                    `identified students' means the number of students--
                                ``(i) who are--
                                        ``(I) homeless children and youths,
                                    as defined under section 725(2) of the
                                    McKinney-Vento Homeless Assistance Act
                                    (42 U.S.C. 11434a(2));
                                        ``(II) runaway and homeless youth
                                    served by programs established under
                                    the Runaway and Homeless Youth Act (34
                                    U.S.C. 11201 et seq.);
                                        ``(III) migratory children, as
                                    defined under section 1309; or
                                        ``(IV) foster children;
                                ``(ii) who are eligible for and receiving
                            medical assistance under the program of medical
                            assistance established under title XIX of the
                            Social Security Act (42 U.S.C. 1396 et seq.);
                            or
                                ``(iii) who participate (or who are part of
                            a household that participates) in at least one
                            of the following:
                                        ``(I) The supplemental nutrition
                                    assistance program established under
                                    the Food and Nutrition Act of 2008 (7
                                    U.S.C. 2011 et seq.).
                                        ``(II) A State program funded under
                                    the program of block grants to States
                                    for temporary assistance for needy
                                    families established under part A of
                                    title IV of the Social Security Act (42
                                    U.S.C. 601 et seq.).
                                        ``(III) The food distribution
                                    program on Indian reservations
                                    established under section 4(b) of the
                                    Food and Nutrition Act of 2008 (7
                                    U.S.C. 2013(b)).
                                        ``(IV) A Head Start program
                                    authorized under the Head Start Act (42
                                    U.S.C. 9831 et seq.) or a comparable
                                    State-funded Head Start or pre-
                                    kindergarten program.
                        ``(B) Multiplier.--In determining the number of
                    identified students under subparagraph (A), the local
                    educational agency shall multiply the number determined
                    under such subparagraph by 1.6.''.

    SEC. 5718. SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM.

        (a) Agreement for Direct Certification.--
                (1) In general.--Section 11 of the Food and Nutrition Act
            of 2008 (7 U.S.C. 2020) is amended--
                        (A) by striking subsection (u); and
                        (B) by redesignating subsections (v) through (x) as
                    subsections (u) through (w), respectively.
                (2) Conforming amendments.--Section 11(e) of the Food and
            Nutrition Act of 2008 (7 U.S.C. 2020(e)) is amended--
                        (A) in paragraph (8)(F), by striking ``or
                    subsection (u)''; and
                        (B) in paragraph (26)(B), by striking ``(x)'' and
                    inserting ``(w)''.
        (b) Nutrition Education and Obesity Prevention Grant Program.--
    Section 28(a) of the Food and Nutrition Act of 2008 (7 U.S.C. 2036a(a))
    is amended by striking paragraph (1) and inserting the following:
                ``(1) an individual eligible for benefits under this
            Act;''.

    SEC. 5719. HIGHER EDUCATION ACT OF 1965.

        (a) Teacher Quality Enhancement.--Subparagraph (A) of section
    200(11) of the Higher Education Act of 1965 (20 U.S.C. 1021(11)) is
    amended to read as follows:
                        ``(A) In general.--The term `high-need school'
                    means a school that is in the highest quartile of
                    schools in a ranking of all schools served by a local
                    educational agency, ranked in descending order by
                    percentage of students from low-income families
                    enrolled in such schools, as determined by the local
                    educational agency based on one of the following
                    measures of poverty:
                                ``(i) The percentage of students aged 5
                            through 17 in poverty counted in the most
                            recent census data approved by the Secretary.
                                ``(ii) The percentage of students in
                            families receiving assistance under the State
                            program funded under the program of block
                            grants to States for temporary assistance for
                            needy families established under part A of
                            title IV of the Social Security Act (42 U.S.C.
                            601 et seq.).
                                ``(iii) The percentage of students eligible
                            to receive medical assistance under the program
                            of medical assistance established under title
                            XIX of the Social Security Act (42 U.S.C. 1396
                            et seq.).
                                ``(iv) A composite of two or more of the
                            measures described in clauses (i) through
                            (iii).''.
        (b) GEAR Up.--Subparagraph (A) of section 404B(d)(1) of the Higher
    Education Act of 1965 (20 U.S.C. 1070a-22(d)(1)) is amended to read as
    follows:
                        ``(A) provide services under this chapter to at
                    least one grade level of students, beginning not later
                    than 7th grade, in a participating school--
                                ``(i) that has a 7th grade; and
                                ``(ii) in which--
                                        ``(I) at least 50 percent of the
                                    students enrolled are identified
                                    students (as defined in section
                                    1113(a)(8) of the Elementary and
                                    Secondary Education Act of 1965); or
                                        ``(II) if an eligible entity
                                    determines that it would promote the
                                    effectiveness of a program, an entire
                                    grade level of students, beginning not
                                    later than the 7th grade, reside in
                                    public housing, as defined in section
                                    3(b)(1) of the United States Housing
                                    Act of 1937 (42 U.S.C. 1437a(b)(1)).''.
        (c) Simplified Needs Test.--Section 479(d)(2) of the Higher
    Education Act of 1965 (20 U.S.C. 1087ss(d)(2)) is amended--
                (1) by striking subparagraph (C); and
                (2) by redesignating subparagraphs (D) through (F) as
            subparagraphs (C) through (E), respectively.
        (d) Early Federal Pell Grant Commitment Demonstration Program.--
    Section 894(b) of the Higher Education Act of 1965 (20 U.S.C. 1161y(b))
    is amended--
                (1) in paragraph (1)(B), by striking ``qualify for a free
            or reduced price school lunch under the Richard B. Russell
            National School Lunch Act (42 U.S.C. 1751 et seq.) or the Child
            Nutrition Act of 1966 (42 U.S.C. 1771 et seq.)'' and inserting
            ``are identified students (as defined in section 1113(a)(8) of
            the Elementary and Secondary Education Act of 1965)''; and
                (2) in paragraph (5), by striking ``eligible for a free or
            reduced price school lunch under the Richard B. Russell
            National School Lunch Act (42 U.S.C. 1751 et seq.) or the Child
            Nutrition Act of 1966 (42 U.S.C. 1771 et seq.)'' and inserting
            ``identified students (as defined in section 1113(a)(8) of the
            Elementary and Secondary Education Act of 1965)''.

    SEC. 5720. ELEMENTARY AND SECONDARY EDUCATION ACT OF 1965.

        (a) Literacy Education for All.--Section 2221(b)(3)(B) of the
    Elementary and Secondary Education Act of 1965 (20 U.S.C.
    6641(b)(3)(B)) is amended--
                (1) by striking clause (i); and
                (2) by redesignating clauses (ii) and (iii) as clauses (i)
            and (ii), respectively.
        (b) Grants for Education Innovation and Research.--Section
    4611(d)(2) of the Elementary and Secondary Education Act of 1965 (20
    U.S.C. 7261(d)(2)) is amended--
                (1) by striking subparagraph (B); and
                (2) by redesignating subparagraphs (C) and (D) as
            subparagraphs (B) and (C), respectively.
        (c) Eligibility for Heavily Impacted Local Educational Agencies.--
    Item (bb) of section 7003(b)(2)(B)(i)(III) of the Elementary and
    Secondary Education Act of 1965 (20 U.S.C. 7703(b)(2)(B)(i)(III)) is
    amended to read as follows:
                                                ``(bb) has an enrollment of
                                            children described in
                                            subsection (a)(1) that
                                            constitutes a percentage of the
                                            total student enrollment of the
                                            agency that is not less than 30
                                            percent; or''.

    SEC. 5721. AMERICA COMPETES ACT.

        Section 6122(3) of the America COMPETES Act (20 U.S.C. 9832(3)) is
    amended by striking ``data on children eligible for free or reduced-
    price lunches under the Richard B. Russell National School Lunch
    Act,''.

    SEC. 5722. WORKFORCE INNOVATION AND OPPORTUNITY ACT.

        Section 3(36)(A) of the Workforce Innovation and Opportunity Act
    (29 U.S.C. 3102(36)(A)) is amended--
                (1) by striking clause (iv); and
                (2) by redesignating clauses (v) and (vi) as clauses (iv)
            and (v), respectively.

    SEC. 5723. NATIONAL SCIENCE FOUNDATION AUTHORIZATION ACT OF 2002.

        Section 4(8) of the National Science Foundation Authorization Act
    of 2002 (42 U.S.C. 1862n note) is amended--
                (1) by striking subparagraph (A); and
                (2) by redesignating subparagraphs (B) and (C) as
            subparagraphs (A) and (B), respectively.

    SEC. 5724. CHILD CARE AND DEVELOPMENT BLOCK GRANT.

        Section 658O(b) of the Child Care and Development Block Grant Act
    of 1990 (42 U.S.C. 9858m(b)) is amended--
                (1) in paragraph (1)(B), by striking ``school lunch
            factor'' and inserting ``identified students factor''; and
                (2) by striking paragraph (3) and inserting the following:
                ``(3) Identified students factor.--The term `identified
            students factor' means the ratio of the number of children in
            the State who are identified students (as defined in paragraph
            (8) of section 1113(a) of the Elementary and Secondary
            Education Act of 1965 (20 U.S.C. 6313(a))) to the number of
            such children in all the States as determined annually by the
            Secretary of Education.''.

    SEC. 5725. CHILDREN'S HEALTH ACT OF 2000.

        Section 1404(b) of the Children's Health Act of 2000 (42 U.S.C.
    9859c(b)) is amended--
                (1) in paragraph (1)(B), by striking ``school lunch
            factor'' and inserting ``identified students factor''; and
                (2) by amending paragraph (3) to read as follows:
                ``(3) Identified students factor.--In this subsection, the
            term `identified students factor' means the ratio of the number
            of children in the State who are identified students (as
            defined in paragraph (8) of section 1113(a) of the Elementary
            and Secondary Education Act of 1965 (20 U.S.C. 6313(a))) to the
            number of such children in all the States as determined
            annually by the Secretary of Education.''.

    SEC. 5726. JUVENILE JUSTICE AND DELINQUENCY PREVENTION.

        Section 252(i) of the Juvenile Justice and Delinquency Prevention
    Act of 1974 (34 U.S.C. 11162(i)) is amended to read as follows:
        ``(i) Free School Lunches for Incarcerated Juveniles.--
                ``(1) In general.--A juvenile who is incarcerated in an
            eligible juvenile detention center is eligible to receive free
            lunch under the Richard B. Russell National School Lunch Act
            (42 U.S.C. 1751 et seq.).
                ``(2) Guidance.--Not later than 1 year after the date of
            the enactment of the Universal School Meals Program Act of
            2022, the Attorney General, in consultation with the Secretary
            of Agriculture, shall provide guidance to States relating to
            the options for school food authorities in the States to apply
            for reimbursement for free lunches under the Richard B. Russell
            National School Lunch Act (42 U.S.C. 1751 et seq.) for
            juveniles who are incarcerated.
                ``(3) Eligible juvenile detention center defined.--In this
            subsection, the term `eligible juvenile detention center' does
            not include any private, for-profit detention center.''.

                             Subtitle I--Elder Care

    SEC. 5801. EXPENSES FOR HOUSEHOLD AND ELDER CARE SERVICES NECESSARY FOR
                  GAINFUL EMPLOYMENT.

        (a) In General.--Subpart A of part IV of subchapter A of chapter 1
    of the Internal Revenue Code of 1986 is amended by adding at the end
    the following new section:

    ``SEC. 25E. EXPENSES FOR HOUSEHOLD AND ELDER CARE SERVICES NECESSARY
                  FOR GAINFUL EMPLOYMENT.

        ``(a) Allowance of Credit.--
                ``(1) In general.--In the case of an individual for which
            there are one or more qualifying individuals (as defined in
            subsection (b)(1)) with respect to such individual, there shall
            be allowed as a credit against the tax imposed by this chapter
            for the taxable year an amount equal to the applicable
            percentage of the employment-related expenses (as defined in
            subsection (b)(2)) paid by such individual during the taxable
            year.
                ``(2) Applicable percentage defined.--For purposes of
            paragraph (1), the term `applicable percentage' means 35
            percent reduced (but not below 20 percent) by 1 percentage
            point for each $2,000 (or fraction thereof) by which the
            taxpayer's adjusted gross income for the taxable year exceeds
            $15,000.
        ``(b) Definitions of Qualifying Individual and Employment-Related
    Expenses.--For purposes of this section--
                ``(1) Qualifying individual.--The term `qualifying
            individual' means an individual who--
                        ``(A) has attained age 50, and
                        ``(B) is one of the following:
                                ``(i) An individual who bears a
                            relationship to the taxpayer described in
                            subparagraph (C) or (D) of section 152(d)(2)
                            (relating to fathers, mothers, and ancestors).
                                ``(ii) An individual would be a dependent
                            of the taxpayer (as defined in section 152,
                            determined without regard to subsections (b)(1)
                            and (b)(2)) as a qualifying relative described
                            in section 152(d)(1) if--
                                        ``(I) in lieu of subparagraphs (B)
                                    and (C) thereof the following applied
                                    with respect to the individual:
                                                ``(aa) the taxpayer has
                                            provided over one-half of the
                                            individual's support for the
                                            calendar year in which such
                                            taxable year begins and each of
                                            the preceding 4 taxable years,
                                            and
                                                ``(bb) the individual's
                                            modified adjusted gross income
                                            for the calendar year in which
                                            such taxable year begins is
                                            less than the exemption amount
                                            (as defined in section 151(d)),
                                        ``(II) the individual is physically
                                    or mentally incapable of caring for
                                    himself or herself, and
                                        ``(III) the individual who has the
                                    same principal place of abode as the
                                    taxpayer for more than one-half of such
                                    taxable year.
                                ``(iii) The spouse of the taxpayer who is
                            physically or mentally incapable of caring for
                            himself or herself.
                ``(2) Modified adjusted gross income.--The term `modified
            adjusted gross income' means adjusted gross income determined
            without regard to section 86.
                ``(3) Employment-related expenses.--
                        ``(A) In general.--The term `employment-related
                    expenses' means amounts paid for the following
                    expenses, but only if such expenses are incurred to
                    enable the taxpayer to be gainfully employed for any
                    period for which there are one or more qualifying
                    individuals with respect to the taxpayer:
                                ``(i) expenses for household services, and
                                ``(ii) expenses for the care of a
                            qualifying individual, including expenses for
                            respite care and hospice care.
                        ``(B) Exception.--Employment-related expenses
                    described in subparagraph (A) which are incurred for
                    services outside the taxpayer's household shall be
                    taken into account only if incurred for the care of--
                                ``(i) a qualifying individual described in
                            paragraph (1)(A), or
                                ``(ii) a qualifying individual (not
                            described in paragraph (1)(A)) who regularly
                            spends at least 8 hours each day in the
                            taxpayer's household.
                        ``(C) Dependent care centers.--Employment-related
                    expenses described in subparagraph (A) which are
                    incurred for services provided outside the taxpayer's
                    household by a dependent care center (as defined in
                    subparagraph (D)) shall be taken into account only if--
                                ``(i) such center complies with all
                            applicable laws and regulations of a State or
                            unit of local government, and
                                ``(ii) the requirements of subparagraph (B)
                            are met.
                        ``(D) Dependent care center defined.--For purposes
                    of this paragraph, the term `dependent care center'
                    means any facility which--
                                ``(i) provides care for more than six
                            individuals (other than individuals who reside
                            at the facility), and
                                ``(ii) receives a fee, payment, or grant
                            for providing services for any of the
                            individuals (regardless of whether such
                            facility is operated for profit).
        ``(c) Dollar Limit on Amount Creditable.--The amount of the
    employment-related expenses incurred during any taxable year which may
    be taken into account under subsection (a) shall not exceed--
                ``(1) $3,000 if there is 1 qualifying individual with
            respect to the taxpayer for such taxable year, or
                ``(2) $6,000 if there are two or more qualifying
            individuals with respect to the taxpayer for such taxable year.
    The amount determined under paragraph (1) or (2) (whichever is
    applicable) shall be reduced by the aggregate amount excludable from
    gross income under section 129 for the taxable year.
        ``(d) Earned Income Limitation.--Except as otherwise provided in
    this subsection, the amount of the employment-related expenses incurred
    during any taxable year which may be taken into account under
    subsection (a) shall not exceed--
                ``(1) in the case of an individual who is not married at
            the close of such year, such individual's earned income for
            such year, or
                ``(2) in the case of an individual who is married at the
            close of such year, the lesser of such individual's earned
            income or the earned income of his spouse for such year.
        ``(e) Special Rules.--For purposes of this section--
                ``(1) Place of abode.--An individual shall not be treated
            as having the same principal place of abode of the taxpayer if
            at any time during the taxable year of the taxpayer the
            relationship between the individual and the taxpayer is in
            violation of local law.
                ``(2) Married couples must file joint return.--If the
            taxpayer is married at the close of the taxable year, the
            credit shall be allowed under subsection (a) only if the
            taxpayer and his spouse file a joint return for the taxable
            year.
                ``(3) Marital status.--An individual legally separated from
            his spouse under a decree of divorce or of separate maintenance
            shall not be considered as married.
                ``(4) Certain married individuals living apart.--If--
                        ``(A) an individual who is married and who files a
                    separate return--
                                ``(i) maintains as his home a household
                            which constitutes for more than one-half of the
                            taxable year the principal place of abode of a
                            qualifying individual, and
                                ``(ii) furnishes over half of the cost of
                            maintaining such household during the taxable
                            year, and
                        ``(B) during the last 6 months of such taxable year
                    such individual's spouse is not a member of such
                    household, such individual shall not be considered as
                    married.
                ``(5) Payments to related individuals.--No credit shall be
            allowed under subsection (a) for any amount paid by the
            taxpayer to an individual--
                        ``(A) with respect to whom, for the taxable year, a
                    deduction under section 151(c) (relating to deduction
                    for personal exemptions for dependents) is allowable
                    either to the taxpayer or his spouse, or
                        ``(B) who is a child of the taxpayer (within the
                    meaning of section 152(f)(1)) who has not attained the
                    age of 19 at the close of the taxable year.
            For purposes of this paragraph, the term `taxable year' means
            the taxable year of the taxpayer in which the service is
            performed.
                ``(6) Identifying information required with respect to
            service provider.--No credit shall be allowed under subsection
            (a) for any amount paid to any person unless--
                        ``(A) the name, address, and taxpayer
                    identification number of such person are included on
                    the return claiming the credit, or
                        ``(B) if such person is an organization described
                    in section 501(c)(3) and exempt from tax under section
                    501(a), the name and address of such person are
                    included on the return claiming the credit.
            In the case of a failure to provide the information required
            under the preceding sentence, the preceding sentence shall not
            apply if it is shown that the taxpayer exercised due diligence
            in attempting to provide the information so required.
                ``(7) Identifying information required with respect to
            qualifying individuals.--No credit shall be allowed under this
            section with respect to any qualifying individual unless the
            TIN of such individual is included on the return claiming the
            credit.
        ``(f) Regulations.--The Secretary shall prescribe such regulations
    as may be necessary to carry out the purposes of this section.''.
        (b) Clerical Amendment.--The table of sections for subpart A of
    part IV of subchapter A of chapter 1 of the Internal Revenue Code of
    1986 is amended by adding at the end the following new item:

    ``Sec. 25E. Expenses for household and elder care services necessary
                                for gainful employment.''.
        (c) Effective Date.--The amendments made by this section shall
    apply to taxable years beginning after the date of the enactment of
    this Act.

                      Subtitle J--Miscellaneous Provisions

    SEC. 5901. CLARIFICATION SUPPORTING PERMISSIBLE USE OF FUNDS FOR
                  STILLBIRTH PREVENTION ACTIVITIES.

        Section 501(a) of the Social Security Act (42 U.S.C. 701(a)) is
    amended--
                (1) in paragraph (1)(B), by inserting ``to reduce the
            incidence of stillbirth,'' after ``among children,''; and
                (2) in paragraph (2), by inserting after ``follow-up
            services'' the following: ``, and for evidence-based programs
            and activities and outcome research to reduce the incidence of
            stillbirth (including tracking and awareness of fetal
            movements, improvement of birth timing for pregnancies with
            risk factors, initiatives that encourage safe sleeping
            positions during pregnancy, screening and surveillance for
            fetal growth restriction, efforts to achieve smoking cessation
            during pregnancy, community-based programs that provide home
            visits or other types of support, and any other research or
            evidence-based programming to prevent stillbirths)''.

              TITLE VI--MENTAL HEALTH AND SUBSTANCE USE DISORDERS

    SEC. 6001. MENTAL HEALTH FINDINGS.

        Congress finds the following:
                (1) Despite the existence of effective treatments,
            inequities lie in the availability, accessibility, and quality
            of mental health services for racial and ethnic minorities and
            people with disabilities.
                (2) These inequities have powerful significance for
            minority groups and for society as a whole.
                (3) Racial and ethnic minorities bear a greater burden from
            unmet mental health needs and thus suffer a greater loss to
            their overall health and productivity.
                (4) Improving community conditions and one's home
            environment, paired with high-quality, accessible, and
            culturally and linguistically tailored mental health services,
            can reduce the likelihood, frequency, and intensity of
            challenges to one's mental health.
                (5) The presence of strong social connections and trust,
            opportunities to experience and share cultural identity, safe
            gathering places, and economic opportunity are community
            factors that benefit mental health.
                (6) The social, physical, economic, and other conditions,
            otherwise known as social determinants of health, in
            communities can have tremendous influence on daily stressors
            that shape mental health outcomes.
                (7) Significant barriers include the cost of and access to
            quality care, societal stigma, mental health workforce
            shortages, the fragmented organization of services and needed
            social supports, and the history of racism and discrimination
            in the mental health system.
                (8) People with severe and persistent mental illness who
            are racial or ethnic minorities often have co-occurring health
            and mental health conditions and experience direct inequities
            in access to necessary supports, resources, and services which,
            without proper accommodations and support, further stigmatize
            them and limit their participation in society.
                (9) African-American, Latinx, Asian American, Pacific
            Islander, Native, Middle Eastern and North African (MENA), and
            other people of color communities are more likely to experience
            systemic discrimination by health care and social service
            providers and may be reluctant to seek mental health care and
            other health interventions.
                (10) Mental health conditions and substance abuse disorders
            retain considerable stigma in many communities of color and
            seeking treatment is not always encouraged.
                (11) Addressing mental health stigma and increasing access
            to culturally and linguistically appropriate treatments and
            supports in communities will help to increase utilization of
            mental health services for people who have functional
            difficulties because of mental health challenges.
                (12) There is a link between a mental health diagnosis and
            the likelihood of an individual committing suicide.
                (13) A comprehensive public health approach to behavioral
            health is one that fosters and finances protective factors in
            racial and ethnic communities that support mental health.
                (14) Approaches to mental health and trauma must keep in
            mind the historical and present day and cultural trauma that
            impacts many communities of color, including trauma and loss
            caused by adverse weather events and structural violence.
                (15) Culturally and linguistically appropriate treatments
            and supports must keep approaches of individual communities to
            mental health in mind, including by considering--
                        (A) approaches to cultural healing practices; and
                        (B) the diverse mental health professionals needed
                    for such practices, such as peer support specialists.
                (16) Approaches to mental health and addressing trauma must
            keep in mind the concept of intersectionality of individuals;
            that individuals may experience many inequities that shape the
            way they process and experience everyday life.

    SEC. 6002. SENSE OF CONGRESS.

        It is the sense of the Congress that it is imperative that a
    comprehensive public health approach to addressing trauma and mental
    health care be focused on care delivery that is culturally and
    linguistically appropriate.

                 Subtitle A--Access to Care and Funding Streams

    SEC. 6011. COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES, MENTAL
                  HEALTH COUNSELOR SERVICES, SUBSTANCE ABUSE COUNSELOR
                  SERVICES, AND PEER SUPPORT SPECIALIST SERVICES UNDER PART
                  B OF THE MEDICARE PROGRAM.

        (a) Coverage of Services.--
                (1) In general.--Section 1861(s)(2) of the Social Security
            Act (42 U.S.C. 1395x(s)(2)), as amended by the previous
            provisions, is amended--
                        (A) in subparagraph (HH), by striking ``and'' at
                    the end;
                        (B) in subparagraph (II), by adding ``and'' after
                    the semicolon at the end; and
                        (C) by adding at the end the following new
                    subparagraph:
                ``(JJ) marriage and family therapist services (as defined
            in subsection (nnn)(1)), mental health counselor services (as
            defined in subsection (nnn)(3)), substance abuse counselor
            services (as defined in subsection (nnn)(5)), and peer support
            specialist services (as defined in subsection (nnn)(7));''.
                (2) Definitions.--Section 1861 of the Social Security Act
            (42 U.S.C. 1395x), as amended by the previous provisions, is
            amended by adding at the end the following new subsection:

         ``Marriage and Family Therapist Services; Marriage and Family
     Therapist; Mental Health Counselor Services; Mental Health Counselor;
      Substance Abuse Counselor Services; Substance Abuse Counselor; Peer
             Support Specialist Services; Peer Support Specialist.

        ``(nnn)(1) The term `marriage and family therapist services' means
    services performed by a marriage and family therapist (as defined in
    paragraph (2)) for the diagnosis and treatment of mental illnesses,
    which the marriage and family therapist is legally authorized to
    perform under State law (or the State regulatory mechanism provided by
    State law) of the State in which such services are performed, as would
    otherwise be covered if furnished by a physician or as an incident to a
    physician's professional service, but only if no facility or other
    provider charges or is paid any amounts with respect to the furnishing
    of such services.
        ``(2) The term `marriage and family therapist' means an individual
    who--
                ``(A) possesses a master's or doctoral degree that
            qualifies for licensure or certification as a marriage and
            family therapist pursuant to State law, including but not
            limited to, clinical social workers and occupational
            therapists;
                ``(B) after obtaining such degree has performed at least 2
            years of clinical supervised experience in marriage and family
            therapy; and
                ``(C) in the case of an individual performing services in a
            State that provides for licensure or certification of marriage
            and family therapists, is licensed or certified as a marriage
            and family therapist in such State.
        ``(3) The term `mental health counselor services' means services
    performed by a mental health counselor (as defined in paragraph (4))
    for the diagnosis and treatment of mental health conditions and
    disabilities that the mental health counselor is legally authorized to
    perform under State law (or the State regulatory mechanism provided by
    the State law) of the State in which such services are performed, as
    would otherwise be covered if furnished by a physician or as incident
    to a physician's professional service, but only if no facility or other
    provider charges or is paid any amounts with respect to the furnishing
    of such services.
        ``(4) The term `mental health counselor' means an individual who--
                ``(A) possesses a master's or doctor's degree in mental
            health counseling or a related field, including clinical social
            workers and occupational therapists;
                ``(B) after obtaining such a degree has performed at least
            2 years of supervised mental health counselor practice; and
                ``(C) in the case of an individual performing services in a
            State that provides for licensure or certification of mental
            health counselors or professional counselors, is licensed or
            certified as a mental health counselor or professional
            counselor in such State.
        ``(5) The term `substance abuse counselor services' means services
    performed by a substance abuse counselor (as defined in paragraph (6))
    for the diagnosis and treatment of substance abuse and addiction that
    the substance abuse counselor is legally authorized to perform under
    State law (or the State regulatory mechanism provided by the State law)
    of the State in which such services are performed, as would otherwise
    be covered if furnished by a physician or as incident to a physician's
    professional service, but only if no facility or other provider charges
    or is paid any amounts with respect to the furnishing of such services.
        ``(6) The term `substance abuse counselor' means an individual
    who--
                ``(A) has performed at least 2 years of supervised
            substance abuse counselor practice;
                ``(B) in the case of an individual performing services in a
            State that provides for licensure or certification of substance
            abuse counselors or professional counselors, is licensed or
            certified as a substance abuse counselor or professional
            counselor in such State; or
                ``(C) is a drug and alcohol counselor as defined in section
            40.281 of title 49, Code of Federal Regulations.
        ``(7) The term `peer support specialist services' means services
    performed by a peer support specialist (as defined in paragraph (8))
    for the well-being of individuals needing mental health support that
    the peer support specialist is legally authorized to perform under
    State law (or the State regulatory mechanism provided by the State law)
    of the State in which such services are performed, as would otherwise
    be covered if furnished by a physician or as incident to a physician's
    professional service, but only if no facility or other provider charges
    or is paid any amounts with respect to the furnishing of such services.
        ``(8) The term `peer support specialist' means an individual who--
                ``(A) is an individual living in recovery with mental
            illness, addiction, or systems involvement;
                ``(B) has skills learned in formal training;
                ``(C) uses assets-based framing in speaking about mental
            health, recovery, and well-being; and
                ``(D) delivers services in behavioral health settings to
            promote mind-body recovery and resiliency.''.
                (3) Provision for payment under part b.--Section
            1832(a)(2)(B) of the Social Security Act (42 U.S.C.
            1395k(a)(2)(B)) is amended--
                        (A) by striking ``and'' at the end of clause (iv);
                    and
                        (B) by adding at the end the following new clause:
                                ``(v) marriage and family therapist
                            services, mental health counselor services,
                            substance abuse counselor services, and peer
                            support specialist services; and''.
                (4) Amount of payment.--Section 1833(a)(1) of the Social
            Security Act (42 U.S.C. 1395l(a)(1)), as amended by section
            431(c)(3), is amended--
                        (A) by striking ``and'' before ``(DD)''; and
                        (B) by inserting before the semicolon at the end
                    the following: ``, and (EE) with respect to marriage
                    and family therapist services, mental health counselor
                    services, substance abuse counselor services, and peer
                    support specialist services under section
                    1861(s)(2)(JJ), the amounts paid shall be 80 percent of
                    the lesser of the actual charge for the services or 75
                    percent of the amount determined for payment of a
                    psychologist under subparagraph (L)''.
                (5) Exclusion of marriage and family therapist services,
            mental health counselor services, and peer support specialist
            services from skilled nursing facility prospective payment
            system.--Section 1888(e)(2)(A)(ii) of the Social Security Act
            (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting
            ``marriage and family therapist services (as defined in section
            1861(nnn)(1)), mental health counselor services (as defined in
            section 1861(nnn)(3)), and peer support specialist services (as
            defined in section 1861(nnn)(7))'' after ``qualified
            psychologist services,''.
                (6) Inclusion of marriage and family therapists, mental
            health counselors, and substance abuse counselors as
            practitioners for assignment of claims.--Section 1842(b)(18)(C)
            of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)) is
            amended by adding at the end the following new clauses:
                ``(vii) A marriage and family therapist (as defined in
            section 1861(nnn)(2)).
                ``(viii) A mental health counselor (as defined in section
            1861(nnn)(4)).
                ``(ix) A substance abuse counselor (as defined in section
            1861(nnn)(6)).
                ``(x) A peer support specialist (as defined in section
            1861(nnn)(8)).''.
        (b) Coverage of Certain Mental Health Services Provided in Certain
    Settings.--
                (1) Rural health clinics and federally qualified health
            centers.--Section 1861(aa)(1)(B) of the Social Security Act (42
            U.S.C. 1395x(aa)(1)(B)) is amended by striking ``or by a
            clinical social worker (as defined in subsection (hh)(1)),''
            and inserting ``, by a clinical social worker (as defined in
            subsection (hh)(1)), by a marriage and family therapist (as
            defined in subsection (nnn)(2)), or by a mental health
            counselor (as defined in subsection (nnn)(4)), or by a
            substance abuse counselor (as defined in section 1861
            (nnn)(6)), or by a peer support specialist (as defined in
            section 1861(nnn)(8)).''.
                (2) Hospice programs.--Section 1861(dd)(2)(B)(i)(III) of
            the Social Security Act (42 U.S.C. 1395x(dd)(2)(B)(i)(III)) is
            amended by inserting ``or one marriage and family therapist (as
            defined in subsection (nnn)(2))'' after ``social worker''.
        (c) Authorization of Marriage and Family Therapists To Develop
    Discharge Plans for Posthospital Services.--Section 1861(ee)(2)(G) of
    the Social Security Act (42 U.S.C. 1395x(ee)(2)(G)) is amended by
    inserting ``marriage and family therapist (as defined in subsection
    (nnn)(2)),'' after ``social worker,''.
        (d) Effective Date.--The amendments made by this section shall
    apply with respect to services furnished on or after January 1, 2023.

    SEC. 6012. REAUTHORIZATION OF MINORITY FELLOWSHIP PROGRAM.

        Section 597(c) of the Public Health Service Act (42 U.S.C.
    297ll(c)) is amended by striking ``$12,669,000 for each of fiscal years
    2018 through 2022'' and inserting ``$25,000,000 for each of fiscal
    years 2023 through 2027''.

    SEC. 6013. ADDITIONAL FUNDS FOR NATIONAL INSTITUTES OF HEALTH.

        (a) In General.--In addition to amounts otherwise authorized to be
    appropriated to the National Institutes of Health, there is authorized
    to be appropriated to such Institutes $100,000,000 for each of fiscal
    years 2023 through 2027 to build relations with communities and conduct
    or support clinical research, including clinical research on racial or
    ethnic disparities in physical and mental health.
        (b) Definition.--In this section, the term ``clinical research''
    has the meaning given to such term in section 409 of the Public Health
    Service Act (42 U.S.C. 284d).

    SEC. 6014. ADDITIONAL FUNDS FOR NATIONAL INSTITUTE ON MINORITY HEALTH
                  AND HEALTH DISPARITIES.

        In addition to amounts otherwise authorized to be appropriated to
    the National Institute on Minority Health and Health Disparities, there
    is authorized to be appropriated to such Institute $650,000,000 for
    each of fiscal years 2023 through 2027.

    SEC. 6015. GRANTS FOR INCREASING RACIAL AND ETHNIC MINORITY ACCESS TO
                  HIGH-QUALITY TRAUMA SUPPORT SERVICES AND MENTAL HEALTH
                  CARE.

        (a) In General.--The Secretary of Health and Human Services (in
    this section referred to as the ``Secretary''), acting through the
    Assistant Secretary for Mental Health and Substance Use, shall award
    grants to eligible entities to establish or expand programs for the
    purpose of increasing racial and ethnic minority access to high-quality
    trauma support services and mental health care.
        (b) Eligible Entities.--To seek a grant under this section, an
    entity shall be a community-based program or organization that--
                (1) provides culturally and linguistically appropriate
            programs and resources that are aligned with evidence-based
            practices for trauma-informed care; and
                (2) has demonstrated expertise in serving communities of
            color or can partner with a program that has such demonstrated
            expertise.
        (c) Use of Funds.--As a condition on receipt of a grant under this
    section, a grantee shall agree to use the grant to increase racial and
    ethnic minority access to high-quality trauma support services and
    mental health care, such as by--
                (1) establishing and maintaining community-based programs
            providing evidence-based services in trauma-informed care and
            culturally specific services and other resources;
                (2) developing innovative, culturally specific strategies
            and projects to enhance access to trauma-informed care and
            resources for racial and ethnic minorities who face obstacles
            to using more traditional services and resources (such as
            obstacles in geographic access to providers, insurance
            coverage, and access to audio and video technologies);
                (3) working with State and local governments and social
            service agencies to develop and enhance effective strategies to
            provide culturally specific services to racial and ethnic
            minorities;
                (4) increasing communities' capacity to provide culturally
            specific resources and support for communities of color;
                (5) working in cooperation with the community to develop
            education and prevention strategies highlighting culturally
            specific issues and resources regarding racial and ethnic
            minorities;
                (6) providing culturally specific programs for racial and
            ethnic minorities exposed to law enforcement violence; and
                (7) examining the dynamics of culture and its impact on
            victimization and healing.
        (d) Priority.--In awarding grants under this section, the Secretary
    shall give priority to eligible entities proposing to serve communities
    that have faced high rates of community trauma, including from exposure
    to law enforcement violence, intergenerational poverty, civil unrest,
    discrimination, or oppression.
        (e) Grant Period.--The period of a grant under this section shall
    be 4 years.
        (f) Evaluation.--Not later than 6 months after the end of the
    period of all grants under this section, the Secretary shall--
                (1) conduct an evaluation of the programs funded by a grant
            under this section;
                (2) include in such evaluation an assessment of the
            outcomes of each such program; and
                (3) submit a report on the results of such evaluation to
            the Congress.
        (g) Authorization of Appropriations.--To carry out this section,
    there is authorized to be appropriated $20,000,000 for each of fiscal
    years 2023 through 2027.

    SEC. 6016. GRANTS FOR UNARMED 9-1-1 RESPONSE PROGRAMS.

        Part D of title V of the Public Health Service Act, as amended by
    sections 6022, 6023, and 6052, is further amended adding at the end the
    following new section:

    ``SEC. 556. GRANTS FOR UNARMED 9-1-1 RESPONSE PROGRAMS.

        ``(a) In General.--The Secretary, acting through the Assistant
    Secretary for Mental Health and Substance Use, may award grants to
    States, territories, political subdivisions of States and territories,
    Tribal governments, and consortia of Tribal governments to establish an
    unarmed 9-1-1 response program under which nonviolent 9-1-1 calls are
    referred to unarmed professional service providers for response,
    instead of to a law enforcement agency.
        ``(b) Program Requirements.--An unarmed 9-1-1 response program
    funded under this section shall--
                ``(1) dispatch unarmed professional service providers in
            groups of two or more in a timely manner;
                ``(2) be capable of providing screening, assessment, de-
            escalation, trauma-informed culturally and linguistically
            appropriate services, referrals to treatment providers, and
            transportation to immediately necessary treatment;
                ``(3) when necessary, coordinate with health or social
            services;
                ``(4) not be subject to oversight of State or local law
            enforcement agencies; and
                ``(5) clearly outline the scope of calls that must or may
            be referred to the unarmed 9-1-1 response program.
        ``(c) Uses of Funds.--A grant under this section may be used for--
                ``(1) hiring unarmed professional service providers and 9-
            1-1 dispatchers;
                ``(2) training unarmed professional service providers to
            respond to 9-1-1 calls by identifying, understanding, and
            responding to signs of mental illnesses, developmental or
            intellectual disabilities, and substance use disorders,
            including by means of--
                        ``(A) de-escalation;
                        ``(B) crisis intervention; and
                        ``(C) connecting individuals to local social
                    service providers, health care providers, community-
                    based organizations, and the full range of other
                    available providers and resources, with a focus on
                    culturally and linguistically appropriate service
                    providers;
                ``(3) updating 9-1-1 response systems to enable triage
            between nonviolent 9-1-1 calls and those that require a
            response from law enforcement;
                ``(4) training 9-1-1 dispatchers on call diversion;
                ``(5) building the capacity--
                        ``(A) to coordinate with local social service
                    providers, health care providers, suicide hotline
                    operators, and community-based organizations; and
                        ``(B) to provide multilingual and culturally and
                    linguistically appropriate services; and
                ``(6) collecting data for reports to the Secretary.
        ``(d) Application.--An applicant seeking a grant under this section
    shall submit to the Secretary an application at such time, in such
    manner, and containing such information as the Secretary may reasonably
    require, including the applicant's plan to train 9-1-1 dispatchers to
    determine when a call should be diverted to the unarmed 9-1-1 response
    program.
        ``(e) Reports to Secretary.--A recipient of a grant under this
    section shall submit to the Secretary, on a biannual basis, a report on
    the following:
                ``(1) The number of calls placed to 9-1-1 that were
            diverted to the grantee's unarmed 9-1-1 response program.
                ``(2) Demographic information on the individuals served by
            the grantee's unarmed 9-1-1 response program, disaggregated by
            race, ethnicity, age, sex, sexual orientation, gender identity,
            and location.
                ``(3) The effects of the grantee's unarmed 9-1-1 response
            program on emergency room visits, hospitalizations, use of
            ambulances, and involvement of law enforcement in mental health
            or substance use disorder crises.
                ``(4) An assessment of the types of events and crises to
            which the grantee's unarmed 9-1-1 response program responded
            and the services provided, including--
                        ``(A) the number of individuals to whom services
                    were provided who were involuntarily committed for
                    treatment;
                        ``(B) the number of individuals successfully
                    transferred to an alternative destination;
                        ``(C) the time between notification by a 9-1-1
                    dispatcher and arrival at the scene by a provider; and
                        ``(D) the time spent by providers at scene.
                ``(5) A cost analysis of the grantee's unarmed 9-1-1
            response program.
                ``(6) An assessment of data sharing limitations or problems
            associated with adherence to--
                        ``(A) Federal regulations (concerning the privacy
                    of individually identifiable health information)
                    promulgated under section 264(c) of the Health
                    Insurance Portability and Accountability Act of 1996;
                    and
                        ``(B) part II of title 42, Code of Federal
                    Regulations.
        ``(f) Reports to Congress.--The Secretary shall submit to the
    Congress, on a biannual basis, a report on the program under this
    section, including a summary of the reports submitted by grantees
    pursuant to subsection (e).
        ``(g) Grant Amount.--The Secretary may make grants to applicants
    that do not meet all of the criteria under subsection (b)(1), but
    applicants that do not meet all such criteria may not receive the full
    grant amount.
        ``(h) Definitions.--In this section:
                ``(1) The term `alternative destination'--
                        ``(A) means any service- or care-providing site
                    other than a hospital emergency department or jail; and
                        ``(B) includes a clinic, primary care office,
                    crisis center, and community care center.
                ``(2) The term `nonviolent 9-1-1 call' means a 9-1-1 call
            that--
                        ``(A) relates to mental health, homelessness,
                    addiction problems, social services, truancy,
                    intellectual and developmental disabilities, or public
                    intoxication; and
                        ``(B) does not involve obvious violent behavior.
                ``(3) The term `unarmed professional service provider'
            means a professional (which may include a nurse, social worker,
            emergency medical technician, counselor, community health
            worker, trauma-informed personnel, social service provider, or
            peer support specialist) who--
                        ``(A) is trained to deal with mental health or
                    substance abuse crises or intellectual and
                    developmental disabilities; and
                        ``(B) does not carry a firearm.''.

                       Subtitle B--Interprofessional Care

    SEC. 6021. HEALTH PROFESSIONS COMPETENCIES TO ADDRESS RACIAL AND ETHNIC
                  MENTAL HEALTH INEQUITIES.

        (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 culturally and linguistically appropriate
            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 inequities 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 inequities among
            racial and ethnic minority groups.
                (2) Planning of workshops in collaboration with community-
            based organizations and communities of color in national fora
            to directly facilitate public input, including input from
            communities of color with lived experience, into the
            educational needs associated with mental health inequities
            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 and
            leadership from communities of color with lived experience of
            the impacts of mental health inequities.
        (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, substance
            use counseling, 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)), as amended by title I of this Act.
        (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 2023 through 2027.

    SEC. 6022. INTERPROFESSIONAL HEALTH CARE TEAMS FOR BEHAVIORAL HEALTH
                  CARE.

        Part D of title V of the Public Health Service Act (42 U.S.C. 290dd
    et seq.) is amended by adding at the end the following:

    ``SEC. 553. INTERPROFESSIONAL HEALTH CARE TEAMS FOR PROVISION OF
                  BEHAVIORAL HEALTH CARE IN PRIMARY CARE SETTINGS.

        ``(a) Grants.--The Secretary, acting through the Assistant
    Secretary for Mental Health and Substance Use, shall award grants to
    eligible entities for the purpose of establishing interprofessional
    health care teams that provide behavioral health care.
        ``(b) Eligible Entities.--To be eligible to receive a grant under
    this section, an entity shall be a Federally qualified health center
    (as defined in section 1861(aa) of the Social Security Act), rural
    health clinic, women's health clinic, or behavioral health program
    (including any such program operated by a community-based organization)
    serving a high proportion of individuals from racial and ethnic
    minority groups (as defined in section 1707(g)).
        ``(c) Loan Forgiveness.--To encourage qualified and diverse allied
    health professionals to enter the mental health field, an eligible
    entity receiving a grant under this section shall agree to use not less
    than $10,000 of the grant funds on a loan forgiveness program for
    practitioners who commit to working in the mental health field for a
    period of 2 years.
        ``(d) Scientifically and Culturally Based.--Integrated health care
    funded through this section shall be scientifically and culturally
    based, taking into consideration the results of the most recent peer-
    reviewed research available, including information on language
    accessibility, cultural humility, diversity of practitioners, and
    consideration of social determinants of health.
        ``(e) Authorization of Appropriations.--To carry out this section,
    there is authorized to be appropriated $20,000,000 for each of fiscal
    years 2023 through 2027.''.

    SEC. 6023. INTEGRATED HEALTH CARE DEMONSTRATION PROGRAM.

        Part D of title V of the Public Health Service Act (42 U.S.C. 290dd
    et seq.), as amended by sections 6022 and 6052, is further amended by
    adding at the end the following:

    ``SEC. 555. INTERPROFESSIONAL HEALTH CARE TEAMS FOR PROVISION OF
                  BEHAVIORAL HEALTH CARE IN PRIMARY CARE SETTINGS.

        ``(a) Grants.--The Secretary shall award grants to eligible
    entities for the purpose of establishing interprofessional health care
    teams that provide behavioral health care.
        ``(b) Eligible Entities.--To be eligible to receive a grant under
    this section, an entity shall be a Federally qualified health center
    (as defined in section 1861(aa) of the Social Security Act), rural
    health clinic, or behavioral health program, serving a high proportion
    of individuals from racial and ethnic minority groups (as defined in
    section 1707(g)).
        ``(c) Scientifically Based.--Integrated health care funded through
    this section shall be scientifically based, taking into consideration
    the results of the most recent peer-reviewed research available.
        ``(d) Authorization of Appropriations.--To carry out this section,
    there is authorized to be appropriated $20,000,000 for each of the
    first 5 fiscal years following the date of enactment of the Pursuing
    Equity in Mental Health Act.''.

                       Subtitle C--Workforce Development

    SEC. 6031. BUILDING AN EFFECTIVE WORKFORCE IN MENTAL HEALTH.

        (a) In General.--The Secretary of Health and Human Services, in
    coordination with the Assistant Secretary for Mental Health and
    Substance Use, the Administrator of the Health Resources and Services
    Administration, the Secretary of Labor, and advocacy and behavioral and
    mental health organizations serving vulnerable populations, including
    youth and young adults, people with low incomes, and people of color,
    shall--
                (1) develop, strengthen, and implement strategies to
            bolster career pathways for diverse mental health
            professionals;
                (2) identify the breadth of settings where mental health
            care and behavioral health care can take place; and
                (3) identify current mental health professional workforce
            shortages, inclusive of shortages of diverse mental health
            professionals.
        (b) Contents.--Strategies under subsection (a) shall include--
                (1) the variety of settings where mental health
            professionals are needed, including community-based
            organizations, women's centers, shelters, organizations focused
            on youth development, workforce agencies, job placement and
            development centers, emergency rooms, the special supplemental
            nutrition program for women, infants, and children under
            section 17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786),
            food banks, legal aid, and benefit issuers as defined in
            section 3 of the Food and Nutrition Act of 2008 (7 U.S.C.
            2012);
                (2) defining career pathways in mental and behavioral
            health, to help diverse communities understand the variety of
            careers in mental and behavioral health that are available;
                (3) building career pathways in mental and behavioral
            health as part of the curriculum at the postsecondary education
            level;
                (4) providing accessible training and certification
            pathways for diverse lay health workers such as community
            health workers and other peer support specialists to ensure
            that careers pay a living wage;
                (5) creating incentives for students in the fields of
            occupational therapy, social work, psychology, medicine, and
            nursing to learn more about mental health, and to include a
            mental health rotation, with a particular focus in racially and
            ethnically diverse communities, as a part of the health
            professional curricula;
                (6) including training and education for teachers about the
            basics of section 504 of the Rehabilitation Act of 1973 (29
            U.S.C. 794) and individualized education programs (as defined
            in section 614(d) of the Individuals with Disabilities
            Education Act (20 U.S.C. 1414(d)));
                (7) researching, developing, and implementing programs for
            mental and behavioral health professionals to prevent burnout;
            and
                (8) finding better and increased avenues to ensure equity
            by providing better loan forgiveness programs, including a
            focus area within the National Health Service Corps focused on
            community trauma.
        (c) Use of Funds.--Programs and activities funded under this
    section shall be consistent with section (a)(1) and must include the
    following:
                (1) Subgrants to entities serving youth and young adults
            which demonstrate a need for an increased mental health
            workforce, using strategies mentioned in subsection (a)(1).
                (2) Funding towards the Health Resources and Services
            Administration's Behavioral Health Workforce Education and
            Training Program.
                (3) Funding towards the development and implementation of a
            National Health Service Corps program focused on community
            trauma.
        (d) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section, $50,000,000 for each of fiscal
    years 2023 through 2033.

    SEC. 6032. PILOT PROGRAM TO INCREASE LANGUAGE ACCESS AT FEDERALLY
                  QUALIFIED HEALTH CENTERS.

        (a) Loan Repayments to Qualified Health Care Professionals.--
                (1) In general.--For the purpose of increasing language
            access to mental health services, the Secretary shall carry out
            a demonstration project under which--
                        (A) the Secretary matches qualified mental health
                    professionals with Federally qualified health centers;
                        (B) the qualified mental health professionals each
                    agree to a period of obligated service at a Federally
                    qualified health center with which they are so matched;
                    and
                        (C) the Secretary agrees to make loan repayments
                    under section 338B of the Public Health Service Act (42
                    U.S.C. 254l-1) on behalf of such qualified mental
                    health professionals.
                (2) Preference.--In matching qualified mental health
            professionals with Federally qualified health centers under
            paragraph (1), the Secretary shall give preference to placement
            at Federally qualified health centers at which at least 20
            percent of the patients are best served in a language other
            than English, as indicated by data in the Uniform Data System
            (or any successor database).
                (3) Enhanced compensation.--For each year of obligated
            service that a qualified mental health professional contracts
            to serve under paragraph (1) at a Federally qualified health
            center at which at least 20 percent of the patients are best
            served in a language other than English, as indicated by data
            in the Uniform Data System (or any successor database), the
            Secretary may pay the higher of--
                        (A) $10,000 above the maximum amount otherwise
                    applicable under section 338B(g)(2)(A) of the Public
                    Health Service Act (42 U.S.C. 254l-1(g)(2)(A)); or
                        (B) if the qualified health professional is fluent
                    in a language other than English that is needed by such
                    Federally qualified health center, $15,000 above such
                    maximum amount.
                (4) Achieving fluency.--A qualified mental health
            professional eligible to receive the enhanced pay amount
            specified in paragraph (3)(A) at the beginning of the
            professional's period of obligated service may transition to
            being eligible to receive the enhanced higher pay amount
            specified in paragraph (3)(B) if the professional is determined
            by the Federally qualified health center at which the
            professional serves to have achieved fluency in a language
            other than English needed by that health center.
        (b) Grants to Health Centers.--
                (1) In general.--The Secretary shall carry out a
            demonstration program consisting of awarding grants under
            section 330 of the Public Health Service Act (42 U.S.C. 254b)
            to Federally qualified health centers to recruit, hire, employ,
            and supervise qualified mental health professionals who are
            fluent in a language other than English to provide mental
            health services in such other language.
                (2) Preference.--In selecting grant recipients under
            paragraph (1), the Secretary shall give preference to Federally
            qualified health centers at which at least 20 percent of the
            patients are best served in a language other than English, as
            indicated by data in the Uniform Data System (or any successor
            database).
                (3) Marketing.--A Federally qualified health center
            receiving a grant under this subsection shall use a portion of
            the grant funds to disseminate information about, and otherwise
            market, the mental health services supported through the grant.
        (c) Reports.--
                (1) Initial report.--Not later than 6 months after awarding
            loan repayment agreements under subsection (a) and grants under
            subsection (b), the Secretary shall submit to the Committees on
            Appropriations of the House of Representatives and the Senate,
            and to other appropriate congressional committees, a report on
            the implementation of the programs under this section. Such
            report shall include--
                        (A) the languages spoken by the qualified mental
                    health professionals receiving loan repayments pursuant
                    to subsection (a) or recruited pursuant to a grant
                    under subsection (b);
                        (B) the Federally qualified health centers at which
                    such professionals were placed;
                        (C) how many Federally qualified health centers
                    received funding through the grant program under
                    subsection (b);
                        (D) an analysis, conducted in consultation with the
                    Federally qualified health centers receiving grants
                    under section (b), of the effectiveness of such grants
                    at increasing language access to mental health
                    services; and
                        (E) best practices, developed in consultation with
                    Federally qualified health centers receiving grants
                    under section (b), for the recruitment and retention of
                    mental health professionals at Federally qualified
                    health centers.
                (2) Final report.--Not later than the end of fiscal year
            2027, the Secretary shall submit to the Committees on
            Appropriations of the House of Representatives and the Senate,
            and to other appropriate congressional committees, a final
            report on the implementation of the programs under this
            section, including the information, analysis, and best
            practices listed in subparagraphs (A) through (E) of paragraph
            (1).
        (d) Definitions.--In this section:
                (1) The term ``Federally qualified health center'' has the
            meaning given the term in section 1861(aa) of the Social
            Security Act (42 U.S.C. 1395x(aa)).
                (2) The term ``qualified mental health professional''
            means--
                        (A) physicians, allopathic physicians, osteopathic
                    physicians, nurse practitioners, and physician
                    assistants with a specialty in mental health and
                    psychiatry;
                        (B) health service psychologists;
                        (C) licensed clinical social workers;
                        (D) psychiatric nurse specialists;
                        (E) marriage and family therapists;
                        (F) licensed professional counselors;
                        (G) substance use disorder counselors;
                        (H) occupational therapists; and
                        (I) other individuals who--
                                (i) have not yet been licensed or certified
                            to serve as a professional listed in any of
                            subparagraphs (A) through (H); and
                                (ii) will serve at the Federally qualified
                            health center under the supervision of a
                            licensed individual or certified professional
                            so listed.
                (3) The term ``Secretary'' means the Secretary of Health
            and Human Services.
        (e) Authorization of Appropriations.--
                (1) In general.--To carry out this section, there is
            authorized to be appropriated $75,000,000 for each of fiscal
            years 2023 through 2027.
                (2) Supplement, not supplant.--Amounts made available to
            carry out this section shall be in addition to amounts
            otherwise available to provide mental health services at
            Federally qualified health centers pursuant to sections 338B
            and 330 of the Public Health Service Act (42 U.S.C. 254l-1,
            254b).

    SEC. 6033. HEALTH PROFESSIONS COMPETENCIES TO ADDRESS RACIAL AND ETHNIC
                  MINORITY MENTAL HEALTH DISPARITIES.

        (a) In General.--The Secretary of Health and Human Services may
    award grants to qualified national organizations for the purposes of--
                (1) developing, and disseminating to health professional
            educational programs, best practices or core competencies
            addressing mental health disparities among racial and ethnic
            minority groups for use in the training of students in the
            professions of social work, psychology, psychiatry, marriage
            and family therapy, mental health counseling, and substance
            abuse counseling; and
                (2) certifying community health workers and peer wellness
            specialists with respect to such best practices and core
            competencies and integrating and expanding the use of such
            workers and specialists into health care to address mental
            health disparities among racial and ethnic minority groups.
        (b) Best Practices; 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 best
    practices 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
            best practices and core competencies relating to mental health
            disparities among racial and ethnic minority groups.
                (2) Planning of workshops at the national level to allow
            for public input into the educational needs associated with
            mental health disparities among racial and ethnic minority
            groups.
                (3) Dissemination and promotion of the use of best
            practices or core competencies for culturally and
            linguistically appropriate mental health services in
            undergraduate and graduate health professions training programs
            nationwide.
                (4) Establishing external stakeholder advisory boards to
            provide meaningful input into policy and program development
            and best practices to reduce mental health disparities among
            racial and ethnic minority groups.
        (c) Definitions.--In this section:
                (1) Qualified national organization.--The term ``qualified
            national organization'' means a national organization that
            focuses on the education of students in one or more of the
            professions of social work, psychology, psychiatry, marriage
            and family therapy, mental health counseling, and substance
            misuse counseling.
                (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)).

                      Subtitle D--Children's Mental Health

    SEC. 6041. PEDIATRIC BEHAVIORAL HEALTH CARE.

        Subpart V of part D of title III of the Public Health Service Act
    (42 U.S.C. 256 et seq.) is amended by adding at the end the following:

    ``SEC. 340A-1. GRANTS TO SUPPORT PEDIATRIC BEHAVIORAL HEALTH CARE
                  INTEGRATION AND COORDINATION.

        ``(a) In General.--The Secretary, acting through the Administrator
    of the Health Resources and Services Administration, shall award grants
    to eligible entities for the purpose of supporting pediatric behavioral
    health care integration and coordination within communities to meet
    local community needs.
        ``(b) Eligible Entities.--Entities eligible for grants under
    subsection (a) include--
                ``(1) pediatricians;
                ``(2) children's hospitals;
                ``(3) pediatric behavioral health providers with the
            capacity to organize and implement activities working with
            community organizations and providers; and
                ``(4) other entities as determined appropriate by the
            Secretary.
        ``(c) Prioritization.--In awarding grants under subsection (a), the
    Secretary shall prioritize applicants that demonstrate the highest
    needs at the local level along the care continuum for strengthening
    children's behavioral health crisis care and access.
        ``(d) Use of Funds.--Activities that may be funded through a grant
    under subsection (a) include--
                ``(1) the recruitment and retention of community health
            workers or navigators to coordinate family access to pediatric
            mental, emotional, and behavioral health services;
                ``(2) training the pediatric mental, emotional, and
            behavioral health care workforce, relevant stakeholders, and
            community members;
                ``(3) expanding evidence-based, integrated models of care
            for pediatric mental, emotional, and behavioral health
            services;
                ``(4) pediatric practice integration for the provision of
            pediatric mental, emotional, and behavioral health services;
                ``(5) addressing surge capacity for pediatric mental,
            emotional, and behavioral health needs;
                ``(6) providing pediatric mental, emotional, and behavioral
            health services to children as delivered by behavioral,
            emotional, and mental health professionals utilizing telehealth
            services;
                ``(7) establishing or maintaining initiatives to decompress
            emergency departments, including partial hospitalization, step
            down residency programs, and intensive outpatient programs;
                ``(8) supporting, enhancing, or expanding pediatric mental,
            emotional, and behavioral health preventive and crisis
            intervention services;
                ``(9) establishing or maintaining pediatric mental,
            emotional, and behavioral health urgent care;
                ``(10) establishing or maintaining community-based
            initiatives, such as school-based partnerships; and
                ``(11) addressing other access and coordination gaps to
            mental, emotional, and behavioral health services in the
            community for children.
        ``(e) Funding.--To carry out this section, there is hereby
    appropriated, out of amounts in the Treasury not otherwise obligated,
    $500,000,000 for each of fiscal years 2023 through 2027.

    ``SEC. 340A-2. PEDIATRIC BEHAVIORAL HEALTH WORKFORCE TRAINING PROGRAM.

        ``(a) In General.--The Secretary, acting through the Administrator
    of the Health Resources and Services Administration, shall award grants
    to eligible entities for the purpose of supporting evidence-based
    pediatric behavioral health workforce training.
        ``(b) Eligible Entities.--Entities eligible for grants under
    subsection (a) include--
                ``(1) children's hospitals; and
                ``(2) other pediatric health care providers as determined
            appropriate by the Secretary.
        ``(c) Use of Funds.--The training that may be supported through a
    grant under subsection (a) includes expanded training in pediatric
    behavioral health for physicians and nonphysician practitioners,
    including the following practitioner types:
                ``(1) Child and adolescent psychiatrists.
                ``(2) Psychiatric nurses.
                ``(3) Psychologists.
                ``(4) Advanced practice nurses.
                ``(5) Family therapists.
                ``(6) Social workers.
                ``(7) Mental health counselors.
                ``(8) Other practitioner types as determined appropriate by
            the Secretary.
        ``(d) Funding.--To carry out this section, there is hereby
    appropriated, out of amounts in the Treasury not otherwise obligated,
    $100,000,000 for each of fiscal years 2023 through 2027.''.

    SEC. 6042. MENTAL HEALTH IN SCHOOLS.

        (a) Purpose.-- It is the purpose of this section to--
                (1) revise, increase funding for, and expand the scope of
            the Project AWARE State Educational Agency Grant Program
            carried out by the Secretary of Health and Human Services, in
            order to provide access to more comprehensive school-based
            mental health services and supports;
                (2) provide for comprehensive staff development for school
            and community service personnel working in the school;
                (3) provide for comprehensive training to improve health
            and academic outcomes for children with, or who have a high
            likelihood of developing, mental health conditions, for parents
            or guardians, siblings, and other family members of such
            children, and for concerned members of the community;
                (4) provide for comprehensive, universal, evidence-based
            screening to identify children and adolescents with potential
            mental health conditions or unmet emotional health needs;
                (5) recognize best practices for the delivery of mental
            health care in school-based settings, including school-based
            health centers;
                (6) provide for comprehensive training for parents or
            guardians, siblings, other family members, and concerned
            members of the community on behalf of children and adolescents
            experiencing mental health trauma, disorders, cooccurring
            conditions, or disabilities; and
                (7) establish formal working relationships among health,
            human service, and educational entities that support the mental
            and emotional health of children and adolescents in the school
            setting or that have a child or youth focus.
        (b) Technical Amendments.--The second part G (relating to services
    provided through religious organizations) of title V of the Public
    Health Service Act (42 U.S.C. 290kk et seq.) is amended--
                (1) by redesignating such part as part J; and
                (2) by redesignating sections 581 through 584 as sections
            596 through 596C, respectively.
        (c) School-Based Mental Health and Children and Violence.--Section
    581 of the Public Health Service Act (42 U.S.C. 290hh) (relating to
    children and violence) is amended to read as follows:

    ``SEC. 581. SCHOOL-BASED MENTAL HEALTH; CHILDREN AND ADOLESCENTS.

        ``(a) In General.--The Secretary, in consultation with the
    Secretary of Education, shall, through grants, contracts, or
    cooperative agreements awarded to eligible entities described in
    subsection (b), provide comprehensive school-based mental health
    services and supports to assist children in local communities and
    schools (including schools funded by the Bureau of Indian Education)
    dealing with traumatic experiences, grief, bereavement, risk of
    suicide, and the risk of experiencing community or interpersonal
    violence, such as abuse or neglect. All services and supports provided
    under such a grant, contract, or cooperative agreement shall be--
                ``(1) developmentally, linguistically, and culturally
            appropriate;
                ``(2) trauma-informed; and
                ``(3) incorporate positive behavioral interventions and
            supports.
        ``(b) Activities.--Grants, contracts, or cooperative agreements
    awarded under subsection (a), shall, as appropriate, be used for--
                ``(1) implementation of school and community-based mental
            health programs that--
                        ``(A) build awareness of individual trauma and the
                    intergenerational continuum of impacts of trauma on
                    populations;
                        ``(B) train appropriate staff to identify, and
                    screen for, signs of trauma exposure, mental health and
                    cooccurring conditions, or risk of suicide; and
                        ``(C) incorporate positive behavioral
                    interventions, family engagement, student treatment,
                    and multigenerational supports to foster the health and
                    development of children, prevent mental health
                    disorders, and ameliorate the impact of trauma;
                ``(2) technical assistance to local communities with
            respect to the development of programs described in paragraph
            (1);
                ``(3) facilitating diverse community partnerships among
            families, students, education agencies, mental health and
            substance use disorder service systems, family-based mental
            health service systems, child welfare agencies, health care
            providers (including primary care physicians, mental health
            professionals, and other professionals who specialize in
            children's mental health such as child and adolescent
            psychiatrists), institutions of higher education, faith-based
            programs, trauma networks, and other community-based systems to
            address child and adolescent trauma, as well as unmet mental
            health needs; and
                ``(4) establishing and promoting best practices that are
            either evidence-based or culturally based for children and
            adolescents to share their experiences of individual and
            community trauma, including their exposure to community and
            domestic violence, with trusted adults.
        ``(c) Requirements.--
                ``(1) In general.--To be eligible for a grant, contract, or
            cooperative agreement under subsection (a), an entity shall be
            a partnership that includes--
                        ``(A) a State educational agency, as defined in
                    section 8101 of the Elementary and Secondary Education
                    Act of 1965, in coordination with one or more local
                    educational agencies, as defined in section 8101 of the
                    Elementary and Secondary Education Act of 1965, or a
                    consortium of any entities described in subparagraph
                    (B), (C), (D), or (E) of section 8101(30) of such Act;
                    and
                        ``(B) at least 1 community-based mental health
                    provider, including a public or private mental health
                    entity, health care entity, family-based mental health
                    entity, trauma network, or other community-based
                    entity, as determined by the Secretary (and which may
                    include additional entities such as a human services
                    agency, child welfare agency, an institution of higher
                    education, or another entity, as determined by the
                    Secretary).
                ``(2) Compliance with hipaa.--Any patient records developed
            by covered entities through activities under the grant shall
            meet the regulations promulgated under section 264(c) of the
            Health Insurance Portability and Accountability Act of 1996.
                ``(3) Compliance with ferpa.--Section 444 of the General
            Education Provisions Act (commonly known as the `Family
            Educational Rights and Privacy Act of 1974') shall apply to any
            entity that is a member of the partnership in the same manner
            that such section applies to an educational agency or
            institution (as that term is defined in such section).
        ``(d) Geographical Distribution.--The Secretary shall ensure that
    grants, contracts, or cooperative agreements under subsection (a) will
    be distributed equitably among the regions of the country and among
    urban and rural areas.
        ``(e) Duration of Awards.--With respect to a grant, contract, or
    cooperative agreement under subsection (a), the period during which
    payments under such an award will be made to the recipient shall be 5
    years, with options for renewal.
        ``(f) Evaluation and Measures of Outcomes.--
                ``(1) Development of process.--The Assistant Secretary
            shall develop a fiscally appropriate process for evaluating
            activities carried out under this section. Such process shall
            include--
                        ``(A) the development of guidelines for the
                    submission of program data by grant, contract, or
                    cooperative agreement recipients;
                        ``(B) the development of measures of outcomes (in
                    accordance with paragraph (2)) to be applied by such
                    recipients in evaluating programs carried out under
                    this section; and
                        ``(C) the submission of annual reports by such
                    recipients concerning the effectiveness of programs
                    carried out under this section.
                ``(2) Measures of outcomes.--The Assistant Secretary shall
            develop measures of outcomes to be applied by recipients of
            assistance under this section to evaluate the effectiveness of
            programs carried out under this section, including outcomes
            related to the student, family, and local educational systems
            supported by this Act.
                ``(3) Submission of annual data.--An eligible entity
            described in subsection (c) that receives a grant, contract, or
            cooperative agreement under this section shall annually submit
            to the Assistant Secretary a report that includes data to
            evaluate the success of the program carried out by the entity
            based on whether such program is achieving the purposes of the
            program. Such reports shall utilize the measures of outcomes
            under paragraph (2) in a reasonable manner to demonstrate the
            progress of the program in achieving such purposes.
                ``(4) Evaluation by assistant secretary.--Based on the data
            submitted under paragraph (3), the Assistant Secretary shall
            annually submit to Congress a report concerning the results and
            effectiveness of the programs carried out with assistance
            received under this section.
                ``(5) Limitation.--An eligible entity shall use not more
            than 20 percent of amounts received under a grant under this
            section to carry out evaluation activities under this
            subsection.
        ``(g) Information and Education.--The Secretary shall disseminate
    best practices based on findings made pursuant to this section.
        ``(h) Amount of Grants and Authorization of Appropriations.--
                ``(1) Amount of grants.--A grant under this section shall
            be in an amount that is not more than $2,000,000 for each of
            the first 5 fiscal years following the date of enactment of
            this section. The Secretary shall determine the amount of each
            such grant based on the population of children up to age 21 of
            the area to be served under the grant.
                ``(2) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this section, $130,000,000 for
            each of fiscal years 2023 through 2026.''.
        (d) Conforming Amendment.--Part G of title V of the Public Health
    Service Act (42 U.S.C. 290hh et seq.), as amended by this section, is
    further amended, in the part heading by striking ``projects for
    children and violence'' and inserting the following: ``school-based
    mental health''.
        (e) School-Based Mental Health Services.--
                (1) In general.--The Secretary of Education shall award
            grants to State educational agencies to support services
            provided by school-based mental health services providers at
            schools receiving funds under part A of title I of the
            Elementary and Secondary Education Act of 1965 (20 U.S.C. 6311
            et seq.).
                (2) Use of funds.--Grants under this subsection shall be
            used to help meet the recommended ratios of--
                        (A) 250 students per school counselor;
                        (B) 500 students per school psychologist; and
                        (C) 250 students per school social worker.
                (3) Condition.--The Secretary shall ensure that funds made
            available under this subsection are used to provide services
            that are developmentally, linguistically, and culturally
            appropriate, trauma-informed, and incorporate positive
            behavioral interventions and supports.
                (4) Definitions.--For purposes of this subsection:
                        (A) The term ``school-based mental health service
                    provider'' has the meaning given such term in section
                    4102 of the Elementary and Secondary Education Act of
                    1965 (20 U.S.C. 7112).
                        (B) The term ``State educational agency'' has the
                    meaning given such term in section 8101 of the
                    Elementary and Secondary Education Act of 1965 (20
                    U.S.C. 7801).

    SEC. 6043. ADDITIONAL SUPPORT FOR YOUTH AND YOUNG ADULT MENTAL HEALTH
                  SERVICE PROVISION.

        Section 1903 of the Social Security Act (42 U.S.C. 1396b) is
    amended by adding at the end the following new subsection:
        ``(cc) Youth and Young Adult Intervention Services.--
                ``(1) In general.--Notwithstanding section 1902(a)(1)
            (relating to Statewideness), section 1902(a)(10)(B) (relating
            to comparability), section 1902(a)(23)(A) (relating to freedom
            of choice of providers), or section 1902(a)(27) (relating to
            provider agreements), a State may, during the 5-year period
            beginning on the first day of the fiscal year quarter that
            begins on or after January 1, 2024, provide medical assistance
            for qualifying youth and young adult mental health and
            substance use intervention services (as defined in paragraph
            (2)(C)) under a State plan amendment or waiver approved under
            section 1115 or 1915(c).
                ``(2) Definitions.--For the purposes of this subsection:
                        ``(A) Priority service.--The term `priority
                    service' means any of the following if voluntarily
                    received and provided in a manner that maintains the
                    privacy and confidentiality of patient information
                    consistent with Federal and State requirements:
                                ``(i) Community based mobile crisis
                            intervention services, as defined in section
                            1947.
                                ``(ii) Telehealth.
                                ``(iii) Youth peer support.
                                ``(iv) Screening for adverse childhood
                            experiences.
                                ``(v) Trauma responsive care.
                                ``(vi) Other priority services for youth,
                            as defined by the Secretary.
                        ``(B) Qualified mental health providers.--The term
                    `qualified mental health providers' means a behavioral
                    health care professional who is capable of conducting
                    an assessment of the individual, in accordance with the
                    professional's permitted scope of practice under State
                    law, and other professionals or paraprofessionals with
                    appropriate expertise in youth and young adult
                    behavioral health or mental health, including social
                    workers, peer support specialists, recovery coaches,
                    community health workers, mental health clinicians, and
                    others, as designated by the State and approved by the
                    Secretary.
                        ``(C) Qualifying youth and young adult mental
                    health and substance use intervention services
                    defined.--The term `qualifying youth and young adult
                    mental health and substance use intervention services'
                    means, with respect to a State, items and services for
                    which medical assistance is available under the State
                    plan under this title or a waiver of such plan, that
                    are--
                                ``(i) furnished to an individual 16 to 25
                            years of age who is--
                                        ``(I) experiencing a mental health
                                    or substance use disorder crisis;
                                        ``(II) subject to the juvenile or
                                    adult justice system as defined in
                                    section 3102 of title 29, United States
                                    Code;
                                        ``(III)(aa) experiencing
                                    homelessness (as defined in section
                                    41403(6) of the Violence Against Women
                                    Act of 1994 (42 U.S.C. 14043e-2(6)));
                                        ``(bb) a homeless child or youth
                                    (as defined in section 725(2) of the
                                    McKinney-Vento Homeless Assistance Act
                                    (42 U.S.C. 11434a(2)));
                                        ``(cc) a runaway, in foster care,
                                    or has aged out of the foster care
                                    system;
                                        ``(dd) a child eligible for
                                    assistance under section 477 of the
                                    Social Security Act (42 U.S.C. 677); or
                                        ``(ee) in an out-of-home placement;
                                        ``(IV) pregnant or parenting as
                                    defined in section 3102 of title 29,
                                    United States Code;
                                        ``(V) a youth who is an individual
                                    with a disability as defined in section
                                    3102 of title 29, United States Code;
                                        ``(VI) a low income youth requiring
                                    additional assistance to enter or
                                    complete an educational program or to
                                    secure or hold employment as defined in
                                    section 3102 of title 29, United States
                                    Code; or
                                        ``(VII) living in a community that
                                    has faced acute or long-term exposure
                                    to substantial discrimination,
                                    historical oppression,
                                    intergenerational poverty, civil
                                    unrest, or a high rate of violence or
                                    drug overdose deaths;
                                ``(ii) furnished by qualified mental health
                            providers; and
                                ``(iii) a priority service.
                        ``(D) Telehealth.--The term `telehealth' means use
                    of electronic information and telecommunications
                    technologies, including voice only audio, text, remote
                    patient monitoring, and mHealth via applications, to
                    support clinical mental health care, patient and
                    professional health-related education, public health,
                    and health administration.
                ``(3) Payments.--Notwithstanding section 1905(b), beginning
            January 1, 2024, during each of the first 20 fiscal quarters
            that a State meets the requirements described in paragraph (4),
            the Federal medical assistance percentage applicable to amounts
            expended by the State for medical assistance for qualifying
            youth and young adult mental health and substance use
            intervention services furnished during such quarter shall be
            equal to 100 percent.
                ``(4) Requirements.--The requirements described in this
            paragraph are the following:
                        ``(A) The State demonstrates, to the satisfaction
                    of the Secretary--
                                ``(i) that it will be able to support the
                            provision of qualifying youth and young adult
                            mental health and substance use intervention
                            services that meet the conditions specified in
                            paragraphs (1) and (2)); and
                                ``(ii) how it will support coordination
                            between qualified mental health providers and
                            substance use teams and community partners,
                            including health care providers, to enable the
                            provision of services, needed referrals, and
                            other activities identified by the Secretary.
                        ``(B) The State provides assurances satisfactory to
                    the Secretary that--
                                ``(i) any additional Federal funds received
                            by the State for qualifying youth and young
                            adult mental health and substance use
                            intervention services provided under this
                            subsection that are attributable to the
                            increased Federal medical assistance percentage
                            under paragraph (3)(A) will be used to
                            supplement, and not supplant, the level of
                            State funds expended for such services for
                            fiscal year 2024;
                                ``(ii) if the State made qualifying youth
                            and young adult mental health and substance use
                            intervention services available in a region of
                            the State in fiscal year 2023 the State will
                            continue to make such services available in
                            such region under this subsection at the same
                            level that the State made such services
                            available in such fiscal year; and
                                ``(iii) the State will conduct the
                            evaluation and assessment, and submit the
                            report required under paragraph (5).
                ``(5) State evaluation and report.--
                        ``(A) State evaluation.--Not later than 4 fiscal
                    quarters after a State begins providing qualifying
                    youth and young adult mental health and substance use
                    intervention services in accordance with this
                    subsection, the State shall enter into a contract with
                    an independent entity or organization to conduct an
                    evaluation for the purposes of--
                                ``(i) determining the effect of the
                            provision of such services on--
                                        ``(I) emergency room visits;
                                        ``(II) use of ambulatory services;
                                        ``(III) hospitalizations;
                                        ``(IV) the involvement of law
                                    enforcement in mental health or
                                    substance use disorder crisis events;
                                    and
                                        ``(V) the diversion of individuals
                                    from jails or similar settings; and
                                ``(ii) assessing--
                                        ``(I) the types of services
                                    provided to individuals;
                                        ``(II) the types of events
                                    responded to;
                                        ``(III) cost savings or cost-
                                    effectiveness attributable to such
                                    services;
                                        ``(IV) the experiences of
                                    individuals who receive qualifying
                                    youth and young adult mental health and
                                    substance use intervention services;
                                        ``(V) the successful connection of
                                    individuals with follow-up services;
                                    and
                                        ``(VI) other relevant outcomes
                                    identified by the Secretary.
                        ``(B) Comparison to historical measures.--The
                    contract described in subparagraph (A) shall specify
                    that the evaluation is based on a comparison of the
                    historical measures of State performance with respect
                    to the outcomes specified under such subparagraph to
                    the State's performance with respect to such outcomes
                    during the period beginning with the first quarter in
                    which the State begins providing qualifying youth and
                    young adult mental health and substance use
                    intervention services in accordance with this
                    subsection.
                        ``(C) Report.--Not later than 2 years after a State
                    begins to provide qualifying youth and young adult
                    mental health and substance use intervention services
                    in accordance with this subsection, the State shall
                    submit a report to the Secretary on the following:
                                ``(i) The results of the evaluation carried
                            out under subparagraph (A).
                                ``(ii) The number of individuals who
                            received qualifying youth and young adult
                            mental health and substance use intervention
                            services.
                                ``(iii) Demographic information regarding
                            such individuals when available, including the
                            race and ethnicity, age, sex, sexual
                            orientation, gender identity, and geographic
                            location of such individuals.
                                ``(iv) The processes and models developed
                            by the State to provide qualifying youth and
                            young adult mental health and substance use
                            intervention services under such the State plan
                            or waiver, including the processes developed to
                            provide referrals for, or coordination with,
                            follow-up care and services.
                                ``(v) Lessons learned regarding the
                            provision of such services.
                        ``(D) Public availability.--The State shall make
                    the report required under subparagraph (C) publicly
                    available, including on the website of the appropriate
                    State agency, upon submission of such report to the
                    Secretary.
                ``(6) Best practices report.--
                        ``(A) In general.--Not later than 3 years after the
                    first State begins to provide qualifying youth and
                    young adult mental health and substance use
                    intervention services in accordance with this
                    subsection, the Secretary shall submit a report to
                    Congress that--
                                ``(i) identifies the States that elected to
                            provide services in accordance with this
                            subsection;
                                ``(ii) summarizes the information reported
                            by such States under paragraph (5)(C); and
                                ``(iii) identifies best practices for the
                            effective delivery of youth and young adult
                            mental health and substance use intervention
                            services.
                        ``(B) Public availability.--The report required
                    under subparagraph (A) shall be made publicly
                    available, including on the website of the Department
                    of Health and Human Services, upon submission to
                    Congress.
                ``(7) Nondiscrimination.--
                        ``(A) Federally funded activities.--(i) For the
                    purpose of applying the prohibitions against
                    discrimination on the basis of age under the Age
                    Discrimination Act of 1975 (42 U.S.C. 6101 et seq.), on
                    the basis of handicap under section 504 of the
                    Rehabilitation Act of 1973 (29 U.S.C. 794), on the
                    basis of sex under title IX of the Education Amendments
                    of 1972 (20 U.S.C. 1681 et seq.), or on the basis of
                    race, color, or national origin under title VI of the
                    Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.),
                    programs and activities funded in whole or in part with
                    funds made available under this subchapter are
                    considered to be programs and activities receiving
                    Federal financial assistance.
                        ``(ii) No person shall on the ground of sex or
                    religion be excluded from participation in, be denied
                    the benefits of, or be subjected to discrimination
                    under, any program or activity funded in whole or in
                    part with funds made available under this title.
                        ``(B) Compliance.--Whenever the Secretary finds
                    that a State, or an entity that has received a payment
                    from an allotment to a State under section 702(c) of
                    this title, has failed to comply with a provision of
                    law referred to in subsection (a)(1), with subsection
                    (a)(2), or with an applicable regulation (including one
                    prescribed to carry out subsection (a)(2)), he shall
                    notify the chief executive officer of the State and
                    shall request him to secure compliance. If within a
                    reasonable period of time, not to exceed 60 days, the
                    chief executive officer fails or refuses to secure
                    compliance, the Secretary may--
                                ``(i) refer the matter to the Attorney
                            General with a recommendation that an
                            appropriate civil action be instituted;
                                ``(ii) exercise the powers and functions
                            provided by title VI of the Civil Rights Act of
                            1964 (42 U.S.C. 2000d et seq.), the Age
                            Discrimination Act of 1975 (42 U.S.C. 6101 et
                            seq.), or section 504 of the Rehabilitation Act
                            of 1973 (29 U.S.C. 794), as may be applicable;
                            or
                                ``(iii) take such other action as may be
                            provided by law.
                        ``(C) Authority of attorney general; civil
                    actions.--When a matter is referred to the Attorney
                    General pursuant to subsection (b)(1), or whenever he
                    has reason to believe that the entity is engaged in a
                    pattern or practice in violation of a provision of law
                    referred to in subsection (a)(1) or in violation of
                    subsection (a)(2), the Attorney General may bring a
                    civil action in any appropriate district court of the
                    United States for such relief as may be appropriate,
                    including injunctive relief.''.

    SEC. 6044. EARLY INTERVENTION AND PREVENTION PROGRAMS FOR TRANSITION-
                  AGE YOUTH.

        (a) In General.--Section 1912(b)(1) of the Public Health Service
    Act (42 U.S.C. 300x-1(b)(1)) is amended--
                (1) by redesignating subparagraph (E) as (F); and
                (2) by inserting after subparagraph (D) the following:
                        ``(E) Early intervention and prevention programs
                    for transition-age youth.--The plan shall describe the
                    State's plans to carry out demonstration grants or
                    contracts for early intervention and prevention
                    programs for transition-age youth of 16 to 25 years of
                    age who meet one or more of the criteria specified in
                    section 129(1)(B) of the Workforce Innovation and
                    Opportunity Act to be considered out-of-school
                    youth.''.
        (b) Set-Aside.--Section 1920 of the Public Health Service Act (42
    U.S.C. 300x-9) is amended by adding at the end the following:
        ``(d) Early Intervention and Prevention Programs for Transition-Age
    Youth.--
                ``(1) In general.--Except as provided in paragraph (2), a
            State shall expend at least 15 percent of the amount of the
            allotment of the State pursuant to a funding agreement under
            section 1911 for each fiscal year to support programs described
            in section 1912(b)(1)(E).
                ``(2) State flexibility.--In lieu of expending 15 percent
            of the amount the allotment for a fiscal year as required by
            paragraph (1), a State may elect to expend not less than 30
            percent of such amount to support such programs by the end of
            two consecutive fiscal years.''.

    SEC. 6045. STRATEGIES TO INCREASE ACCESS TO TELEHEALTH UNDER MEDICAID
                  AND CHILDREN'S HEALTH INSURANCE PROGRAM.

        (a) Guidance.--Not later than 1 year after the date of the
    enactment of this Act, the Secretary of Health and Human Services shall
    issue and disseminate guidance to States to clarify strategies to
    overcome existing barriers and increase access to telehealth under the
    Medicaid program under title XIX of the Social Security Act (42 U.S.C.
    1396 et seq.) and the Children's Health Insurance Program under title
    XXI of such Act (42 U.S.C. 1397aa et seq.). Such guidance shall include
    technical assistance and best practices regarding--
                (1) telehealth delivery of covered services;
                (2) recommended voluntary billing codes, modifiers, and
            place-of-service designations for telehealth and other virtual
            health care services;
                (3) the simplification or alignment (including through
            reciprocity) of provider licensing, credentialing, and
            enrollment protocols with respect to telehealth across States,
            State Medicaid plans under such title XIX, and Medicaid managed
            care organizations, including during national public health
            emergencies;
                (4) existing strategies States can use to integrate
            telehealth and other virtual health care services into value-
            based health care models; and
                (5) examples of States that have used waivers under the
            Medicaid program to test expanded access to telehealth,
            including during the emergency period described in section
            1135(g)(1)(B) of the Social Security Act (42 U.S.C. 1320b-
            5(g)(1)(B)).
        (b) Studies.--
                (1) Telehealth impact on health care access.--Not later
            than 1 year after the date of the enactment of this Act, the
            Medicaid and CHIP Payment and Access Commission shall conduct a
            study, with respect to a minimum of 10 States across geographic
            regions of the United States, and submit to Congress a report,
            on the impact of telehealth on health care access, utilization,
            cost, and outcomes, broken down by race, ethnicity, sex, age,
            disability status, and zip code. Such report shall--
                        (A) evaluate cost, access, utilization, outcomes,
                    and patient experience data from across the health care
                    field, including States, Medicaid managed care
                    organizations, provider organizations, and other
                    organizations that provide or pay for telehealth under
                    the Medicaid program and Children's Health Insurance
                    Program;
                        (B) identify barriers and potential solutions to
                    provider entry and participation in telehealth that
                    States are experiencing, as well as barriers to
                    providing telehealth across State lines, including
                    during times of public health crisis or public health
                    emergency;
                        (C) determine the frequency at which out-of-State
                    telehealth is provided to patients enrolled in the
                    Medicaid program and the potential impact on access to
                    telehealth if State Medicaid policies were more
                    aligned; and
                        (D) identify and evaluate opportunities for more
                    alignment among such policies to promote access to
                    telehealth across all States, State Medicaid plans
                    under title XIX of the Social Security Act (42 U.S.C.
                    1396 et seq.), State child health plans under title XXI
                    of such Act (42 U.S.C. 1397aa et seq.), and Medicaid
                    managed care organizations, including the potential for
                    regional compacts or reciprocity agreements.
                (2) Federal agency telehealth collaboration.--Not later
            than 1 year after the date of the enactment of this Act, the
            Comptroller General of the United States shall conduct a study
            and submit to Congress a report evaluating collaboration
            between Federal agencies with respect to telehealth services
            furnished under the Medicaid or CHIP program to individuals
            under the age of 18, including such services furnished to such
            individuals in early care and education settings. Such report
            shall include recommendations on--
                        (A) opportunities for Federal agencies to improve
                    collaboration with respect to such telehealth services;
                    and
                        (B) opportunities for collaboration between Federal
                    agencies to expand telehealth access to such
                    individuals enrolled under the Medicaid or CHIP
                    program, including in early care and education
                    settings.

    SEC. 6046. YOUTH AND YOUNG ADULT MENTAL HEALTH PROMOTION, PREVENTION,
                  INTERVENTION, AND TREATMENT.

        Title III of the Public Health Service Act is amended by inserting
    after section 399Z-2 (42 U.S.C. 280h-5) the following:

    ``SEC. 399Z-3. YOUTH AND YOUNG ADULT MENTAL HEALTH PROMOTION,
                  PREVENTION, INTERVENTION, AND TREATMENT.

        ``(a) Grants.--The Secretary shall--
                ``(1) award grants to eligible entities to develop,
            maintain, or enhance youth and young adult mental health
            promotion, prevention, intervention, and treatment programs,
            including--
                        ``(A) programs for youth and young adults who may
                    be likely to develop, are showing early signs of, or
                    have been diagnosed with a mental health condition,
                    including a serious emotional disturbance; and
                        ``(B) infrastructure and organization change at a
                    State, tribal, or territorial level to improve cross-
                    system collaboration, service capacity and expertise
                    related to youth and young adults; and
                ``(2) ensure that programs funded through grants under this
            section use community-driven, evidence-informed, or evidence-
            based models, practices, and methods that are, as appropriate,
            culturally and linguistically appropriate, and can be
            replicated in other appropriate settings.
        ``(b) Eligible Transition Age Youth and Entities.--In this section:
                ``(1) Eligible entity.--The term `eligible entity' means--
                        ``(A) a local educational agency;
                        ``(B) a State educational agency;
                        ``(C) an institution of higher education (or
                    consortia of such institutions), which may include a
                    recovery program at an institution of higher education;
                        ``(D) a local board, or a one-stop operator as
                    defined in section 3 of the Workforce Innovation and
                    Opportunity Act;
                        ``(E) a nonprofit organization with appropriate
                    expertise in providing services or programs for
                    children, adolescents, or young adults, excluding a
                    school;
                        ``(F) a State, political subdivision of a State,
                    Indian tribe, or tribal organization; or
                        ``(G) a high school or dormitory serving high
                    school students that receives funding from the Bureau
                    of Indian Education.
                ``(2) Eligible transition age youth.--The term `eligible
            transition age youth' means a youth or young adult from age 16
            to not more than 25 years of age who is--
                        ``(A) an out-of-school youth as defined in section
                    129(a)(1)(B) of the Workforce Innovation and
                    Opportunity Act;
                        ``(B) a homeless individual (as defined in section
                    41403(6) of the Violence Against Women Act of 1994), a
                    homeless child or youth (as defined in section 725(2)
                    of the McKinney-Vento Homeless Assistance Act) a
                    runaway, in foster care or has aged out of the foster
                    care system, a child eligible for assistance under
                    section 477 of the Social Security Act, or in an out-
                    of-home placement;
                        ``(C) an individual who is pregnant or parenting,
                    as referred to in section 129(a)(1)(B) of the Workforce
                    Innovation and Opportunity Act;
                        ``(D) a youth who is an individual with a
                    disability, as referred to in section 129(a)(1)(B) of
                    the Workforce Innovation and Opportunity Act;
                        ``(E) a low-income individual who requires
                    additional assistance to enter or complete an
                    educational program or to secure or hold employment, as
                    referred to in section 129(a)(1)(B) of the Workforce
                    Innovation and Opportunity Act; or
                        ``(F) living in a community that has faced acute or
                    long-term exposure to substantial discrimination,
                    historical oppression, intergenerational poverty, civil
                    unrest, a high rate of violence, or drug overdose
                    deaths.
        ``(c) Application.--An eligible entity seeking a grant under
    subsection (a) shall submit to the Secretary an application at such
    time, in such manner, and containing such information as the Secretary
    may require.
        ``(d) Use of Funds for Mental Health Promotion, Prevention,
    Intervention and Treatment Programs.--An eligible entity may use
    amounts awarded under a grant under subsection (a)(1) to carry out the
    following:
                ``(1) Creation, implementation, and expansion of services
            and supports that are culturally and linguistically appropriate
            and youth-guided, involve and include family and community
            members (including business leaders and faith-based
            organizations), and provide for continuity of care between
            child- and adult-serving systems to ensure seamless transition.
                ``(2) Infrastructure and organization change at a State,
            Tribal, or territorial level to improve cross-system
            collaboration, service capacity, and expertise related to youth
            and young adults with, or at-risk of, mental health conditions
            and substance use disorders as they transition into adult roles
            and responsibilities.
                ``(3) Public awareness and cross-system provider training
            for individuals employed at institutions of higher education
            and community colleges, behavioral health providers,
            individuals working in the criminal justice system, primary
            care providers, vocational service providers, and child welfare
            workers.
        ``(e) Matching Funds.--The Secretary may not award a grant under
    this section to an eligible entity unless the eligible entity agrees,
    with respect to the costs to be incurred by the eligible entity in
    carrying out the activities described in subsection (d), to make
    available non-Federal contributions (in cash or in kind) toward such
    costs in an amount that is not less than 10 percent of the total amount
    of Federal funds provided in the grant.
        ``(f) Authorization of Appropriations.--To carry out this section,
    there are authorized to be appropriated $25,000,000 for each of fiscal
    years 2024 through 2033.''.

    SEC. 6047. STUDY ON THE EFFECTS OF SMARTPHONE AND SOCIAL MEDIA USE ON
                  ADOLESCENTS.

        (a) In General.--Not later than 1 year after the date of enactment
    of this Act, the Secretary of Health and Human Services shall conduct
    or support research on--
                (1) smartphone and social media use by adolescents; and
                (2) the effects of such use on--
                        (A) emotional, behavioral, and physical health and
                    development; and
                        (B) disparities in minority and underserved
                    populations.
        (b) Report.--Not later than 5 years after the date of the enactment
    of this Act, the Secretary shall submit to the Congress, and make
    publicly available, a report on the findings of research described in
    this section.

                        Subtitle E--Community-Based Care

    SEC. 6051. MENTAL HEALTH AT THE BORDER.

        (a) Short Title.--This section may be cited as the ``Immigrants'
    Mental Health Act of 2022''.
        (b) Training for Certain CBP Personnel in Mental Health Issues.--
                (1) Training to identify risk factors and warning signs in
            immigrants and refugees.--
                        (A) In general.--The Commissioner of U.S. Customs
                    and Border Protection, in consultation with the
                    Assistant Secretary for Mental Health and Substance
                    Use, the Administrator of the Health Resources and
                    Services Administration, and nongovernmental experts in
                    the delivery of health care in humanitarian crises and
                    in the delivery of health care to children, shall
                    develop and implement a training curriculum for U.S.
                    Customs and Border Protection agents and officers
                    assigned to U.S. Customs and Border Protection
                    facilities to enable such agents and officers to
                    identify the risk factors and warning signs in
                    immigrants and refugees of mental health issues
                    relating to trauma.
                        (B) Requirements.--The training curriculum
                    described in subparagraph (A) shall--
                                (i) apply to all U.S. Customs and Border
                            Protection agents and officers working at U.S.
                            Customs and Border Protection facilities;
                                (ii) provide for crisis intervention using
                            a trauma-informed approach; and
                                (iii) provide for mental health screenings
                            for immigrants and refugees arriving at the
                            border in their preferred language or with
                            appropriate language assistance.
                (2) Training to address mental health and wellness of cbp
            agents and officers.--
                        (A) In general.--The Commissioner of U.S. Customs
                    and Border Protection, in consultation with the
                    Assistant Secretary for Mental Health and Substance
                    Use, the Administrator of the Health Resources and
                    Services Administration, and nongovernmental experts in
                    the delivery of mental health care, shall develop and
                    implement a training curriculum for U.S. Customs and
                    Border Protection agents and officers assigned to U.S.
                    Customs and Border Protection facilities to address the
                    mental health and wellness of individuals working at
                    such facilities.
                        (B) Requirement.--The training curriculum described
                    in subparagraph (A) shall be designed to help U.S.
                    Customs and Border Protection agents and officers
                    working at U.S. Customs and Border Protection
                    facilities to--
                                (i) better manage their own stress and the
                            stress of their coworkers; and
                                (ii) be more aware of the psychological
                            pressures experienced during their jobs.
                (3) Annual review of training.--Beginning with respect to
            fiscal year 2023, the Assistant Secretary for Mental Health and
            Substance Use shall--
                        (A) conduct an annual review of the training
                    implemented pursuant to paragraphs (1) and (2); and
                        (B) submit the results of each such review,
                    including any recommendations for improvement of such
                    training, to--
                                (i) the Commissioner of U.S. Customs and
                            Border Protection; and
                                (ii) the Committees on Appropriations,
                            Energy and Commerce, Homeland Security, and the
                            Judiciary of the House of Representatives and
                            the Committees on Appropriations, Health,
                            Education, Labor, and Pensions, and Homeland
                            Security and Governmental Affairs of the
                            Senate.
                (4) Authorization of appropriations.--To carry out this
            subsection, there is authorized to be appropriated--
                        (A) for fiscal year 2023, $50,000 to develop the
                    training under paragraphs (1) and (2); and
                        (B) for each of fiscal years 2024 through 2028--
                                (i) $20,000 to implement such training
                            pursuant to paragraphs (1) and (2); and
                                (ii) such sums as may be necessary to
                            review and make recommendations for such
                            training pursuant to paragraph (3).
        (c) Staffing Border Facilities and Detention Centers.--
                (1) In general.--To adequately evaluate the mental health
            needs of immigrants, refugees, border patrol agents, and staff,
            the Commissioner of U.S. Customs and Border Protection shall
            assign at least one qualified mental or behavioral health
            expert to each U.S. Customs and Border Protection facility.
                (2) Qualifications.--To be qualified for purposes of
            paragraph (1), a mental or behavioral health expert shall be--
                        (A) bilingual;
                        (B) well-versed in culturally and linguistically
                    appropriate and trauma-informed interventions; and
                        (C) have particular expertise in child or
                    adolescent mental health or family mental health.
                (3) Authorization of appropriations.--To carry out this
            subsection, there is authorized to be appropriated $3,000,000
            for each of fiscal years 2023 through 2027.
        (d) No Sharing of Department of Health and Human Services Mental
    Health Information for Asylum Determinations, Immigration Hearings, or
    Deportation Proceedings.--The officers, employees, and agents of the
    Department of Health and Human Services, including the Office of
    Refugee Resettlement, may not share with the Department of Homeland
    Security, and the officers, employees, and agents of the Department of
    Homeland Security may not request or receive from the Department of
    Health and Human Services, for the purposes of an asylum determination,
    immigration hearing, or deportation proceeding, any information or
    record that--
                (1) concerns the mental health of an alien; and
                (2) was obtained or produced by a mental or behavioral
            health professional while the alien was in a shelter or
            otherwise in the custody of the Federal Government.
        (e) Definitions.--In this section:
                (1) The term ``forward operating base'' means a permanent
            facility established by U.S. Customs and Border Protection in
            forward or remote locations, and designated as such by U.S.
            Customs and Border Protection.
                (2) The term ``U.S. Customs and Border Protection
            facility'' means any of the following facilities that typically
            detain migrants on behalf of U.S. Customs and Border
            Protection:
                        (A) U.S. Border Patrol stations.
                        (B) Ports of entry.
                        (C) Checkpoints.
                        (D) Forward operating bases.
                        (E) Secondary inspection areas.
                        (F) Short-term custody facilities.

    SEC. 6052. ASIAN AMERICAN, AFRICAN AMERICAN, NATIVE HAWAIIAN, PACIFIC
                  ISLANDER, INDIGENOUS, MIDDLE EASTERN AND NORTH AFRICAN,
                  AND HISPANIC AND LATINO BEHAVIORAL AND MENTAL HEALTH
                  OUTREACH AND EDUCATION STRATEGY.

        Part D of title V of the Public Health Service Act (42 U.S.C. 290dd
    et seq.), as amended by section 6022, is further amended by adding at
    the end the following new section:

    ``SEC. 554. BEHAVIORAL AND MENTAL HEALTH OUTREACH AND EDUCATION
                  STRATEGY.

        ``(a) In General.--The Secretary, acting through the Assistant
    Secretary for Mental Health and Substance Use, shall, in coordination
    with advocacy and behavioral and mental health organizations serving
    populations of Asian American, African American, Native Hawaiian,
    Pacific Islander, Indigenous, Middle Eastern and North African (in this
    section referred to as `MENA'), and Hispanic and Latino/a/x individuals
    or communities, develop and implement an outreach and education
    strategy to promote behavioral and mental health, emphasize that
    behavioral and mental health conditions are treatable and that
    reasonable accommodations under section 504 of the Rehabilitation Act
    of 1973 and titles II and III of the Americans with Disabilities Act of
    1990 are necessary and may help, as well as reduce stigma associated
    with mental health conditions and substance abuse among the Asian
    American, African American, Native Hawaiian, Pacific Islander,
    Indigenous, MENA, and Hispanic and Latino/a/x populations. Such
    strategy shall--
                ``(1) be designed to--
                        ``(A) meet the diverse cultural and language needs
                    of the various Asian American, African American,
                    Indigenous, MENA, Native Hawaiian, Pacific Islander,
                    and Hispanic and Latino/a/x populations; and
                        ``(B) ensure that approaches recommended in the
                    strategy are developmentally (with respect to the
                    beneficiary's relative age and experience) and age
                    appropriate, as well as cognitively accessible to
                    persons with cognitive disabilities;
                ``(2) increase awareness of symptoms of mental illnesses
            common among such populations, taking into account differences
            within subgroups (such as gender, gender identity, age, sexual
            orientation, disability, and ethnicity) of such populations;
                ``(3) provide information on evidence-based, culturally and
            linguistically appropriate and adapted interventions and
            treatments;
                ``(4) ensure full participation of, and engage, both
            consumers and community members representing the communities of
            focus in the development and implementation of materials; and
                ``(5) seek to broaden the perspective among both
            individuals in such communities and stakeholders serving such
            communities to use a comprehensive public health approach to
            promoting behavioral and mental health that addresses a
            holistic view of health by focusing on the intersection between
            behavioral and physical health.
        ``(b) Reports.--Beginning not later than 1 year after the date of
    the enactment of this section and annually thereafter, the Secretary,
    acting through the Assistant Secretary, shall submit to the Congress,
    and make publicly available, a report on the extent to which the
    strategy developed and implemented under subsection (a) increased
    behavioral and mental health outcomes associated with mental health
    conditions and substance abuse among Asian American, African American,
    Native Hawaiian, Pacific Islander, Indigenous, MENA, and Hispanic and
    Latino/a/x populations.
        ``(c) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section $10,000,000 for each of fiscal
    years 2024 through 2028.''.

                              Subtitle F--Reports

    SEC. 6061. ADDRESSING RACIAL AND ETHNIC MENTAL HEALTH INEQUITIES
                  RESEARCH GAPS.

        (a) In General.--Not later than 6 months after the date of the
    enactment of this Act--
                (1) the Director of the National Institute on Minority
            Health and Health Disparities shall enter into an arrangement
            with the National Academy of Sciences to carry out the
            activities under subsection (b); or
                (2) if the National Academy of Sciences declines to enter
            into such an arrangement, the Director of the National
            Institute on Minority Health and Health Disparities, in
            cooperation with the Agency for Healthcare Research and
            Quality, shall carry out the activities under subsection (b).
        (b) Activities.--The applicable entity under subsection (a) shall--
                (1) conduct a study with respect to mental health
            inequities in racial and ethnic minority groups (as defined in
            section 1707(g) of the Public Health Service Act (42 U.S.C.
            300u-6(g)), as amended by title I of this Act); and
                (2) submit to the Congress a report on the results of such
            study, including--
                        (A) a compilation of information on the dynamics of
                    mental health outcomes in such racial and ethnic
                    minority groups;
                        (B) the degree and impacts of the co-occurrence of
                    mental conditions with other disabilities in such
                    racial and ethnic groups, including physical
                    disabilities, mental disabilities, substance use
                    disorders, severe and persistent mental illness, and
                    mental disorders or mental health conditions which co-
                    occur with one another;
                        (C) a compilation of information on the impact of
                    community violence, community trauma, adverse childhood
                    experiences, weather extremes worsened by climate
                    change (such as heat waves, flooding, hurricanes, and
                    wildfires), substance use, and other psychological
                    traumas, on mental disorders in such racial and ethnic
                    minority groups, stratified by household income level;
                        (D) a compilation of information on the impact of
                    the intersectionality of transgender individuals,
                    gender nonbinary individuals, sexual orientation, and
                    age in racial and ethnic minority groups; and
                        (E) a description of how protective factors
                    contrast and compare among different communities of
                    color, identifying cultural strengths.

    SEC. 6062. RESEARCH ON ADVERSE HEALTH EFFECTS ASSOCIATED WITH
                  INTERACTIONS WITH LAW ENFORCEMENT.

        (a) In General.--The Secretary of Health and Human Services (in
    this section referred to as the ``Secretary''), acting through the
    Director of the Office of Minority Health of the Centers for Disease
    Control and Prevention (established pursuant to section 1707A of the
    Public Health Service Act (42 U.S.C. 300u-6a)), shall conduct research
    on the adverse health effects associated with interactions with law
    enforcement.
        (b) Effects Among Racial and Ethnic Minorities.--The research under
    subsection (a) shall include research on--
                (1) the health consequences, both individual and community-
            wide, of trauma related to violence committed by law
            enforcement among racial and ethnic minorities; and
                (2) the disproportionate burden of morbidity and mortality
            associated with such trauma.
        (c) Report.--Not later than 1 year after the date of enactment of
    this Act, the Secretary shall--
                (1) complete the research under this section; and
                (2) submit to the Congress a report on the findings,
            conclusions, and recommendations resulting from such research.

    SEC. 6063. GEOACCESS STUDY.

        The Assistant Secretary for Mental Health and Substance Use shall--
                (1) conduct a study to--
                        (A) determine which geographic areas of the United
                    States have shortages of racially and ethnically
                    diverse mental health providers, as well as mental
                    health providers trained to work with racially and
                    ethnically diverse clients and clients with multiple
                    mental health, cognitive, and developmental
                    disabilities; and
                        (B) assess the preparedness of mental health
                    providers to deliver culturally and linguistically
                    appropriate, affordable, and accessible services; and
                (2) submit a report to Congress on the results of such
            study.

    SEC. 6064. COOCCURRING CONDITIONS.

        (a) GAO Report.--Not later than two years after the date of
    enactment of this Act, the Comptroller General of the United States
    shall submit to Congress a report on barriers to care for persons with
    cooccurring conditions and access to care in the United States. Such
    report shall include the information and recommendations described in
    subsection (b).
        (b) Content of Report.--The report under subsection (a) shall
    include--
                (1) an assessment of current barriers to behavioral health
            and substance use disorder treatment for low-income, uninsured,
            and Medicaid-enrolled adults, and recommendations for
            addressing such barriers, particularly for women and diverse
            racial and ethnic groups;
                (2) an assessment of--
                        (A) how many adults have a behavioral health
                    condition and options for adults to receive behavioral
                    health and substance use disorder treatment in
                    nonexpansion States;
                        (B) Medicaid expansion States who provide
                    behavioral health coverage for newly eligible
                    enrollees;
                        (C) how enrollment in coverage affects treatment
                    availability; and
                        (D) the impacts of COVID-19 to receiving and
                    accessing treatment for behavioral health, substance
                    use disorders, diverse racial and ethnic groups, and
                    recommendations for addressing such barriers;
                (3) an assessment of current barriers, inclusive of social
            determinants of health and cultural barriers, that prevent
            adults from receiving behavioral health and substance use
            disorder treatment, recommendations for addressing such
            barriers, particularly for low-income women and adults from
            racial and ethnic groups;
                (4) an assessment of disparities in access to addiction
            counselors, mental or behavioral health care providers acting
            in accordance with State law, stratified by race, ethnicity,
            gender identity, geographic location, and insurance type and
            recommendations to promote greater access equity; and
                (5) recommendations to promote greater equity in access to
            care for behavioral services and substance use disorders,
            particularly for low-income women and adults from diverse
            racial and ethnic groups.

    SEC. 6065. TECHNICAL CORRECTION.

        Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.)
    is amended--
                (1) by redesignating the second section 550 (42 U.S.C.
            290ee-10) (relating to Sobriety Treatment And Recovery Teams)
            as section 552A; and
                (2) by moving such section, as so redesignated, so as to
            appear after section 552 (42 U.S.C. 290ee-7).

                      Subtitle G--Miscellaneous Provisions

    SEC. 6071. CHILDREN'S MENTAL HEALTH INFRASTRUCTURE ACT.

         Part D of title III of the Public Health Service Act (42 U.S.C.
    254b et seq.) is amended by inserting after subpart V the following new
    subpart:

      ``Subpart VI--Increasing Investment in Pediatric Behavioral Health
                                    Services

    ``SEC. 340A-1. GRANTS TO CHILDREN'S HOSPITALS.

        ``(a) In General.--The Secretary, acting through the Administrator
    of the Health Resources and Services Administration, shall make grants
    to eligible entities for the purpose of improving their ability to
    provide pediatric behavioral health services, including by--
                ``(1) constructing or modernizing sites of care for
            pediatric behavioral health services;
                ``(2) expanding capacity to provide pediatric behavioral
            health services, including enhancements to digital
            infrastructure, telehealth capabilities, or other improvements
            to patient care infrastructure; and
                ``(3) supporting the reallocation of existing resources to
            accommodate pediatric behavioral health patients, including
            by--
                        ``(A) converting or adding a sufficient number of
                    beds to establish or increase the hospital's inventory
                    of licensed and operational, short-term psychiatric and
                    substance use inpatient beds; and
                        ``(B) ensuring compliance with safety standards.
        ``(b) Eligibility.--To be eligible to seek a grant under this
    section, an entity shall be a hospital that predominantly treats
    individuals under the age of 21, including any hospital that receives
    funds under section 340E.
        ``(c) Funding.--To carry out this section, there is hereby
    appropriated, out of amounts in the Treasury not otherwise obligated,
    $2,000,000,000 for each of fiscal years 2022 through 2026.''.

    SEC. 6072. MENTAL HEALTH FOR LATINOS.

        Part D of title V of the Public Health Service Act (42 U.S.C. 290dd
    et seq.) is amended by adding at the end the following new section:

    ``SEC. 553. BEHAVIORAL AND MENTAL HEALTH OUTREACH AND EDUCATION
                  STRATEGY.

        ``(a) In General.--The Secretary, acting through the Assistant
    Secretary, shall, in coordination with advocacy and behavioral and
    mental health organizations serving populations of Hispanic and Latino
    individuals or communities, develop and implement an outreach and
    education strategy to promote behavioral and mental health and reduce
    stigma associated with mental health conditions and substance abuse
    among the Hispanic and Latino populations. Such strategy shall--
                ``(1) be designed to--
                        ``(A) meet the diverse cultural and language needs
                    of the various Hispanic and Latino populations; and
                        ``(B) be developmentally and age-appropriate;
                ``(2) increase awareness of symptoms of mental illnesses
            common among such populations, taking into account differences
            within subgroups, such as gender, gender identity, age, sexual
            orientation, or ethnicity, of such populations;
                ``(3) provide information on evidence-based, culturally and
            linguistically appropriate and adapted interventions and
            treatments;
                ``(4) ensure full participation of, and engage, both
            consumers and community members in the development and
            implementation of materials;
                ``(5) seek to broaden the perspective among both
            individuals in these communities and stakeholders serving these
            communities to use a comprehensive public health approach to
            promoting behavioral health that addresses a holistic view of
            health by focusing on the intersection between behavioral and
            physical health; and
                ``(6) address the impact of the SARS-CoV-2 pandemic on the
            mental and behavioral health of the Hispanic and Latino
            populations.
        ``(b) Reports.--Beginning not later than 1 year after the date of
    the enactment of this section and annually thereafter, the Secretary,
    acting through the Assistant Secretary, shall submit to Congress, and
    make publicly available, a report on the extent to which the strategy
    developed and implemented under subsection (a) improved behavioral and
    mental health outcomes associated with mental health conditions and
    substance abuse among Hispanic and Latino populations.
        ``(c) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section $1,000,000 for each of fiscal
    years 2023 through 2025.''.

    SEC. 6073. STRENGTHENING MENTAL HEALTH SUPPORTS FOR BIPOC COMMUNITIES.

        (a) In General.--Section 1942(a) of the Public Health Service Act
    (42 U.S.C. 300x-52(a)) is amended--
                (1) in paragraph (1), by striking ``and'' at the end;
                (2) by redesignating paragraph (2) as paragraph (5); and
                (3) by inserting after paragraph (1) the following:
                ``(2) services provided by the State to adults with a
            serious mental illness and children with a serious emotional
            disturbance who are members of historically racial and ethnic
            minority groups, including--
                        ``(A) the extent to which such services are
                    provided to such adults and children; and
                        ``(B) the outcomes experienced by such adults and
                    children as a result of the provision of such services,
                    including with respect to--
                                ``(i) diversions from hospitalization and
                            criminal justice system involvement;
                                ``(ii) treatment for first episode
                            psychosis or undefined psychosis;
                                ``(iii) reductions in suicide and increased
                            utilization of appropriate treatments and
                            interventions for suicidal ideation;
                                ``(iv) response through crisis services,
                            including mobile crisis services;
                                ``(v) treatment of individuals who are
                            experiencing homelessness or housing insecurity
                            and individuals residing in rural communities;
                            and
                                ``(vi) increased patient family and
                            caregiver engagement and education on serious
                            mental illness to reduce social stigma and
                            promote healthy social support for patients;
                ``(3) any outreach by the State to, and the hiring of,
            providers of mental health services from multiple disciplines
            (such as a psychologist, psychiatrist, peer support provider,
            or social worker) who are members of historically racial and
            ethnic minority groups;
                ``(4) any outreach by the State to providers from multiple
            disciplines of mental health services--
                        ``(A) to provide training on culturally effective,
                    culturally affirming, and linguistically competent
                    services; and
                        ``(B) to increase awareness of community-defined
                    practices by practitioners of historically racial and
                    ethnic minority groups; and''.
        (b) Applicability.--The amendments made by subsection (a) shall
    apply with respect to funding agreements entered into under section
    1911 or 1921 of the Public Health Service Act (42 U.S.C. 300x; 42
    U.S.C. 300x-21) on or after the date of the enactment of this Act.

    SEC. 6074. STRONG SUPPORT FOR CHILDREN.

        (a) Data Analysis and Strategy Implementation To Prevent and
    Mitigate Childhood Trauma.--Title XXXI of the Public Health Service Act
    (42 U.S.C. 300kk) is amended by adding at the end the following:

    ``SEC. 3102. DATA ANALYSIS AND STRATEGY IMPLEMENTATION TO PREVENT AND
                  MITIGATE CHILDHOOD TRAUMA.

        ``(a) In General.--The Secretary shall establish a program--
                ``(1) to support the development and implementation of
            programs that use data analysis methods to identify and
            facilitate strategies for early intervention and prevention, in
            order to prevent and mitigate childhood trauma and support
            communities and families, including--
                        ``(A) improving connections through care
                    coordination;
                        ``(B) aligning community initiatives in targeted
                    areas of need; and
                        ``(C) expanding community capacity through cross-
                    sector collaboration; and
                ``(2) to evaluate the effectiveness of these programs in
            improving outcomes for children.
        ``(b) Grants.--The Secretary shall award grants to up to 5 eligible
    entities to carry out the activities described in subsection (a).
        ``(c) Use of Funds.--A grant for activities under this section
    shall be used to support the development and implementation of programs
    that use data analysis methods to identify and facilitate strategies
    for early intervention and prevention, in order to prevent and mitigate
    childhood trauma and support communities and families, including as
    follows:
                ``(1) Utilize data analysis methods to--
                        ``(A) identify specific geographic areas, such as
                    census tracts, with a high prevalence of adverse
                    childhood experiences and significant risk factors for
                    poor outcomes for children (such as increased risk of
                    experiencing adverse childhood experiences), including
                    areas with high rates of--
                                ``(i) poor public health outcomes including
                            illness, disease, suicide, and mortality;
                                ``(ii) exclusionary discipline practices,
                            including suspensions, expulsions, and
                            referrals to law enforcement, as well as low
                            graduation rates;
                                ``(iii) substance use disorders;
                                ``(iv) poverty;
                                ``(v) foster system involvement or
                            referrals;
                                ``(vi) housing instability and
                            homelessness;
                                ``(vii) food insecurity;
                                ``(viii) inequity, including disparities in
                            income, wealth, employment, educational
                            attainment, health care access, and public
                            health outcomes, along lines of race, sex,
                            sexuality and gender identity, ethnicity, or
                            nationality;
                                ``(ix) incarceration rates; or
                                ``(x) other indicators of adversity as
                            defined by the Secretary; and
                        ``(B) identify strategies to improve outcomes for
                    children aged 0 through 17 that build on strengths in
                    communities that could be further supported,
                    including--
                                ``(i) existing support networks for
                            families; and
                                ``(ii) enhanced connections to community-
                            based organizations.
                ``(2) Implement strategies identified pursuant to paragraph
            (1)(B) to facilitate outreach and involvement of children and
            their caregivers in Federal, State, or local programs that
            provide reparative, gender-responsive, culturally specific, and
            trauma-informed prevention services, and for which children and
            their caregivers are eligible, including--
                        ``(A) home visiting programs;
                        ``(B) training and education on parenting skills;
                        ``(C) substance use disorder prevention and
                    treatment that is voluntary and noncoercive;
                        ``(D) mental health supports and care that is
                    voluntary and noncoercive;
                        ``(E) family and intimate partner violence
                    prevention services;
                        ``(F) child advocacy center programming;
                        ``(G) economic and nutrition support services;
                        ``(H) housing support services, including emergency
                    and temporary shelter for those experiencing
                    homelessness and housing insecurity, as well as stable,
                    long-term housing;
                        ``(I) voluntary, noncoercive, gender-responsive,
                    and culturally specific mental health supports in
                    school and early childhood education center-based
                    settings;
                        ``(J) wraparound programs for transitioning youth
                    and youth currently in the foster system;
                        ``(K) programming to support the health and well-
                    being of lesbian, gay, bisexual, transgender, and
                    intersex children and their families; and
                        ``(L) family resource center services.
        ``(d) Special Rules.--
                ``(1) Primary payer restriction.--The Secretary may not
            award a grant under this section to an eligible entity for a
            service if the service to be provided is available pursuant to
            the State plan approved under title XIX of the Social Security
            Act for the State in which the program funded by the grant is
            being conducted unless the State and all eligible subdivisions
            involved--
                        ``(A) will enter into agreements with public or
                    nonprofit private entities under which the entities
                    will provide the service; and
                        ``(B) demonstrate that the State and all eligible
                    subdivisions will ensure that the entities providing
                    the service--
                                ``(i) will seek payment for each such
                            service rendered in accordance with the usual
                            payment schedule under the State plan; and
                                ``(ii) the entities have entered into a
                            participation agreement and are qualified to
                            receive payments under such plan.
                ``(2) Implementation.--An eligible entity that receives a
            grant under this section may use--
                        ``(A) not more than 25 percent of the amounts made
                    available through the grant for the first 24 months of
                    the grant period to utilize data analysis methods to--
                                ``(i) identify specific geographic areas
                            where care coordination, prevention and early
                            intervention, and facilitation services will be
                            provided; and
                                ``(ii) identify support and intervention
                            services to improve outcomes for children
                            located in a geographic area identified under
                            subsection (c)(1)(A); and
                        ``(B) not more than 10 percent of the grant in each
                    subsequent year to continue data analysis activities.
                ``(3) Administration.--An eligible entity that receives a
            grant under this section may not use more than 5 percent of
            amounts received through the grant for administration,
            reporting, and program oversight functions, including the
            development of systems to improve data collection and data
            sharing for the purposes of improving services and the
            provision of care.
                ``(4) Priority.--
                        ``(A) In general.--In awarding grants under this
                    section, the Secretary shall give priority, to the
                    extent practical, to eligible entities that use
                    community-based system dynamic modeling as the primary
                    data analysis method.
                        ``(B) System dynamic modeling defined.--The term
                    `system dynamic modeling' means a method of data
                    analysis and predictive modeling that includes--
                                ``(i) utilization of community-based
                            participatory research methods for involving
                            community in the process of understanding and
                            changing systems and evaluating outcomes of
                            grants;
                                ``(ii) consideration of a multitude of
                            environmental risk factors and ascertainment of
                            the significance of contributing community risk
                            factors for purposes of identifying strategies
                            to reduce adverse child outcomes, including--
                                        ``(I) maltreatment cases;
                                        ``(II) involvement with the
                                    juvenile criminal legal system or
                                    foster system;
                                        ``(III) exclusionary school
                                    discipline; or
                                        ``(IV) exposure to violence; and
                                ``(iii) identification of cross-sector
                            responses involving reparative, trauma-
                            informed, culturally specific, gender-
                            responsive, and community-based organizations
                            to reduce adverse child outcomes.
                ``(5) Subgrant.--
                        ``(A) In general.--An eligible entity that receives
                    a grant under this section shall use at least 25
                    percent of the total amount of the grant to make
                    subgrants to organizations that aide in implementing
                    the strategy identified under subsection (c)(1)(B) for
                    preventing and mitigating childhood trauma and
                    supporting communities and families.
                        ``(B) Eligibility.--To be eligible to receive a
                    subgrant under this paragraph, an organization shall
                    prepare and submit to the eligible entity an
                    application in such form, and containing such
                    information, as the eligible entity may require,
                    including evidence that the--
                                ``(i) needs of the population to be served
                            are urgent and are not met by the services
                            currently available in the geographic area; and
                                ``(ii) the organization has the capacity to
                            provide the services listed in subsection
                            (c)(2).
                        ``(C) Supplement, not supplant.--Subgrant funds
                    received pursuant to this paragraph by an organization
                    shall be used to supplement and not supplant State or
                    local funds provided to the partnership organization
                    for services listed in subsection (c)(2).
        ``(e) Application.--To be eligible to receive a grant under this
    section, an eligible entity shall submit to the Secretary an
    application in such form, and containing such information, as the
    Secretary may require, to include the following:
                ``(1) A demonstration that--
                        ``(A) the applicant utilizes trauma-informed,
                    culturally specific, and gender-responsive practices,
                    including a demonstration of the extent to which the
                    applicant has trained staff in these practices;
                        ``(B) the applicant has the capacity to administer
                    the grant, including conducting all required data
                    analysis activities; and
                        ``(C) services will be provided to children and
                    families in an accessible, culturally relevant, and
                    linguistically specific manner consistent with local
                    needs.
                ``(2) A preliminary analysis of how the applicant will use
            the grant to--
                        ``(A) identify the geographic area or areas to be
                    served using data analysis methods;
                        ``(B) utilize data analysis methods to identify
                    strategies to improve outcomes for children in the
                    geographic area;
                        ``(C) facilitate strategies identified through care
                    coordination efforts; and
                        ``(D) track data for evaluation of outcomes.
                ``(3) A detailed project plan for the use of the grant that
            includes anticipated technical assistance needs.
                ``(4) Additional funding sources, including State and local
            funds, supporting the prevention and mitigation of adverse
            childhood experiences.
        ``(f) Grant Amount.--The amount of a grant under this section shall
    not exceed $9,500,000.
        ``(g) Period of a Grant.--The period of a grant under this section
    shall not exceed 7 years.
        ``(h) Service Provision Without Regard to Ability To Pay.--As a
    condition on receipt of a grant under this section, an eligible entity
    shall agree that any assistance provided to an individual through the
    grant will be provided without regard to--
                ``(1) the ability of the individual to pay for such
            services;
                ``(2) the current or past health condition of the
            individual to be served;
                ``(3) the immigration status of the individual to be
            served;
                ``(4) the sexual orientation and gender identity of the
            individual to be served; and
                ``(5) any prior involvement of the individual in the
            criminal legal system.
        ``(i) Prohibitions.--In addition to any other prohibitions
    determined by the Secretary, an eligible entity may not use a grant
    under this section to--
                ``(1) use data analysis methods to inform individual case
            decisions, including child removal or placement decisions, or
            to target services at certain individuals or families;
                ``(2) require any individual or family to participate in
            any service or program as a condition of receipt of a benefit
            to which the individual or family is otherwise eligible;
                ``(3) increase the presence or funding of law enforcement
            surveillance, involvement, or activity in implementing the
            strategies identified under subsection (c)(1)(B); or
                ``(4) enable the practice of conversion therapy.
        ``(j) Evaluation.--
                ``(1) Data model evaluation.--Not later than 36 months
            after the date of enactment of this section, the Assistant
            Secretary for Planning and Evaluation of the Department of
            Health and Human Services, in coordination with the grantees
            receiving a grant under this section, shall complete an
            evaluation of the effectiveness of the data model accuracy of
            the grant program under this section to address each of the
            following:
                        ``(A) Determining the effectiveness of the
                    grantees' use of data analysis methods to identify
                    geographic areas pursuant to subsection (c)(1).
                        ``(B) Examining the grantees' development and
                    utilization of data analysis methods.
                        ``(C) Examining the grantees' ability to
                    effectively utilize data analysis methods in future
                    prevention work.
                        ``(D) Establishing a method for rigorously
                    evaluating the activities of grantees and comparing the
                    reduction of child and family exposure to adverse
                    experiences in other communities with similar
                    demographics.
                        ``(E) Examining the grantees' utilization of
                    community-based system dynamics modeling methods and
                    other community engagement methods.
                ``(2) Program evaluation.--Not later than 6 years after the
            date of enactment of this section, the Assistant Secretary for
            Planning and Evaluation of the Department of Health and Human
            Services, in coordination with eligible entities receiving
            grants under this section, shall complete an evaluation of the
            effectiveness of the grant program under this section.
                ``(3) Data collection.--
                        ``(A) In general.--The Assistant Secretary for
                    Planning and Evaluation of the Department of Health and
                    Human Services and each eligible entity receiving a
                    grant under this section shall collect any relevant
                    data necessary to complete the evaluations required by
                    paragraphs (1) and (2) to include--
                                ``(i) the activities funded by the grant
                            under this section, including development and
                            implementation data analysis methods;
                                ``(ii) the number of children and of
                            families receiving coordination and
                            facilitation of care and services; and
                                ``(iii) the effect of activities supported
                            by the grant under this section on the local
                            area serviced by the program, including such
                            effects on--
                                        ``(I) children and adolescents'
                                    health and well-being;
                                        ``(II) the number of children who
                                    enter into or depart from foster
                                    services; and
                                        ``(III) homelessness and housing
                                    insecurity.
                        ``(B) Study.--
                                ``(i) In general.--Not later than 7 years
                            after the date of enactment of this section,
                            the Assistant Secretary for Planning and
                            Evaluation of the Department of Health and
                            Human Services shall--
                                        ``(I) complete a study on the
                                    results of the grant program under this
                                    section using the community-based
                                    participatory action research method,
                                    which focuses on social, structural,
                                    and physical environmental inequities
                                    through active involvement of community
                                    members, clients, organizational
                                    representatives, and researchers in all
                                    aspects of the research process; and
                                        ``(II) submit a report on the
                                    results of the study to the Congress.
                                ``(ii) Partners.--In conducting the study
                            under clause (i), the Assistant Secretary for
                            Planning and Evaluation of the Department of
                            Health and Human Services shall ensure that
                            partners and persons that have participated in
                            the grant program under this section on every
                            level, especially those such partners or
                            persons receiving services and support through
                            the program, have an opportunity to contribute
                            their expertise to evaluating the strategy and
                            outcomes.
        ``(k) Report.--Not later than three months after the completion of
    the evaluation required by subsection (j)(2), the Assistant Secretary
    for Planning and Evaluation of the Department of Health and Human
    Services shall submit to Congress and make available to the public on
    the internet website of the Department of Health and Human Services a
    report based upon the evaluation under subsection (j)(2), to include--
                ``(1) the impact of the program under this section on
            homelessness and housing insecurity, substance use disorder and
            drug deaths, incarceration, foster system involvement, and
            other child and family outcomes as identified by the Assistant
            Secretary for Planning and Evaluation of the Department of
            Health and Human Services;
                ``(2) an analysis of which elements of the program should
            be replicated and scaled by governmental or non-governmental
            entities; and
                ``(3) such recommendations for legislation and
            administrative action as the Secretary determines appropriate.
        ``(l) Definitions.--In this section:
                ``(1) The term `adverse childhood experience' means a
            potentially traumatic experience that occurs in childhood and
            can have a tremendous impact on the child's lifelong health and
            opportunity outcomes, such as any of the following:
                        ``(A) Abuse, such as any of the following:
                                ``(i) Emotional and psychological abuse.
                                ``(ii) Physical abuse.
                                ``(iii) Sexual abuse.
                        ``(B) Household challenges such as any of the
                    following:
                                ``(i) A household member is treated
                            violently.
                                ``(ii) A household member has a substance
                            use disorder.
                                ``(iii) A household member has a mental
                            health condition.
                                ``(iv) Parental separation or divorce.
                                ``(v) A household member is incarcerated,
                            placed in immigrant detention, or has been
                            deported.
                                ``(vi) A household member has a life-
                            threatening illness such as COVID-19.
                        ``(C) Neglect.
                        ``(D) Living in--
                                ``(i) impoverished communities that lack
                            access to human services;
                                ``(ii) areas of high unemployment
                            neighborhoods; or
                                ``(iii) communities experiencing de facto
                            segregation.
                        ``(E) Experiencing food insecurity and poor
                    nutrition.
                        ``(F) Witnessing violence.
                        ``(G) Involvement with the foster system.
                        ``(H) Experiencing discrimination.
                        ``(I) Dealing with historical and ongoing traumas
                    due to systemic and interpersonal racism.
                        ``(J) Dealing with historical and ongoing traumas
                    regarding systemic and interpersonal sexism,
                    homophobia, biphobia, and transphobia.
                        ``(K) Dealing with the threat of deportation or
                    detention as a result of immigration status.
                        ``(L) The impacts of multigenerational poverty
                    resulting from limited educational and economic
                    opportunities.
                        ``(M) Living through natural disasters such as
                    earthquakes, forest fires, floods, or hurricanes.
                ``(2) The term `eligible entity' means a State or local
            health department.
                ``(3) The term `practice of conversion therapy'--
                        ``(A) means any practice or treatment by any person
                    that seeks to change another individual's sexual
                    orientation or gender identity, including efforts to
                    change behaviors or gender expressions, or to eliminate
                    or reduce sexual or romantic attractions or feelings
                    toward individuals of the same gender, if such person
                    receives monetary compensation in exchange for any such
                    practice or treatment; and
                        ``(B) does not include any practice or treatment
                    that does not seek to change sexual orientation or
                    gender identity and--
                                ``(i) provides assistance to an individual
                            undergoing a gender transition; or
                                ``(ii) provides acceptance, support, and
                            understanding of a client or facilitation of a
                            client's coping, social support, and identity
                            exploration and development.
        ``(m) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section for the period of fiscal years
    2023 through 2030--
                ``(1) to carry out subsection (a)(1) through the award of
            grants under subsection (b)--
                        ``(A) $47,500,000 for grants; and
                        ``(B) such sums as may be necessary for the
                    administrative costs of carrying out such subsection;
                    and
                ``(2) $7,500,000 to carry out the evaluation under
            subsection (a)(2).''.
        (b) Care Coordination Grants.--Part E of title XII of the Public
    Health Service Act (42 U.S.C. 300d-51 et seq.) is amended by adding at
    the end the following new section:

    ``SEC. 1255. CARE COORDINATION GRANTS.

        ``(a) In General.--The Secretary shall award grants to eligible
    entities to establish or expand trauma-informed care coordination
    services to support--
                ``(1) children aged 0 through 5 at risk of adverse
            childhood experiences; and
                ``(2) their caregivers, including prenatal people of any
            age.
        ``(b) Number of Grants.--Subject to the availability of
    appropriations, the Secretary shall award not fewer than 9 and not more
    than 40 grants under this section.
        ``(c) Amount of Grants.--Subject to the availability of
    appropriations, the amount of a grant under this section for a fiscal
    year shall be--
                ``(1) not less than $250,000; and
                ``(2) not more than $1,000,000.
        ``(d) Eligible Entities.--To be eligible to receive a grant under
    this section, an entity shall be a local government or Indian Tribe,
    acting through the public health department thereof if such government
    or Tribe has a public health department.
        ``(e) Priority.--
                ``(1) In general.--In awarding grants under this section,
            the Secretary shall give priority to eligible entities
            proposing to serve communities with a high need for trauma-
            informed care coordination services, as demonstrated by
            indicators such as--
                        ``(A) pregnant people who face barriers to prenatal
                    care;
                        ``(B) mortality or morbidity of people giving birth
                    or infants;
                        ``(C) caretakers and parents who are living with a
                    mental health condition or substance use disorder;
                        ``(D) a high prevalence of community violence,
                    including domestic violence, as demonstrated by
                    instances of homicide and public health statistics,
                    including treatment of injury or trauma;
                        ``(E) high proportions of low-income children;
                        ``(F) a high prevalence of child fatalities or near
                    fatalities related to child abuse and neglect;
                        ``(G) significant disparities in health outcomes
                    for people giving birth and infants;
                        ``(H) a high rate of exclusionary discipline and
                    referrals to law enforcement; and
                        ``(I) a high rate of homelessness and housing
                    instability.
                ``(2) Data from tribal areas.--The Secretary, acting
            through the Director of the Indian Health Service, shall
            consult with Indian Tribes to establish criteria to measure
            indicators of need, for purposes of paragraph (1), with respect
            to Tribal areas.
        ``(f) Use of Funds.--
                ``(1) Required uses.--
                        ``(A) In general.--A grant received under this
                    section shall be used to establish or expand gender-
                    responsive, culturally specific, trauma-informed care
                    coordination services, including by instituting and
                    conducting risk and needs assessments including--
                                ``(i) using strengths-based approaches
                            focused on protective factors for children and
                            their caregivers, including prenatal people of
                            any age; and
                                ``(ii) inputting screening results into a
                            centralized intake system to promote a single
                            point of access system across providers and
                            services.
                        ``(B) Training.--A grant received under this
                    section shall be used to ensure that individuals
                    employed through the grant funds, in whole or in part,
                    have received sufficient and up-to-date training on
                    trauma-informed care and strategies that are
                    reparative, culturally sensitive, gender-responsive,
                    and healing-centered.
                ``(2) Permissible uses.--A grant received under this
            section may be used for any of the following:
                        ``(A) Employing care coordinators, case managers,
                    community health workers, certified infant mental
                    health specialists, and outreach and engagement
                    specialists to work with children and their caregivers,
                    including prenatal individuals, to prevent and respond
                    to adverse childhood experiences by connecting clients
                    with culturally specific, trauma-informed care
                    treatment services, including economic, social, food,
                    and housing supports.
                        ``(B) Providing training described in paragraph
                    (1)(B) to community health providers and community
                    partners.
                        ``(C) Expanding, enhancing, modifying, and
                    connecting the existing network of community programs
                    and services to achieve a more comprehensive and
                    coordinated system of care approach, including--
                                ``(i) developing local infrastructure to
                            bolster and shape community support systems and
                            map and build access to services in a
                            coordinated and comprehensive way; and
                                ``(ii) creating infrastructure to conduct
                            outreach to children and families, including
                            those experiencing homelessness and housing
                            instability, so they acquire access to the
                            services and supports they need and the
                            benefits to which they are entitled.
                        ``(D) Compiling information on resources (including
                    any referral services) available through community-
                    based organizations and local, State, and Federal
                    agencies, such as--
                                ``(i) programs addressing social
                            determinants of health, including--
                                        ``(I) emergency, temporary, and
                                    long-term housing;
                                        ``(II) programs that offer free or
                                    affordable and nutritious food;
                                        ``(III) vocational and workforce
                                    development; and
                                        ``(IV) transportation supports;
                                ``(ii) home visiting programs for new
                            parents and their infants;
                                ``(iii) workforce development programs to
                            support caregivers in skill building;
                                ``(iv) trauma-responsive, parenting skills-
                            building programs;
                                ``(v) the continuum of substance use
                            prevention, intervention, and treatment
                            programs and mental health support programs,
                            including programs with trauma-informed,
                            gender-responsive, and culturally specific
                            counseling; and
                                ``(vi) childcare support and early
                            childhood education, including Head Start and
                            Early Head Start programs.
                        ``(E) Subject to subsection (g)(2), establishing or
                    updating a database that compiles data used to track
                    the effectiveness of the care coordination services
                    funded through the grant.
                        ``(F) Developing and implementing referral
                    partnership agreements with community-based
                    organizations, parent organizations, substance use
                    disorder treatment providers and facilities, housing
                    and shelter providers, health care providers, mental
                    health care providers, and Federal and State offices
                    and programs that implement practices to support
                    children ages 0 through 5 who are at risk of adverse
                    childhood experiences and their caregivers, including
                    prenatal people. Such practices shall include--
                                ``(i) a bilateral `warm handoff' system
                            whereby a grantee understands the needs of the
                            children and their families, and families are
                            involved in addressing these needs; and
                                ``(ii) an active service connection whereby
                            the children and families are each actively
                            connected with a resource in a well-coordinated
                            way that ensures availability and direct
                            contact.
                        ``(G) Supporting cross-system planning and
                    collaboration among employees who may work in emergency
                    medical services, health care services, public health,
                    early childhood education, and substance use disorder
                    treatment and recovery support.
                        ``(H) Providing or subsidizing services to address
                    barriers that children, prenatal individuals, and
                    caregivers face to utilizing community resources and
                    services, such as by providing or subsidizing
                    transportation or childcare costs as applicable and
                    within reasonable amounts.
                        ``(I) Creating or expanding infrastructure and
                    investing in technology, including the provision of
                    communications technology and internet service to
                    children and their caregivers, to enable increased
                    telemedicine capabilities to reach participants.
                ``(3) Indian tribes.--In the case of an eligible entity
            that is an Indian tribe, the Secretary may waive such
            provisions of this subsection as the Secretary determines
            appropriate.
                ``(4) Prohibitions.--In addition to any other prohibitions
            determined by the Secretary, an eligible entity may not use a
            grant under this section to--
                        ``(A) use data analysis methods to inform
                    individual case decisions, including child removal or
                    placement decisions, or to target services at certain
                    individuals or families;
                        ``(B) require any individual or family to
                    participate in any service or program as a condition of
                    receipt of a benefit to which the individual or family
                    is otherwise eligible; or
                        ``(C) increase the presence or funding of law
                    enforcement surveillance, involvement, or activity in
                    connection with trauma-informed care coordination
                    services supported pursuant to this section.
        ``(g) Requirements.--As a condition on receipt of a grant under
    this section, an eligible entity shall agree to each of the following
    funding conditions:
                ``(1) Restriction of funding allocation.--The eligible
            entity will not use more than 30 percent of the funds made
            available to the entity through the grant (for the total grant
            period) to establish or update a database pursuant to
            subsection (f)(2)(E).
                ``(2) Accessible setting.--
                        ``(A) In general.--The eligible entity will ensure
                    that all care coordination services provided through
                    the grant are provided in a setting that is accessible,
                    including through mobile settings, to--
                                ``(i) low-income or no-income individuals,
                            including individuals experiencing homelessness
                            or housing instability; and
                                ``(ii) individuals in rural areas.
                        ``(B) Community outreach.--In complying with
                    subparagraph (A), the eligible entity will ensure that
                    at least 50 percent of the care coordination services
                    provided through the grant occur in community settings
                    that are convenient to the children and caregivers who
                    are being served, such as homes, schools, and shelters,
                    whether for initial outreach or as part of long-term
                    care.
                ``(3) Supplement, not supplant.--The grant will be used to
            supplement, not supplant other Federal, State, or local funds
            available for care coordination services.
                ``(4) Confidentiality.--The eligible entity will maintain
            the confidentiality of individuals receiving services through
            the grant in a manner consistent with applicable law.
                ``(5) Partnering; risk stratification.--In providing care
            coordination services through the grant, the eligible entity
            will--
                        ``(A) partner with community-based organizations
                    with experience serving child populations prenatally
                    through age 5;
                        ``(B) coordinate with the local agency responsible
                    for administering the State plan approved under title
                    XIX of the Social Security Act; and
                        ``(C) employ risk stratification to develop
                    different effective models of care for different
                    populations based on their needs.
        ``(h) Application.--
                ``(1) In general.--To seek a grant under this section, an
            eligible entity shall submit an application to the Secretary at
            such time, in such manner, and containing such information, as
            the Secretary may require.
                ``(2) Contents.--An application under paragraph (1) shall,
            at a minimum, contain each of the following:
                        ``(A) Goals to be achieved through the grant,
                    including the activities that will be undertaken to
                    achieve those goals.
                        ``(B) The number of individuals likely to be served
                    through the grant, including demographic data on the
                    populations to be served.
                        ``(C) Existing programs and services that can be
                    used to significantly increase the proportion of
                    children and families who receive needed supports and
                    services.
                        ``(D) A plan for expanding, coordinating, or
                    modifying the existing network of programs and services
                    to meet the needs of children and families for
                    preventing and mitigating the traumatic impact of
                    adverse childhood experiences.
                        ``(E) A demonstration of the ability of the
                    eligible entity to reach the individuals to be served,
                    including by partnering with local stakeholders.
                        ``(F) An indication of how the personnel involved
                    are reflective of the communities to be served.
                        ``(G) A list of stakeholders with whom the entity
                    plans to partner or consult.
        ``(i) Reporting by Grantees.--Not later than 4 years after the date
    of enactment of this section, an eligible entity receiving a grant
    under this section shall submit to the Secretary a report on the
    activities funded through the grant. Such report shall include, at a
    minimum, a description of--
                ``(1) the number of individuals served through activities
            funded through the grant, including demographics as applicable;
                ``(2) the number of referrals made through the grant and
            the rate of such referrals successfully linked or closed;
                ``(3) a qualitative analysis or number of collaborative
            partnerships with other organizations in carrying out the
            activities funded through the grant;
                ``(4) the number of services provided to individuals
            through the grant;
                ``(5) aggregated and de-identified outcomes experienced by
            individuals served through the grant such as--
                        ``(A) the rate of successful service connections;
                        ``(B) any increases in development of protective
                    factors for children;
                        ``(C) any increase in development of protective
                    factors for the caregivers;
                        ``(D) any mitigation of the negative outcomes
                    associated with adverse childhood experiences or
                    decreased likelihood of children experiencing an
                    adverse childhood experience as evidenced by--
                                ``(i) decreased presence of law enforcement
                            or other punitive State surveillance in the
                            community;
                                ``(ii) a parent completing substance use
                            treatment;
                                ``(iii) a parent receiving voluntary
                            treatment for mental health-related conditions;
                                ``(iv) a family entering into or
                            maintaining a stable housing situation;
                                ``(v) a family achieving or maintaining
                            economic security;
                                ``(vi) a parent achieving or maintaining
                            job stability; or
                                ``(vii) a child meeting developmental
                            markers for school readiness; and
                        ``(E) reports of satisfaction with the coordination
                    of care by people served; and
                ``(6) any other information required by the Secretary.
        ``(j) Convening Participants for Sharing Lessons Learned.--After
    the period of all grants awarded under this section has concluded, the
    Assistant Secretary for Planning and Evaluation of the Department of
    Health and Human Services shall provide an in-person or online
    opportunity for persons participating in the programs funded through
    this section to share with each other--
                ``(1) lessons learned;
                ``(2) challenges experienced; and
                ``(3) ideas for next steps and solutions.
        ``(k) Compiling Findings and Conclusions.--After providing the
    opportunity required by subsection (j), the Secretary shall--
                ``(1) compile the findings and conclusions of grantees
            under this section on the provision of care coordination
            services described in subsection (a);
                ``(2) submit a report on such findings and conclusions to
            the appropriate congressional committees; and
                ``(3) make such report publicly available.
        ``(l) Definitions.--In this section:
                ``(1) Adverse childhood experience.--The term `adverse
            childhood experience' means a potentially traumatic experience
            that occurs in childhood and can have a tremendous impact on
            the child's lifelong health and opportunity outcomes, such as
            any of the following:
                        ``(A) Abuse, such as any of the following:
                                ``(i) Emotional and psychological abuse.
                                ``(ii) Physical abuse.
                                ``(iii) Sexual abuse.
                        ``(B) Household challenges such as any of the
                    following:
                                ``(i) A household member is treated
                            violently.
                                ``(ii) A household member has a substance
                            use disorder.
                                ``(iii) A household member has a mental
                            health condition.
                                ``(iv) Parental separation or divorce.
                                ``(v) A household member is incarcerated,
                            placed in immigrant detention, or has been
                            deported.
                                ``(vi) A household member has a life-
                            threatening illness such as COVID-19.
                        ``(C) Neglect.
                        ``(D) Living in--
                                ``(i) impoverished communities that lack
                            access to human services;
                                ``(ii) areas of high unemployment
                            neighborhoods; or
                                ``(iii) communities experiencing de facto
                            segregation.
                        ``(E) Experiencing food insecurity and poor
                    nutrition.
                        ``(F) Witnessing violence.
                        ``(G) Involvement with the foster system.
                        ``(H) Experiencing discrimination.
                        ``(I) Dealing with historical and ongoing traumas
                    due to systemic and interpersonal racism.
                        ``(J) Dealing with historical and ongoing traumas
                    regarding systemic and interpersonal sexism,
                    homophobia, biphobia, and transphobia.
                        ``(K) Dealing with the threat of deportation or
                    detention as a result of immigration status.
                        ``(L) The impacts of multigenerational poverty
                    resulting from limited educational and economic
                    opportunities.
                        ``(M) Living through natural disasters such as
                    earthquakes, forest fires, floods, or hurricanes.
                ``(2) Care coordination.--The term `care coordination'
            means an active, ongoing process that--
                        ``(A) assists children ages 0 through 5 at risk of,
                    or who have experienced, an adverse childhood
                    experience, and their caregivers, including prenatal
                    people of any age, to identify, access, and use
                    community resources and services;
                        ``(B) is client-centered and comprehensive of the
                    services a child or caregiver may need;
                        ``(C) ensures a closed loop referral by obtaining
                    feedback from the families served; and
                        ``(D) works across systems and services to promote
                    collaboration to effectively meet the needs of
                    community members.
                ``(3) Indian tribe.--The term `Indian Tribe' has the
            meaning given such term in section 4 of the Indian Self-
            Determination and Education Assistance Act.
                ``(4) Protective factors.--The term `protective factors'
            refers to any supportive element in a child or caretaker's life
            that helps the child or caretaker to withstand trauma such as a
            stable school environment or supportive peer relationships.
        ``(m) Authorization of Appropriations.--
                ``(1) In general.--To carry out this section, there is
            authorized to be appropriated $15,000,000 for each of the 5
            fiscal years following the fiscal year in which this section is
            enacted.
                ``(2) Grants to indian tribes.--Of the amount made
            available to carry out this section for a fiscal year, the
            Secretary shall use not less than 10 percent of such amount for
            grants to eligible entities that are Indian tribes.
                ``(3) Administrative expenses.--Of the amount made
            available to carry out this section for a fiscal year, the
            Secretary may use not more than 15 percent of such amount for
            administrative expenses, including the expenses of the
            Assistant Secretary for Planning and Evaluation of the
            Department of Health and Human Services for compiling and
            reporting information.
                ``(4) Technical assistance.--Of the amount made available
            to carry out this section for a fiscal year, the Secretary may
            reserve up to 5 percent of such amount to provide technical
            assistance to eligible entities in preparing and submitting
            applications under this section.''.

    SEC. 6075. IMPROVING ACCESS TO MENTAL HEALTH.

        (a) Access to Clinical Social Workers.--Section 1833(a)(1)(F)(ii)
    of the Social Security Act (42 U.S.C. 1395l(a)(1)(F)(ii)) is amended by
    striking ``75 percent of the amount determined for payment of a
    psychologist under clause (L)'' and inserting ``85 percent of the fee
    schedule amount provided under section 1848''.
        (b) Access to Clinical Social Worker Services Provided to Residents
    of Skilled Nursing Facilities.--
                (1) In general.--Section 1888(e)(2)(A)(ii) of the Social
            Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by
            inserting ``clinical social worker services,'' after
            ``qualified psychologist services,''.
                (2) Conforming amendment.--Section 1861(hh)(2) of the
            Social Security Act (42 U.S.C. 1395x(hh)(2)) is amended by
            striking ``and other than services furnished to an inpatient of
            a skilled nursing facility which the facility is required to
            provide as a requirement for participation''.
        (c) Access to the Complete Set of Clinical Social Worker
    Services.--Section 1861(hh)(2) of the Social Security Act (42 U.S.C.
    1395x(hh)(2)) is further amended by striking ``for the diagnosis and
    treatment of mental illnesses (other than services'' and inserting
    ``(including services for the diagnosis and treatment of mental
    illnesses or services for health and behavior assessment and
    intervention (identified as of January 1, 2021, by HCPCS codes 96150
    through 96161 (and any succeeding codes)), but not including
    services''.
        (d) Effective Date.--The amendments made by this section shall
    apply to items and services furnished on or after January 1, 2022.

    SEC. 6076. MENTAL HEALTH IN SCHOOLS EXCELLENCE PROGRAM.

        (a) Program To Establish Public-Private Contributions To Increase
    the Available Workforce of School-Based Mental Health Service
    Providers.--
                (1) Program authorized.--The Secretary shall carry out a
            program under which eligible graduate institutions may enter
            into an agreement with the Secretary to cover a portion of the
            cost of attendance of a participating student, which
            contributions shall be matched by equivalent contributions
            towards such cost of attendance by the Secretary.
                (2) Designation of program.--The program under this
            subsection shall be known as the ``Mental Health in Schools
            Excellence Program''.
                (3) Agreements.--The Secretary shall enter into an
            agreement with each eligible graduate institution seeking to
            participate in the program under this section. Each agreement
            shall specify the following:
                        (A) The manner (whether by direct grant,
                    scholarship, or otherwise) in which the eligible
                    graduate institution will contribute to the cost of
                    attendance of a participating student.
                        (B) The maximum amount of the contribution to be
                    made by the eligible graduate institution with respect
                    to any particular participating student in any given
                    academic year.
                        (C) The maximum number of individuals for whom the
                    eligible graduate institution will make contributions
                    in any given academic year.
                        (D) That the eligible graduate institution, in
                    selecting participating students to receive assistance
                    under the program, shall prioritize the participating
                    students described in paragraph (4)(B).
                        (E) Such other matters as the Secretary and the
                    eligible graduate institution determine appropriate.
                (4) Outreach.--The Secretary shall--
                        (A) make publicly available and periodically update
                    on the internet website of the Department of Education
                    a list of the eligible graduate institutions
                    participating in the program under this subsection that
                    shall specify, for each such graduate institution,
                    appropriate information on the agreement between the
                    Secretary and such college or university under
                    paragraph (3); and
                        (B) conduct outreach about the program under this
                    section to participating students who, as
                    undergraduates--
                                (i) received a Federal Pell Grant under
                            section 401 of the Higher Education Act of 1965
                            (20 U.S.C. 1070a); or
                                (ii) attended an institution listed in
                            section 371(a) of the Higher Education Act of
                            1965 (20 U.S.C. 1067q(a)).
                (5) Matching contributions.--The Secretary may provide a
            contribution of up to 50 percent of the cost of attendance of a
            participating student if the eligible graduate institution at
            which such student is enrolled enters into an agreement under
            paragraph (3) with the Secretary to match such contribution.
        (b) Definitions.--In this section:
                (1) Cost of attendance.--The term ``cost of attendance''
            has the meaning given the term in section 472 of the Higher
            Education Act of 1965 (20 U.S.C. 1087ll).
                (2) Eligible graduate institution.--The term ``eligible
            graduate institution'' means an institution of higher education
            that offers a program of study that leads to a graduate
            degree--
                        (A) in school psychology that is accredited or
                    approved by the National Association of School
                    Psychologists' Program Accreditation Board or the
                    Commission on Accreditation of the American
                    Psychological Association and that prepares students in
                    such program for the State licensing or certification
                    examination in school psychology at the specialist
                    level;
                        (B) in an accredited school counseling program that
                    prepares students in such program for the State
                    licensing or certification examination in school
                    counseling;
                        (C) in school social work that is accredited by the
                    Council on Social Work Education and that prepares
                    students in such program for the State licensing or
                    certification examination in school social work;
                        (D) in another school-based mental health field
                    that prepares students in such program for the State
                    licensing or certification examination in such field,
                    if applicable; or
                        (E) in any combination of study described in
                    subparagraphs (A) through (D).
                (3) Institution of higher education.--The term
            ``institution of higher education'' has the meaning given such
            term in section 101 of the Higher Education Act of 1965 (20
            U.S.C. 1001), but excludes any institution of higher education
            described in section 102(a)(1)(C) of such Act.
                (4) Participating student.--The term ``participating
            student'' means an individual who is enrolled in a graduate
            degree program in a school-based mental health field at a
            participating eligible graduate institution.
                (5) School-based mental health field.--The term ``school-
            based mental health field'' means each of the following fields:
                        (A) School counseling.
                        (B) School social work.
                        (C) School psychology.
                        (D) Any other field of study that leads to
                    employment as a school-based mental health services
                    provider, as determined by the Secretary.
                (6) School-based mental health services provider.--The term
            ``school-based mental health services provider'' has the
            meaning given the term in section 4102 of the Elementary and
            Secondary Education Act of 1965 (20 U.S.C. 7112).
                (7) Secretary.--The term ``Secretary'' means the Secretary
            of Education.

    SEC. 6077. SCHOOL SOCIAL WORKERS IMPROVING STUDENT SUCCESS.

        (a) School Social Worker Grants.--
                (1) Purposes.--The purpose of this section is to assist
            States and local educational agencies in hiring additional
            school social workers in order to increase access to mental
            health and other student support services to students in
            elementary and secondary schools in the United States to the
            minimum ratios recommended by the National Association of
            Social Workers, the School Social Work Association of America,
            and the American Council for School Social Work of one school
            social worker for every 250 students, and one school social
            worker for every 50 students when a social worker is providing
            services to students with intensive needs.
                (2) ESEA amendment.--Subpart 4 of part F of title IV of the
            Elementary and Secondary Education Act of 1965 (10 U.S.C. 7271
            et seq.) is amended by adding at the end the following new
            section:

    ``SEC. 4645. GRANTS FOR SCHOOL SOCIAL WORKERS.

        ``(a) Grants Authorized.--
                ``(1) In general.--From the amounts appropriated under
            subsection (g), the Secretary shall award grants to high-need
            local educational agencies to enable such agencies to retain
            school social workers employed by such agencies or to hire
            additional school social workers.
                ``(2) Duration.--A grant awarded under this section shall
            be awarded for a period not to exceed 4 years.
                ``(3) Supplement, not supplant.--Funds made available under
            this section shall be used to supplement, and not to supplant,
            other Federal, State, or local funds used for hiring and
            retaining school social workers.
        ``(b) Application.--
                ``(1) In general.--To be eligible to receive a grant under
            this section, a high-need local educational agency shall submit
            to the Secretary an application at such time, in such manner,
            and containing such information as the Secretary may require.
                ``(2) Contents.--An application submitted under paragraph
            (1) shall include an assurance that each school social worker
            who receives assistance under the grant will provide the
            services described in subsection (d), and a description of the
            specific services to be provided by such social worker.
        ``(c) Use of Funds.--A high-need local educational agency receiving
    a grant under this section--
                ``(1) shall use the grant--
                        ``(A) to achieve a ratio of not less than 1 school
                    social worker for every 250 students served by the
                    agency, by--
                                ``(i) retaining school social workers
                            employed by such agency; or
                                ``(ii)(I) employing additional school
                            social workers; or
                                ``(II) hiring contractors to serve as
                            school social workers only in a case in which--
                                        ``(aa) the local educational agency
                                    demonstrates to the Secretary that the
                                    agency--
                                                ``(AA) has not been able to
                                            employ a sufficient number of
                                            school social workers under
                                            subclause (I) to achieve such
                                            ratio despite strong and
                                            continuing efforts to recruit
                                            and employ school social
                                            workers; and
                                                ``(BB) hiring contractors
                                            is the only viable option to
                                            ensure students have adequate
                                            access to school social work
                                            services; and
                                        ``(bb) each such contractor meets
                                    the requirements of subparagraphs (A)
                                    and (B) of subsection (h)(2); and
                        ``(B) to ensure that each school social worker who
                    receives assistance under such grant provides the
                    services described in subsection (d); and
                ``(2) may use the grant to reimburse school social workers
            who receive assistance under such grant for--
                        ``(A) in the case of a school served by the agency
                    in which the majority of students are higher risk
                    students, to hire or retain additional school social
                    workers in accordance with clauses (i) and (ii) of
                    paragraph (1)(A) to achieve a ratio of not less than 1
                    school social worker for every 50 students;
                        ``(B) travel expenses incurred during home visits
                    and other school-related trips;
                        ``(C) any additional expenses incurred by such
                    social workers in rendering any service described in
                    subsection (d); and
                        ``(D) the cost of clinical social work supervision
                    for such social workers.
        ``(d) Responsibilities of a School Social Worker.--A school social
    worker who receives assistance under a grant under this section shall
    provide the following services:
                ``(1) Identifying high-need students in each school that
            the social worker serves, and targeting services provided at
            the school to such students.
                ``(2) Providing students in each school that the school
            social worker serves, social work services to promote school
            engagement and improve academic outcomes, including--
                        ``(A) counseling and crisis intervention;
                        ``(B) trauma-informed services;
                        ``(C) evidence-based educational, behavioral, and
                    mental health services (such as implementing multi-
                    tiered programs and practices, monitoring progress, and
                    evaluating service effectiveness);
                        ``(D) addressing the social and emotional learning
                    needs of students;
                        ``(E) promoting a school climate and culture
                    conducive to student learning and teaching excellence
                    (such as promoting effective school policies and
                    administrative procedures, enhancing the professional
                    capacity of school personnel, and facilitating
                    engagement between student, family, school, and
                    community);
                        ``(F) providing access to school-based and
                    community based resources (such as promoting a
                    continuum of services, mobilizing resources and
                    promoting assets, and providing leadership,
                    interdisciplinary collaboration, systems coordination,
                    professional consultation, and connecting students and
                    families to resource systems);
                        ``(G) working with students, families, schools, and
                    communities to address barriers to educational
                    attainment (such as homelessness and housing
                    insecurity, lack of transportation, food insecurity,
                    equity, social justice issues, access to quality
                    education, and school, family, and community risk
                    factors);
                        ``(H) providing assistance to schools and teachers
                    to design social-emotional, educational, behavioral,
                    and mental health interventions;
                        ``(I) case management activities to coordinate the
                    delivery of and access to the appropriate social work
                    services to the highest-need students;
                        ``(J) home visits to meet the family of students in
                    need of social work services in the home environment;
                        ``(K) supervising or coordinating district level
                    school social work services; and
                        ``(L) other services the Secretary determines, in
                    partnership with students, educators, and community
                    member voices are necessary to be carried out by such a
                    social worker.
        ``(e) Grant Renewal.--
                ``(1) In general.--A grant awarded under this section may
            be renewed for additional periods with the same duration as the
            original grant period.
                ``(2) Continuing eligibility application.--To be eligible
            for a renewal under this section a high-need local educational
            agency shall submit to the Secretary, for each renewal, a
            report on the progress of such agency in retaining and hiring
            school social workers to achieve the ratio of not less than 1
            school social worker for every 250 students served by the
            agency, and shall include--
                        ``(A) a description of the staffing expansion of
                    school social workers funded through the original grant
                    received under this section; and
                        ``(B) a description of the work conducted by such
                    social workers for higher risk students.
        ``(f) Technical Assistance.--
                ``(1) In general.--The Secretary shall provide technical
            assistance to high-need local educational agencies, including
            such agencies that do not have adequate staff, in applying for
            grants under this section.
                ``(2) Extension of application period.--The Secretary shall
            extend any application period for a grant under this section
            for any high-need local educational agency that--
                        ``(A) submits to the Secretary a written
                    notification of the intent to apply for a grant under
                    this section before requesting technical assistance
                    under paragraph (1); and
                        ``(B) after submitting the notification under
                    paragraph (1), requests such technical assistance.
        ``(g) Authorization for Appropriations.--There is authorized to be
    appropriated to carry out this section, $100,000,000 for each of fiscal
    years 2023 through 2027.
        ``(h) Definitions.--In this section:
                ``(1) High-need local educational agency.--The term `high-
            need local educational agency' has the meaning given the term
            in section 200 of the Higher Education Act of 1965 (20 U.S.C.
            1021).
                ``(2) School social worker.--The term `school social
            worker' means an individual who--
                        ``(A) has a graduate degree in social work from a
                    social work program that is accredited by the Council
                    on Social Work Education; and
                        ``(B) meets all other State and local credentialing
                    requirements for practicing as a social worker in an
                    elementary school or secondary school.''.
        (b) National Technical Assistance Center for School Social Work.--
                (1) In general.--The Secretary of Education, acting through
            the Assistant Secretary, shall establish an evaluation,
            documentation, dissemination, and technical assistance resource
            center to provide appropriate information, training, and
            technical assistance to States, political subdivisions of
            States, federally recognized Indian Tribes, Tribal
            organizations, institutions of higher education, State and
            local educational agencies, and individual students and
            educators with respect to hiring and retaining school social
            workers at elementary schools and secondary schools served by
            local educational agencies.
                (2) Responsibilities of the center.--The center established
            under paragraph (1) shall conduct activities for the purpose
            of--
                        (A) developing and continuing statewide or Tribal
                    strategies for improving the effectiveness of the
                    school social work workforce;
                        (B) studying the costs and effectiveness of school
                    social work programs at institutions of higher
                    education to identify areas of improvement and provide
                    information on relevant issues of importance to State,
                    Tribal, and national policymakers;
                        (C) working with Federal agencies and other State,
                    Tribal, and national stakeholders to collect, evaluate,
                    and disseminate data regarding school social work
                    ratios, outcomes and best practices of school-based
                    mental health services, and impact of expanding the
                    number of school social workers within elementary
                    schools and secondary schools; and
                        (D) establishing partnerships among National,
                    State, Tribal, and local governments, and local
                    educational agencies, institutions of higher education,
                    non-profit organizations, and State and national trade
                    associations for the purposes of--
                                (i) data collection and dissemination;
                                (ii) establishing a school social work
                            workforce development program;
                                (iii) documenting the success of school
                            social work methods on a national level; and
                                (iv) conducting other activities determined
                            appropriate by the Secretary.
                (3) Definitions.--In this subsection:
                        (A) ESEA terms.--Except as otherwise provided, any
                    term used in this subsection that is defined in section
                    8101 of the Elementary and Secondary Education Act of
                    1965 (20 U.S.C. 7801) shall have the meaning given that
                    term in such section.
                        (B) School social worker.--The term ``school social
                    worker'' has the meaning given the term in section
                    4645(h) of the Elementary and Secondary Education Act
                    of 1965, as added by subsection (a).

    SEC. 6078. OPIOID GRANTS TO SUPPORT CAREGIVERS, KINSHIP CARE FAMILIES,
                  AND KINSHIP CAREGIVERS.

        (a) Opioid Grants.--Section 1003(b)(2) of the 21st Century Cures
    Act (42 U.S.C. 290ee-3 note) is amended--
                (1) by redesignating subparagraph (E) as subparagraph (F);
            and
                (2) by inserting after subparagraph (D) the following:
                        ``(E) Supporting opioid abuse prevention and
                    treatment services within a State provided by State and
                    local agencies for children and caregivers, kinship
                    care families, and kinship caregivers through--
                                ``(i) workforce recruitment and training;
                                ``(ii) health care services (including such
                            services described in subparagraph (D)); and
                                ``(iii) foster and adoptive parent
                            recruitment and training.''.
        (b) Definitions.--Section 1003 of the 21st Century Cures Act (42
    U.S.C. 290ee-3 note) is amended--
                (1) by redesignating subsections (h), (i), and (j) as
            subsections (i), (j), and (k), respectively; and
                (2) by inserting after subsection (g) the following:
        ``(h) Definitions.--In this section:
                ``(1) The term `kinship care family' means a family with a
            kinship caregiver.
                ``(2) The term `kinship caregiver' means a relative of a
            child by blood, marriage, or adoption, who--
                        ``(A) lives with the child;
                        ``(B) is the primary caregiver of the child because
                    the biological or adoptive parent of the child is
                    unable or unwilling to serve as the primary caregiver
                    of the child; and
                        ``(C) has a legal relationship to the child or is
                    raising the child informally.''.
        (c) Authorization of Appropriations.--Section 1003(i) of the 21st
    Century Cures Act (42 U.S.C. 290ee-3 note), as redesignated, is amended
    by inserting ``, and $255,000,000 for each of fiscal years 2022 through
    2026'' after ``2021''.
        (d) Set Aside.--Section 1003(j) of the 21st Century Cures Act (42
    U.S.C. 290ee-3 note), as redesignated, is amended--
                (1) by striking ``, and up to'' and inserting ``, up to'';
            and
                (2) by inserting before the period at the end ``, and 1
            percent of such amount for such fiscal year shall be made
            available to carry out subsection (b)(2)(E)''.

    SEC. 6079. ADVANCING STUDENT SERVICES IN SCHOOLS TODAY ACT (ASSIST
                  ACT).

        (a) Program To Increase Mental Health and Substance Use Disorder
    Care Providers in Schools and School-Based Health Centers.--Subpart I
    of part D of title III of the Public Health Service Act (42 U.S.C. 254b
    et seq.) is amended by adding at the end the following:

    ``SEC. 330O. PROGRAM TO INCREASE MENTAL HEALTH AND SUBSTANCE USE
                  DISORDER CARE PROVIDERS IN SCHOOLS AND SCHOOL-BASED
                  HEALTH CENTERS.

        ``(a) In General.--Not later than 3 months after the date of
    enactment of this section, the Secretary, in consultation with the
    Secretary of Education, shall award grants, contracts, or cooperative
    agreements to eligible entities to increase the number of mental health
    and substance use disorder care providers in schools and health centers
    served by such entities.
        ``(b) Application.--An eligible entity seeking an award under this
    section shall submit an application to the Secretary at such time, in
    such manner, and containing such information as the Secretary may
    require, including a description of--
                ``(1) the mental health and substance use disorder needs of
            the student population served by the eligible entity; and
                ``(2) with respect to the student population served by the
            eligible entity, how the eligible entity will ensure that the
            mental health and substance use disorder care providers
            supported by the eligible entity, and the services administered
            by such providers, are culturally competent and linguistically
            appropriate.
        ``(c) Reporting.--
                ``(1) Eligible entity reporting.--Eligible entities
            receiving an award under this section shall submit an annual
            report to the Secretary accompanied by such information as the
            Secretary may require, including--
                        ``(A) the number of mental health and substance use
                    disorder care providers working at the schools or
                    health centers served by the eligible entity, and the
                    number of such providers supported through the award;
                        ``(B) the types of services provided by the mental
                    health and substance use disorder care providers and
                    the efficacy of such services;
                        ``(C) the practices used by the schools or health
                    centers served by the eligible entity to recruit and
                    retain mental health and substance use disorder care
                    providers; and
                        ``(D) the rates of retention of mental health and
                    substance use disorder care providers at the school or
                    health center.
                ``(2) Secretary.--Not later than 18 months after the date
            of enactment of this section, and annually thereafter, the
            Secretary shall submit to Congress a report on the
            effectiveness of the awards under this section.
        ``(d) Definitions.--In this section:
                ``(1) Eligible entity.--The term `eligible entity' means--
                        ``(A) a local educational agency, as defined in
                    section 8101 of the Elementary and Secondary Education
                    Act of 1965;
                        ``(B) an institution of higher education (as
                    defined in section 101 of the Higher Education Act of
                    1965);
                        ``(C) a school operated by the Bureau of Indian
                    Affairs; or
                        ``(D) a school-based health center, as defined in
                    section 399Z-1(a)(3).
                ``(2) Mental health and substance use disorder care
            provider.--The term `behavioral health care provider' means an
            individual who is licensed to provide mental and behavioral
            health services, including--
                        ``(A) a school counselor;
                        ``(B) a school psychologist or any other
                    psychologist;
                        ``(C) a psychiatrist who specializes in child or
                    adolescent psychiatry;
                        ``(D) a school social worker; and
                        ``(E) other providers, as the Secretary determines
                    appropriate.''.
        (b) Increasing the Applicable FMAP for State Expenditures
    Attributable to Certain Behavioral Health Services.--Section 1905 of
    the Social Security Act (42 U.S.C. 1396d) is amended--
                (1) in subsection (b), by striking ``and (ii)'' and
            inserting ``(ii), and (jj)''; and
                (2) by adding at the end the following new subsection:
        ``(jj)(1) Notwithstanding any preceding provision of this section,
    with respect to State expenditures for medical assistance consisting of
    services provided by a behavioral care provider and furnished at a
    school (as defined in section 330O(d) of the Public Health Service Act)
    or at a school-based health center (as defined in section 399Z-1(a)(3)
    of such Act) on or after the date that is 3 months after the date of
    the enactment of this subsection, the Federal medical assistance
    percentage otherwise determined under subsection (b) shall, subject to
    paragraph (2), be equal to 90 percent.
        ``(2) Paragraph (1) shall not apply in the case of State
    expenditures described in such paragraph if application of such
    paragraph would result in a lower Federal medical assistance percentage
    for such expenditures than would otherwise apply without application of
    such paragraph.''.

              TITLE VII--ADDRESSING HIGH IMPACT MINORITY DISEASES

                               Subtitle A--Cancer

    SEC. 7001. LUNG CANCER MORTALITY REDUCTION.

        (a) Findings.--Congress makes the following findings:
                (1) Lung cancer is the leading cause of cancer death for
            both men and women, accounting for 25 percent of all cancer
            deaths.
                (2) Since the National Cancer Act of 1971 (Public Law 92-
            218; 85 Stat. 778), coordinated and comprehensive research has
            raised the 5-year survival rates for breast cancer to 90
            percent, for prostate cancer to 99 percent, and for colon
            cancer to 64 percent.
                (3) The 5-year survival rate for lung cancer is still only
            18 percent, and a similar coordinated and comprehensive
            research effort is required to achieve increases in lung cancer
            survivability rates.
                (4) Sixty percent of lung cancer cases are now diagnosed in
            nonsmokers or former smokers.
                (5) Two-thirds of nonsmokers diagnosed with lung cancer are
            women.
                (6) Certain minority populations, such as African-American
            males, have disproportionately high rates of lung cancer
            incidence and mortality, despite their smoking rate being
            similar to other racial groups.
                (7) Members of the Baby Boomer Generation are entering
            their 60s, the most common age at which people develop lung
            cancer.
                (8) Tobacco addiction and exposure to other lung cancer
            carcinogens such as Agent Orange and other herbicides and
            battlefield emissions are serious problems among military
            personnel and war veterans.
                (9) Significant and rapid improvements in lung cancer
            mortality can be expected through greater use and access to
            lung cancer screening tests for at-risk individuals.
                (10) Recent research has shown that screening with low-dose
            computed tomography scan reduced lung cancer death mortality by
            20 percent for those with a high risk of lung cancer through
            early detection. The Centers for Medicare & Medicaid Services
            supports annual lung cancer screening for high-risk patients
            with low-dose computed tomography.
                (11) Additional strategies are necessary to further enhance
            the existing tests and therapies available to diagnose and
            treat lung cancer in the future.
                (12) The August 2001 Report of the Lung Cancer Progress
            Review Group of the National Cancer Institute stated that
            funding for lung cancer research was ``far below the levels
            characterized for other common malignancies and far out of
            proportion to its massive health impact''.
                (13) The Report of the Lung Cancer Progress Review Group
            identified as its ``highest priority'' the creation of
            integrated, multidisciplinary, multi-institutional research
            consortia organized around the problem of lung cancer rather
            than around specific research disciplines.
                (14) The United States must enhance its response to the
            issues raised in the Report of the Lung Cancer Progress Review
            Group, and this can be accomplished through the establishment
            of a coordinated effort designed to reduce the lung cancer
            mortality rate by 50 percent by 2020 and targeted funding to
            support this coordinated effort.
        (b) Sense of Congress Concerning Investment in Lung Cancer
    Research.--It is the sense of the Congress that--
                (1) lung cancer mortality reduction should be made a
            national public health priority; and
                (2) a comprehensive mortality reduction program coordinated
            by the Secretary of Health and Human Services is justified and
            necessary to adequately address and reduce lung cancer
            mortality.
        (c) Lung Cancer Mortality Reduction Program.--
                (1) In general.--Subpart 1 of part C of title IV of the
            Public Health Service Act (42 U.S.C. 285 et seq.) is amended by
            adding at the end the following:

    ``SEC. 417H. LUNG CANCER MORTALITY REDUCTION PROGRAM.

        ``(a) In General.--Not later than 6 months after the date of the
    enactment of the Health Equity and Accountability Act of 2022, the
    Secretary, in consultation with the Secretary of Defense, the Secretary
    of Veterans Affairs, the Director of the National Institutes of Health,
    the Director of the Centers for Disease Control and Prevention, the
    Commissioner of Food and Drugs, the Administrator of the Centers for
    Medicare & Medicaid Services, the Director of the National Institute on
    Minority Health and Health Disparities, the Administrator of the
    Environmental Protection Agency, and other members of the Lung Cancer
    Advisory Board established under section 7001 of the Health Equity and
    Accountability Act of 2022, shall implement a comprehensive program, to
    be known as the Lung Cancer Mortality Reduction Program, to achieve a
    reduction of at least 25 percent in the mortality rate of lung cancer
    by 2027.
        ``(b) Requirements.--The Program shall include at least the
    following:
                ``(1) With respect to the National Institutes of Health--
                        ``(A) a strategic review and prioritization by the
                    National Cancer Institute of research grants to achieve
                    the goal specified in subsection (a);
                        ``(B) the provision of funds to enable the Airway
                    Biology and Disease Branch of the National Heart, Lung,
                    and Blood Institute to expand its research programs to
                    include predispositions to lung cancer, the
                    interrelationship between lung cancer and other
                    pulmonary and cardiac disease, and the diagnosis and
                    treatment of such diseases;
                        ``(C) the provision of funds to enable the National
                    Institute of Biomedical Imaging and Bioengineering to
                    expedite the development of computer-assisted
                    diagnostic, surgical, treatment, and drug-testing
                    innovations to reduce lung cancer mortality, such as
                    through expansion of the Institute's Quantum Grant
                    Program and Image-Guided Interventions program; and
                        ``(D) the provision of funds to enable the National
                    Institute of Environmental Health Sciences to implement
                    research programs relative to the lung cancer
                    incidence.
                ``(2) With respect to the Food and Drug Administration--
                        ``(A) activities under section 529B of the Federal
                    Food, Drug, and Cosmetic Act; and
                        ``(B) activities under section 561 of the Federal
                    Food, Drug, and Cosmetic Act to expand access to
                    investigational drugs and devices for the diagnosis,
                    monitoring, or treatment of lung cancer.
                ``(3) With respect to the Centers for Disease Control and
            Prevention, the establishment of an early disease research and
            management program under section 1511.
                ``(4) With respect to the Agency for Healthcare Research
            and Quality, the conduct of a biannual review of lung cancer
            screening, diagnostic, and treatment protocols, and the
            issuance of updated guidelines.
                ``(5) The promotion (including education) of lung cancer
            screening within minority and rural populations and the study
            of the effectiveness of efforts to increase such screening.
                ``(6) The cooperation and coordination of all minority and
            health disparity programs within the Department of Health and
            Human Services to ensure that all aspects of the Lung Cancer
            Mortality Reduction Program under this section adequately
            address the burden of lung cancer on minority and rural
            populations.
                ``(7) The cooperation and coordination of all tobacco
            control and cessation programs within agencies of the
            Department of Health and Human Services to achieve the goals of
            the Lung Cancer Mortality Reduction Program under this section
            with particular emphasis on the coordination of drug and other
            cessation treatments with early detection protocols.''.
                (2) Federal food, drug, and cosmetic act.--Subchapter B of
            chapter V of the Federal Food, Drug, and Cosmetic Act (21
            U.S.C. 360aaa et seq.) is amended by adding at the end the
            following:

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

        ``(a) In General.--The provisions of this subchapter shall apply to
    a drug described in subsection (b) to the same extent and in the same
    manner as such provisions apply to a drug for a rare disease or
    condition (as defined in section 526).
        ``(b) Qualified Drugs.--A drug described in this subsection is--
                ``(1) a chemoprevention drug for precancerous conditions of
            the lung;
                ``(2) a drug for targeted therapeutic treatments, including
            any vaccine, for lung cancer; or
                ``(3) a drug to curtail or prevent nicotine addiction.
        ``(c) Board.--The Board established under section 7001 of the
    Health Equity and Accountability Act of 2022 shall monitor the program
    implemented under this section.''.
                (3) Access to unapproved therapies.--Section 561(e) of the
            Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb(e)) is
            amended by inserting before the period the following: ``and
            shall include expanding access to drugs under section 529B,
            with substantial consideration being given to whether the
            totality of information available to the Secretary regarding
            the safety and effectiveness of an investigational drug, as
            compared to the risk of morbidity and death from the disease,
            indicates that a patient may obtain more benefit than risk if
            treated with the drug''.
                (4) CDC.--Title XV of the Public Health Service Act (42
            U.S.C. 300k et seq.) is amended by adding at the end the
            following:

    ``SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT PROGRAM.

        ``The Secretary shall establish and implement an early disease
    research and management program targeted at the high incidence and
    mortality rates of lung cancer among minority and low-income
    populations.''.
        (d) Department of Defense and the Department of Veterans Affairs.--
    The Secretary of Defense and the Secretary of Veterans Affairs, each in
    coordination with the Secretary of Health and Human Services, shall
    engage--
                (1) in the implementation within the Department of Defense
            and the Department of Veterans Affairs of an early detection
            and disease management research program for military personnel
            and veterans whose smoking history and exposure to carcinogens
            during active duty service has increased their risk for lung
            cancer; and
                (2) in the implementation of coordinated care programs for
            military personnel and veterans diagnosed with lung cancer.
        (e) Lung Cancer Advisory Board.--
                (1) In general.--The Secretary of Health and Human Services
            shall convene a Lung Cancer Advisory Board (referred to in this
            section as the ``Board'')--
                        (A) to monitor the programs established under this
                    section (and the amendments made by this section); and
                        (B) to provide annual reports to the Congress
                    concerning benchmarks, expenditures, lung cancer
                    statistics, and the public health impact of such
                    programs.
                (2) Composition.--The Board shall be comprised of--
                        (A) the Secretary of Health and Human Services;
                        (B) the Secretary of Defense;
                        (C) the Secretary of Veterans Affairs; and
                        (D) 2 representatives each from the fields of
                    clinical medicine focused on lung cancer, lung cancer
                    research, imaging, drug development, and lung cancer
                    advocacy, to be appointed by the Secretary of Health
                    and Human Services.
        (f) Authorization of Appropriations.--
                (1) In general.--To carry out this section (and the
            amendments made by this section), there are authorized to be
            appropriated $75,000,000 for fiscal year 2023 and such sums as
            may be necessary for each of fiscal years 2024 through 2026.
                (2) Lung cancer mortality reduction program.--The amounts
            appropriated under paragraph (1) shall be allocated as follows:
                        (A) $25,000,000 for fiscal year 2023, and such sums
                    as may be necessary for each of fiscal years 2024
                    through 2026, for the activities described in section
                    417H(b)(1)(B) of the Public Health Service Act, as
                    added by subsection (d);
                        (B) $25,000,000 for fiscal year 2023, and such sums
                    as may be necessary for each of fiscal years 2024
                    through 2026, for the activities described in section
                    417H(b)(1)(C) of the Public Health Service Act;
                        (C) $10,000,000 for fiscal year 2023, and such sums
                    as may be necessary for each of fiscal years 2024
                    through 2026, for the activities described in section
                    417H(b)(1)(D) of the Public Health Service Act; and
                        (D) $15,000,000 for fiscal year 2023, and such sums
                    as may be necessary for each of fiscal years 2024
                    through 2026, for the activities described in section
                    417H(b)(3) of the Public Health Service Act.

    SEC. 7002. EXPANDING PROSTATE CANCER RESEARCH, OUTREACH, SCREENING,
                  TESTING, ACCESS, AND TREATMENT EFFECTIVENESS.

        (a) Findings.--Congress makes the following findings:
                (1) Prostate cancer is the second leading cause of cancer
            death among men.
                (2) In 2020, an estimated 191,930 individuals in the United
            States will be diagnosed with prostate cancer and approximately
            33,330 will die from the disease.
                (3) Roughly 2,000,000 to 3,000,000 people in the United
            States are living with a diagnosis of prostate cancer and its
            consequences.
                (4) Although prostate cancer generally affects older
            individuals, younger men are also at risk for the disease, and
            when prostate cancer appears in early middle age, it frequently
            takes on a more aggressive form.
                (5) There are significant racial and ethnic disparities
            that demand attention, for example, African Americans have
            prostate cancer mortality rates that are more than double those
            in the White population.
                (6) Underserved rural populations have higher rates of
            mortality compared to their urban counterparts, and innovative
            and cost-efficient methods to improve rural access to high-
            quality care should take advantage of advances in telehealth to
            diagnose and treat prostate cancer when appropriate.
                (7) Certain populations of veterans may have nearly twice
            the incidence of prostate cancer as the general population of
            the United States.
                (8) Urologists may constitute the specialists who diagnose
            and treat the vast majority of prostate cancer patients.
                (9) Although much basic and translational research has been
            completed and much is currently known, there are still many
            unanswered questions, such as the extent to which known
            disparities are attributable to disease etiology, access to
            care, or education and awareness in the community.
                (10) Causes of prostate cancer are not known. There is not
            good information regarding how to differentiate accurately,
            early on, between aggressive and indolent forms of the disease.
            As a result, there is significant overtreatment in prostate
            cancer. There are no treatments that can durably arrest growth
            or cure prostate cancer once it has metastasized.
                (11) A significant proportion of cases may be clinically
            indolent and ``overdiagnosed'', resulting in significant
            overtreatment. More accurate tests will allow men and their
            families to face less physical, psychological, financial, and
            emotional trauma, and billions of dollars could be saved in
            private and public health care systems.
                (12) Prostate cancer research and health care programs
            across Federal agencies should be coordinated to improve
            accountability and actively encourage the translation of
            research into practice and to identify and implement best
            practices in order to foster an integrated and consistent focus
            on effective prevention, diagnosis, and treatment of the
            disease.
        (b) Prostate Cancer Coordination and Education.--
                (1) Interagency prostate cancer coordination and education
            task force.--Not later than 180 days after the date of the
            enactment of this Act, the Secretary of Veterans Affairs, in
            cooperation with the Secretary of Defense and the Secretary of
            Health and Human Services, shall establish an Interagency
            Prostate Cancer Coordination and Education Task Force (in this
            section referred to as the ``Prostate Cancer Task Force'').
                (2) Duties.--The Prostate Cancer Task Force shall--
                        (A) develop a summary of advances in prostate
                    cancer research supported or conducted by Federal
                    agencies relevant to the diagnosis, prevention, and
                    treatment of prostate cancer, including psychosocial
                    impairments related to prostate cancer treatment, and
                    compile a list of best practices that warrant broader
                    adoption in health care programs;
                        (B) consider establishing, and advocating for, a
                    guidance to enable physicians to allow screening of men
                    who are age 74 or older, on a case-by-case basis,
                    taking into account quality of life and family history
                    of prostate cancer;
                        (C) share and coordinate information on research
                    and health care program activities by the Federal
                    Government, including activities related to--
                                (i) determining how to improve research and
                            health care programs, including psychosocial
                            impairments related to prostate cancer
                            treatment;
                                (ii) identifying any gaps in the overall
                            research inventory and in health care programs;
                                (iii) identifying opportunities to promote
                            translation of research into practice; and
                                (iv) maximizing the effects of Federal
                            Government efforts by identifying opportunities
                            for collaboration and leveraging of resources
                            in research and health care programs that serve
                            individuals who are susceptible to or diagnosed
                            with prostate cancer;
                        (D) develop a comprehensive interagency strategy
                    and advise relevant Federal agencies in the
                    solicitation of proposals for collaborative,
                    multidisciplinary research and health care programs,
                    including proposals to evaluate factors that may be
                    related to the etiology of prostate cancer, that
                    would--
                                (i) result in innovative approaches to
                            study emerging scientific opportunities or
                            eliminate knowledge gaps in research to improve
                            the prostate cancer research portfolio of the
                            Federal Government; and
                                (ii) outline key research questions,
                            methodologies, and knowledge gaps;
                        (E) develop a coordinated message related to
                    screening and treatment for prostate cancer to be
                    reflected in educational and beneficiary materials for
                    Federal health programs as such materials are updated;
                    and
                        (F) not later than 2 years after the date of the
                    establishment of the Prostate Cancer Task Force, submit
                    to the expert advisory panels appointed under paragraph
                    (4) to be reviewed and returned within 30 days, and
                    then within 90 days submitted to Congress,
                    recommendations--
                                (i) regarding any appropriate changes to
                            research and health care programs, including
                            recommendations to improve the research
                            portfolio of the Department of Veterans
                            Affairs, the Department of Defense, the
                            National Institutes of Health, and other
                            Federal agencies to ensure that scientifically
                            based strategic planning is implemented in
                            support of research and health care program
                            priorities;
                                (ii) designed to ensure that the research
                            and health care programs and activities of the
                            Department of Veterans Affairs, the Department
                            of Defense, the Department of Health and Human
                            Services, and other Federal agencies are free
                            of unnecessary duplication;
                                (iii) regarding public participation in
                            decisions relating to prostate cancer research
                            and health care programs to increase the
                            involvement of patient advocates, community
                            organizations, and medical associations
                            representing a broad geographical area;
                                (iv) on how to best disseminate information
                            on prostate cancer research and progress
                            achieved by health care programs;
                                (v) about how to expand partnerships
                            between public entities, including Federal
                            agencies, and private entities to encourage
                            collaborative, cross-cutting research and
                            health care delivery;
                                (vi) assessing any cost savings and
                            efficiencies realized through the efforts
                            identified in, and supported through, this
                            subsection and recommending expansion of those
                            efforts that have proved most promising while
                            also ensuring against any conflicts in
                            directives in law;
                                (vii) identifying key priority action items
                            from among the recommendations; and
                                (viii) with respect to the level of funding
                            needed by each agency to implement the
                            recommendations contained in the report.
                (3) Members of the prostate cancer task force.--The
            Prostate Cancer Task Force shall be comprised of
            representatives from such Federal agencies as the head of each
            such applicable agency determines necessary, so as to
            coordinate a uniform message relating to prostate cancer
            screening and treatment where appropriate, including
            representatives of each of the following:
                        (A) The Department of Veterans Affairs, including
                    representatives of each relevant program area of the
                    Department of Veterans Affairs.
                        (B) The Prostate Cancer Research Program of the
                    Congressionally Directed Medical Research Program of
                    the Department of Defense.
                        (C) The Department of Health and Human Services,
                    including, at a minimum, representatives of each of the
                    following:
                                (i) The National Institutes of Health.
                                (ii) National research institutes and
                            centers, including the National Cancer
                            Institute, the National Institute of Allergy
                            and Infectious Diseases, and the Office of
                            Minority Health.
                                (iii) The Centers for Medicare & Medicaid
                            Services.
                                (iv) The Food and Drug Administration.
                                (v) The Centers for Disease Control and
                            Prevention.
                                (vi) The Agency for Healthcare Research and
                            Quality.
                                (vii) The Health Resources and Services
                            Administration.
                (4) Appointing expert advisory panels.--The Prostate Cancer
            Task Force shall appoint expert advisory panels, as the task
            force determines appropriate, to provide input and concurrence
            from--
                        (A) individuals and organizations from the medical,
                    prostate cancer patient and advocate, research, and
                    delivery communities with expertise in prostate cancer
                    diagnosis, treatment, and research, including
                    practicing urologists, primary care providers, and
                    others; and
                        (B) individuals with expertise in education and
                    outreach to underserved populations affected by
                    prostate cancer.
                (5) Meetings.--The Prostate Cancer Task Force shall convene
            not less frequently than twice each year, or more frequently as
            the Secretary of Veterans Affairs determines to be appropriate.
                (6) Federal advisory committee act.--The Federal Advisory
            Committee Act (5 U.S.C. App.) shall apply to the Prostate
            Cancer Task Force.
                (7) Sunset date.--The Prostate Cancer Task Force shall
            terminate on September 30, 2025.
        (c) Prostate Cancer Research.--
                (1) Research coordination program.--
                        (A) In general.--The Secretary of Veterans Affairs,
                    in coordination with the Secretary of Defense and the
                    Secretary of Health and Human Services, shall establish
                    and carry out a program to coordinate and intensify
                    prostate cancer research.
                        (B) Elements.--The program established under
                    subparagraph (A) shall--
                                (i) develop advances in diagnostic and
                            prognostic methods and tests, including
                            biomarkers and an improved prostate cancer
                            screening blood test, including improvements or
                            alternatives to the prostate specific antigen
                            test and additional tests to distinguish
                            indolent from aggressive disease;
                                (ii) develop a better understanding of the
                            etiology of the disease (including an analysis
                            of lifestyle factors proven to be involved in
                            higher rates of prostate cancer, such as
                            obesity and diet, and in different ethnic,
                            racial, and socioeconomic groups, such as the
                            African-American, Latino or Hispanic, and
                            American Indian populations and men with a
                            family history of prostate cancer) to improve
                            prevention efforts;
                                (iii) expand basic research into prostate
                            cancer, including studies of fundamental
                            molecular and cellular mechanisms;
                                (iv) identify and provide clinical testing
                            of novel agents for the prevention and
                            treatment of prostate cancer;
                                (v) establish clinical registries for
                            prostate cancer;
                                (vi) use the National Institute of
                            Biomedical Imaging and Bioengineering and the
                            National Cancer Institute for assessment of
                            appropriate imaging modalities; and
                                (vii) address such other matters relating
                            to prostate cancer research as may be
                            identified by the Federal agencies
                            participating in the program under this
                            subsection.
                        (C) Underserved minority grant program.--In
                    carrying out the program established under subparagraph
                    (A), the Secretary shall--
                                (i) award grants to eligible entities to
                            carry out components of the research outlined
                            in subparagraph (B);
                                (ii) integrate and build upon existing
                            knowledge gained from comparative effectiveness
                            research; and
                                (iii) recognize and address--
                                        (I) the racial and ethnic
                                    disparities in the incidence and
                                    mortality rates of prostate cancer and
                                    men with a family history of prostate
                                    cancer;
                                        (II) any barriers in access to care
                                    and participation in clinical trials
                                    that are specific to racial, ethnic,
                                    and other underserved minorities and
                                    men with a family history of prostate
                                    cancer;
                                        (III) outreach and educational
                                    efforts to raise awareness among the
                                    populations described in subclause
                                    (II); and
                                        (IV) appropriate access and
                                    utilization of imaging modalities.
                (2) Prostate cancer advisory board.--
                        (A) In general.--There is established in the Office
                    of the Chief Scientist of the Food and Drug
                    Administration a Prostate Cancer Scientific Advisory
                    Board.
                        (B) Duties.--The board established under
                    subparagraph (A) shall be responsible for accelerating
                    real-time sharing of the latest research data and
                    accelerating movement of new medicines for the
                    treatment of prostate cancer to patients.
        (d) Telehealth and Rural Access Pilot Projects.--
                (1) Establishment of pilot projects.--
                        (A) In general.--The Secretary of Veterans Affairs,
                    in cooperation with the Secretary of Defense and the
                    Secretary of Health and Human Services (referred to in
                    this subsection collectively as the ``Secretaries'')
                    shall establish 4-year telehealth pilot projects for
                    the purpose of analyzing the clinical outcomes and
                    cost-effectiveness associated with telehealth services
                    in a variety of geographic areas that contain high
                    proportions of medically underserved populations,
                    including African Americans, Latinos or Hispanics,
                    American Indians or Alaska Natives, and those in rural
                    areas.
                        (B) Efficient and effective care.--Pilot projects
                    established under subparagraph (A) shall promote
                    efficient use of specialist care through better
                    coordination of primary care and physician extender
                    teams in underserved areas and more effectively employ
                    tumor boards to better counsel patients.
                (2) Eligible entities.--
                        (A) In general.--The Secretaries shall select
                    eligible entities to participate in the pilot projects
                    established under this subsection.
                        (B) Priority.--In selecting eligible entities to
                    participate in the pilot projects under this
                    subsection, the Secretaries shall give priority to
                    entities located in medically underserved areas,
                    particularly those that include African Americans,
                    Latinos and Hispanics, and facilities of the Indian
                    Health Service, including facilities operated by the
                    Indian Health Service, tribally operated facilities,
                    and Urban Indian Clinics, and those in rural areas.
                (3) Evaluation.--The Secretaries shall, through the pilot
            projects, evaluate--
                        (A) the effective and economic delivery of care in
                    diagnosing and treating prostate cancer with the use of
                    telehealth services in medically underserved and Tribal
                    areas including collaborative uses of health
                    professionals and integration of the range of
                    telehealth and other technologies;
                        (B) the effectiveness of improving the capacity of
                    nonmedical providers and nonspecialized medical
                    providers to provide health services for prostate
                    cancer in medically underserved and Tribal areas,
                    including the exploration of innovative medical home
                    models with collaboration between urologists, other
                    relevant medical specialists, including oncologists,
                    radiologists, and primary care teams, and coordination
                    of care through the efficient use of primary care teams
                    and physician extenders; and
                        (C) the effectiveness of using telehealth services
                    to provide prostate cancer treatment in medically
                    underserved areas, including the use of tumor boards to
                    facilitate better patient counseling.
                (4) Report.--Not later than 1 year after the completion of
            the pilot projects under this subsection, the Secretaries shall
            submit to Congress a report describing the outcomes of such
            pilot projects, including any cost savings and efficiencies
            realized, and providing recommendations, if any, for expanding
            the use of telehealth services.
        (e) Education and Awareness.--
                (1) Campaign.--
                        (A) In general.--The Secretary of Veterans Affairs
                    shall develop a national education campaign for
                    prostate cancer.
                        (B) Elements.--The campaign developed under
                    subparagraph (A) shall involve the use of written
                    educational materials and public service announcements
                    consistent with the findings of the Prostate Cancer
                    Task Force under subsection (c) that are intended to
                    encourage men to seek prostate cancer screening when
                    appropriate.
                (2) Racial disparities and the population of men with a
            family history of prostate cancer.--In developing the campaign
            under paragraph (1), the Secretary shall ensure that
            educational materials and public service announcements used in
            the campaign are more readily available in communities
            experiencing racial disparities in the incidence and mortality
            rates of prostate cancer and to men of any race classification
            with a family history of prostate cancer.
                (3) Grants.--In carrying out the campaign under this
            subsection, the Secretary shall award grants to nonprofit
            private entities to enable such entities to test alternative
            outreach and education strategies.
        (f) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section for the period of fiscal years
    2023 through 2027 an amount equal to the amount of savings for the
    Federal Government projected to be achieved over such period by
    implementation of this section.

    SEC. 7003. PROSTATE RESEARCH, IMAGING, AND MEN'S EDUCATION (PRIME).

        (a) Findings.--Congress makes the following findings:
                (1) Prostate cancer has reached epidemic proportions,
            particularly among African-American men, and strikes and kills
            men in numbers comparable to the number of women who lose their
            lives from breast cancer.
                (2) Life-saving breakthroughs in screening, diagnosis, and
            treatment of breast cancer resulted from the development of
            advanced imaging technologies led by the Federal Government.
                (3) Men should have accurate and affordable prostate cancer
            screening exams and minimally invasive treatment tools, similar
            to what women have for breast cancer.
                (4) While it is important for men to take advantage of
            current prostate cancer screening techniques, a recent NCI-
            funded study demonstrated that the most common available
            methods of detecting prostate cancer (PSA blood test and
            physical exams) are not foolproof, causing numerous false
            alarms and false reassurances.
                (5) The absence of advanced imaging technologies for
            prostate cancer causes the lack of accurate information
            critical for clinical decisions, resulting in missed cancers
            and lost lives, as well as unnecessary and costly medical
            procedures, with related complications.
                (6) With prostate imaging tools, men and their families
            would face less physical, psychological, financial, and
            emotional trauma and billions of dollars could be saved in
            private and public health care systems.
        (b) Research and Development of Prostate Cancer Imaging
    Technologies.--
                (1) Expansion of research.--The Secretary of Health and
            Human Services (referred to in this section as the
            ``Secretary''), acting through the Director of the National
            Institutes of Health and the Administrator of the Health
            Resources and Services Administration, and in consultation with
            the Secretary of Defense, shall carry out a program to expand
            and intensify research to develop innovative advanced imaging
            technologies for prostate cancer detection, diagnosis, and
            treatment comparable to state-of-the-art mammography
            technologies.
                (2) Early stage research.--In implementing the program
            under paragraph (1), the Secretary, acting through the
            Administrator of the Health Resources and Services
            Administration, shall carry out a grant program to encourage
            the early stages of research in prostate imaging to develop and
            implement new ideas, proof of concepts, and pilot studies for
            high-risk technologic innovation in prostate cancer imaging
            that would have a high potential impact for improving patient
            care, including individualized care, quality of life, and cost-
            effectiveness.
                (3) Large scale later stage research.--In implementing the
            program under paragraph (1), the Secretary, acting through the
            Director of the National Institutes of Health, shall utilize
            the National Institute of Biomedical Imaging and Bioengineering
            and the National Cancer Institute for advanced stages of
            research in prostate imaging, including technology development
            and clinical trials for projects determined by the Secretary to
            have demonstrated promising preliminary results and proof of
            concept.
                (4) Interdisciplinary private-public partnerships.--In
            developing the program under paragraph (1), the Secretary,
            acting through the Administrator of the Health Resources and
            Services Administration, shall establish interdisciplinary
            private-public partnerships to develop and implement research
            strategies for expedited innovation in imaging and image-guided
            treatment and to conduct such research.
                (5) Racial disparities.--In developing the program under
            paragraph (1), the Secretary shall recognize and address--
                        (A) the racial disparities in the incidences of
                    prostate cancer and mortality rates with respect to
                    such disease; and
                        (B) any barriers in access to care and
                    participation in clinical trials that are specific to
                    racial minorities.
                (6) Authorization of appropriations.--
                        (A) In general.--Subject to subparagraph (B), there
                    is authorized to be appropriated to carry out this
                    subsection, $100,000,000 for each of fiscal years 2023
                    through 2027.
                        (B) Specific allocations.--Of the amount authorized
                    to be appropriated under subparagraph (A) for each of
                    the fiscal years described in such subparagraph--
                                (i) no less than 10 percent may be used to
                            carry out the grant program under paragraph
                            (2); and
                                (ii) no more than 1 percent may be used to
                            carry out paragraph (4).
        (c) Public Awareness and Education Campaign.--
                (1) National campaign.--The Secretary shall carry out a
            national campaign to increase the awareness and knowledge of
            individuals in the United States with respect to the need for
            prostate cancer screening and for improved detection
            technologies.
                (2) Requirements.--The national campaign conducted under
            this subsection shall include--
                        (A) roles for the Health Resources Services
                    Administration, the Office of Minority Health of the
                    Department of Health and Human Services, the Centers
                    for Disease Control and Prevention, and the Office of
                    Minority Health and Health Equity of the Centers for
                    Disease Control and Prevention; and
                        (B) the development and distribution of written
                    educational materials, and the development and placing
                    of public service announcements, that are intended to
                    encourage men to seek prostate cancer screening and to
                    create awareness of the need for improved imaging
                    technologies for prostate cancer screening and
                    diagnosis, including in vitro blood testing and imaging
                    technologies.
                (3) Racial disparities.--In developing the national
            campaign under paragraph (1), the Secretary shall recognize and
            address--
                        (A) the racial disparities in the incidences of
                    prostate cancer and mortality rates with respect to
                    such disease; and
                        (B) any barriers in access to care and
                    participation in clinical trials that are specific to
                    racial minorities.
                (4) Grants.--The Secretary shall establish a program to
            award grants to nonprofit private entities to enable such
            entities to test alternative outreach and education strategies
            to increase the awareness and knowledge of individuals in the
            United States with respect to the need for prostate cancer
            screening and improved imaging technologies.
                (5) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this subsection $10,000,000 for
            each of fiscal years 2023 through 2027.
        (d) Improving Prostate Cancer Screening Blood Tests.--
                (1) In general.--The Secretary, in coordination with the
            Secretary of Defense, shall support research to develop an
            improved prostate cancer screening blood test using in-vitro
            detection.
                (2) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this subsection, $20,000,000
            for each of fiscal years 2023 through 2027.
        (e) Reporting and Compliance.--
                (1) Report and strategy.--Not later than 12 months after
            the date of the enactment of this Act, the Secretary shall
            submit to Congress a report that details the strategy of the
            Secretary for implementing the requirements of this section and
            the status of such efforts.
                (2) Full compliance.--Not later than 36 months after the
            date of the enactment of this Act, and annually thereafter, the
            Secretary shall submit to Congress a report that--
                        (A) describes the research and development and
                    public awareness and education campaigns funded under
                    this section;
                        (B) provides evidence that projects involving high-
                    risk, high impact technologic innovation, proof of
                    concept, and pilot studies are prioritized;
                        (C) provides evidence that the Secretary recognizes
                    and addresses any barriers in access to care and
                    participation in clinical trials that are specific to
                    racial minorities in the implementation of this
                    section;
                        (D) contains assurances that all the other
                    provisions of this section are fully implemented; and
                        (E) certifies compliance with the provisions of
                    this section, or in the case of a Federal agency that
                    has not complied with any of such provisions, an
                    explanation as to such failure to comply.

    SEC. 7004. PROSTATE CANCER DETECTION RESEARCH AND EDUCATION.

        (a) Plan To Develop and Validate a Test or Tests for Prostate
    Cancer.--
                (1) In general.--The Secretary of Health and Human Services
            (referred to in this section as the ``Secretary''), acting
            through the Director of the National Institutes of Health,
            shall establish an advisory council on prostate cancer
            (referred to in this section as the ``advisory council'') to
            draft a plan for the development and validation of an accurate
            test or tests, such as biomarkers or imaging, to detect and
            diagnose prostate cancer.
                (2) Advisory council.--
                        (A) Membership.--
                                (i) Federal members.--The advisory council
                            shall be comprised of the following experts:
                                        (I) A designee of the Centers for
                                    Disease Control and Prevention.
                                        (II) A designee of the Centers for
                                    Medicare & Medicaid Services.
                                        (III) A designee of the Office of
                                    the Director of the National Cancer
                                    Institute.
                                        (IV) A designee of the Director of
                                    the Department of Defense
                                    Congressionally Directed Medical
                                    Research Programs.
                                        (V) A designee of the Director of
                                    the National Institute of Biomedical
                                    Imaging and Bioengineering.
                                        (VI) A designee of the Director of
                                    the National Institute of General
                                    Medical Sciences.
                                        (VII) A designee of the Director of
                                    the National Institute on Minority
                                    Health and Health Disparities.
                                        (VIII) A designee of the Director
                                    of the National Institutes of Health.
                                        (IX) A designee of the Commissioner
                                    of Food Drugs.
                                        (X) A designee of the Director of
                                    the Agency for Healthcare Research and
                                    Quality.
                                        (XI) A designee of the Director of
                                    the Telemedicine and Advanced
                                    Technology Research Center of the
                                    Department of Defense.
                                (ii) Non-federal members.--In addition to
                            the members described in clause (i), the
                            advisory council shall include 8 expert members
                            from outside the Federal Government to be
                            appointed by the Secretary, which shall
                            include--
                                        (I) 2 prostate cancer patient
                                    advocates;
                                        (II) 2 health care providers with a
                                    range of expertise and experience in
                                    prostate cancer; and
                                        (III) 4 leading researchers with
                                    prostate cancer-related expertise in a
                                    range of clinical disciplines.
                        (B) Meetings.--The advisory council shall meet
                    quarterly and such meetings shall be open to the
                    public.
                        (C) Advice.--The advisory council shall advise the
                    Secretary, or the Secretary's designee.
                        (D) Annual report.--Not later than 1 year after the
                    date of enactment of this Act, the advisory council
                    shall provide to the Secretary, or the Secretary's
                    designee, and Congress--
                                (i) an initial evaluation of all federally
                            funded efforts in prostate cancer research
                            relating to the development and validation of
                            an accurate test or tests to detect and
                            diagnose prostate cancer;
                                (ii) a plan for the development and
                            validation of a reliable test or tests for the
                            detection and accurate diagnosis of prostate
                            cancer; and
                                (iii) a set of standards for prostate
                            cancer screening, developed in coordination
                            with the United States Preventive Services Task
                            Force, to ensure that any tools for screening,
                            detection, and diagnosis developed in
                            accordance with the plan under clause (ii) will
                            meet the requirements of the Task Force for
                            recommendation as a proven preventive or
                            diagnostic service.
                        (E) Termination.--The advisory council shall
                    terminate on December 31, 2026.
                (3) Funding.--Notwithstanding any other provision of law,
            the Secretary may make available $1,000,000, from any
            unobligated amounts appropriated to the National Institutes of
            Health, for each of fiscal years 2023 through 2027 to carry out
            this subsection.
        (b) Coordination and Intensification of Prostate Cancer Research.--
                (1) In general.--The Director of the National Institutes of
            Health, in consultation with the Secretary of Defense, shall
            coordinate and intensify research in accordance with the plan
            provided under subsection (a)(2)(D)(ii), with particular
            attention provided to leveraging existing research to develop
            and validate a test or tests, such as biomarkers or imaging, to
            detect and accurately diagnose prostate cancer in order to
            improve quality of life for millions of individuals in the
            United States, and decrease health care system costs.
                (2) Funding.--Notwithstanding any other provision of law,
            the Secretary may make available $30,000,000, from any
            unobligated amounts appropriated to the National Institutes of
            Health, for each of fiscal years 2024 through 2028 to carry out
            this subsection.

    SEC. 7005. NATIONAL PROSTATE CANCER COUNCIL.

        (a) National Prostate Cancer Council.--
                (1) Establishment.--There is established in the Office of
            the Secretary of Health and Human Services (referred to in this
            section as the ``Secretary'') the National Prostate Cancer
            Council on Screening, Early Detection, Assessment, and
            Monitoring of Prostate Cancer (referred to in this section as
            the ``Council'').
                (2) Purpose of the council.--The Council shall--
                        (A) develop and implement a national strategic plan
                    for the accelerated creation, advancement, and testing
                    of diagnostic tools to improve screening, early
                    detection, assessment, and monitoring of prostate
                    cancer, including--
                                (i) early detection of aggressive prostate
                            cancer to save lives;
                                (ii) monitoring of tumor response to
                            treatment, including recurrence and
                            progression; and
                                (iii) accurate assessment and surveillance
                            of indolent disease to reduce unnecessary
                            biopsies and treatment;
                        (B) provide information and coordination of
                    prostate cancer research and services across all
                    Federal agencies;
                        (C) review diagnostic tools and their overall
                    effectiveness at screening, detecting, assessing, and
                    monitoring of prostate cancer;
                        (D) evaluate all programs in prostate cancer that
                    are in existence on the date of enactment of this Act,
                    including Federal budget requests and approvals and
                    public-private partnerships;
                        (E) submit an annual report to the Secretary and
                    Congress on the creation and implementation of the
                    national strategic plan under subparagraph (A); and
                        (F) ensure the inclusion of men at high-risk for
                    prostate cancer, including men from minority ethnic and
                    racial populations and men who are least likely to
                    receive care, in clinical, research, and service
                    efforts, with the purpose of decreasing health
                    disparities.
                (3) Membership.--
                        (A) Federal members.--The Council shall be led by
                    the Secretary or the Secretary's designee and comprised
                    of the following experts:
                                (i) Two representatives of the National
                            Institutes of Health, including 1
                            representative of the National Institute of
                            Biomedical Imaging and Bioengineering and 1
                            representative of the National Cancer
                            Institute.
                                (ii) A representative of the Centers for
                            Disease Control and Prevention.
                                (iii) A representative of the Centers for
                            Medicare & Medicaid Services.
                                (iv) A designee of the Director of the
                            Department of Defense Congressionally Directed
                            Medical Research Programs.
                                (v) A designee of the Director of the
                            Office of Minority Health.
                                (vi) A representative of the Food and Drug
                            Administration.
                                (vii) A representative of the Agency for
                            Healthcare Research and Quality.
                        (B) Non-federal members.--In addition to the
                    members described in subparagraph (A), the Council
                    shall include 14 expert members from outside the
                    Federal Government, which shall include--
                                (i) 6 prostate cancer patient advocates,
                            including--
                                        (I) 2 patient-survivors;
                                        (II) 2 caregivers of prostate
                                    cancer patients; and
                                        (III) 2 representatives from
                                    national prostate cancer disease
                                    organizations that fund research or
                                    have demonstrated experience in
                                    providing assistance to patients,
                                    families, and medical professionals,
                                    including information on health care
                                    options, education, and referral; and
                                (ii) 8 health care stakeholders with
                            specific expertise in prostate cancer research
                            in the critical areas of clinical expertise,
                            including medical oncology, radiology,
                            radiation oncology, urology, and pathology.
                (4) Meetings.--The Council shall meet quarterly and
            meetings shall be open to the public.
                (5) Advice.--The Council shall advise the Secretary, or the
            Secretary's designee.
                (6) Annual report.--The Council shall submit annual
            reports, beginning not later than 1 year after the date of
            enactment of this Act, to the Secretary or the Secretary's
            designee and to Congress. The annual report shall include--
                        (A) in the first year--
                                (i) an evaluation of all federally funded
                            efforts in prostate cancer research and gaps
                            relating to the development and validation of
                            diagnostic tools for prostate cancer; and
                                (ii) recommendations for priority actions
                            to expand, eliminate, coordinate, or condense
                            programs based on the performance, mission, and
                            purpose of the programs; and
                        (B) annually thereafter for 5 years--
                                (i) an outline for the development and
                            implementation of a national research plan for
                            creation and validation of accurate diagnostic
                            tools to improve prostate cancer care in
                            accordance with paragraph (1);
                                (ii) roles for the National Cancer
                            Institute, National Institute on Minority
                            Health and Health Disparities, and the Office
                            of Minority Health of the Department of Health
                            and Human Services;
                                (iii) an analysis of the disparities in the
                            incidence and mortality rates of prostate
                            cancer in men at high risk of the disease,
                            including individuals with family history,
                            increasing age, or African-American heritage;
                            and
                                (iv) a review of the progress towards the
                            realization of the proposed strategic plan.
                (7) Termination.--The Council shall terminate on December
            31, 2027.

    SEC. 7006. IMPROVED MEDICAID COVERAGE FOR CERTAIN BREAST AND CERVICAL
                  CANCER PATIENTS IN THE TERRITORIES.

        (a) Elimination of Funding Limitations.--Section 1108(g)(4) of the
    Social Security Act (42 U.S.C. 1308(g)(4)) is amended--
                (1) by striking ``paragraphs (1), (2), (3), and (4) of'';
            and
                (2) by adding at the end the following: ``With respect to
            fiscal years beginning with fiscal year 2023, payment for
            medical assistance for individuals who are eligible for such
            assistance only on the basis of section
            1902(a)(10)(A)(ii)(XVIII) shall not be taken into account in
            applying subsection (f) (as increased in accordance with this
            subsection) to Puerto Rico, the Virgin Islands, Guam, the
            Northern Mariana Islands, or American Samoa for such fiscal
            year.''.
        (b) Application of Enhanced FMAP for Highest State.--Section
    1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by adding at the
    end the following: ``Notwithstanding the first sentence of this
    subsection, with respect to medical assistance described in clause (4)
    of such sentence that is furnished in Puerto Rico, the Virgin Islands,
    Guam, the Northern Mariana Islands, or American Samoa in a fiscal year,
    the Federal medical assistance percentage is equal to the highest such
    percentage applied under such clause for such fiscal year for any of
    the 50 States or the District of Columbia that provides such medical
    assistance for any portion of such fiscal year.''.
        (c) Effective Date.--The amendments made by this section shall
    apply to payment for medical assistance for items and services
    furnished on or after October 1, 2023.

    SEC. 7007. CANCER PREVENTION AND TREATMENT DEMONSTRATION FOR ETHNIC AND
                  RACIAL MINORITIES.

        (a) Demonstration.--
                (1) In general.--The Secretary of Health and Human Services
            (referred to in this section as the ``Secretary'') shall
            conduct demonstration projects for the purpose of developing
            models and evaluating methods that--
                        (A) improve the quality of items and services
                    provided to target individuals in order to facilitate
                    reduced disparities in early detection and treatment of
                    cancer;
                        (B) improve clinical outcomes, satisfaction,
                    quality of life, appropriate use of items and services
                    covered under the Medicare program under title XVIII of
                    the Social Security Act (42 U.S.C. 1395 et seq.), and
                    referral patterns with respect to target individuals
                    with cancer;
                        (C) eliminate disparities in the rate of preventive
                    cancer screening measures, such as Pap smears, prostate
                    cancer screenings, colon and colorectal cancer
                    screenings, breast cancer screenings, and computed
                    tomography scans, for lung cancer among target
                    individuals;
                        (D) promote collaboration with community-based
                    organizations to ensure cultural competency of health
                    care professionals and linguistic access for target
                    individuals who are persons with limited English
                    proficiency; and
                        (E) encourage the incorporation of community health
                    workers to increase the efficiency and appropriateness
                    of cancer screening programs.
                (2) Community health worker defined.--In this section, the
            term ``community health worker'' includes a community health
            advocate, a lay health worker, a community health
            representative, a peer health promoter, a community health
            outreach worker, and a promotore de salud, who promotes health
            or nutrition within the community in which the individual
            resides.
                (3) Target individual defined.--In this section, the term
            ``target individual'' means an individual of a racial and
            ethnic minority group, as defined in section 1707(g)(1) of the
            Public Health Service Act (42 U.S.C. 300u-6(g)(1)), who is
            entitled to benefits under part A, and enrolled under part B,
            of title XVIII of the Social Security Act.
        (b) Program Design.--
                (1) Initial design.--Not later than 1 year after the date
            of the enactment of this Act, the Secretary shall evaluate best
            practices in the private sector, community programs, and
            academic research of methods that reduce disparities among
            individuals of racial and ethnic minority groups in the
            prevention and treatment of cancer and shall design the
            demonstration projects based on such evaluation.
                (2) Number and project areas.--Not later than 2 years after
            the date of the enactment of this Act, the Secretary shall
            implement at least 9 demonstration projects, including the
            following:
                        (A) Two projects, each of which shall target
                    different ethnic subpopulations, for each of the 4
                    following major racial and ethnic minority groups:
                                (i) American Indians and Alaska Natives,
                            Eskimos, and Aleuts.
                                (ii) Asian Americans.
                                (iii) Blacks and African Americans.
                                (iv) Latinos and Hispanics.
                                (v) Native Hawaiians and other Pacific
                            Islanders.
                        (B) One project within the Pacific Islands or
                    United States insular areas.
                        (C) At least one project in a rural area.
                        (D) At least one project in an inner-city area.
                (3) Expansion of projects; implementation of demonstration
            project results.--The Secretary shall continue the existing
            demonstration projects and may expand the number of
            demonstration projects if the initial report under subsection
            (c) contains an evaluation that demonstration projects--
                        (A) reduce expenditures under the Medicare program
                    under title XVIII of the Social Security Act (42 U.S.C.
                    1395 et seq.); or
                        (B) do not increase expenditures under such
                    Medicare program and reduce racial and ethnic health
                    disparities in the quality of health care services
                    provided to target individuals and increase
                    satisfaction of Medicare beneficiaries and health care
                    providers.
        (c) Report to Congress.--
                (1) In general.--Not later than 2 years after the date the
            Secretary implements the initial demonstration projects, and
            biannually thereafter, the Secretary shall submit to Congress a
            report regarding the demonstration projects.
                (2) Content of report.--Each report under paragraph (1)
            shall include the following:
                        (A) A description of the demonstration projects.
                        (B) An evaluation of--
                                (i) the cost-effectiveness of the
                            demonstration projects;
                                (ii) the quality of the health care
                            services provided to target individuals under
                            the demonstration projects; and
                                (iii) beneficiary and health care provider
                            satisfaction under the demonstration projects.
                        (C) Any other information regarding the
                    demonstration projects that the Secretary determines to
                    be appropriate.
        (d) Waiver Authority.--The Secretary shall waive compliance with
    the requirements of title XVIII of the Social Security Act (42 U.S.C.
    1395 et seq.) to such extent and for such period as the Secretary
    determines is necessary to conduct demonstration projects.

    SEC. 7008. REDUCING CANCER DISPARITIES WITHIN MEDICARE.

        (a) Development of Measures of Disparities in Quality of Cancer
    Care.--
                (1) Development of measures.--The Secretary of Health and
            Human Services (in this section referred to as the
            ``Secretary'') shall enter into an agreement with an entity
            that specializes in developing quality measures for cancer care
            under which the entity shall develop a uniform set of measures
            to evaluate disparities in the quality of cancer care and
            annually update such set of measures.
                (2) Measures to be included.--Such set of measures shall
            include, with respect to the treatment of cancer, measures of
            patient outcomes, the process for delivering medical care
            related to such treatment, patient counseling and engagement in
            decision-making, patient experience of care, resource use, and
            practice capabilities, such as care coordination.
        (b) Establishment of Reporting Process.--
                (1) In general.--The Secretary shall establish a reporting
            process that requires and provides for a method for health care
            providers specified under paragraph (2) to submit to the
            Secretary and make public data on the performance of such
            providers during each reporting period through use of the
            measures developed pursuant to subsection (a). Such data shall
            be submitted in a form and manner and at a time specified by
            the Secretary.
                (2) Specification of providers to report on measures.--The
            Secretary shall specify the classes of Medicare providers of
            services and suppliers, including hospitals, cancer centers,
            physicians, primary care providers, and specialty providers,
            that will be required under such process to publicly report on
            the measures specified under subsection (a).
                (3) Assessment of changes.--Under such reporting process,
            the Secretary shall establish a format that assesses changes in
            both the absolute and relative disparities in cancer care over
            time. These measures shall be presented in an easily
            comprehensible format, such as those presented in the final
            publications relating to Healthy People 2010 or the National
            Healthcare Disparities Report.
                (4) Initial implementation.--The Secretary shall implement
            the reporting process under this subsection for reporting
            periods beginning not later than 6 months after the date that
            measures are first established under subsection (a).

      Subtitle B--Viral Hepatitis and Liver Cancer Control and Prevention

    SEC. 7051. VIRAL HEPATITIS AND LIVER CANCER CONTROL AND PREVENTION.

        (a) Short Title.--This section may be cited as the ``Viral
    Hepatitis and Liver Cancer Control and Prevention Act of 2022''.
        (b) Findings.--Congress finds the following:
                (1) In the United States, nearly 5,000,000 persons are
            living with the hepatitis B virus (referred to in this section
            as ``HBV'') or the hepatitis C virus (referred to in this
            section as ``HCV'').
                (2) The Centers for Disease Control and Prevention
            (referred to in this section as the ``CDC''), has recognized
            HCV as the Nation's most common chronic bloodborne virus
            infection and HBV as the deadliest vaccine-preventable disease.
                (3) HBV is transmitted through contact with infectious
            blood, semen, or other bodily fluids and is 100 times more
            infectious than HIV. HCV is transmitted by contact with
            infectious blood, particularly through percutaneous exposures
            (such as puncture through the skin).
                (4) In the United States, chronic HBV and HCV are the most
            common causes of liver cancer, the second deadliest and fastest
            growing cancer in this country. These viruses are the most
            common cause of chronic liver disease, liver cirrhosis, and the
            most common indications for liver transplantation. In 2019,
            nearly 16,000 deaths per year in the United States were
            attributed to chronic HBV and HCV. Chronic HCV is also a
            leading cause of death in Americans living with HIV/AIDS, many
            of those living with HIV/AIDS are coinfected with chronic HBV,
            chronic HCV, or both.
                (5) The CDC estimates that in 2019, 57,500 people in the
            United States were newly infected with HCV and 20,700 people in
            the United States were newly infected with HBV. These estimates
            could be much higher due to many reasons, including lack of
            screening education and awareness, and perceived
            marginalization of the populations at risk.
                (6) The CDC reported a 374 percent increase in hepatitis C
            cases from 2010 to 2017, stemming from the opioid, heroin, and
            overdose epidemics affecting communities nationwide. From 2014
            to 2015, the number of reported cases of acute hepatitis B
            infection in the United States rose for the first time since
            2006, increasing by 20.7 percent, which is also largely
            attributable to the opioid epidemic.
                (7) HBV and HCV disproportionately affect certain
            populations in the United States. Although representing only
            about 6 percent of the population, Asian Americans and Pacific
            Islanders account for half of all chronic HBV cases in the
            United States. Baby boomers (those born between 1945 and 1965)
            account for approximately 75 percent of domestic chronic HCV
            cases. In addition, African Americans, Latinos, and American
            Indian and Native Alaskans are among the groups which have
            disproportionately high rates of HBV or HCV infections in the
            United States.
                (8) Liver cancer is a leading cause of cancer death among
            the Asian American and Pacific Islander community. Asian and
            Pacific Islander men and women are more than twice as likely to
            develop liver cancer compared to the non-Hispanic White
            population. The higher incidence rate of liver cancer is
            partially explained by higher incidence rates of hepatitis B
            and diabetes, which are comorbidities shown to increase an
            individual's risk of developing liver cancer.
                (9) Chronic HBV and chronic HCV usually do not cause
            symptoms early in the course of the disease, but after many
            years of a clinically ``silent'' phase, CDC estimates show more
            than 33 percent of infected individuals will develop cirrhosis,
            end-stage liver disease, or liver cancer. Since most
            individuals with chronic HBV, HCV, or both are unaware of their
            infection, they do not know to take precautions to prevent the
            spread of their infection and can unknowingly exacerbate their
            own disease progression. For those chronically infected with
            HBV or HCV, regular monitoring can lead to the early detection
            of liver cancer at a stage where a treatment is still possible.
                (10) For both chronic HBV and chronic HCV, behavioral
            changes and appropriate medical care can slow disease
            progression if diagnosis is made early. Early diagnosis, which
            is determined through simple blood tests, can reduce the risk
            of transmission and disease progression through education and
            vaccination of household members and other susceptible persons
            at risk.
                (11) Treatment for chronic HCV can eradicate the disease in
            approximately 90 percent of those currently treated. While
            there is no cure for chronic HBV, available treatments can
            effectively suppress viral replication in the overwhelming
            majority of those treated, thereby reducing the risk of
            transmission and progression to liver scarring or liver cancer.
                (12) The annual health care costs attributable to HBV and
            HCV in the United States are significant. For HBV, it is
            estimated to be approximately $2,500,000,000 ($2,000 per
            infected person). In 2000, the lifetime cost of HBV, before the
            availability of most current therapies, was approximately
            $80,000 per chronically infected person, totaling more than
            $100,000,000,000. For HCV, medical costs for patients are
            expected to increase from $30,000,000,000 in 2009 to over
            $85,000,000,000 in 2024. Avoiding these costs by screening and
            diagnosing individuals earlier, and connecting them to
            appropriate treatment and care, will save lives and critical
            health care dollars. Currently, without a comprehensive
            screening, testing, and diagnosis program, most patients are
            diagnosed too late when they need a liver transplant costing at
            least $314,000 for uncomplicated cases or when they have liver
            cancer or end-stage liver disease which costs $30,980 to
            $110,576 per hospital admission. As health care costs continue
            to grow, it is critical that the Federal Government invests in
            effective mechanisms to avoid documented cost drivers.
                (13) In 2021, the Department of Health and Human Services
            released its ``Viral Hepatitis National Strategic Plan: A
            Roadmap for Elimination for the United States, 2021-2025''
            (referred to in this section as the ``HHS Strategic Plan''). In
            March 2017, the National Academies of Sciences, Engineering,
            and Medicine released a report entitled, ``A National Strategy
            for the Elimination of Hepatitis B and C: Phase Two Report''
            (referred to in this section as the ``NAS report''),
            recommending specific actions to eliminate viral hepatitis as
            public health problems in the United States by 2030.
                (14) According to the NAS report, chronic HBV and HCV
            infections cause substantial morbidity and mortality despite
            being preventable and treatable. Deficiencies in the
            implementation of established guidelines for the prevention,
            diagnosis, and medical management of chronic HBV and HCV
            infections perpetuate personal and economic burdens. Existing
            grants are not sufficient for the scale of the health burden
            presented by HBV and HCV.
                (15) Screening and testing for HBV and HCV is aligned with
            the goals of Healthy People 2030 to increase immunization
            rates, reduce rates of infectious diseases, and improve health
            for people with chronic infections. Awareness of disease and
            access to prevention and treatment remain essential components
            for reducing infectious disease transmission.
                (16) Federal support is necessary to increase knowledge and
            awareness of HBV and HCV and to assist State and local
            prevention and control efforts in reducing the morbidity and
            mortality of these epidemics.
                (17) The Secretary of Health and Human Services has the
            discretion to carry out this section (including the amendments
            made by this section) directly and through whichever of the
            agencies of the Public Health Service the Secretary determines
            to be appropriate, which may (in the Secretary's discretion)
            include the Centers for Disease Control and Prevention, the
            Health Resources and Services Administration, the Substance
            Abuse and Mental Health Services Administration, the National
            Institutes of Health (including the National Institute on
            Minority Health and Health Disparities), and other agencies of
            such Service.
        (c) Biennial Assessment of HHS Hepatitis B and Hepatitis C
    Prevention, Education, Research, and Medical Management Plan.--Title
    III of the Public Health Service Act (42 U.S.C. 241 et seq.) is further
    amended--
                (1) by striking section 317N (42 U.S.C. 247b-15); and
                (2) by adding after part V the following:

       ``PART W--BIENNIAL ASSESSMENT OF HHS HEPATITIS B AND HEPATITIS C
          PREVENTION, EDUCATION, RESEARCH, AND MEDICAL MANAGEMENT PLAN

    ``SEC. 399OO. BIENNIAL UPDATE OF THE PLAN.

        ``(a) In General.--The Secretary shall conduct a biennial
    assessment of the Secretary's plan for the prevention, control, and
    medical management of, and education and research relating to,
    hepatitis B and hepatitis C, for the purposes of--
                ``(1) incorporating into such plan new knowledge or
            observations relating to hepatitis B and hepatitis C (such as
            knowledge and observations that may be derived from clinical,
            laboratory, and epidemiological research and disease detection,
            prevention, and surveillance outcomes);
                ``(2) addressing gaps in the coverage or effectiveness of
            the plan; and
                ``(3) evaluating and, if appropriate, updating
            recommendations, guidelines, or educational materials of the
            Centers for Disease Control and Prevention or the National
            Institutes of Health for health care providers or the public on
            viral hepatitis in order to be consistent with the plan.
        ``(b) Publication of Notice of Assessments.--Not later than October
    1 of the first even-numbered year beginning after the date of the
    enactment of this part, and October 1 of each even-numbered year
    thereafter, the Secretary shall publish in the Federal Register a
    notice of the results of the assessments conducted under subsection
    (a). Such notice shall include--
                ``(1) a description of any revisions to the plan referred
            to in subsection (a) as a result of the assessment;
                ``(2) an explanation of the basis for any such revisions,
            including the ways in which such revisions can reasonably be
            expected to further promote the original goals and objectives
            of the plan; and
                ``(3) in the case of a determination by the Secretary that
            the plan does not need revision, an explanation of the basis
            for such determination.

    ``SEC. 399OO-1. ELEMENTS OF PROGRAM.

        ``(a) Education and Awareness Programs.--The Secretary, acting
    through the Director of the Centers for Disease Control and Prevention,
    the Administrator of the Health Resources and Services Administration,
    and the Assistant Secretary for Mental Health and Substance Use, and in
    accordance with the plan referred to in section 399OO(a), shall
    implement programs to increase awareness and enhance knowledge and
    understanding of hepatitis B and hepatitis C. Such programs shall
    include--
                ``(1) the conduct of culturally and linguistically
            appropriate health education in primary and secondary schools,
            college campuses, public awareness campaigns, and community
            outreach activities (especially to the ethnic communities with
            high rates of chronic hepatitis B and chronic hepatitis C and
            other high-risk groups) to promote public awareness and
            knowledge about the value of hepatitis A and hepatitis B
            immunization; risk factors, transmission, and prevention of
            hepatitis B and hepatitis C; the value of screening for the
            early detection of hepatitis B and hepatitis C; and options
            available for the treatment of chronic hepatitis B and chronic
            hepatitis C;
                ``(2) the promotion of immunization programs that increase
            awareness and access to hepatitis A and hepatitis B vaccines
            for susceptible adults and children;
                ``(3) the training of health care professionals regarding
            the importance of vaccinating individuals infected with
            hepatitis C and individuals who are at risk for hepatitis C
            infection against hepatitis A and hepatitis B;
                ``(4) the training of health care professionals regarding
            the importance of vaccinating individuals chronically infected
            with hepatitis B and individuals who are at risk for chronic
            hepatitis B infection against the hepatitis A virus;
                ``(5) the training of health care professionals and health
            educators to make them aware of the high rates of chronic
            hepatitis B and chronic hepatitis C in certain adult ethnic
            populations, and the importance of prevention, detection, and
            medical management of hepatitis B and hepatitis C and of liver
            cancer screening;
                ``(6) the development and distribution of health education
            curricula (including information relating to the special needs
            of individuals infected with or at risk of hepatitis B and
            hepatitis C, such as the importance of prevention and early
            intervention, regular monitoring, the recognition of
            psychosocial needs, appropriate treatment, and liver cancer
            screening) for individuals providing hepatitis B and hepatitis
            C counseling; and
                ``(7) support for the implementation of the curricula
            described in paragraph (6) by State and local public health
            agencies.
        ``(b) Immunization, Prevention, and Control Programs.--
                ``(1) In general.--The Secretary, acting through the
            Director of the Centers for Disease Control and Prevention,
            shall support the integration of activities described in
            paragraph (3) into existing clinical and public health programs
            at State, local, territorial, and Tribal levels (including
            community health clinics, programs for the prevention and
            treatment of HIV/AIDS, sexually transmitted infections, and
            substance abuse, and programs for individuals in correctional
            settings).
                ``(2) Coordination of development of federal screening
            guidelines.--
                        ``(A) References.--For purposes of this subsection,
                    the term `CDC Director' means the Director of the
                    Centers for Disease Control and Prevention, and the
                    term `AHRQ Director' means the Director of the Agency
                    for Healthcare Research and Quality.
                        ``(B) Agency for healthcare research and quality.--
                    Due to the rapidly evolving standard of care associated
                    with diagnosing and treating viral hepatitis infection,
                    the AHRQ Director shall convene the Preventive Services
                    Task Force under section 915(a) to review its
                    recommendation for screening for HBV and HCV infection
                    every 3 years.
                ``(3) Activities.--
                        ``(A) Voluntary testing programs.--
                                ``(i) In general.--The Secretary shall
                            establish a mechanism by which to support and
                            promote the development of State, local,
                            territorial, and Tribal voluntary hepatitis B
                            and hepatitis C testing programs to screen the
                            high-prevalence populations to aid in the early
                            identification of chronically infected
                            individuals.
                                ``(ii) Confidentiality of the test
                            results.--The Secretary shall prohibit the use
                            of the results of a hepatitis B or hepatitis C
                            test conducted by a testing program developed
                            or supported under this subparagraph for any of
                            the following:
                                        ``(I) Issues relating to health
                                    insurance.
                                        ``(II) To screen or determine
                                    suitability for employment.
                                        ``(III) To discharge a person from
                                    employment.
                        ``(B) Counseling regarding viral hepatitis.--The
                    Secretary shall support State, local, territorial, and
                    Tribal programs in a wide variety of settings,
                    including those providing primary and specialty health
                    care services in nonprofit private and public sectors,
                    to--
                                ``(i) provide individuals with ongoing risk
                            factors for hepatitis B and hepatitis C
                            infection with client-centered education and
                            counseling which concentrates on--
                                        ``(I) promoting testing of
                                    individuals that have been exposed to
                                    their blood, family members, and their
                                    sexual partners; and
                                        ``(II) changing behaviors that
                                    place individuals at risk for
                                    infection;
                                ``(ii) provide individuals chronically
                            infected with hepatitis B or hepatitis C with
                            education, health information, and counseling
                            to reduce their risk of--
                                        ``(I) dying from end-stage liver
                                    disease and liver cancer; and
                                        ``(II) transmitting viral hepatitis
                                    to others; and
                                ``(iii) provide people chronically infected
                            with hepatitis B or hepatitis C who are
                            pregnant or of childbearing age with culturally
                            and linguistically appropriate health
                            information, such as how to prevent hepatitis B
                            perinatal infection, and to alleviate fears
                            associated with pregnancy or raising a family.
                        ``(C) Immunization.--The Secretary shall support
                    State, local, territorial, and Tribal efforts to expand
                    the current vaccination programs to protect every child
                    in the Nation and all susceptible adults, particularly
                    those infected with hepatitis C and high-prevalence
                    ethnic populations and other high-risk groups, from the
                    risks of acute and chronic hepatitis B infection by--
                                ``(i) ensuring continued funding for
                            hepatitis B vaccination for all children 18
                            years of age or younger through the Vaccines
                            for Children program;
                                ``(ii) ensuring that the recommendations of
                            the Advisory Committee on Immunization
                            Practices of the Centers for Disease Control
                            and Prevention are followed regarding hepatitis
                            B vaccination for infants, children, and
                            adults;
                                ``(iii) requiring proof of hepatitis B
                            vaccination for entry into public or private
                            daycare, preschool, elementary school,
                            secondary school, and institutions of higher
                            education;
                                ``(iv) expanding the availability of
                            hepatitis B vaccination for all adults to
                            protect them from becoming acutely or
                            chronically infected, including ethnic and
                            other populations with high prevalence rates of
                            chronic hepatitis B infection;
                                ``(v) expanding the availability of
                            hepatitis B vaccination for all adults,
                            particularly those of reproductive age (women
                            and men less than 45 years of age), to protect
                            them from the risk of hepatitis B infection;
                                ``(vi) ensuring the vaccination of
                            individuals infected, or at risk for infection,
                            with hepatitis C against hepatitis A, hepatitis
                            B, and other infectious diseases, as
                            appropriate, for which such individuals may be
                            at increased risk; and
                                ``(vii) ensuring the vaccination of
                            individuals infected, or at risk for infection,
                            with hepatitis B against hepatitis A virus and
                            other infectious diseases, as appropriate, for
                            which such individuals may be at increased
                            risk.
                        ``(D) Medical referral.--The Secretary shall
                    support State, local, territorial, and Tribal programs
                    that support--
                                ``(i) referral of persons chronically
                            infected with hepatitis B or hepatitis C--
                                        ``(I) for medical evaluation to
                                    determine the appropriateness for
                                    antiviral treatment to reduce the risk
                                    of progression to cirrhosis and liver
                                    cancer; and
                                        ``(II) for ongoing medical
                                    management including regular monitoring
                                    of liver function and screening for
                                    liver cancer; and
                                ``(ii) referral of persons infected with
                            acute or chronic hepatitis B infection or acute
                            or chronic hepatitis C infection for drug and
                            alcohol abuse treatment where appropriate.
                ``(4) Increased support for adult viral hepatitis
            prevention coordinators.--The Secretary, acting through the CDC
            Director, shall provide increased support to adult viral
            hepatitis prevention coordinators in State, local, territorial,
            and Tribal health departments in order to enhance the
            additional management, networking, and technical expertise
            needed to ensure successful integration of hepatitis B and
            hepatitis C prevention and control activities into existing
            public health programs.
        ``(c) Epidemiological Surveillance.--
                ``(1) In general.--The Secretary, acting through the
            Director of the Centers for Disease Control and Prevention,
            shall support the establishment and maintenance of a national
            chronic and acute hepatitis B and hepatitis C surveillance
            program, in order to identify--
                        ``(A) trends in the incidence of acute and chronic
                    hepatitis B and acute and chronic hepatitis C;
                        ``(B) trends in the prevalence of acute and chronic
                    hepatitis B and acute and chronic hepatitis C infection
                    among groups that may be disproportionately affected;
                    and
                        ``(C) trends in liver cancer and end-stage liver
                    disease incidence and deaths, caused by chronic
                    hepatitis B and chronic hepatitis C in the high-risk
                    ethnic populations.
                ``(2) Seroprevalence and liver cancer studies.--The
            Secretary, acting through the Director of the Centers for
            Disease Control and Prevention, shall prepare a report
            outlining the population-based seroprevalence studies currently
            underway, future planned studies, the criteria involved in
            determining which seroprevalence studies to conduct, defer, or
            suspend, and the scope of those studies, the economic and
            clinical impact of hepatitis B and hepatitis C, and the impact
            of chronic hepatitis B and chronic hepatitis C infections on
            the quality of life. Not later than one year after the date of
            the enactment of this part, the Secretary shall submit the
            report to the Committee on Health, Education, Labor, and
            Pensions of the Senate and the Committee on Energy and Commerce
            of the House of Representatives.
                ``(3) Confidentiality.--The Secretary shall not disclose
            any individually identifiable information identified under
            paragraph (1) or derived through studies under paragraph (2).
        ``(d) Research.--The Secretary, acting through the Director of the
    Centers for Disease Control and Prevention, the Director of the
    National Cancer Institute, and the Director of the National Institutes
    of Health, shall--
                ``(1) conduct epidemiologic and community-based research to
            develop, implement, and evaluate best practices for hepatitis B
            and hepatitis C prevention especially in the ethnic populations
            with high rates of chronic hepatitis B and chronic hepatitis C
            and other high-risk groups;
                ``(2) conduct research on hepatitis B and hepatitis C
            natural history, pathophysiology, improved treatments and
            prevention (such as the hepatitis C vaccine), and noninvasive
            tests that help to predict the risk of progression to liver
            cirrhosis and liver cancer;
                ``(3) conduct research that will lead to better noninvasive
            or blood tests to screen for liver cancer, and more effective
            treatments of liver cancer caused by chronic hepatitis B and
            chronic hepatitis C; and
                ``(4) conduct research comparing the effectiveness of
            screening, diagnostic, management, and treatment approaches for
            chronic hepatitis B, chronic hepatitis C, and liver cancer in
            the affected communities.
        ``(e) Underserved and Disproportionately Affected Populations.--In
    carrying out this section, the Secretary shall provide expanded support
    for individuals with limited access to health education, testing, and
    health care services and groups that may be disproportionately affected
    by hepatitis B and hepatitis C.
        ``(f) Evaluation of Program.--The Secretary shall develop
    benchmarks for evaluating the effectiveness of the programs and
    activities conducted under this section and make determinations as to
    whether such benchmarks have been achieved.

    ``SEC. 399OO-2. GRANTS.

        ``(a) In General.--The Secretary may award grants to, or enter into
    contracts or cooperative agreements with, States, political
    subdivisions of States, territories, Indian Tribes, or nonprofit
    entities that have special expertise relating to hepatitis B, hepatitis
    C, or both, to carry out activities under this part.
        ``(b) Application.--To be eligible for a grant, contract, or
    cooperative agreement under subsection (a), an entity shall prepare and
    submit to the Secretary an application at such time, in such manner,
    and containing such information as the Secretary may require.

    ``SEC. 399OO-3. AUTHORIZATION OF APPROPRIATIONS.

        ``There are authorized to be appropriated to carry out this part
    $90,000,000 for fiscal year 2023, $90,000,000 for fiscal year 2023,
    $110,000,000 for fiscal year 2024, $130,000,000 for fiscal year 2025,
    and $150,000,000 for fiscal year 2026.''.

    SEC. 7052. LIVER CANCER AND DISEASE PREVENTION, AWARENESS, AND PATIENT
                  TRACKING GRANTS.

        Subpart I of part D of title III of the Public Health Service Act
    (42 U.S.C. 254b et seq.) is amended by adding at the end the following
    new section:

    ``SEC. 330Q. LIVER CANCER AND DISEASE PREVENTION, AWARENESS, AND
                  PATIENT TRACKING GRANTS.

        ``(a) Prevention Initiative Grant Program.--
                ``(1) In general.--The Secretary, acting through the
            Director of the Centers for Disease Control and Prevention, may
            award grants and enter into cooperative agreements with
            entities for the purpose of expanding and supporting--
                        ``(A) prevention activities (including providing
                    screenings, vaccinations, or other preventative
                    interventions) for conditions known to increase an
                    individual's risk of developing a major liver disease,
                    such as liver cancer, hepatitis B, hepatitis C,
                    nonalcoholic fatty liver disease, nonalcoholic
                    steatohepatitis, and cirrhosis of the liver;
                        ``(B) activities relating to detection and
                    provision of guidance for individuals at high risk for
                    contracting liver cancer and other liver diseases; and
                        ``(C) viral hepatitis surveillance to provide for
                    timely and accurate information regarding progress to
                    eliminate viral hepatitis.
                ``(2) Report.--An entity that receives a grant or
            cooperative agreement under paragraph (1) shall submit to the
            Secretary, at a time specified by the Secretary, a report
            describing each activity carried out pursuant to such paragraph
            and evaluating the effectiveness of such activity in promoting
            prevention and treatment of liver cancer and other liver
            diseases.
                ``(3) Authorization of appropriations.--For purposes of
            carrying out this subsection, there is authorized to be
            appropriated $90,000,000 for each of fiscal years 2023 through
            2027.
        ``(b) Awareness Initiative Grant Program.--
                ``(1) In general.--The Secretary, acting through the
            Director of the Centers for Disease Control and Prevention, may
            award grants to eligible entities for the purpose of raising
            awareness for liver cancer and other liver diseases, which may
            include the production, dissemination, and distribution of
            informational materials targeted towards communities and
            populations with a higher risk for developing liver cancer and
            other liver diseases.
                ``(2) Eligible entities.--To be eligible to receive a grant
            under paragraph (1), an entity shall submit to the Secretary an
            application, at such time, in such manner, and containing such
            information as the Secretary may require, including a
            description of how the entity, in disseminating information on
            liver cancer and other liver diseases pursuant to paragraph
            (1), will--
                        ``(A) with respect to any community or population,
                    consult with members of such community or population
                    and provide such information in a manner that is
                    culturally and linguistically appropriate for such
                    community or population;
                        ``(B) highlight the range of preventative measures
                    and treatments available for liver cancer and other
                    liver diseases;
                        ``(C) integrate information on available hepatitis
                    B and hepatitis C testing programs into any liver
                    cancer presentations carried out by the entity; and
                        ``(D) address communities and populations with a
                    higher risk for contracting liver cancer and other
                    liver diseases.
                ``(3) Preference.--In awarding grants under paragraph (1),
            the Secretary shall give preference to entities that--
                        ``(A) work with a Federally qualified health
                    center;
                        ``(B) are community-based organizations; or
                        ``(C) serve communities and populations with a
                    higher risk for contracting liver cancer and other
                    liver diseases.
                ``(4) Report.--An entity that receives a grant under
            paragraph (1) shall submit to the Secretary, at a time
            specified by the Secretary, a report describing each activity
            carried out pursuant to such paragraph and evaluating the
            effectiveness of such activity in raising awareness for liver
            cancer and other liver diseases.
                ``(5) Authorization of appropriations.--For purposes of
            carrying out this subsection, there is authorized to be
            appropriated $10,000,000 for each of fiscal years 2023 through
            2027.''.

               Subtitle C--Acquired Bone Marrow Failure Diseases

    SEC. 7101. ACQUIRED BONE MARROW FAILURE DISEASES.

        (a) Short Title.--This section may be cited as the ``Bone Marrow
    Failure Disease Research and Treatment Act of 2020''.
        (b) Findings.--The Congress finds the following:
                (1) Between 20,000 and 30,000 people in the United States
            are diagnosed each year with myelodysplastic syndromes,
            aplastic anemia, paroxysmal nocturnal hemoglobinuria, and other
            acquired bone marrow failure diseases.
                (2) Acquired bone marrow failure diseases have a
            debilitating and often fatal impact on those diagnosed with
            these diseases.
                (3) While some treatments for acquired bone marrow failure
            diseases can prolong and improve the quality of patients'
            lives, there is no single cure for these diseases.
                (4) The prevalence of acquired bone marrow failure diseases
            in the United States will continue to grow as the general
            public ages.
                (5) Evidence exists suggesting that acquired bone marrow
            failure diseases occur more often in minority populations,
            particularly in Asian-American and Latino or Hispanic
            populations.
                (6) The National Heart, Lung, and Blood Institute and the
            National Cancer Institute have conducted important research
            into the causes of and treatments for acquired bone marrow
            failure diseases.
                (7) The National Marrow Donor Program Registry has made
            significant contributions to the fight against bone marrow
            failure diseases by connecting millions of potential marrow
            donors with individuals and families suffering from these
            conditions.
                (8) Despite these advances, a more comprehensive Federal
            strategic effort among numerous Federal agencies is needed to
            discover a cure for acquired bone marrow failure disorders.
                (9) Greater Federal surveillance of acquired bone marrow
            failure diseases is needed to gain a better understanding of
            the causes of acquired bone marrow failure diseases.
                (10) The Federal Government should increase its research
            support for and engage with public and private organizations in
            developing a comprehensive approach to combat and cure acquired
            bone marrow failure diseases.
        (c) National Acquired Bone Marrow Failure Disease Registry.--Title
    III of the Public Health Service Act (42 U.S.C. 241 et seq.) is amended
    by inserting after section 317U (42 U.S.C. 247b-23) the following:

    ``SEC. 317V. NATIONAL ACQUIRED BONE MARROW FAILURE DISEASE REGISTRY.

        ``(a) Establishment of Registry.--
                ``(1) In general.--Not later than 6 months after the date
            of the enactment of this section, the Secretary, acting through
            the Director of the Centers for Disease Control and Prevention,
            shall--
                        ``(A) develop a system to collect data on acquired
                    bone marrow failure diseases; and
                        ``(B) establish and maintain a national and
                    publicly available registry, to be known as the
                    National Acquired Bone Marrow Failure Disease Registry,
                    in accordance with paragraph (3).
                ``(2) Recommendations of advisory committee.--In carrying
            out this subsection, the Secretary shall take into
            consideration the recommendations of the Advisory Committee on
            Acquired Bone Marrow Failure Diseases established under
            subsection (b).
                ``(3) Purposes of registry.--The National Acquired Bone
            Marrow Failure Disease Registry shall--
                        ``(A) identify the incidence and prevalence of
                    acquired bone marrow failure diseases in the United
                    States;
                        ``(B) be used to collect and store data on acquired
                    bone marrow failure diseases, including data
                    concerning--
                                ``(i) the age, race or ethnicity, general
                            geographic location, sex, and family history of
                            individuals who are diagnosed with acquired
                            bone marrow failure diseases, and any other
                            characteristics of such individuals determined
                            appropriate by the Secretary;
                                ``(ii) the genetic and environmental
                            factors that may be associated with developing
                            acquired bone marrow failure diseases;
                                ``(iii) treatment approaches for dealing
                            with acquired bone marrow failure diseases;
                                ``(iv) outcomes for individuals treated for
                            acquired bone marrow failure diseases,
                            including outcomes for recipients of stem cell
                            therapeutic products as contained in the
                            database established pursuant to section 379A;
                            and
                                ``(v) any other factors pertaining to
                            acquired bone marrow failure diseases
                            determined appropriate by the Secretary; and
                        ``(C) be made available--
                                ``(i) to the general public; and
                                ``(ii) to researchers to facilitate further
                            research into the causes of, and treatments
                            for, acquired bone marrow failure diseases in
                            accordance with standard practices of the
                            Centers for Disease Control and Prevention.
        ``(b) Advisory Committee.--
                ``(1) Establishment.--Not later than 6 months after the
            date of the enactment of this section, the Secretary, acting
            through the Director of the Centers for Disease Control and
            Prevention, shall establish an advisory committee, to be known
            as the Advisory Committee on Acquired Bone Marrow Failure
            Diseases.
                ``(2) Members.--The members of the Advisory Committee on
            Acquired Bone Marrow Failure Diseases shall be appointed by the
            Secretary, acting through the Director of the Centers for
            Disease Control and Prevention, and shall include at least one
            representative from each of the following:
                        ``(A) A national patient advocacy organization with
                    experience advocating on behalf of patients suffering
                    from acquired bone marrow failure diseases.
                        ``(B) The National Institutes of Health, including
                    at least one representative from each of--
                                ``(i) the National Cancer Institute;
                                ``(ii) the National Heart, Lung, and Blood
                            Institute; and
                                ``(iii) the Office of Rare Diseases.
                        ``(C) The Centers for Disease Control and
                    Prevention.
                        ``(D) Clinicians with experience in--
                                ``(i) diagnosing or treating acquired bone
                            marrow failure diseases; or
                                ``(ii) medical data registries.
                        ``(E) Epidemiologists who have experience with data
                    registries.
                        ``(F) Publicly or privately funded researchers who
                    have experience researching acquired bone marrow
                    failure diseases.
                        ``(G) The entity operating the C.W. Bill Young Cell
                    Transplantation Program established pursuant to section
                    379 and the entity operating the C.W. Bill Young Cell
                    Transplantation Program Outcomes Database.
                ``(3) Responsibilities.--The Advisory Committee on Acquired
            Bone Marrow Failure Diseases shall provide recommendations to
            the Secretary on the establishment and maintenance of the
            National Acquired Bone Marrow Failure Disease Registry,
            including recommendations on the collection, maintenance, and
            dissemination of data.
                ``(4) Public availability.--The Secretary shall make the
            recommendations of the Advisory Committee on Acquired Bone
            Marrow Failure Disease publicly available.
        ``(c) Grants.--The Secretary, acting through the Director of the
    Centers for Disease Control and Prevention, may award grants to, and
    enter into contracts and cooperative agreements with, public or private
    nonprofit entities for the management of, as well as the collection,
    analysis, and reporting of data to be included in, the National
    Acquired Bone Marrow Failure Disease Registry.
        ``(d) Definition.--In this section, the term `acquired bone marrow
    failure disease' means--
                ``(1) myelodysplastic syndromes;
                ``(2) aplastic anemia;
                ``(3) paroxysmal nocturnal hemoglobinuria;
                ``(4) pure red cell aplasia;
                ``(5) acute myeloid leukemia that has progressed from
            myelodysplastic syndromes; or
                ``(6) large granular lymphocytic leukemia.
        ``(e) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section $3,000,000 for each of fiscal
    years 2023 through 2027.''.
        (d) Pilot Studies Through the Agency for Toxic Substances and
    Disease Registry.--
                (1) Pilot studies.--The Secretary of Health and Human
            Services, acting through the Director of the Agency for Toxic
            Substances and Disease Registry, shall conduct pilot studies to
            determine which environmental factors, including exposure to
            toxins, may cause acquired bone marrow failure diseases.
                (2) Collaboration with the radiation injury treatment
            network.--In carrying out the directives of this section, the
            Secretary of Health and Human Services may collaborate with the
            Radiation Injury Treatment Network of the C.W. Bill Young Cell
            Transplantation Program established pursuant to section 379 of
            the Public Health Service Act (42 U.S.C. 274k) to--
                        (A) augment data for the pilot studies authorized
                    by this section;
                        (B) access technical assistance that may be
                    provided by the Radiation Injury Treatment Network; or
                        (C) perform joint research projects.
                (3) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this section $1,000,000 for
            each of fiscal years 2023 through 2027.
        (e) Minority-Focused Programs on Acquired Bone Marrow Failure
    Diseases.--Title XVII of the Public Health Service Act (42 U.S.C. 300u
    et seq.) is amended by inserting after section 1707A the following:

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

        ``(a) Information and Referral Services.--
                ``(1) In general.--Not later than 6 months after the date
            of the enactment of this section, the Secretary, acting through
            the Deputy Assistant Secretary for Minority Health, shall
            establish and coordinate outreach and informational programs
            targeted to minority populations affected by acquired bone
            marrow failure diseases.
                ``(2) Program requirements.--Minority-focused outreach and
            informational programs authorized by this section at the
            National Minority Health Resource Center supported under
            section 1707(b)(8) (including by means of the Center's website,
            through appropriate locations such as the Center's knowledge
            center, and through appropriate programs such as the Center's
            resource persons network) and through minority health
            consultants located at each Department of Health and Human
            Services regional office--
                        ``(A) shall make information about treatment
                    options and clinical trials for acquired bone marrow
                    failure diseases publicly available; and
                        ``(B) shall provide referral services for treatment
                    options and clinical trials.
        ``(b) Hispanic and Asian-American and Pacific Islander Outreach.--
                ``(1) In general.--The Secretary, acting through the Deputy
            Assistant Secretary for Minority Health, shall undertake a
            coordinated outreach effort to connect Hispanic, Asian-
            American, and Pacific Islander communities with comprehensive
            services focused on treatment of, and information about,
            acquired bone marrow failure diseases.
                ``(2) Collaboration.--In carrying out this subsection, the
            Secretary may collaborate with public health agencies,
            nonprofit organizations, community groups, and online entities
            to disseminate information about treatment options and clinical
            trials for acquired bone marrow failure diseases.
        ``(c) Grants and Cooperative Agreements.--
                ``(1) In general.--Not later than 6 months after the date
            of the enactment of this section, the Secretary, acting through
            the Deputy Assistant Secretary for Minority Health, shall award
            grants to, or enter into cooperative agreements with, entities
            to perform research on acquired bone marrow failure diseases.
                ``(2) Requirement.--Grants and cooperative agreements
            authorized by this subsection shall be awarded or entered into
            on a competitive, peer-reviewed basis.
                ``(3) Scope of research.--Research funded under this
            section shall examine factors affecting the incidence of
            acquired bone marrow failure diseases in minority populations.
        ``(d) Definition.--In this section, the term `acquired bone marrow
    failure disease' has the meaning given to such term in section 317V(d).
        ``(e) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section $2,000,000 for each of fiscal
    years 2023 through 2027''.
        (f) Diagnosis and Quality of Care for Acquired Bone Marrow Failure
    Diseases.--
                (1) Grants.--The Secretary of Health and Human Services,
            acting through the Director of the Agency for Healthcare
            Research and Quality, shall award grants to entities to improve
            diagnostic practices and quality of care with respect to
            patients with acquired bone marrow failure diseases.
                (2) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this section $2,000,000 for
            each of fiscal years 2023 through 2027.
        (g) Definition.--In this section, the term ``acquired bone marrow
    failure disease'' has the meaning given such term in section 317V(d) of
    the Public Health Service Act, as added by subsection (c).

    Subtitle D--Cardiovascular Disease, Chronic Disease, Obesity, and Other
                                 Disease Issues

    SEC. 7151. GUIDELINES FOR DISEASE SCREENING FOR MINORITY PATIENTS.

        (a) In General.--The Secretary of Health and Human Services (in
    this section referred to as the ``Secretary''), acting through the
    Director of the Agency for Healthcare Research and Quality, shall
    convene a series of meetings to develop guidelines for disease
    screening for minority patient populations that have a higher than
    average risk for many chronic diseases and cancers.
        (b) Participants.--In convening meetings under subsection (a), the
    Secretary shall ensure that meeting participants include
    representatives of--
                (1) professional societies and associations;
                (2) minority health organizations;
                (3) health care researchers and providers, including those
            with expertise in minority health;
                (4) Federal health agencies, including the Office of
            Minority Health, the National Institute on Minority Health and
            Health Disparities, and the National Institutes of Health; and
                (5) other experts as the Secretary determines appropriate.
        (c) Diseases.--Screening guidelines for minority populations shall
    be developed as appropriate under subsection (a) for--
                (1) hypertension;
                (2) hypercholesterolemia;
                (3) diabetes;
                (4) cardiovascular disease;
                (5) cancers, including breast, prostate, colon, cervical,
            and lung cancer;
                (6) other pulmonary problems including sleep apnea;
                (7) asthma;
                (8) kidney diseases;
                (9) eye diseases and disorders, including glaucoma;
                (10) HIV/AIDS and sexually transmitted infections;
                (11) uterine fibroids;
                (12) autoimmune diseases, including lupus;
                (13) mental health conditions;
                (14) dental health conditions and oral diseases, including
            oral cancer;
                (15) environmental and related health illnesses and
            conditions;
                (16) sickle cell disease and sickle cell trait;
                (17) violence and injury prevention and control;
                (18) genetic and related conditions;
                (19) heart disease and stroke;
                (20) tuberculosis;
                (21) chronic obstructive pulmonary disease;
                (22) musculoskeletal diseases, arthritis, and obesity; and
                (23) other diseases determined appropriate by the
            Secretary.
        (d) Dissemination.--Not later than 2 years after the date of
    enactment of this Act, the Secretary shall publish and disseminate to
    health care provider organizations the guidelines developed under
    subsection (a).
        (e) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section such sums as may be necessary
    for each of fiscal years 2023 through 2027.

    SEC. 7152. CDC WISEWOMAN SCREENING PROGRAM.

        Section 1509 of the Public Health Service Act (42 U.S.C. 300n-4a)
    is amended--
                (1) in subsection (a)--
                        (A) by striking the heading and inserting ``In
                    General.--''; and
                        (B) in the matter preceding paragraph (1), by
                    striking ``may make grants'' and all that follows
                    through ``purpose'' and inserting the following: ``may
                    make grants to such States for the purpose''; and
                (2) in subsection (d)(1), by striking ``there are
            authorized'' and all that follows through the period and
            inserting ``there are authorized to be appropriated $23,000,000
            for fiscal year 2023, $25,300,000 for fiscal year 2024,
            $27,800,000 for fiscal year 2025, $30,800,000 for fiscal year
            2026, and $34,000,000 for fiscal year 2027.''.

    SEC. 7153. REPORT ON CARDIOVASCULAR CARE FOR WOMEN AND MINORITIES.

        Part P of title III of the Public Health Service Act (42 U.S.C.
    280g et seq.) is amended by adding at the end the following:

    ``SEC. 399V-7. REPORT ON CARDIOVASCULAR CARE FOR WOMEN AND MINORITIES.

        ``Not later than September 30, 2023, and annually thereafter, the
    Secretary shall prepare and submit to Congress a report on the quality
    of and access to care for women and minorities with heart disease,
    stroke, and other cardiovascular diseases. The report shall contain
    recommendations for eliminating disparities in, and improving the
    treatment of, heart disease, stroke, and other cardiovascular diseases
    in women, racial and ethnic minorities, those for whom English is not
    their primary language, and individuals with disabilities.''.

    SEC. 7154. COVERAGE OF COMPREHENSIVE TOBACCO CESSATION SERVICES IN
                  MEDICAID, CHIP, AND PRIVATE HEALTH INSURANCE.

        (a) Requiring Medicaid Coverage of Counseling and Pharmacotherapy
    for Cessation of Tobacco Use and Temporary Enhanced FMAP for Coverage
    of Tobacco Cessation Services.--Section 1905 of the Social Security Act
    (42 U.S.C. 1396d) is amended--
                (1) by amending subsection (a)(4)(D) to read as follows:
                        ``(D) counseling and pharmacotherapy for cessation
                    of tobacco use by individuals who are eligible under
                    the State plan (as defined in subsection (bb)); and'';
                (2) in subsection (b), by inserting ``(bb)(2),'' after
            ``(aa),''; and
                (3) by striking subsection (bb) and inserting the
            following:
        ``(bb) Counseling and Pharmacotherapy for Cessation of Tobacco
    Use.--
                ``(1) In general.--For purposes of this title, the term
            `counseling and pharmacotherapy for cessation of tobacco use by
            individuals who are eligible under the State plan' means
            diagnostic, therapy, and counseling services and
            pharmacotherapy (including the coverage of prescription and
            nonprescription tobacco cessation agents approved by the Food
            and Drug Administration) for the cessation of tobacco use by
            individuals who use tobacco products or who are being treated
            for tobacco use that is furnished--
                        ``(A) by or under the supervision of a physician;
                    or
                        ``(B) by any other health care professional who--
                                ``(i) is legally authorized to furnish such
                            services under State law (or the State
                            regulatory mechanism provided by State law) of
                            the State in which the services are furnished;
                            and
                                ``(ii) is authorized to receive payment for
                            other services under this title or is
                            designated by the Secretary for this purpose;
                    which is recommended in the guideline entitled,
                    `Treating Tobacco Use and Dependence: 2008 Update: A
                    Clinical Practice Guideline' published by the Public
                    Health Service in May 2008 (or any subsequent
                    modification of such guideline) or is recommended for
                    the cessation of tobacco use by the United States
                    Preventive Services Task Force or any additional
                    intervention approved by the Food and Drug
                    Administration as safe and effective in helping smokers
                    quit.
                ``(2) Temporary enhanced fmap for coverage of tobacco
            cessation services.--Notwithstanding subsection (b), for
            calendar quarters occurring during the period beginning on the
            date of the enactment of this paragraph and ending 2 years
            after the last day of the emergency period described in section
            1135(g)(1)(B), the Federal medical assistance percentage with
            respect to amounts expended by a State for medical assistance
            for counseling and pharmacotherapy for cessation of tobacco use
            by individuals who are eligible under the State plan (as
            defined in paragraph (1)) shall be equal to 100 percent.''.
        (b) No Cost Sharing.--
                (1) In general.--Subsections (a)(2) and (b)(2) of section
            1916 of the Social Security Act (42 U.S.C. 1396o) are each
            amended--
                        (A) in subparagraph (B), by striking ``, and
                    counseling'' and all that follows through ``section
                    1905(bb)(2)(A)'';
                        (B) by adjusting the left margins of subparagraphs
                    (H) and (I) so as to align with the left margin of
                    subparagraph (G);
                        (C) in subparagraph (H), by striking ``or'' at the
                    end;
                        (D) in subparagraph (I), by striking ``; and'' and
                    inserting ``; or''; and
                        (E) by adding at the end the following new
                    subparagraph:
                        ``(J) counseling and pharmacotherapy for cessation
                    of tobacco use by individuals who are eligible under
                    the State plan (as defined in section 1905(bb)) and
                    covered outpatient drugs (as defined in subsection
                    (k)(2) of section 1927 and including nonprescription
                    drugs described in subsection (d)(2) of such section)
                    that are prescribed for purposes of promoting tobacco
                    cessation in accordance with the guideline specified in
                    section 1905(bb); and''.
                (2) 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--
                        (A) in clause (iii), by striking ``, and counseling
                    and pharmacotherapy for cessation of tobacco use by
                    pregnant women (as defined in section 1905(bb))'';
                        (B) by adjusting the left margins of clauses (xii)
                    and (xiii) so as to align with the left margin of
                    clause (xi); and
                        (C) by adding at the end the following new clause:
                                ``(xiv) Counseling and pharmacotherapy for
                            cessation of tobacco use by individuals who are
                            eligible under the State plan (as defined in
                            section 1905(bb)) and covered outpatient drugs
                            (as defined in subsection (k)(2) of section
                            1927 and including nonprescription drugs
                            described in subsection (d)(2) of such section)
                            that are prescribed for purposes of promoting
                            tobacco cessation in accordance with the
                            guideline specified in section 1905(bb).''.
        (c) Exception From Optional Restriction Under Medicaid Prescription
    Drug Coverage.--Section 1927(d)(2)(F) of the Social Security Act (42
    U.S.C. 1396r-8(d)(2)(F)) is amended to read as follows:
                        ``(F) Nonprescription drugs, except, when
                    recommended in accordance with the guideline referred
                    to in section 1905(bb), agents approved by the Food and
                    Drug Administration under the over-the-counter
                    monograph process for purposes of promoting tobacco
                    cessation.''.
        (d) State Monitoring and Promoting of Comprehensive Tobacco
    Cessation Services Under Medicaid.--Section 1902(a) of the Social
    Security Act (42 U.S.C. 1396a(a)) is amended--
                (1) in paragraph (86), by striking ``and'' at the end;
                (2) in paragraph (87), by striking the period at the end
            and inserting ``; and''; and
                (3) by inserting after paragraph (87) the following new
            paragraph:
                ``(88) provide for the State to monitor and promote the use
            of comprehensive tobacco cessation services under the State
            plan (including conducting an outreach campaign to increase
            awareness of the benefits of using such services) among--
                        ``(A) individuals entitled to medical assistance
                    under the State plan who use tobacco products; and
                        ``(B) clinicians and others who provide services to
                    individuals entitled to medical assistance under the
                    State plan.''.
        (e) Federal Reimbursement for Outreach Campaign.--Section 1903(a)
    of the Social Security Act (42 U.S.C. 1396b(a)) is amended--
                (1) in paragraph (6)(B), by striking ``plus'' at the end;
                (2) in paragraph (7), by striking the period at the end and
            inserting ``; plus''; and
                (3) by inserting after paragraph (7) the following new
            paragraph:
                ``(8) with respect to the development, implementation, and
            evaluation of an outreach campaign to--
                        ``(A) increase awareness of comprehensive tobacco
                    cessation services covered in the State plan among--
                                ``(i) individuals who are likely to be
                            eligible for medical assistance under the State
                            plan; and
                                ``(ii) clinicians and others who provide
                            services to individuals who are likely to be
                            eligible for medical assistance under the State
                            plan; and
                        ``(B) increase awareness of the benefits of using
                    comprehensive tobacco cessation services covered in the
                    State plan among--
                                ``(i) individuals who are likely to be
                            eligible for medical assistance under the State
                            plan; and
                                ``(ii) clinicians and others who provide
                            services to individuals who are likely to be
                            eligible for medical assistance under the State
                            plan about the benefits of using comprehensive
                            tobacco cessation services;
                    for calendar quarters occurring during the period
                    beginning on the date of the enactment of this
                    paragraph and ending on 2 years after the last day of
                    the emergency period described in section
                    1135(g)(1)(B), an amount equal to 100 percent of the
                    sums expended during each quarter which are
                    attributable to such development, implementation, and
                    evaluation, and for calendar quarters succeeding such
                    period, an amount equal to Federal medical assistance
                    percentage determined under section 1905(b) of the sums
                    expended during each quarter which are so
                    attributable.''.
        (f) No Prior Authorization for Tobacco Cessation Drugs Under
    Medicaid.--Section 1927(d) of the Social Security Act (42 U.S.C. 1396r-
    8(d)) is amended--
                (1) in paragraph (1)(A), by striking ``A State'' and
            inserting ``Subject to paragraph (8), a State''; and
                (2) by adding at the end the following new paragraph:
                ``(8) No prior authorization programs for tobacco cessation
            drugs.--A State plan may not require, as a condition of
            coverage or payment for a covered outpatient drug, the approval
            of an agent to promote smoking cessation (including agents
            approved by the Food and Drug Administration) or tobacco
            cessation.''.
        (g) Exclusion of Enhanced Payments From Territorial Caps.--
    Notwithstanding any other provision of law, for purposes of section
    1108 of the Social Security Act (42 U.S.C. 1308), with respect to any
    additional amount paid to a territory as a result of the application of
    section 1905(bb)(2) of the Social Security Act (42 U.S.C.
    1396d(bb)(2))--
                (1) the limitation on payments to territories under
            subsections (f) and (g) of such section 1108 shall not apply to
            such additional amounts; and
                (2) such additional amounts shall be disregarded in
            applying such subsections.
        (h) Requiring CHIP Coverage of Counseling and Pharmacotherapy for
    Cessation of Tobacco Use.--
                (1) In general.--Section 2103(c)(2) of the Social Security
            Act (42 U.S.C. 1397cc(c)(2)) is amended by adding at the end
            the following new subparagraph:
                        ``(D) Counseling and pharmacotherapy for cessation
                    of tobacco use by individuals who are eligible under
                    the State child health plan.''.
                (2) Counseling and pharmacotherapy for cessation of tobacco
            use defined.--Section 2110(c) of the Social Security Act (42
            U.S.C. 1397jj(c)) is amended by adding at the end the following
            new paragraph:
                ``(10) Counseling and pharmacotherapy for cessation of
            tobacco use.--The term `counseling and pharmacotherapy for
            cessation of tobacco use' means diagnostic, therapy, and
            counseling services and pharmacotherapy (including the coverage
            of prescription and nonprescription tobacco cessation agents
            approved by the Food and Drug Administration) for the cessation
            of tobacco use by individuals who use tobacco products or who
            are being treated for tobacco use that are furnished--
                        ``(A) by or under the supervision of a physician;
                    or
                        ``(B) by any other health care professional who--
                                ``(i) is legally authorized to furnish such
                            services under State law (or the State
                            regulatory mechanism provided by State law) of
                            the State in which the services are furnished;
                            and
                                ``(ii) is authorized to receive payment for
                            other services under this title or is
                            designated by the Secretary for this purpose;
                    which is recommended in the guideline entitled,
                    `Treating Tobacco Use and Dependence: 2008 Update: A
                    Clinical Practice Guideline' published by the Public
                    Health Service in May 2008 (or any subsequent
                    modification of such guideline) or is recommended for
                    the cessation of tobacco use by the United States
                    Preventive Services Task Force or any additional
                    intervention approved by the Food and Drug
                    Administration as safe and effective in helping smokers
                    quit.''.
        (i) No Cost Sharing.--Section 2103(e) of the Social Security Act
    (42 U.S.C. 1397cc(e)) is amended by adding at the end the following new
    paragraph:
                ``(5) No cost sharing on benefits for counseling and
            pharmacotherapy for cessation of tobacco use.--The State child
            health plan may not impose deductibles, coinsurance, or other
            cost sharing with respect to benefits for counseling and
            pharmacotherapy for cessation of tobacco use (as defined in
            section 2110(c)(10)) and prescription drugs that are covered
            under a State child health plan that are prescribed for
            purposes of promoting tobacco cessation in accordance with the
            guideline specified in section 2110(c)(10)(B).''.
        (j) Exception From Optional Restriction Under CHIP Prescription
    Drug Coverage.--Section 2103 of the Social Security Act (42 U.S.C.
    1397cc) is amended by adding at the end the following new subsection:
        ``(g) Exception From Optional Restriction Under CHIP Prescription
    Drug Coverage.--The State child health plan may exclude or otherwise
    restrict nonprescription drugs, except, in the case of--
                ``(1) pregnant women when recommended in accordance with
            the guideline specified in section 2110(c)(10)(B), agents
            approved by the Food and Drug Administration under the over-
            the-counter monograph process for purposes of promoting tobacco
            cessation; and
                ``(2) individuals who are eligible under the State child
            health plan when recommended in accordance with the Guideline
            referred to in section 2110(c)(10)(B), agents approved by the
            Food and Drug Administration under the over-the-counter
            monograph process for purposes of promoting tobacco
            cessation.''.
        (k) State Monitoring and Promoting of Comprehensive Tobacco
    Cessation Services Under CHIP.--Section 2102 of the Social Security Act
    (42 U.S.C. 1397bb) is amended by adding at the end the following new
    subsection:
        ``(d) State Monitoring and Promoting of Comprehensive Tobacco
    Cessation Services Under CHIP.--A State child health plan shall include
    a description of the procedures to be used by the State to monitor and
    promote the use of comprehensive tobacco cessation services under the
    State plan (including conducting an outreach campaign to increase
    awareness of the benefits of using such services) among--
                ``(1) individuals entitled to medical assistance under the
            State child health plan who use tobacco products; and
                ``(2) clinicians and others who provide services to
            individuals entitled to medical assistance under the State
            child health plan.''.
        (l) Federal Reimbursement for CHIP Coverage and Outreach
    Campaign.--
                (1) In general.--Section 2105(a) of the Social Security Act
            (42 U.S.C. 1397ee(a)) is amended by adding at the end the
            following new paragraph:
                ``(5) Federal reimbursement for chip coverage of
            comprehensive tobacco cessation services and outreach
            campaign.--In addition to the payments made under paragraph (1)
            for calendar quarters occurring during the period beginning on
            the date of the enactment of this paragraph and ending on 2
            years after the last day of the emergency period described in
            section 1135(g)(1)(B), the Secretary shall pay--
                        ``(A) an amount equal to 100 percent of the sums
                    expended during each quarter which are attributable to
                    the cost of furnishing counseling and pharmacotherapy
                    for cessation of tobacco use by individuals who are
                    eligible under the State child health plan (net of any
                    payments made to the State under paragraph (1) with
                    respect to such counseling and pharmacotherapy); plus
                        ``(B) an amount equal to 100 percent of the sums
                    expended during each quarter which are attributable to
                    the development, implementation, and evaluation of an
                    outreach campaign to--
                                ``(i) increase awareness of comprehensive
                            tobacco cessation services covered in the State
                            child health plan among--
                                        ``(I) individuals who are likely to
                                    be eligible for medical assistance
                                    under the State child health plan; and
                                        ``(II) clinicians and others who
                                    provide services to individuals who are
                                    likely to be eligible for medical
                                    assistance under the State child health
                                    plan; and
                                ``(ii) increase awareness of the benefits
                            of using comprehensive tobacco cessation
                            services covered in the State child health plan
                            among--
                                        ``(I) individuals who are likely to
                                    be eligible for medical assistance
                                    under the State child health plan; and
                                        ``(II) clinicians and others who
                                    provide services to individuals who are
                                    likely to be eligible for medical
                                    assistance under the State child health
                                    plan about the benefits of using
                                    comprehensive tobacco cessation
                                    services.''.
                (2) Adjustment of chip allotments.--Section 2104(m) of the
            Social Security Act (42 U.S.C. 1397dd(m)) is amended--
                        (A) in paragraph (2)(B), by striking ``and (12)''
                    and inserting ``(12), and (13)''; and
                        (B) by adding at the end the following new
                    paragraph:
                ``(13) Adjusting allotments to account for federal payments
            for chip coverage of comprehensive tobacco cessation services
            and outreach campaign.--If a State (including the District of
            Columbia and each commonwealth and territory) receives a
            payment for a fiscal year under section 2105(a)(5), the
            allotment determined for the State for such fiscal year shall
            be increased by the amount of such payment.''.
        (m) No Prior Authorization for Tobacco Cessation Drugs Under
    CHIP.--Section 2103 of the Social Security Act (42 U.S.C. 1397cc), as
    amended by subsection (h), is further amended--
                (1) in subsection (c)(2)(A), by inserting ``(in accordance
            with subsection (h))'' after ``Coverage of prescription
            drugs''; and
                (2) by adding at the end the following new subsection:
        ``(h) No Prior Authorization Programs for Tobacco Cessation
    Drugs.--A State child health plan may not require, as a condition of
    coverage or payment for a prescription drugs, the approval of an agent
    to promote smoking cessation (including agents approved by the Food and
    Drug Administration) or tobacco cessation.''.
        (n) Comprehensive Coverage of Tobacco Cessation Coverage in Private
    Health Insurance.--Section 2713 of the Public Health Service Act (42
    U.S.C. 300gg-13) is amended by adding at the end the following:
        ``(d) No Prior Authorization.--A group health plan and a health
    insurance issuer offering group or individual health insurance coverage
    shall not impose any prior authorization requirement for tobacco
    cessation counseling and pharmacotherapy that has in effect a rating of
    `A' or `B' in the current recommendations of the United States
    Preventive Services Task Force.''.
        (o) Rule of Construction.--None of the amendments made by this
    section shall be construed to limit coverage of any counseling or
    pharmacotherapy for individuals under 18 years of age.
        (p) Effective Date.--The amendments made by this section shall take
    effect on the first day of the first fiscal year that begins on or
    after the date of enactment of this Act.

    SEC. 7155. CLINICAL RESEARCH FUNDING FOR ORAL HEALTH.

        (a) In General.--The Secretary of Health and Human Services shall
    expand and intensify the conduct and support of the research activities
    of the National Institutes of Health and the National Institute of
    Dental and Craniofacial Research to improve the oral health of the
    population through the prevention and management of oral diseases and
    conditions.
        (b) Included Research Activities.--Research activities under
    subsection (a) shall include--
                (1) comparative effectiveness research and clinical disease
            management research addressing early childhood caries and oral
            cancer; and
                (2) awarding of grants and contracts to support the
            training and development of health services researchers,
            comparative effectiveness researchers, and clinical researchers
            whose research improves the oral health of the population.

    SEC. 7156. GUIDE ON EVIDENCE-BASED STRATEGIES FOR PUBLIC HEALTH
                  DEPARTMENT OBESITY PREVENTION PROGRAMS.

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

    SEC. 7157. STEPHANIE TUBBS JONES UTERINE FIBROID RESEARCH AND EDUCATION
                  ACT.

        (a) Research With Respect to Uterine Fibroids.--
                (1) Research.--The Secretary of Health and Human Services
            (referred to in this section as the ``Secretary'') shall
            expand, intensify, and coordinate programs for the conduct and
            support of research with respect to uterine fibroids.
                (2) Administration and coordination.--The Secretary shall
            carry out the conduct and support of research pursuant to
            paragraph (1), in coordination with the appropriate institutes,
            offices, and centers of the National Institutes of Health and
            any other relevant Federal agency, as determined by the
            Director.
                (3) Authorization of appropriations.--For the purpose of
            carrying out this subsection, there are authorized to be
            appropriated $30,000,000 for each of fiscal years 2022 through
            2026.
        (b) Research With Respect to Medicaid Coverage of Uterine Fibroids
    Treatment.--
                (1) Research.--The Secretary (or the Secretary's designee)
            shall establish a research database, or expand an existing
            research database, to collect data on services furnished to
            individuals diagnosed with uterine fibroids under a State plan
            (or a waiver of such a plan) under the Medicaid program under
            title XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
            or under a State child health plan (or a waiver of such a plan)
            under the Children's Health Insurance Program under title XXI
            of such Act (42 U.S.C. 1397aa et seq.) for the treatment of
            such fibroids for purposes of assessing the frequency at which
            such individuals are furnished such services.
                (2) Report.--
                        (A) In general.--Not later than the date that is
                    two years after the date of the enactment of this Act,
                    the Secretary shall submit to Congress a report on the
                    amount of Federal and State expenditures with respect
                    to services furnished for the treatment of uterine
                    fibroids under State plans (or waivers of such plans)
                    under the Medicaid program under such title XIX and
                    State child health plans (or waivers of such plans)
                    under the Children's Health Insurance Program under
                    such title XXI.
                        (B) Coordination.--The Secretary shall coordinate
                    the development and submission of the report required
                    under subparagraph (A) with any other relevant Federal
                    agency, as determined by the Secretary.
        (c) Education and Dissemination of Information With Respect to
    Uterine Fibroids.--
                (1) Uterine fibroids public education program.--The
            Secretary shall develop and disseminate to the public
            information regarding uterine fibroids, including information
            on--
                        (A) the awareness, incidence, and prevalence of
                    uterine fibroids among individuals, including all
                    minority individuals;
                        (B) the elevated risk for minority individuals to
                    develop uterine fibroids; and
                        (C) the availability, as medically appropriate, of
                    the range of treatment options for symptomatic uterine
                    fibroids, including non-hysterectomy treatments and
                    procedures.
                (2) Dissemination of information.--The Secretary may
            disseminate information under paragraph (1) directly or through
            arrangements with intra-agency initiatives, nonprofit
            organizations, consumer groups, institutions of higher
            education (as defined in section 101 of the Higher Education
            Act of 1965 (20 U.S.C. 1001)), or Federal, State, or local
            public private partnerships.
                (3) Authorization of appropriations.--For the purpose of
            carrying out this subsection, there are authorized to be
            appropriated such sums as may be necessary for each of fiscal
            years 2022 through 2026.

                              Subtitle E--HIV/AIDS

    SEC. 7201. STATEMENT OF POLICY.

        It is the policy of the United States to achieve an AIDS-free
    generation, and to--
                (1) expand access to lifesaving antiretroviral therapy for
            people living with HIV and immediately link people to
            continuous and coordinated high-quality care when they learn
            they are living with HIV;
                (2) expand targeted efforts to prevent HIV infection using
            a combination of effective, evidence-based approaches,
            including routine HIV screening, and universal access to HIV
            prevention tools, including preexposure prophylaxis, in
            communities disproportionately impacted by HIV, particularly
            communities of color;
                (3) ensure laws, policies, and regulations do not impede
            access to prevention, treatment, and care for people living
            with HIV or disproportionately impacted by HIV;
                (4) accelerate research for more efficacious HIV prevention
            and treatments tools, a cure, and a vaccine; and
                (5) respect the human rights and dignity of persons living
            with HIV.

    SEC. 7202. FINDINGS.

        The Congress finds the following:
                (1) Over 1,100,000 people are estimated to be living with
            HIV in the United States according to the Centers for Disease
            Control and Prevention, 14 percent of whom are unaware they are
            living with HIV.
                (2) The Centers for Disease Control and Prevention
            estimates that, in 2019, there were approximately 34,800 people
            newly diagnosed with HIV. New HIV infections declined 8 percent
            from 37,800 in 2015, after a period of general stability. From
            2015 to 2019, new infections among young gay and bisexual men
            (ages 13 to 24) dropped 33 percent overall, with declines in
            young men of all races, but African Americans, Hispanics, and
            Latinos continue to be severely and disproportionately
            affected.
                (3) HIV disproportionately affects certain populations in
            the United States. Though Blacks/African Americans represent
            approximately 13 percent of the population, they account for
            almost half (44 percent) of all people living with HIV in the
            United States. Black/African-American men who have sex with men
            account for 26 percent of all new HIV infections and have
            remained stable from 2010 to 2019.
                (4) Disparities continue to exist among Latinos and
            Hispanics; in 2019, Latinos and Hispanics made up 18 percent of
            the United States population and 30 percent of new infections.
                (5) Though the rate of new infections among American
            Indians and Alaska Natives (referred to in this section as
            ``AI/AN'') is proportional to their population size, from 2015
            to 2019, the annual number of HIV diagnoses increased among
            American Indians and Alaska Natives.
                (6) Asian Americans account for about 2 percent of new HIV
            infections, but in 2013, 22 percent were undiagnosed, the
            highest rate of undiagnosed HIV among any race or ethnicity.
            Between 2010 and 2016, the number of Asian Americans receiving
            an HIV diagnosis increased by 42 percent.
                (7) The latest data from the Centers for Disease Control
            and Prevention indicates that new infections among women
            remained stable for women in 2019.
                (8) The history of HIV shows that culturally relevant and
            gender-responsive supportive services, including psychosocial
            support, treatment literacy, case management, and
            transportation are necessary strategies to reach and engage
            women and girls in medical care.
                (9) From 2015 through 2019 in the United States and 6
            dependent areas, the number of diagnoses of HIV infection for
            transgender adults and adolescents increased. In 2019, among
            transgender adults and adolescents, the largest percentage (93
            percent) of diagnoses of HIV infections was for transgender
            male-to-female (MTF) people. By age, in 2019, the largest
            percentage (24 percent) of diagnoses of HIV infection among
            transgender persons was for transgender MTF adults and
            adolescents aged 20 to 24 years, followed by transgender MTF
            adults and adolescents aged 25 to 29 years (23 percent).
                (10) Stigma and discrimination contribute to such
            disparities.
                (11) The Centers for Disease Control and Prevention has
            determined that increasing the proportion of people who know
            their HIV status is an essential component of comprehensive HIV
            treatment and prevention efforts and that early diagnosis is
            critical in order for people with HIV to receive life-extending
            therapy. Additionally, the Centers for Disease Control and
            Prevention recommend routine HIV screening in health care
            settings for all patients aged 13 to 64, regardless of risk.
                (12) In 1998, Congress created the National Minority AIDS
            Initiative to provide technical assistance, build capacity, and
            strengthen outreach efforts among local institutions and
            community-based organizations that serve racial and ethnic
            minorities living with or vulnerable to HIV.
                (13) To combat the HIV epidemic in the United States, the
            National HIV/AIDS Strategy (referred to in this section as
            ``NHAS'') provides a framework of increasing access to care,
            reducing new infections, and eliminating HIV-related health
            disparities. The vision of NHAS is ``The United States will be
            a place where new HIV infections are prevented, every person
            knows their status, and every person with HIV has high-quality
            care and treatment, lives free from stigma and discrimination,
            and can achieve their full potential for health and well-being
            across the lifespan. This vision includes all people,
            regardless of age, sex, gender identity, sexual orientation,
            race, ethnicity, religion, disability, geographic location, or
            socioeconomic circumstance.''.
                (14) In January 2019, the Department of Health and Human
            Services began implementing the initiative ``Ending the HIV
            Epidemic: A Plan for America''. The initiative seeks to reduce
            the number of new HIV infections in the United States by 75
            percent by 2025, and then by at least 90 percent by 2030, for
            an estimated 250,000 total HIV infection averted.
                (15) At present, many States and United States territories
            have criminal statutes based on ``exposure'' to HIV. Most of
            these laws were adopted before the availability of effective
            antiretroviral treatment for HIV/AIDS.
                (16) Research shows that stable housing leads to better
            health outcomes for those living with HIV. Inadequate or
            unstable housing is not only a barrier to effective treatment,
            but also increases the likelihood of engaging in risky
            behaviors leading to HIV infection. Insecure housing puts
            people with HIV/AIDS at risk of premature death from exposure
            to other diseases, poor nutrition, and lack of medical care.
                (17) Due to advances in treatment, many people living with
            HIV today are living healthy lives and have the ability and
            desire to fully participate in all aspects of community life,
            including employment. Research associates being employed with
            tremendous economic, social, and health benefits for many
            people living with HIV.
                (18) Despite the tremendous progress made in the treatment
            and prevention of HIV/AIDS, discriminatory policies stemming
            from continued stigmatization of HIV/AIDS and the LGBTQ+
            community continue to plague the scientific community. This
            includes blood donation guidance updated by Food and Drug
            Administration in 2020 that recommends a 3-month deferral
            policy for gay and bisexual men before they are eligible to
            donate blood. Health agencies in the United States must
            implement blood donation policies that are grounded in science
            and that do not unfairly single out any group of individuals.
                (19) The common benefits associated with employment include
            income, autonomy, productivity, and status within society,
            daily structure, making a contribution to one's community, and
            increased skills and self-esteem. Research also indicates that
            many people with disabilities, including people living with
            HIV, report perceiving themselves as being less disabled or not
            disabled at all, when working. Furthermore, some studies link
            working with better physical and mental health outcomes for
            people living with HIV when compared to those who are not
            working. Preliminary data also suggest that transitioning to
            employment is associated with reduced HIV-related health risk
            behavior for many people.
                (20) In July 2012, the Food and Drug Administration
            approved the first drug to be used as pre-exposure prophylaxis
            (PrEP). PrEP reduces the risk of HIV infection in HIV-negative
            individuals. Studies have shown that PrEP reduces HIV
            transmission from sex by about 99 percent when taken
            consistently. Despite increases in PrEP uptake, PrEP use
            remains low among gay and bisexual men of color. The Centers
            for Disease Control and Prevention found that uptake was lower
            among African-American (26 percent) and Latino (30 percent) men
            compared with White men (42 percent). Similarly, PrEP awareness
            was lower among African-American (86 percent) and Latino (87
            percent) men compared with White men (95 percent). While
            clinical research on transgender populations and PrEP is
            currently limited, the Centers for Disease Control and
            Prevention recommends PrEP use in transgender populations. In
            September 2019, the Food and Drug Administration approved the
            second drug to be used as PrEP.
                (21) Syringe service programs have been associated with
            lowered HIV infections, lower hepatitis C infections, and
            increased linkage to substance use treatment.
                (22) There is now conclusive scientific evidence that a
            person living with HIV who is on antiretroviral therapy and is
            durably virally suppressed (defined as having a consistent
            viral load of less than 200 copies/ml) does not sexually
            transmit HIV. The conclusive evidence about the highly
            effective preventative benefits of antiretroviral therapy
            provides an unprecedented opportunity to improve the lives of
            people living with HIV, improve treatment uptake and adherence,
            and advocate for expanded access to treatment and care.

    SEC. 7203. ADDITIONAL FUNDING FOR AIDS DRUG ASSISTANCE PROGRAM
                  TREATMENTS.

        Section 2623 of the Public Health Service Act (42 U.S.C. 300ff-31b)
    is amended by adding at the end the following:
        ``(c) Additional Funding for AIDS Drug Assistance Program
    Treatments.--In addition to amounts otherwise authorized to be
    appropriated for carrying out this subpart, there are authorized to be
    appropriated such sums as may be necessary to carry out sections
    2612(b)(3)(B) and 2616 for each of fiscal years 2023 through 2026.''.

    SEC. 7204. ENHANCING THE NATIONAL HIV SURVEILLANCE SYSTEM.

        (a) Grants.--The Secretary of Health and Human Services, acting
    through the Director of the Centers for Disease Control and Prevention,
    shall make grants to States to support integration of public health
    surveillance systems into all electronic health records in order to
    allow rapid communications between the clinical setting and health
    departments, by means that include--
                (1) providing technical assistance and policy guidance to
            State and local health departments, clinical providers, and
            other agencies serving individuals with HIV to improve the
            interoperability of data systems relevant to monitoring HIV
            care and supportive services;
                (2) capturing longitudinal data pertaining to the
            initiation and ongoing prescription or dispensing of
            antiretroviral therapy for individuals diagnosed with HIV (such
            as through pharmacy-based reporting);
                (3) obtaining information--
                        (A) on a voluntary basis, on sexual orientation and
                    gender identity; and
                        (B) on sources of coverage (or the lack of
                    coverage) for medical treatment (including coverage
                    through the Medicaid program under title XIX of the
                    Social Security Act (42 U.S.C. 1396 et seq.), the
                    Medicare program under title XVIII of such Act (42
                    U.S.C. 1395 et seq.), the program under title XXVI of
                    the Public Health Service Act (42 U.S.C. 300ff-11 et
                    seq.); commonly referred to as the ``Ryan White HIV/
                    AIDS Program''), other public funding, private
                    insurance, and health maintenance organizations); and
                (4) obtaining and using current geographic markers of
            residence (such as current address, zip code, partial zip code,
            and census block).
        (b) Privacy and Security Safeguards.--In carrying out this section,
    the Secretary of Health and Human Services shall ensure that
    appropriate privacy and security safeguards are met to prevent
    unauthorized disclosure of protected health information and compliance
    with the HIPAA privacy and security law (as defined in section 3009 of
    the Public Health Service Act (42 U.S.C. 300jj-19)) and other relevant
    laws and regulations.
        (c) Prohibition Against Improper Use of Data.--No grant under this
    section may be used to allow or facilitate the collection or use of
    surveillance or clinical data or records--
                (1) for punitive measures of any kind, civil or criminal,
            against the subject of such data or records; or
                (2) for imposing any requirement or restriction with
            respect to an individual without the individual's written
            consent.
        (d) Authorization of Appropriations.--To carry out this section,
    there are authorized to be appropriated such sums as may be necessary
    for each of fiscal years 2023 through 2026.

    SEC. 7205. EVIDENCE-BASED STRATEGIES FOR IMPROVING LINKAGE TO, AND
                  RETENTION IN, APPROPRIATE CARE.

        (a) Strategies.--The Secretary of Health and Human Services, in
    collaboration with the Director of the Centers for Disease Control and
    Prevention, the Assistant Secretary for Mental Health and Substance
    Use, the Director of the Office of AIDS Research, the Administrator of
    the Health Resources and Services Administration, and the Administrator
    of the Centers for Medicare & Medicaid Services, shall--
                (1) identify evidence-based strategies most effective at
            addressing the multifaceted issues that impede disease status
            awareness with respect to HIV/AIDS and linkage to, and
            retention in, appropriate care, taking into consideration
            health care systems issues, clinic and provider issues, and
            individual psychosocial, environmental, and other contextual
            factors;
                (2) support the wide-scale implementation of the evidence-
            based strategies identified pursuant to paragraph (1),
            including through incorporating such strategies into health
            care coverage supported by the Medicaid program under title XIX
            of the Social Security Act (42 U.S.C. 1396 et seq.), the
            program under title XXVI of the Public Health Service Act (42
            U.S.C. 300ff-11 et seq.; commonly referred to as the ``Ryan
            White HIV/AIDS Program''), and health plans purchased through
            an Exchange established under title I of the Patient Protection
            and Affordable Care Act (Public Law 111-148); and
                (3) not later than 1 year after the date of the enactment
            of this Act, submit a report to the Congress on the status of
            activities under paragraphs (1) and (2).
        (b) Authorization of Appropriations.--To carry out this section,
    there are authorized to be appropriated such sums as may be necessary
    for fiscal years 2023 through 2026.

    SEC. 7206. IMPROVING ENTRY INTO, AND RETENTION IN, CARE AND
                  ANTIRETROVIRAL ADHERENCE FOR PERSONS WITH HIV.

        (a) Sense of Congress.--It is the sense of Congress that AIDS
    research has led to scientific advancements that have--
                (1) saved the lives of millions of people living with HIV;
                (2) prevented millions of individuals from receiving new
            diagnoses of HIV; and
                (3) had broad benefits that extend far beyond helping
            people at risk for, or living with, HIV.
        (b) In General.--The Secretary of Health and Human Services, acting
    through the Director of the National Institutes of Health, shall
    expand, intensify, and coordinate operational and translational
    research and other activities of the National Institutes of Health
    regarding methods--
                (1) to increase adoption of evidence-based adherence
            strategies within HIV care and treatment programs;
                (2) to increase HIV testing and case detection rates;
                (3) to reduce HIV-related health disparities;
                (4) to ensure that research to improve adherence to HIV
            care and treatment programs address the unique concerns of
            women;
                (5) to integrate HIV prevention and care services with
            mental health and substance use prevention and treatment
            delivery systems;
                (6) to increase knowledge on the implementation of
            preexposure prophylaxis (referred to in this section as
            ``PrEP''), including with respect to--
                        (A) who can benefit most from PrEP;
                        (B) how to provide PrEP safely and efficiently;
                        (C) how to integrate PrEP with other essential
                    prevention methods such as condoms; and
                        (D) how to ensure high levels of adherence; and
                (7) to increase knowledge of ``undetectable and
            untransmittable'', when a person living with HIV who is on
            antiretroviral therapy and is durably virally suppressed
            (defined as having a consistent viral load of less than 200
            copies/ml) cannot sexually transmit HIV.
        (c) Authorization of Appropriations.--To carry out this section,
    there are authorized to be appropriated such sums as may be necessary
    for fiscal years 2023 through 2026.

    SEC. 7207. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND ETHNIC MINORITY
                  COMMUNITIES.

        (a) In General.--For the purpose of reducing new HIV diagnoses in
    racial and ethnic minority communities, the Secretary of Health and
    Human Services, acting through the Deputy Assistant Secretary for
    Minority Health, may make grants to public health agencies and faith-
    based organizations to conduct--
                (1) outreach activities related to HIV prevention and
            testing activities;
                (2) HIV prevention activities;
                (3) HIV testing activities; and
                (4) public health education campaigns on accessing HIV
            prevention medication.
        (b) Authorization of Appropriations.--To carry out this section,
    there are authorized to be appropriated such sums as may be necessary
    for fiscal years 2023 through 2026.

    SEC. 7208. MINORITY AIDS INITIATIVE.

        (a) Expanded Funding.--The Secretary of Health and Human Services,
    in collaboration with the Deputy Assistant Secretary for Minority
    Health, the Director of the Centers for Disease Control and Prevention,
    the Administrator of the Health Resources and Services Administration,
    and the Assistant Secretary for Mental Health and Substance Use, shall
    provide funds and carry out activities to expand the Minority AIDS
    Initiative.
        (b) Use of Funds.--The additional funds made available under this
    section may be used, through the Minority AIDS Initiative, to support
    the following activities:
                (1) Providing technical assistance and infrastructure
            support to reduce HIV/AIDS in minority populations.
                (2) Increasing minority populations' access to HIV
            prevention and care services.
                (3) Building strong community programs and partnerships to
            address HIV prevention and the health care needs of specific
            racial and ethnic minority populations.
        (c) Priority Interventions.--Within the racial and ethnic minority
    populations referred to in subsection (b), priority in conducting
    intervention services shall be given to--
                (1) men who have sex with men;
                (2) youth;
                (3) persons who engage in intravenous drug abuse;
                (4) women;
                (5) homeless individuals;
                (6) individuals incarcerated or in the penal system;
                (7) transgender individuals; and
                (8) nonbinary individuals.
        (d) Authorization of Appropriations.--For carrying out this
    section, there are authorized to be appropriated $610,000,000 for
    fiscal year 2023 and such sums as may be necessary for each of fiscal
    years 2024 through 2027.

    SEC. 7209. HEALTH CARE PROFESSIONALS TREATING INDIVIDUALS WITH HIV.

        (a) In General.--The Secretary of Health and Human Services, acting
    through the Administrator of the Health Resources and Services
    Administration, shall expand, intensify, and coordinate workforce
    initiatives of the Health Resources and Services Administration to
    increase the capacity of the health workforce focusing primarily on HIV
    to meet the demand for culturally competent care, and may award grants
    for any of the following:
                (1) Development of curricula for training primary care
            providers in HIV/AIDS prevention and care, including routine
            HIV testing.
                (2) Support to expand access to culturally and
            linguistically accessible benefits counselors, trained peer
            navigators, and mental and behavioral health professionals with
            expertise in HIV.
                (3) Training health care professionals to provide care to
            individuals living with HIV.
                (4) Development by grant recipients under title XXVI of the
            Public Health Service Act (42 U.S.C. 300ff-11 et seq.; commonly
            referred to as the ``Ryan White HIV/AIDS Program'') and other
            persons, of policies for providing culturally relevant and
            sensitive treatment to individuals living with HIV, with
            particular emphasis on treatment to racial and ethnic
            minorities, men who have sex with men, and women, young people,
            and children living with HIV.
                (5) Development and implementation of programs to increase
            the use of telehealth to respond to HIV-specific health care
            needs in rural and minority communities, with particular
            emphasis given to medically underserved communities and insular
            areas.
                (6) Evaluating interdisciplinary medical provider care team
            models that promote high-quality care, with particular emphasis
            on care to racial and ethnic minorities.
                (7) Training health care professionals to make them aware
            of the high rates of chronic hepatitis B and chronic hepatitis
            C in adult racial and ethnic minority populations, and the
            importance of prevention, detection, and medical management of
            hepatitis B and hepatitis C and of liver cancer screening.
                (8) Development of curricula for training primary care
            providers that HIV and tuberculosis are significant mutual
            comorbidities, and that a patient who tests positive for one
            disease should be offered and encouraged to receive testing for
            the other.
        (b) Authorization of Appropriations.--To carry out this section,
    there are authorized to be appropriated such sums as may be necessary
    for fiscal years 2023 through 2026.

    SEC. 7210. HIV/AIDS PROVIDER LOAN REPAYMENT PROGRAM.

        (a) In General.--The Secretary may enter into an agreement with any
    physician, nurse practitioner, or physician assistant under which--
                (1) the physician, nurse practitioner, or physician
            assistant agrees to serve as a medical provider for a period of
            not less than 2 years--
                        (A) at a Ryan White-funded or title X-funded
                    facility with a critical shortage of doctors (as
                    determined by the Secretary); or
                        (B) in an area with a high incidence of HIV/AIDS;
                    and
                (2) the Secretary agrees to make payments in accordance
            with subsection (b) on the professional education loans of the
            physician, nurse practitioner, or physician assistant.
        (b) Manner of Payments.--The payments described in subsection (a)
    shall be made by the Secretary as follows:
                (1) Upon completion by the physician, nurse practitioner,
            or physician assistant for whom the payments are to be made of
            the first year of the service specified in the agreement
            entered into with the Secretary under subsection (a), the
            Secretary shall pay 30 percent of the principal of and the
            interest on the individual's professional education loans.
                (2) Upon completion by the physician, nurse practitioner,
            or physician assistant of the second year of such service, the
            Secretary shall pay another 30 percent of the principal of and
            the interest on such loans.
                (3) Upon completion by that individual of a third year of
            such service, the Secretary shall pay another 25 percent of the
            principal of and the interest on such loans.
        (c) Applicability of Certain Provisions.--Subpart III of part D of
    title III of the Public Health Service Act (42 U.S.C. 254l et seq.)
    shall, except as inconsistent with this section, apply to the program
    carried out under this section in the same manner and to the same
    extent as such provisions apply to the National Health Service Corps
    loan repayment program.
        (d) Reports.--Not later than 18 months after the date of the
    enactment of this Act, and annually thereafter, the Secretary shall
    prepare and submit to Congress a report describing the program carried
    out under this section, including statements regarding the following:
                (1) The number of physicians, nurse practitioners, and
            physician assistants enrolled in the program.
                (2) The number and amount of loan repayments provided
            through the program.
                (3) The placement location of loan repayment recipients at
            facilities described in subsection (a)(1).
                (4) The default rate on such loans and actions required.
                (5) The amount of outstanding default funds with respect to
            such loans.
                (6) To the extent that it can be determined, the reason for
            the default on such a loan.
                (7) The demographics of individuals participating in the
            program.
                (8) An evaluation of the overall costs and benefits of the
            program.
        (e) Definitions.--In this section:
                (1) HIV/AIDS.--The term ``HIV/AIDS'' means human
            immunodeficiency virus and acquired immune deficiency syndrome.
                (2) Nurse practitioner.--The term ``nurse practitioner''
            means a registered nurse who has completed an accredited
            graduate degree program in advanced nurse practice and has
            successfully passed a national certification exam.
                (3) Physician.--The term ``physician'' means a graduate of
            a school of medicine who has completed postgraduate training in
            general or pediatric medicine.
                (4) Physician assistant.--The term ``physician assistant''
            means a medical provider who completed an accredited physician
            assistant training program and successfully passed the
            Physician Assistant National Certifying Examination.
                (5) Professional education loan.--The term ``professional
            education loan''--
                        (A) means a loan that is incurred for the cost of
                    attendance (including tuition, other reasonable
                    educational expenses, and reasonable living costs) at a
                    school of medicine, nursing, or physician assistant
                    training program; and
                        (B) includes only the portion of the loan that is
                    outstanding on the date the physician, nurse
                    practitioner, or physician assistant involved begins
                    the service specified in the agreement under subsection
                    (a).
                (6) Ryan white-funded.--The term ``Ryan White-funded''
            means, with respect to a facility, receiving funds under title
            XXVI of the Public Health Service Act (42 U.S.C. 300ff-11 et
            seq.).
                (7) Secretary.--The term ``Secretary'' means the Secretary
            of Health and Human Services.
                (8) School of medicine.--The term ``school of medicine''
            has the meaning given to that term in section 799B of the
            Public Health Service Act (42 U.S.C. 295p).
                (9) Title x-funded.--The term ``title X-funded'' means,
            with respect to a facility, receiving funds under title X of
            the Public Health Service Act (42 U.S.C. 300 et seq.).
        (f) Authorization of Appropriations.--To carry out this section,
    there are authorized to be appropriated such sums as may be necessary
    for fiscal years 2023 through 2026.

    SEC. 7211. DENTAL EDUCATION LOAN REPAYMENT PROGRAM.

        (a) In General.--The Secretary may enter into an agreement with any
    dentist under which--
                (1) the dentist agrees to serve as a dentist for a period
            of not less than 2 years at a facility with a critical shortage
            of dentists (as determined by the Secretary) in an area with a
            high incidence of HIV/AIDS; and
                (2) the Secretary agrees to make payments in accordance
            with subsection (b) on the dental education loans of the
            dentist.
        (b) Manner of Payments.--The payments described in subsection (a)
    shall be made by the Secretary as follows:
                (1) Upon completion by the dentist for whom the payments
            are to be made of the first year of the service specified in
            the agreement entered into with the Secretary under subsection
            (a), the Secretary shall pay 30 percent of the principal of and
            the interest on the dental education loans of the dentist.
                (2) Upon completion by the dentist of the second year of
            such service, the Secretary shall pay another 30 percent of the
            principal of and the interest on such loans.
                (3) Upon completion by that individual of a third year of
            such service, the Secretary shall pay another 25 percent of the
            principal of and the interest on such loans.
        (c) Applicability of Certain Provisions.--Subpart III of part D of
    title III of the Public Health Service Act (42 U.S.C. 254l et seq.)
    shall, except as inconsistent with this section, apply to the program
    carried out under this section in the same manner and to the same
    extent as such provisions apply to the National Health Service Corps
    Loan Repayment Program.
        (d) Reports.--Not later than 18 months after the date of the
    enactment of this Act, and annually thereafter, the Secretary shall
    prepare and submit to the Congress a report describing the program
    carried out under this section, including statements regarding the
    following:
                (1) The number of dentists enrolled in the program.
                (2) The number and amount of loan repayments provided
            through the program.
                (3) The placement location of loan repayment recipients at
            facilities described in subsection (a)(1).
                (4) The default rate on such loans and actions required.
                (5) The amount of outstanding default funds with respect to
            such loans.
                (6) To the extent that it can be determined, the reason for
            the default on such a loan.
                (7) The demographics of individuals participating in the
            program.
                (8) An evaluation of the overall costs and benefits of the
            program.
        (e) Definitions.--In this section:
                (1) Dental education loan.--The term ``dental education
            loan''--
                        (A) means a loan that is incurred for the cost of
                    attendance (including tuition, other reasonable
                    educational expenses, and reasonable living costs) at a
                    school of dentistry; and
                        (B) includes only the portion of the loan that is
                    outstanding on the date the dentist involved begins the
                    service specified in the agreement under subsection
                    (a).
                (2) Dentist.--The term ``dentist'' means a graduate of a
            school of dentistry who has completed postgraduate training in
            general or pediatric dentistry.
                (3) HIV/AIDS.--The term ``HIV/AIDS'' means human
            immunodeficiency virus and acquired immune deficiency syndrome.
                (4) School of dentistry.--The term ``school of dentistry''
            has the meaning given to that term in section 799B of the
            Public Health Service Act (42 U.S.C. 295p).
                (5) Secretary.--The term ``Secretary'' means the Secretary
            of Health and Human Services.
        (f) Authorization of Appropriations.--To carry out this section,
    there are authorized to be appropriated such sums as may be necessary
    for each of fiscal years 2023 through 2026.

    SEC. 7212. REDUCING NEW HIV INFECTIONS AMONG INJECTING DRUG USERS.

        (a) Sense of Congress.--It is the sense of Congress that providing
    sterile syringes and sterilized equipment to injecting drug users
    substantially reduces risk of HIV infection, increases the probability
    that they will initiate drug treatment, and does not increase drug use.
        (b) In General.--The Secretary of Health and Human Services may
    provide grants and technical assistance for the purpose of reducing the
    rate of HIV infections among injecting drug users through a
    comprehensive package of services for such users, including the
    provision of sterile syringes, education and outreach, access to
    infectious disease testing, overdose prevention, and treatment for drug
    dependence.
        (c) Authorization of Appropriations.--To carry out this section,
    there are authorized to be appropriated such sums as may be necessary
    for fiscal years 2023 through 2026.

    SEC. 7213. REPORT ON IMPACT OF HIV/AIDS IN VULNERABLE POPULATIONS.

        (a) In General.--The Secretary shall submit to Congress and the
    President an annual report on the impact of HIV/AIDS for racial and
    ethnic minority communities, women, and youth aged 24 and younger.
        (b) Contents.--The report under subsection (a) shall include
    information on the--
                (1) progress that has been made in reducing the impact of
            HIV/AIDS in such communities;
                (2) opportunities that exist to make additional progress in
            reducing the impact of HIV/AIDS in such communities;
                (3) challenges that may impede such additional progress;
            and
                (4) Federal funding necessary to achieve substantial
            reductions in HIV/AIDS in racial and ethnic minority
            communities.

    SEC. 7214. NATIONAL HIV/AIDS OBSERVANCE DAYS.

        (a) National Observance Days.--It is the sense of Congress that
    national observance days highlighting the impact of HIV on communities
    of color include the following:
                (1) National Black HIV/AIDS Awareness Day.
                (2) National Latino AIDS Awareness Day.
                (3) National Asian and Pacific Islander HIV/AIDS Awareness
            Day.
                (4) National Native American HIV/AIDS Awareness Day.
                (5) National Youth HIV/AIDS Awareness Day.
        (b) Call to Action.--It is the sense of Congress that the President
    should call on members of communities of color--
                (1) to become involved at the local community level in HIV
            testing, policy, and advocacy;
                (2) to become aware, engaged, and empowered on the HIV
            epidemic within their communities; and
                (3) to urge members of their communities to reduce risk
            factors, practice safe sex and other preventive measures, be
            tested for HIV, and seek care when appropriate.

    SEC. 7215. REVIEW OF ALL FEDERAL AND STATE LAWS, POLICIES, AND
                  REGULATIONS REGARDING THE CRIMINAL PROSECUTION OF
                  INDIVIDUALS FOR HIV-RELATED OFFENSES.

        (a) Findings.--Congress makes the following findings:
                (1) At present, 32 States and 2 United States territories
            have criminal statutes based on perceived exposure to HIV,
            rather than behaviors motivated by an intent to harm,
            presenting a significant risk of transmission and resulting in
            actual transmission of HIV to another. 11 States have HIV-
            specific laws that make spitting or biting a felony, even
            though it is not possible to transmit HIV via saliva. 24 States
            require persons who are aware that they have HIV to disclose
            their status to sexual partners, regardless of whether they are
            noninfectious. 14 of these 24 States also require disclosure to
            needle-sharing partners. 25 States criminalize 1 or more
            behaviors that pose a low or negligible risk for HIV
            transmission.
                (2) HIV-specific criminal laws are classified as felonies
            in 28 States. In 3 States, a person's exposure to another to
            HIV does not subject the person to criminal prosecution for
            that act alone but may result in a sentence enhancement. 18
            States impose sentences of up to 10 years per violation, 7
            States impose sentences between 11 and 20 years, and 5 States
            impose sentences of greater than 20 years.
                (3) When members of the Armed Forces acquire HIV, they are
            issued orders that require them to disclose and use a condom
            under all circumstances including when the known risk of
            transmission is 0. Failure to disclose can result in
            prosecution under the Uniform Code of Military Justice (UCMJ).
                (4) The number of prosecutions, arrests, and instances
            where HIV-based charges are used to induce plea agreements is
            unknown. Because State-level prosecution and arrest data are
            not readily available in any national legal database, the
            societal impact of these laws may be underestimated and most
            cases that go to trial are not reduced to written, published
            opinions.
                (5) State and Federal criminal law does not currently
            reflect the 4 decades of medical advances and discoveries made
            with regard to transmission and treatment of HIV/AIDS.
                (6) According to the CDC, correct and consistent male or
            female condom use, or adherence to a preexposure prophylaxis
            (PrEP) regimen that results in viral suppression, are very
            effective in preventing HIV transmission. However, most State
            HIV-specific laws and prosecutions do not treat the use of a
            condom during sexual intercourse or adherence to PrEP as a
            mitigating factor or evidence that the defendant did not intend
            to transmit HIV.
                (7) Criminal laws and prosecutions do not take into account
            the benefits of effective antiretroviral medications, which
            suppress the virus to extremely low levels and further reduce
            the already low risk of transmitting HIV to near 0.
                (8) In addition to HIV-specific criminal laws, general
            criminal laws are often misused to prosecute people based on
            their HIV status. Although HIV, and even AIDS, currently is
            viewed as a treatable, chronic, medical condition, people
            living with HIV have been charged under aggravated assault,
            attempted murder, and even bioterrorism statutes because
            prosecutors, courts, and legislators continue to view and
            characterize the blood, semen, and saliva of people living with
            HIV as a ``deadly weapon''.
                (9) Multiple peer-reviewed studies demonstrate that HIV-
            specific laws do not reduce risk-taking behavior or increase
            disclosure by people living with or at risk of HIV, and there
            is increasing evidence that these laws reduce the willingness
            to get tested. Furthermore, placing legal responsibility for
            preventing the transmission of HIV and other pathogens that can
            be sexually transmitted exclusively on people diagnosed with a
            sexually transmitted infection undermines the public health
            message that all people are responsible for practicing
            behaviors that protect themselves from HIV and other sexually
            transmitted infections. Unfortunately, some State laws create
            an expectation of disclosure work against public health
            communication and discourage risk-reduction measures that could
            prevent transmission as a result of those who are acutely
            infected and unaware of their status.
                (10) The identity of an individual subject to an HIV-based
            prosecution is broadcast through media reports, potentially
            destroying employment opportunities and relationships and
            violating the person's right to privacy.
                (11) Individuals who are convicted after an HIV-based
            prosecution often must register as sex offenders even in cases
            involving consensual sexual activity. Their employability is
            destroyed, and their family relationships are fractured.
                (12) The United Nations, including the Joint United Nations
            Programme on HIV/AIDS (UNAIDS), urges governments to ``limit
            criminalization to cases of intentional transmission''. This
            requirement would limit prosecutions to situations ``where a
            person knows his or her HIV-positive status, acts with the
            intention to transmit HIV, and does in fact transmit it''.
            UNAIDS also recommends that criminal law should not be applied
            to cases where there is no significant risk of transmission.
                (13) In 2010, the Federal Government released the first
            ever National HIV/AIDS Strategy (NHAS), which addressed HIV-
            specific criminal laws, stating: ``While we understand the
            intent behind these laws, they may not have the desired effect
            and they may make people less willing to disclose their status
            by making people feel at even greater risk of discrimination.
            In some cases, it may be appropriate for legislators to
            reconsider whether existing laws continue to further the public
            interest and public health. In many instances, the continued
            existence and enforcement of these types of laws run counter to
            scientific evidence about routes of HIV transmission and may
            undermine the public health goals of promoting HIV screening
            and treatment.''. The NHAS also states that State legislatures
            should consider reviewing HIV-specific criminal statutes to
            ensure that they are consistent with current knowledge of HIV
            transmission and support public health approaches to preventing
            and treating HIV.
                (14) The Global Commission on HIV and the Law was launched
            in June 2010 to examine laws and practices that criminalize
            people living with and vulnerable to HIV and to develop
            evidence-based recommendations for effective HIV responses. The
            Commission calls for ``governments, civil society and
            international bodies to repeal punitive laws and enact laws
            that facilitate and enable effective responses to HIV
            prevention, care and treatment services for all who need
            them''. The Commission recommends against the enactment of
            ``laws that explicitly criminalize HIV transmission, exposure
            or non-disclosure of HIV status, which are counterproductive''.
                (15) In February 2019, the Department of Health and Human
            Services (HHS) launched ``Ending the HIV Epidemic: A Plan for
            America'', a new initiative with an ambitious goal to end the
            domestic HIV epidemic in 10 years by reducing new cases of HIV
            by 75 percent by 2025 and by 90 percent by 2030. In this plan,
            HHS notes that stigma ``can be a debilitating barrier
            preventing people living with, or at risk for, HIV from
            receiving the health care, services, and respect they need and
            deserve''. Many of the States and jurisdictions identified as a
            priority for the first 5 years of the plan have stigma-based
            criminal statutes for perceived exposure to HIV. These statutes
            run counter to the goals of this new initiative and stand in
            the way of ending the domestic HIV epidemic.
        (b) Sense of Congress Regarding Laws or Regulations Directed at
    People Living With HIV.--It is the sense of Congress that Federal and
    State laws, policies, and regulations regarding people living with
    HIV--
                (1) should not place unique or additional burdens on such
            individuals solely as a result of their HIV status; and
                (2) should instead demonstrate a public health-oriented,
            evidence-based, medically accurate, and contemporary
            understanding of--
                        (A) the multiple factors that lead to HIV
                    transmission;
                        (B) the relative risk of demonstrated HIV
                    transmission routes;
                        (C) the current health implications of living with
                    HIV;
                        (D) the associated benefits of treatment and
                    support services for people living with HIV; and
                        (E) the impact of punitive HIV-specific laws,
                    policies, regulations, and judicial precedents and
                    decisions on public health, on people living with or
                    affected by HIV, and on their families and communities.
        (c) Review of Federal and State Laws.--
                (1) Review of federal and state laws.--
                        (A) In general.--Not later than 90 days after the
                    date of the enactment of this Act, the Attorney
                    General, the Secretary of Health and Human Services,
                    and the Secretary of Defense acting jointly (in this
                    section referred to as the ``designated officials'')
                    shall initiate a national review of Federal and State
                    laws, policies, regulations, and judicial precedents
                    and decisions regarding criminal and related civil
                    commitment cases involving people living with HIV/AIDS,
                    including the Uniform Code of Military Justice.
                        (B) Consultation.--In carrying out the review under
                    subparagraph (A), the designated officials shall seek
                    to include diverse participation from, and consultation
                    with, each of the following:
                                (i) Each State.
                                (ii) State attorneys general (or their
                            representatives).
                                (iii) State public health officials (or
                            their representatives).
                                (iv) State judicial and court system
                            officers, including judges, district attorneys,
                            prosecutors, defense attorneys, law
                            enforcement, and correctional officers.
                                (v) Members of the United States Armed
                            Forces, including members of other Federal
                            services subject to the UCMJ.
                                (vi) People living with HIV/AIDS,
                            particularly those who have been subject to
                            HIV-related prosecution or who are from
                            minority communities whose members have been
                            disproportionately subject to HIV-specific
                            arrests and prosecution.
                                (vii) Legal advocacy and HIV/AIDS service
                            organizations that work with people living with
                            HIV/AIDS.
                                (viii) Nongovernmental health organizations
                            that work on behalf of people living with HIV/
                            AIDS, including syringe services programs,
                            LGBTQ-focused health organizations, and
                            organizations who serve people who engage in
                            sex work.
                                (ix) Trade organizations or associations
                            representing persons or entities described in
                            clause (i) through (vii).
                        (C) Relation to other reviews.--In carrying out the
                    review under subparagraph (A), the designated officials
                    may utilize other existing reviews of criminal and
                    related civil commitment cases involving people living
                    with HIV, including any such review conducted by any
                    Federal or State agency or any public health, legal
                    advocacy, or trade organization or association if the
                    designated officials determines that such reviews were
                    conducted in accordance with the principles set forth
                    in subsection (b).
                (2) Report.--Not later than 180 days after initiating the
            review required by paragraph (1), the Attorney General shall
            transmit to the Congress and make publicly available a report
            containing the results of the review, which includes the
            following:
                        (A) For each State and for the UCMJ, a summary of
                    the relevant laws, policies, regulations, and judicial
                    precedents and decisions regarding criminal cases
                    involving people living with HIV, including the
                    following:
                                (i) A determination of whether such laws,
                            policies, regulations, and judicial precedents
                            and decisions place any unique or additional
                            burdens upon people living with HIV.
                                (ii) A determination of whether such laws,
                            policies, regulations, and judicial precedents
                            and decisions demonstrate a public health-
                            oriented, evidence-based, medically accurate,
                            and contemporary understanding of--
                                        (I) the multiple factors that lead
                                    to HIV transmission;
                                        (II) the relative risk of HIV
                                    transmission routes, including that a
                                    person that has an undetectable viral
                                    load cannot transmit the disease;
                                        (III) the current health
                                    implications of living with HIV,
                                    including data disaggregated by race
                                    and ethnicity;
                                        (IV) the current status of
                                    providing protection to people who
                                    engage in survival sex work against
                                    whom condom possession has been used as
                                    evidence to intent to commit a crime;
                                        (V) States that have the
                                    classification of mandatory sex
                                    offenders;
                                        (VI) the associated benefits of
                                    treatment and support services for
                                    people living with HIV; and
                                        (VII) the impact of punitive HIV-
                                    specific laws and policies on public
                                    health, on people living with or
                                    affected by HIV, and on their families
                                    and communities, including people who
                                    are in abusive, dependent, violent, and
                                    nonconsensual relationships and are
                                    unable to both negotiate the use of
                                    condoms and status disclosure.
                                (iii) An analysis of the public health and
                            legal implications of such laws, policies,
                            regulations, and judicial precedents and
                            decisions, including an analysis of the
                            consequences of having a similar penal scheme
                            applied to comparable situations involving
                            other communicable diseases.
                                (iv) An analysis of the proportionality of
                            punishments imposed under HIV-specific laws,
                            policies, regulations, and judicial precedents,
                            taking into consideration penalties attached to
                            violation of State laws against similar degrees
                            of endangerment or harm, such as driving while
                            intoxicated or transmission of other
                            communicable diseases, or more serious harms,
                            such as vehicular manslaughter offenses.
                        (B) An analysis of common elements shared between
                    State laws, policies, regulations, and judicial
                    precedents.
                        (C) A set of best practice recommendations directed
                    to State governments, including State attorneys
                    general, public health officials, and judicial
                    officers, in order to ensure that laws, policies,
                    regulations, and judicial precedents regarding people
                    living with HIV are in accordance with the principles
                    set forth in subsection (b).
                        (D) Recommendations for adjustments to the UCMJ,
                    including discontinuing the use of a service member's
                    HIV diagnosis as the basis for prosecution, enhanced
                    penalties, or discharge from military service, in order
                    to ensure that laws, policies, regulations, and
                    judicial precedents regarding people living with HIV
                    are in accordance with the principles set forth in
                    subsection (b). Such recommendations should include any
                    necessary and appropriate changes to ``Orders to Follow
                    Preventative Medicine Requirements''.
                (3) Guidance.--Within 90 days of the release of the report
            required by paragraph (2), the Attorney General and the
            Secretary of Health and Human Services, acting jointly, shall
            develop and publicly release updated guidance for States based
            on the set of best practice recommendations required by
            paragraph (2)(C) in order to assist States dealing with
            criminal and related civil commitment cases regarding people
            living with HIV.
                (4) Monitoring and evaluation system.--Within 60 days of
            the release of the guidance required by paragraph (3), the
            Attorney General and the Secretary of Health and Human
            Services, acting jointly, shall establish an integrated
            monitoring and evaluation system which includes, where
            appropriate, objective and quantifiable performance goals and
            indicators to measure progress toward statewide implementation
            in each State of the best practice recommendations required in
            paragraph (2)(C).
                (5) Modernization of federal laws, policies, and
            regulations.--Within 90 days of the release of the report
            required by paragraph (2), the designated officials shall
            develop and transmit to the President and the Congress, and
            make publicly available, such proposals as may be necessary to
            implement adjustments to Federal laws, policies, or
            regulations, including to the UCMJ, based on the
            recommendations required by paragraph (2)(D), either through
            Executive order or through changes to statutory law.
        (d) Rule of Construction.--Nothing in this section shall be
    construed to discourage the prosecution of individuals who
    intentionally transmit or attempt to transmit HIV to another
    individual.
        (e) No Additional Appropriations Authorized.--This section shall
    not be construed to increase the amount of appropriations that are
    authorized to be appropriated for any fiscal year.

    SEC. 7216. EXPANDING SUPPORT FOR CONDOMS IN PRISONS.

        (a) Sense of Congress Regarding Distribution of Sexual Barrier
    Protection Devices in State Prison Systems.--It is the sense of the
    Congress that States shall allow for the legal distribution of sexual
    barrier protection devices in State correctional facilities to reduce
    the prevalence and spread of STIs in those facilities.
        (b) Authority To Allow Community Organizations To Provide STI
    Counseling, STI Prevention Education, and Sexual Barrier Protection
    Devices in Federal Correctional Facilities.--
                (1) Directive to attorney general.--Not later than 30 days
            after the date of enactment of this Act, the Attorney General
            shall direct the Director of the Bureau of Prisons to allow
            community organizations to, in accordance with all relevant
            Federal laws and regulations that govern visitation in Federal
            correctional facilities--
                        (A) distribute sexual barrier protection devices in
                    Federal correctional facilities; and
                        (B) engage in STI counseling and STI prevention
                    education in Federal correctional facilities.
                (2) Information requirement.--Any community organization
            permitted to distribute sexual barrier protection devices under
            paragraph (1) shall ensure that the individuals to whom the
            devices are distributed are informed about the proper use and
            disposal of sexual barrier protection devices in accordance
            with established public health practices. Any community
            organization conducting STI counseling or STI prevention
            education under paragraph (1) shall offer comprehensive
            sexuality education.
                (3) Possession of device protected.--A Federal correctional
            facility may not, because of the possession or use of a sexual
            barrier protection device--
                        (A) take adverse action against an incarcerated
                    individual; or
                        (B) consider possession or use as evidence of
                    prohibited activity for the purpose of any Federal
                    correctional facility administrative proceeding.
                (4) Implementation.--The Attorney General and the Director
            of the Bureau of Prisons shall implement this section according
            to established public health practices in a manner that
            protects the health, safety, and privacy of incarcerated
            individuals and of correctional facility staff.
        (c) Survey of and Report on Correctional Facility Programs Aimed at
    Reducing the Spread of STIs.--
                (1) Survey.--Not later than 180 days after the date of
            enactment of this Act, and annually thereafter for 5 years, the
            Attorney General, after consulting with the Secretary of Health
            and Human Services, State officials, and community
            organizations, shall, to the maximum extent practicable,
            conduct a survey of all Federal and State correctional
            facilities, to determine the following:
                        (A) Counseling, treatment, and supportive
                    services.--Whether the correctional facility--
                                (i) requires incarcerated individuals to
                            participate in counseling, treatment, and
                            supportive services related to STIs; or
                                (ii) offers such programs to incarcerated
                            individuals.
                        (B) Access to sexual barrier protection devices.--
                    Whether incarcerated individuals can--
                                (i) possess sexual barrier protection
                            devices;
                                (ii) purchase sexual barrier protection
                            devices;
                                (iii) purchase sexual barrier protection
                            devices at a reduced cost; or
                                (iv) obtain sexual barrier protection
                            devices without cost.
                        (C) Incidence of sexual violence.--The incidence of
                    sexual violence and assault committed by incarcerated
                    individuals and by correctional facility staff.
                        (D) Prevention education offered.--The type of
                    prevention education, information, or training offered
                    to incarcerated individuals and correctional facility
                    staff regarding sexual violence and the spread of STIs,
                    including whether such education, information, or
                    training--
                                (i) constitutes comprehensive sexuality
                            education;
                                (ii) is compulsory for new incarcerated
                            individuals and for new correctional facility
                            staff; and
                                (iii) is offered on an ongoing basis.
                        (E) STI testing.--Whether the correctional facility
                    tests incarcerated individuals for STIs or gives them
                    the option to undergo such testing--
                                (i) at intake;
                                (ii) on a regular basis; and
                                (iii) prior to release.
                        (F) STI test results.--The number of incarcerated
                    individuals who are tested for STIs and the outcome of
                    such tests at each correctional facility, disaggregated
                    to include results for--
                                (i) the type of STI tested for;
                                (ii) the race and ethnicity of an
                            individual tested;
                                (iii) the age of an individual tested; and
                                (iv) the gender of the individual tested.
                        (G) Prerelease referral policy.--Whether
                    incarcerated individuals are informed prior to release
                    about STI-related services or other health services in
                    their communities, including free and low-cost
                    counseling and treatment options.
                        (H) Prerelease referrals made.--The number of
                    referrals to community-based organizations or public
                    health facilities offering STI-related or other health
                    services provided to incarcerated individuals prior to
                    release, and the type of counseling or treatment for
                    which the referral was made.
                        (I) Reinstatement of medicaid benefits.--Whether
                    the correctional facility assists incarcerated
                    individuals that were enrolled in the State Medicaid
                    program prior to their incarceration, in reinstating
                    their enrollment upon release and whether such
                    individuals receive referrals as provided by
                    subparagraph (G) to entities that accept the State
                    Medicaid program, including if applicable--
                                (i) the number of such individuals,
                            including those diagnosed with HIV, that have
                            been reinstated;
                                (ii) a list of obstacles to reinstating
                            enrollment or to making determinations of
                            eligibility for reinstatement, if any; and
                                (iii) the number of individuals denied
                            enrollment.
                        (J) Other actions taken.--Whether the correctional
                    facility has taken any other action, in conjunction
                    with community organizations or otherwise, to reduce
                    the prevalence and spread of STIs in that facility.
                (2) Privacy.--In conducting the survey under paragraph (1),
            the Attorney General shall not request or retain the identity
            of any individual who has sought or been offered counseling,
            treatment, testing, or prevention education information
            regarding an STI (including information about sexual barrier
            protection devices), or who has tested positive for an STI.
                (3) Report.--
                        (A) In general.--The Attorney General shall
                    transmit to Congress and make publicly available the
                    results of the survey required under paragraph (1),
                    both for the United States as a whole and disaggregated
                    as to each State and each correctional facility.
                        (B) Deadlines.--To the maximum extent possible, the
                    Attorney General shall--
                                (i) issue the first report under
                            subparagraph (A) not later than 1 year after
                            the date of enactment of this Act; and
                                (ii) issue reports under subparagraph (A)
                            annually thereafter for 5 years.
        (d) Strategy.--
                (1) Directive to attorney general.--The Attorney General,
            in consultation with the Secretary of Health and Human
            Services, State officials, and community organizations, shall
            develop and implement a 5-year strategy to reduce the
            prevalence and spread of STIs in Federal and State correctional
            facilities. To the maximum extent possible, the strategy shall
            be developed, transmitted to Congress, and made publicly
            available no later than 180 days after the transmission of the
            first report required under subsection (d)(3).
                (2) Contents of strategy.--The strategy developed under
            paragraph (1) shall include the following:
                        (A) Prevention education.--A plan for improving
                    prevention education, information, and training offered
                    to incarcerated individuals and correctional facility
                    staff, including information and training on sexual
                    violence and the spread of STIs, and comprehensive
                    sexuality education.
                        (B) Sexual barrier protection device access.--A
                    plan for expanding access to sexual barrier protection
                    devices in correctional facilities.
                        (C) Sexual violence reduction.--A plan for reducing
                    the incidence of sexual violence among incarcerated
                    individuals and correctional facility staff, developed
                    in consultation with the National Prison Rape
                    Elimination Commission.
                        (D) Counseling and supportive services.--A plan for
                    expanding access to counseling and supportive services
                    related to STIs in correctional facilities.
                        (E) Testing.--A plan for testing incarcerated
                    individuals for STIs during intake, during regular
                    health exams, and prior to release, and that--
                                (i) is conducted in accordance with
                            guidelines established by the Centers for
                            Disease Control and Prevention;
                                (ii) includes pretest counseling;
                                (iii) requires that incarcerated
                            individuals are notified of their option to
                            decline testing at any time;
                                (iv) requires that incarcerated individuals
                            are confidentially notified of their test
                            results in a timely manner; and
                                (v) ensures that incarcerated individuals
                            testing positive for STIs receive post-test
                            counseling, care, treatment, and supportive
                            services.
                        (F) Treatment.--A plan for ensuring that
                    correctional facilities have the necessary medicine and
                    equipment to treat and monitor STIs and for ensuring
                    that incarcerated individuals living with or testing
                    positive for STIs receive and have access to care and
                    treatment services.
                        (G) Strategies for demographic groups.--A plan for
                    developing and implementing culturally appropriate,
                    sensitive, and specific strategies to reduce the spread
                    of STIs among demographic groups heavily impacted by
                    STIs.
                        (H) Linkages with communities and facilities.--A
                    plan for establishing and strengthening linkages to
                    local community and health facilities that--
                                (i) provide counseling, testing, care, and
                            treatment services;
                                (ii) may receive individuals recently
                            released from incarceration who are living with
                            STIs; and
                                (iii) accept payment through the State
                            Medicaid program.
                        (I) Enrollment in state medicaid programs.--Plans
                    to ensure that--
                                (i) incarcerated individuals who were
                            enrolled in their State Medicaid program prior
                            to incarceration in a correctional facility are
                            automatically reenrolled in such program upon
                            their release; and
                                (ii) incarcerated individuals who were not
                            enrolled in their State Medicaid program prior
                            to incarceration, and who are diagnosed with
                            HIV while incarcerated in a correctional
                            facility, are automatically enrolled in such
                            program upon their release.
                        (J) Other plans.--Any other plans developed by the
                    Attorney General for reducing the spread of STIs or
                    improving the quality of health care in correctional
                    facilities.
                        (K) Monitoring system.--A monitoring system that
                    establishes performance goals related to reducing the
                    prevalence and spread of STIs in correctional
                    facilities and which, where feasible, express such
                    goals in quantifiable form.
                        (L) Monitoring system performance indicators.--
                    Performance indicators that measure or assess the
                    achievement of the performance goals described in
                    subparagraph (K).
                        (M) Cost estimate.--A detailed estimate of the
                    funding necessary to implement the strategy at the
                    Federal and State levels for all 5 years, including the
                    amount of funds required by community organizations to
                    implement the parts of the strategy in which they take
                    part.
                (3) Report.--Not later than 1 year after the date of the
            enactment of this Act, and annually thereafter, the Attorney
            General shall transmit to Congress and make publicly available
            an annual progress report regarding the implementation and
            effectiveness of the strategy described in paragraph (1). The
            progress report shall include an evaluation of the
            implementation of the strategy using the monitoring system and
            performance indicators provided for in subparagraphs (K) and
            (L) of paragraph (2).
        (e) Authorization of Appropriations.--
                (1) In general.--There are authorized to be appropriated
            such sums as may be necessary to carry out this section for
            each of fiscal years 2023 through 2027.
                (2) Availability of funds.--Amounts made available under
            paragraph (1) are authorized to remain available until
            expended.
        (f) Definitions.--In this section:
                (1) Community organization.--The term ``community
            organization'' means a public health care facility or a
            nonprofit organization that provides health- or STI-related
            services according to established public health standards.
                (2) Comprehensive sexuality education.--The term
            ``comprehensive sexuality education'' means sexuality
            education--
                        (A) that includes information about abstinence and
                    about the proper use and disposal of sexual barrier
                    protection devices; and
                        (B) that is--
                                (i) evidence-based;
                                (ii) medically accurate;
                                (iii) age and developmentally appropriate;
                                (iv) gender and identity sensitive;
                                (v) culturally and linguistically
                            appropriate; and
                                (vi) structured to promote critical
                            thinking, self-esteem, respect for others, and
                            the development of healthy attitudes and
                            relationships.
                (3) Correctional facility.--The term ``correctional
            facility'' means any prison, penitentiary, adult detention
            facility, juvenile detention facility, jail, or other facility
            to which individuals may be sent after conviction of a crime or
            act of juvenile delinquency within the United States.
                (4) Incarcerated individual.--The term ``incarcerated
            individual'' means any individual who is serving a sentence in
            a correctional facility after conviction of a crime.
                (5) Sexual barrier protection device.--The term ``sexual
            barrier protection device'' means any physical device approved,
            cleared, or otherwise authorized by the Food and Drug
            Administration that has not been tampered with and which
            reduces the probability of STI transmission or infection
            between sexual partners, including female condoms, male
            condoms, and dental dams.
                (6) Sexually transmitted infection.--The term ``sexually
            transmitted infection'' or ``STI'' means any disease or
            infection that is commonly transmitted through sexual activity,
            including HIV, gonorrhea, chlamydia, syphilis, genital herpes,
            viral hepatitis, and human papillomavirus.
                (7) State.--The term ``State'' includes the District of
            Columbia, American Samoa, the Commonwealth of the Northern
            Mariana Islands, Guam, Puerto Rico, and the United States
            Virgin Islands.
                (8) State medicaid program.--The term ``State Medicaid
            program'' means the State plan (or a waiver of such plan) under
            title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).

    SEC. 7217. AUTOMATIC REINSTATEMENT OR ENROLLMENT IN MEDICAID FOR PEOPLE
                  WHO TEST POSITIVE FOR HIV BEFORE REENTERING COMMUNITIES.

        (a) In General.--Section 1902(e) of the Social Security Act (42
    U.S.C. 1396a(e)) is amended by adding at the end the following:
                ``(17) Enrollment of ex-offenders.--
                        ``(A) Automatic enrollment or reinstatement.--
                                ``(i) In general.--The State plan shall
                            provide for the automatic enrollment or
                            reinstatement of enrollment of an eligible
                            individual--
                                        ``(I) if such individual is
                                    scheduled to be released from a public
                                    institution due to the completion of
                                    sentence, not less than 30 days prior
                                    to the scheduled date of the release;
                                    and
                                        ``(II) if such individual is to be
                                    released from a public institution on
                                    parole or on probation, as soon as
                                    possible after the date on which the
                                    determination to release such
                                    individual was made, and before the
                                    date such individual is released.
                                ``(ii) Exception.--If a State makes a
                            determination that an individual is not
                            eligible to be enrolled under the State plan--
                                        ``(I) on or before the date by
                                    which the individual would be enrolled
                                    under clause (i), such clause shall not
                                    apply to such individual; or
                                        ``(II) after such date, the State
                                    may terminate the enrollment of such
                                    individual.
                        ``(B) Relationship of enrollment to payment for
                    services.--
                                ``(i) In general.--Subject to subparagraph
                            (A)(ii), an eligible individual who is
                            enrolled, or whose enrollment is reinstated,
                            under subparagraph (A) shall be eligible for
                            all services for which medical assistance is
                            provided under the State plan after the date
                            that the eligible individual is released from
                            the public institution.
                                ``(ii) Relationship to payment prohibition
                            for inmates.--No provision of this paragraph
                            may be construed to permit payment for care or
                            services for which payment is excluded under
                            subdivision (A) following paragraph (31) of
                            section 1905(a).
                        ``(C) Treatment of continuous eligibility.--
                                ``(i) Suspension for inmates.--Any period
                            of continuous eligibility under this title
                            shall be suspended on the date an individual
                            enrolled under this title becomes an inmate of
                            a public institution (except as a patient of a
                            medical institution).
                                ``(ii) Determination of remaining period.--
                            Notwithstanding any changes to State law
                            related to continuous eligibility during the
                            time that an individual is an inmate of a
                            public institution (except as a patient of a
                            medical institution), subject to clause (iii),
                            with respect to an eligible individual who was
                            subject to a suspension under clause (i), on
                            the date that such individual is released from
                            a public institution the suspension of
                            continuous eligibility under such clause shall
                            be lifted for a period that is equal to the
                            time remaining in the period of continuous
                            eligibility for such individual on the date
                            that such period was suspended under such
                            clause.
                                ``(iii) Exception.--If a State makes a
                            determination that an individual is not
                            eligible to be enrolled under the State plan--
                                        ``(I) on or before the date that
                                    the suspension of continuous
                                    eligibility is lifted under clause
                                    (ii), such clause shall not apply to
                                    such individual; or
                                        ``(II) after such date, the State
                                    may terminate the enrollment of such
                                    individual.
                        ``(D) Automatic enrollment or reinstatement of
                    enrollment defined.--For purposes of this paragraph,
                    the term `automatic enrollment or reinstatement of
                    enrollment' means that the State determines eligibility
                    for medical assistance under the State plan without a
                    program application from, or on behalf of, the eligible
                    individual, but an individual can only be automatically
                    enrolled in the State Medicaid plan if the individual
                    affirmatively consents to being enrolled through
                    affirmation in writing, by telephone, orally, through
                    electronic signature, or through any other means
                    specified by the Secretary.
                        ``(E) Eligible individual defined.--For purposes of
                    this paragraph, the term `eligible individual' means an
                    individual who is an inmate of a public institution
                    (except as a patient in a medical institution)--
                                ``(i) who was enrolled under the State plan
                            for medical assistance immediately before
                            becoming an inmate of such an institution; or
                                ``(ii) who is diagnosed with human
                            immunodeficiency virus.''.
        (b) Supplemental Funding for State Implementation of Automatic
    Reinstatement of Medicaid Benefits.--
                (1) In general.--Subject to paragraph (3), with respect to
            a State, for each of the first 4 calendar quarters in which the
            State plan meets the requirements of paragraph (17) of section
            1902(e) of the Social Security Act (42 U.S.C. 1396a(e)) (as
            added by subsection (a)), the Federal matching payments
            (including payments based on the Federal medical assistance
            percentage) made to such State under section 1903 of the Social
            Security Act (42 U.S.C. 1396b) for the State expenditures
            described in paragraph (2) shall be increased by 5 percentage
            points.
                (2) Expenditures.--The expenditures described in this
            paragraph are the following:
                        (A) Expenditures for which payment is available
                    under section 1903 of the Social Security Act (42
                    U.S.C. 1396b) and which are attributable to
                    strengthening the State's enrollment and administrative
                    resources for the purpose of improving processes for
                    enrolling (or reinstating the enrollment of) eligible
                    individuals (as such term is defined in subparagraph
                    (E) of paragraph (16) of section 1902(e) of the Social
                    Security Act (42 U.S.C. 1396a(e)) (as amended by
                    subsection (a))).
                        (B) Expenditures for medical assistance (as such
                    term is defined in section 1905(a) of the Social
                    Security Act (42 U.S.C. 1396d(a))) provided to such
                    eligible individuals.
                (3) Requirements; limitation.--
                        (A) Report.--A State is not eligible for an
                    increase in its Federal matching payments under
                    paragraph (1) unless the State agrees to submit to the
                    Secretary of Health and Human Services, and make
                    publicly available, a report that contains the
                    information required under paragraph (4) by the end of
                    the 1-year period during which the State receives
                    increased Federal matching payments in accordance with
                    that paragraph.
                        (B) Maintenance of eligibility.--
                                (i) In general.--Subject to clause (ii), a
                            State is not eligible for an increase in its
                            Federal matching payments under paragraph (1)
                            if eligibility standards, methodologies, or
                            procedures under its State plan under title XIX
                            of the Social Security Act (42 U.S.C. 1396 et
                            seq.), or waiver of such a plan, are more
                            restrictive than the eligibility standards,
                            methodologies, or procedures, respectively,
                            under such plan or waiver as in effect on the
                            date of enactment of this Act.
                                (ii) State reinstatement of eligibility
                            permitted.--A State that has restricted
                            eligibility standards, methodologies, or
                            procedures under its State plan under title XIX
                            of the Social Security Act (42 U.S.C. 1396 et
                            seq.), or a waiver of such plan, after the date
                            of enactment of this Act, is no longer
                            ineligible under clause (i) beginning with the
                            first calendar quarter in which the State has
                            reinstated eligibility standards,
                            methodologies, or procedures that are no more
                            restrictive than the eligibility standards,
                            methodologies, or procedures, respectively,
                            under such plan (or waiver) as in effect on
                            such date.
                        (C) Limitation of matching payments to 100
                    percent.--In no case shall an increase in Federal
                    matching payments under paragraph (1) result in Federal
                    matching payments that exceed 100 percent of State
                    expenditures.
                (4) Required report information.--The information that is
            required in the report under paragraph (3)(A) shall include--
                        (A) the results of an evaluation of the impact of
                    the implementation of the requirements of paragraph
                    (17) of section 1902(e) of the Social Security Act (42
                    U.S.C. 1396a(e)) on improving the State's processes for
                    enrolling individuals who are released from public
                    institutions under the State Medicaid plan;
                        (B) the number of individuals who were
                    automatically enrolled (or whose enrollment was
                    reinstated) under such paragraph during the 1-year
                    period during which the State received increased
                    payments under this subsection; and
                        (C) any other information that is required by the
                    Secretary of Health and Human Services.
        (c) Effective Date.--
                (1) In general.--Except as provided in paragraph (2), the
            amendments made by subsection (a) shall take effect 180 days
            after the date of the enactment of this Act.
                (2) Rule for changes requiring state legislation.--In the
            case of a State plan for medical assistance under title XIX of
            the Social Security Act (42 U.S.C. 1396 et seq.) which the
            Secretary of Health and Human Services determines requires
            State legislation (other than legislation appropriating funds)
            in order for the plan to meet the additional requirement
            imposed by the amendments made by subsection (a), the State
            plan shall not be regarded as failing to comply with the
            requirements of such title solely on the basis of its failure
            to meet this additional requirement before the first day of the
            first calendar quarter beginning after the close of the first
            regular session of the State legislature that begins after the
            date of the enactment of this Act. For purposes of the previous
            sentence, in the case of a State that has a 2-year legislative
            session, each year of such session shall be deemed to be a
            separate regular session of the State legislature.

    SEC. 7218. STOP HIV IN PRISON.

        (a) Short Title.--This section may be cited as the ``Stop HIV in
    Prison Act''.
        (b) In General.--The Director of the Bureau of Prisons (referred to
    in this section as the ``Director'') shall develop a comprehensive
    policy to provide HIV testing, treatment, and prevention for inmates
    within the correctional setting and upon reentry.
        (c) Purpose.--The purposes of the policy required to be developed
    under subsection (b) shall be as follows:
                (1) To stop the spread of HIV among inmates.
                (2) To protect prison guards and other personnel from HIV
            infection.
                (3) To provide comprehensive medical treatment to inmates
            who are living with HIV.
                (4) To promote HIV awareness and prevention among inmates.
                (5) To encourage inmates to take personal responsibility
            for their health.
                (6) To reduce the risk that inmates will transmit HIV to
            other persons in the community following their release from
            prison.
        (d) Consultation.--The Director shall consult with appropriate
    officials of the Department of Health and Human Services, the Office of
    National Drug Control Policy, and the Centers for Disease Control and
    Prevention regarding the development of the policy required under
    subsection (b).
        (e) Time Limit.--Not later than 1 year after the date of enactment
    of this Act, the Director shall draft appropriate regulations to
    implement the policy required to be developed under subsection (b).
        (f) Requirements for Policy.--The policy required to be developed
    under subsection (b) shall provide for the following:
                (1) Testing and counseling upon intake.--
                        (A) Health care personnel shall provide routine HIV
                    testing to all inmates as a part of a comprehensive
                    medical examination immediately following admission to
                    a facility. Health care personnel need not provide
                    routine HIV testing to an inmate who is transferred to
                    a facility from another facility if the inmate's
                    medical records are transferred with the inmate and
                    indicate that the inmate has been tested previously.
                        (B) To all inmates admitted to a facility prior to
                    the effective date of this policy, health care
                    personnel shall provide routine HIV testing within no
                    more than 6 months. HIV testing for these inmates may
                    be performed in conjunction with other health services
                    provided to these inmates by health care personnel.
                        (C) All HIV tests under this paragraph shall comply
                    with the opt-out provision.
                (2) Pre-test and post-test counseling.--Health care
            personnel shall provide confidential pre-test and post-test
            counseling to all inmates who are tested for HIV. Counseling
            may be included with other general health counseling provided
            to inmates by health care personnel.
                (3) HIV prevention education.--
                        (A) Health care personnel shall improve HIV
                    awareness through frequent educational programs for all
                    inmates. HIV educational programs may be provided by
                    community-based organizations, local health
                    departments, and inmate peer educators.
                        (B) HIV educational materials shall be made
                    available to all inmates at orientation, at health care
                    clinics, at regular educational programs, and prior to
                    release. Both written and audiovisual materials shall
                    be made available to all inmates.
                        (C)(i) The HIV educational programs and materials
                    under this paragraph shall include information on--
                                (I) modes of transmission, including
                            transmission through tattooing, sexual contact,
                            and intravenous drug use;
                                (II) prevention methods;
                                (III) treatment; and
                                (IV) disease progression.
                        (ii) The programs and materials shall be culturally
                    sensitive, written or designed for low-literacy levels,
                    available in a variety of languages, and present
                    scientifically accurate information in a clear and
                    understandable manner.
                (4) HIV testing upon request.--
                        (A) Health care personnel shall allow inmates to
                    obtain HIV tests upon request once per year or whenever
                    an inmate has a reason to believe the inmate may have
                    been exposed to HIV. Health care personnel shall, both
                    orally and in writing, inform inmates, during
                    orientation and periodically throughout incarceration,
                    of their right to obtain HIV tests.
                        (B) Health care personnel shall encourage inmates
                    to request HIV tests if the inmate is sexually active,
                    has been raped, uses intravenous drugs, receives a
                    tattoo, or if the inmate is concerned that the inmate
                    may have been exposed to HIV.
                        (C) An inmate's request for an HIV test shall not
                    be considered an indication that the inmate has put
                    themselves at risk of infection or committed a
                    violation of prison rules.
                (5) HIV testing of pregnant woman.--
                        (A) Health care personnel shall provide routine HIV
                    testing to all inmates who become pregnant.
                        (B) All HIV tests under this paragraph shall comply
                    with the opt-out provision under paragraph (9).
                (6) Comprehensive treatment.--
                        (A) Health care personnel shall provide all inmates
                    who test positive for HIV--
                                (i) timely, comprehensive medical
                            treatment;
                                (ii) confidential counseling on managing
                            their medical condition and preventing its
                            transmission to other persons; and
                                (iii) voluntary partner notification
                            services.
                        (B) Health care provided under this paragraph shall
                    be consistent with Department of Health and Human
                    Services guidelines and standard medical practice.
                    Health care personnel shall discuss treatment options,
                    the importance of adherence to antiretroviral therapy,
                    and the side effects of medications with inmates
                    receiving treatment.
                        (C) Health care personnel and pharmacy personnel
                    shall ensure that the facility formulary contains all
                    Food and Drug Administration-approved medications
                    necessary to provide comprehensive treatment for
                    inmates living with HIV, and that the facility
                    maintains adequate supplies of such medications to meet
                    inmates' medical needs. Health care personnel and
                    pharmacy personnel shall also develop and implement
                    automatic renewal systems for these medications to
                    prevent interruptions in care.
                        (D) Correctional staff, health care personnel, and
                    pharmacy personnel shall develop and implement
                    distribution procedures to ensure timely and
                    confidential access to medications.
                (7) Protection of confidentiality.--
                        (A) Health care personnel shall develop and
                    implement procedures to ensure the confidentiality of
                    inmate tests, diagnoses, and treatment. Health care
                    personnel and correctional staff shall receive regular
                    training on the implementation of these procedures.
                    Penalties for violations of inmate confidentiality by
                    health care personnel or correctional staff shall be
                    specified and strictly enforced.
                        (B) HIV testing, counseling, and treatment shall be
                    provided in a confidential setting where other routine
                    health services are provided and in a manner that
                    allows the inmate to request and obtain these services
                    as routine medical services.
                (8) Testing, counseling, and referral prior to reentry.--
                        (A) Health care personnel shall provide routine HIV
                    testing to all inmates not earlier than 3 months prior
                    to their release and reentry into the community.
                    Inmates who are already known to be infected need not
                    be tested again. This requirement may be waived if an
                    inmate's release occurs without sufficient notice to
                    the Director to allow health care personnel to perform
                    a routine HIV test and notify the inmate of the
                    results.
                        (B) All HIV tests under this paragraph shall comply
                    with the opt-out provision.
                        (C) To all inmates who test positive for HIV and
                    all inmates who already are known to have HIV, health
                    care personnel shall provide--
                                (i) confidential prerelease counseling on
                            managing their medical condition in the
                            community, accessing appropriate treatment and
                            services in the community, and preventing the
                            transmission of their condition to family
                            members and other persons in the community;
                                (ii) referrals to appropriate health care
                            providers and social service agencies in the
                            community that meet the inmate's individual
                            needs, including voluntary partner notification
                            services and prevention counseling services for
                            people living with HIV; and
                                (iii) a 30-day supply of any medically
                            necessary medications the inmate is currently
                            receiving.
                (9) Opt-out provision.--Inmates shall have the right to
            refuse routine HIV testing. Inmates shall be informed both
            orally and in writing of this right. Oral and written
            disclosure of this right may be included with other general
            health information and counseling provided to inmates by health
            care personnel. If an inmate refuses a routine test for HIV,
            health care personnel shall make a note of the inmate's refusal
            in the inmate's confidential medical records. However, the
            inmate's refusal shall not be considered a violation of prison
            rules or result in disciplinary action. Any reference in this
            section to the ``opt-out provision'' shall be deemed a
            reference to the requirement of this paragraph.
                (10) Exclusion of tests performed under section 4014(b)
            from the definition of routine hiv testing.--HIV testing of an
            inmate under section 4014(b) of title 18, United States Code,
            is not routine HIV testing for the purposes of the opt-out
            provision. Health care personnel shall document the reason for
            testing under section 4014(b) of title 18, United States Code,
            in the inmate's confidential medical records.
                (11) Timely notification of test results.--Health care
            personnel shall provide timely notification to inmates of the
            results of HIV tests.
        (g) Changes in Existing Law.--
                (1) Screening in general.--Section 4014(a) of title 18,
            United States Code, is amended--
                        (A) by striking ``for a period of 6 months or
                    more'';
                        (B) by striking ``, as appropriate,''; and
                        (C) by striking ``if such individual is determined
                    to be at risk for infection with such virus in
                    accordance with the guidelines issued by the Bureau of
                    Prisons relating to infectious disease management'' and
                    inserting ``unless the individual declines. The
                    Attorney General shall also cause such individual to be
                    so tested before release unless the individual
                    declines.''.
                (2) Inadmissibility of hiv test results in civil and
            criminal proceedings.--Section 4014(d) of title 18, United
            States Code, is amended by inserting ``or under the Stop HIV in
            Prison Act'' after ``under this section''.
                (3) Screening as part of routine screening.--Section
            4014(e) of title 18, United States Code, is amended by adding
            at the end the following: ``Such rules shall also provide that
            the initial test under this section be performed as part of the
            routine health screening conducted at intake.''.
        (h) Reporting Requirements.--
                (1) Report on hepatitis, liver, and other diseases.--Not
            later than 1 year after the date of enactment of this Act, the
            Director shall provide a report to the Congress on the policies
            and procedures of the Bureau of Prisons to provide testing,
            treatment, and prevention education programs for hepatitis,
            liver failure, and other liver-related diseases transmitted
            through sexual activity, intravenous drug use, or other means.
            The Director shall consult with appropriate officials of the
            Department of Health and Human Services, the Office of National
            Drug Control Policy, the Office of National AIDS Policy, and
            the Centers for Disease Control and Prevention regarding the
            development of this report.
                (2) Annual reports.--
                        (A) Generally.--Not later than 2 years after the
                    date of enactment of this Act, and then annually
                    thereafter, the Director shall report to Congress on
                    the incidence among inmates of diseases transmitted
                    through sexual activity and intravenous drug use.
                        (B) Matters pertaining to various diseases.--Each
                    report under subparagraph (A) shall discuss--
                                (i) the incidence among inmates of HIV,
                            hepatitis, and other diseases transmitted
                            through sexual activity and intravenous drug
                            use; and
                                (ii) updates on the testing, treatment, and
                            prevention education programs for these
                            diseases conducted by the Bureau of Prisons.
                        (C) Matters pertaining to hiv only.--Each report
                    under subparagraph (A) shall also include--
                                (i) the number of inmates who tested
                            positive for HIV upon intake;
                                (ii) the number of inmates who tested
                            positive prior to reentry;
                                (iii) the number of inmates who were not
                            tested prior to reentry because they were
                            released without sufficient notice;
                                (iv) the number of inmates who opted out of
                            taking the test;
                                (v) the number of inmates who were tested
                            under section 4014(b) of title 18, United
                            States Code; and
                                (vi) the number of inmates under treatment
                            for HIV.
                        (D) Consultation.--The Director shall consult with
                    appropriate officials of the Department of Health and
                    Human Services, the Office of National Drug Control
                    Policy, and the Centers for Disease Control and
                    Prevention regarding the development of each report
                    under subparagraph (A).

    SEC. 7219. TRANSFER OF FUNDS FOR IMPLEMENTATION OF ENDING THE HIV
                  EPIDEMIC: A PLAN FOR AMERICA.

        Title II of the Public Health Service Act (42 U.S.C. 202 et seq.)
    is amended by inserting after section 241 (42 U.S.C. 238j) the
    following:

    ``SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION OF NATIONAL HIV/AIDS
                  STRATEGY.

        ``(a) Transfer Authorization.--Of the discretionary appropriations
    made available to the Department of Health and Human Services for any
    fiscal year for programs and activities that, as determined by the
    Secretary, pertain to HIV, the Secretary may transfer up to 1 percent
    of such appropriations to the Office of the Assistant Secretary for
    Health for implementation of the Ending the HIV Epidemic: A Plan for
    America.
        ``(b) Congressional Notification.--Not less than 30 days before
    making any transfer under this section, the Secretary shall give notice
    of the transfer to the Congress.
        ``(c) Definitions.--In this section, the term `Ending the HIV
    Epidemic: A Plan for America' means the initiative of the Department of
    Health and Human Services that seeks to reduce the number of new HIV
    infections in the United States by 75 percent by 2025, and then by at
    least 90 percent by 2030, for an estimated 250,000 total HIV infections
    averted.''.

    SEC. 7220. PREP ACCESS AND COVERAGE.

        (a) Coverage of HIV Testing and Prevention Services.--
                (1) Private insurance.--
                        (A) In general.--Section 2713(a) of the Public
                    Health Service Act (42 U.S.C. 300gg-13(a)) is amended--
                                (i) in paragraph (2), by striking ``; and''
                            and inserting a semicolon;
                                (ii) in paragraph (3), by striking the
                            period and inserting a semicolon;
                                (iii) in paragraph (4), by striking the
                            period and inserting a semicolon;
                                (iv) in paragraph (5), by striking the
                            period and inserting ``; and''; and
                                (v) by adding at the end the following:
                ``(6) any prescription drug approved by the Food and Drug
            Administration for the prevention of HIV (other than a drug
            subject to preauthorization requirements consistent with
            section 2729A), administrative fees for such drugs, laboratory
            and other diagnostic procedures associated with the use of such
            drugs, and clinical follow up and monitoring, including any
            related services recommended in current United States Public
            Health Service clinical practice guidelines, without
            limitation.''.
                        (B) Prohibition on preauthorization requirements.--
                    Subpart II of part A of title XXVII of the Public
                    Health Service Act (42 U.S.C. 300gg-11 et seq.) is
                    amended by adding at the end the following:

    ``SEC. 2729A. PROHIBITION ON PREAUTHORIZATION REQUIREMENTS WITH RESPECT
                  TO CERTAIN SERVICES.

        ``A group health plan or a health insurance issuer offering group
    or individual health insurance coverage shall not impose any
    preauthorization requirements with respect to coverage of the services
    described in section 2713(a)(6), except that a plan or issuer may
    impose preauthorization requirements with respect to coverage of a
    particular drug approved under section 505(c) of the Federal Food,
    Drug, and Cosmetic Act or section 351(a) of this Act if such plan or
    issuer provides coverage without any preauthorization requirements for
    a drug that is therapeutically equivalent.''.
                (2) Coverage under federal employees health benefits
            program.--Section 8904 of title 5, United States Code, is
            amended by adding at the end the following:
        ``(c) Any health benefits plan offered under this chapter shall
    include benefits for, and may not impose any cost sharing requirements
    for, any prescription drug approved by the Food and Drug Administration
    for the prevention of HIV, administrative fees for such drugs,
    laboratory and other diagnostic procedures associated with the use of
    such drugs, and clinical follow up and monitoring, including any
    related services recommended in current United States Public Health
    Service clinical practice guidelines, without limitation.''.
                (3) Medicaid.--
                        (A) In general.--Section 1905 of the Social
                    Security Act (42 U.S.C. 1396d) is amended--
                                (i) in subsection (a)(4)--
                                        (I) by striking ``; and (D)'' and
                                    inserting ``; (D)'';
                                        (II) by striking ``; and (E)'' and
                                    inserting ``; (E)'';
                                        (III) by striking ``; and (F)'' and
                                    inserting ``; (F)''; and
                                        (IV) by striking the semicolon at
                                    the end and inserting ``; and (G) HIV
                                    prevention services;''; and
                                (ii) by adding at the end the following new
                            subsection:
        ``(jj) HIV Prevention Services.--For purposes of subsection
    (a)(4)(G), the term `HIV prevention services' means prescription drugs
    for the prevention of HIV acquisition, administrative fees for such
    drugs, laboratory and other diagnostic procedures associated with the
    use of such drugs, and clinical follow up and monitoring, including any
    related services recommended in current United States Public Health
    Service clinical practice guidelines, without limitation.''.
                        (B) No cost-sharing.--Title XIX of the Social
                    Security Act (42 U.S.C. 1396 et seq.) is amended--
                                (i) in section 1916, by inserting ``HIV
                            prevention services described in section
                            1905(a)(4)(G),'' after ``section
                            1905(a)(4)(C),'' each place it appears; and
                                (ii) in section 1916A(b)(3)(B), by adding
                            at the end the following new clause:
                                ``(xii) HIV prevention services described
                            in section 1905(a)(4)(G).''.
                        (C) Inclusion in benchmark coverage.--Section
                    1937(b)(7) of the Social Security Act (42 U.S.C. 1396u-
                    7(b)(7)) is amended--
                                (i) in the paragraph header, by inserting
                            ``and hiv prevention services'' after
                            ``supplies''; and
                                (ii) by striking ``includes for any
                            individual described in section 1905(a)(4)(C),
                            medical assistance for family planning services
                            and supplies in accordance with such section''
                            and inserting ``includes medical assistance for
                            HIV prevention services described in section
                            1905(a)(4)(G), and includes, for any individual
                            described in section 1905(a)(4)(C), medical
                            assistance for family planning services and
                            supplies in accordance with such section''.
                (4) CHIP.--
                        (A) In general.--Section 2103 of the Social
                    Security Act (42 U.S.C. 1397cc) is amended--
                                (i) in subsection (a), by striking ``and
                            (8)'' and inserting ``(8), (10), (11), and
                            (12)''; and
                                (ii) in subsection (c), by adding at the
                            end the following new paragraph:
                ``(12) HIV prevention services.--Regardless of the type of
            coverage elected by a State under subsection (a), the child
            health assistance provided for a targeted low-income child,
            and, in the case of a State that elects to provide pregnancy-
            related assistance pursuant to section 2112, the pregnancy-
            related assistance provided for a targeted low-income pregnant
            woman (as such terms are defined for purposes of such section),
            shall include coverage of HIV prevention services (as defined
            in section 1905(jj)).''.
                        (B) No cost-sharing.--Section 2103(e)(2) of the
                    Social Security Act (42 U.S.C. 1397cc(e)(2)) is amended
                    by inserting ``HIV prevention services described in
                    subsection (c)(12),'' before ``or for pregnancy-related
                    assistance''.
                        (C) Effective date.--
                                (i) In general.--Subject to clause (ii),
                            the amendments made by paragraph (3) and this
                            paragraph shall take effect on January 1, 2023.
                                (ii) Delay permitted if state legislation
                            required.--In the case of a State plan approved
                            under title XIX of the Social Security Act
                            which the Secretary of Health and Human
                            Services determines requires State legislation
                            (other than legislation appropriating funds) in
                            order for the plan to meet the additional
                            requirements imposed by this subsection, the
                            State plan shall not be regarded as failing to
                            comply with the requirements of such title
                            solely on the basis of the failure of the plan
                            to meet such additional requirements before the
                            1st day of the 1st calendar quarter beginning
                            after the close of the 1st regular session of
                            the State legislature that ends after the 1-
                            year period beginning with the date of the
                            enactment of this Act. For purposes of the
                            preceding sentence, in the case of a State that
                            has a 2-year legislative session, each year of
                            the session is deemed to be a separate regular
                            session of the State legislature.
                (5) Coverage and elimination of cost-sharing under
            medicare.--
                        (A) Coverage of hiv prevention services under part
                    b.--
                                (i) Coverage.--
                                        (I) In general.--Section 1861(s)(2)
                                    of the Social Security Act (42 U.S.C.
                                    1395x(s)(2)) is amended--
                                                (aa) in subparagraph (GG),
                                            by striking ``and'' at the end;
                                                (bb) in subparagraph (HH),
                                            by striking the period at the
                                            end and inserting ``; and'';
                                            and
                                                (cc) by adding at the end
                                            the following new subparagraph:
                        ``(II) HIV prevention services (as defined in
                    subsection (lll));''.
                                        (II) Definition.--Section 1861 of
                                    the Social Security Act (42 U.S.C.
                                    1395x) is amended by adding at the end
                                    the following new subsection:
        ``(LLL) HIV Prevention Services.--The term `HIV prevention
    services' means--
                ``(1) drugs or biologicals approved by the Food and Drug
            Administration for the prevention of HIV;
                ``(2) administrative fees for such drugs;
                ``(3) laboratory and other diagnostic procedures associated
            with the use of such drugs; and
                ``(4) clinical follow up and monitoring, including any
            related services recommended in current United States Public
            Health Service clinical practice guidelines, without
            limitation.''.
                                (ii) Elimination of coinsurance.--Section
                            1833(a)(1) of the Social Security Act (42
                            U.S.C. 1395l(a)(1)) is amended--
                                        (I) by striking ``and (DD)'' and
                                    inserting ``(DD)''; and
                                        (II) by inserting before the
                                    semicolon at the end the following:
                                    ``and (EE) with respect to HIV
                                    prevention services (as defined in
                                    section 1861(lll)), the amount paid
                                    shall be 100 percent of (i) except as
                                    provided in clause (ii), the lesser of
                                    the actual charge for the service or
                                    the amount determined under the fee
                                    schedule that applies to such services
                                    under this part, and (ii) in the case
                                    of such services that are covered OPD
                                    services (as defined in subsection
                                    (t)(1)(B)), the amount determined under
                                    subsection (t)''.
                                (iii) Exemption from part b deductible.--
                            Section 1833(b) of the Social Security Act (42
                            U.S.C. 1395l(b)) is amended--
                                        (I) in paragraph (11), by striking
                                    ``and'' at the end; and
                                        (II) in paragraph (12), by striking
                                    the period at the end and inserting ``,
                                    and (13) such deductible shall not
                                    apply with respect to HIV prevention
                                    services (as defined in section
                                    1861(lll).''.
                                (iv) Effective date.--The amendments made
                            by this subparagraph shall apply to items and
                            services furnished on or after January 1, 2023.
                        (B) Elimination of cost-sharing for drugs for the
                    prevention of hiv under part d.--
                                (i) In general.--Section 1860D-2(b) of the
                            Social Security Act (42 U.S.C. 1395w-102(b)) is
                            amended--
                                        (I) in paragraph (1)(A), by
                                    striking ``The coverage'' and inserting
                                    ``Subject to paragraph (8), the
                                    coverage'';
                                        (II) in paragraph (2)(A), by
                                    striking ``and (D)'' and inserting
                                    ``and (D) and paragraph (8)'';
                                        (III) in paragraph (3)(A), by
                                    striking ``and (4)'' and inserting
                                    ``(4), and (8)'';
                                        (IV) in paragraph (4)(A)(i), by
                                    striking ``The coverage'' and inserting
                                    ``Subject to paragraph (8), the
                                    coverage''; and
                                        (V) by adding at the end the
                                    following new paragraph:
                ``(8) Elimination of cost-sharing for drugs for the
            prevention of hiv.--
                        ``(A) In general.--For plan year 2023 and each
                    subsequent plan year, there shall be no cost-sharing
                    under this part (including under section 1814D-14) for
                    covered part D drugs that are for the prevention of
                    HIV.
                        ``(B) Cost-sharing.--For purposes of subparagraph
                    (A), the elimination of cost-sharing shall include the
                    following:
                                ``(i) No application of deductible.--The
                            waiver of the deductible under paragraph (1).
                                ``(ii) No application of coinsurance.--The
                            waiver of coinsurance under paragraph (2).
                                ``(iii) No application of initial coverage
                            limit.--The initial coverage limit under
                            paragraph (3) shall not apply.
                                ``(iv) No cost-sharing above annual out-of-
                            pocket threshold.--The waiver of cost-sharing
                            under paragraph (4).''.
                                (ii) Conforming amendments to cost-sharing
                            for low-income individuals.--Section 1860D-
                            14(a) of the Social Security Act (42 U.S.C.
                            1395w-114(a)) is amended--
                                        (I) in paragraph (1), in the matter
                                    preceding subparagraph (A), by striking
                                    ``In the case'' and inserting ``Subject
                                    to section 1860D-2(b)(8), in the
                                    case''; and
                                        (II) in paragraph (2), in the
                                    matter preceding subparagraph (A), by
                                    striking ``In the case'' and inserting
                                    ``Subject to section 1860D-2(b)(8), in
                                    the case''.
                (6) Coverage of hiv prevention treatment by department of
            veterans affairs.--
                        (A) Elimination of medication copayments.--Section
                    1722A(a) of title 38, United States Code, is amended by
                    adding at the end the following new paragraph:
                ``(5) Paragraph (1) does not apply to a medication for the
            prevention of HIV.''.
                        (B) Elimination of hospital care and medical
                    services copayments.--Section 1710 of such title is
                    amended--
                                (i) in subsection (f)--
                                        (I) by redesignating paragraph (5)
                                    as paragraph (6); and
                                        (II) by inserting after paragraph
                                    (4) the following new paragraph (5):
                ``(5) A veteran shall not be liable to the United States
            under this subsection for any amounts for laboratory and other
            diagnostic procedures associated with the use of any
            prescription drug approved by the Food and Drug Administration
            for the prevention of HIV, administrative fees for such drugs,
            or for laboratory or other diagnostic procedures associated
            with the use of such drugs, or clinical follow up and
            monitoring, including any related services recommended in
            current United States Public Health Service clinical practice
            guidelines, without limitation.''; and
                                (ii) in subsection (g)(3), by adding at the
                            end the following new subparagraph:
                        ``(C) Any prescription drug approved by the Food
                    and Drug Administration for the prevention of HIV,
                    administrative fees for such drugs, laboratory and
                    other diagnostic procedures associated with the use of
                    such drugs, and clinical follow up and monitoring,
                    including any related services recommended in current
                    United States Public Health Service clinical practice
                    guidelines, without limitation.''.
                        (C) Inclusion as preventive health service.--
                    Section 1701(9) of such title is amended--
                                (i) in subparagraph (K), by striking ``;
                            and'' and inserting a semicolon;
                                (ii) by redesignating subparagraph (L) as
                            subparagraph (M); and
                                (iii) by inserting after subparagraph (K)
                            the following new subparagraph (L):
                        ``(L) any prescription drug approved by the Food
                    and Drug Administration for the prevention of HIV,
                    administrative fees for such drugs, laboratory and
                    other diagnostic procedures associated with the use of
                    such drugs, and clinical follow up and monitoring,
                    including any related services recommended in current
                    United States Public Health Service clinical practice
                    guidelines, without limitation; and''.
                (7) Coverage of hiv prevention treatment by department of
            defense.--
                        (A) In general.--Chapter 55 of title 10, United
                    States Code, is amended by inserting after section
                    1079c the following new section:
    ``Sec. 1079d. Coverage of HIV prevention treatment
        ``(a) In General.--The Secretary of Defense shall ensure coverage
    under the TRICARE program of HIV prevention treatment described in
    subsection (b) for any beneficiary under section 1074(a) of this title.
        ``(b) HIV Prevention Treatment Described.--HIV prevention treatment
    described in this subsection includes any prescription drug approved by
    the Food and Drug Administration for the prevention of HIV,
    administrative fees for such drugs, laboratory and other diagnostic
    procedures associated with the use of such drugs, and clinical follow
    up and monitoring, including any related services recommended in
    current United States Public Health Service clinical practice
    guidelines, without limitation.
        ``(c) No Cost-Sharing.--Notwithstanding section 1075, 1075a, or
    1074g(a)(6) of this title or any other provision of law, there is no
    cost-sharing requirement for HIV prevention treatment covered under
    this section.''.
                        (B) Clerical amendment.--The table of sections at
                    the beginning of such chapter is amended by inserting
                    after the item relating to section 1079c the following
                    new item:

    ``1079d. Coverage of HIV prevention treatment.''.
                (8) Indian health service testing, monitoring, and
            prescription drugs for the prevention of hiv.--The Indian
            Health Care Improvement Act is amended by inserting after
            section 223 (25 U.S.C. 1621v) the following:

    ``SEC. 224. TESTING, MONITORING, AND PRESCRIPTION DRUGS FOR THE
                  PREVENTION OF HIV.

        ``(a) In General.--The Secretary, acting through the Service,
    Indian tribes, and Tribal organizations, shall provide funding for any
    prescription drug approved by the Food and Drug Administration for the
    prevention of human immunodeficiency virus (commonly known as `HIV'),
    administrative fees for such a drug, laboratory and other diagnostic
    procedures associated with the use of such a drug, and clinical follow
    up and monitoring, including any related services recommended in
    current United States Public Health Service clinical practice
    guidelines, without limitation.
        ``(b) Authorization of Appropriations.--There are authorized to be
    appropriated such sums as may be necessary to carry out this
    section.''.
                (9) Effective date.--The amendments made by paragraphs (1),
            (2), (5), (6), (7), and (8) shall take effect with respect to
            plan years beginning on or after January 1, 2023.
        (b) Prohibition on Denial of Coverage or Increase in Premiums of
    Life, Disability, or Long-Term Care Insurance for Individuals Taking
    Medication for the Prevention of HIV Acquisition.--
                (1) Prohibition.--Notwithstanding any other provision of
            law, it shall be unlawful to--
                        (A) decline or limit coverage of a person under any
                    life insurance policy, disability insurance policy, or
                    long-term care insurance policy, on account of the
                    individual taking medication for the purpose of
                    preventing the acquisition of HIV;
                        (B) preclude an individual from taking medication
                    for the purpose of preventing the acquisition of HIV as
                    a condition of receiving a life insurance policy,
                    disability insurance policy, or long-term care
                    insurance policy;
                        (C) consider whether an individual is taking
                    medication for the purpose of preventing the
                    acquisition of HIV in determining the premium rate for
                    coverage of such individual under a life insurance
                    policy, disability insurance policy, or long-term care
                    insurance policy; or
                        (D) otherwise discriminate in the offering,
                    issuance, cancellation, amount of such coverage, price,
                    or any other condition of a life insurance policy,
                    disability insurance policy, or long-term care
                    insurance policy for an individual, based solely and
                    without any additional actuarial risks upon whether the
                    individual is taking medication for the purpose of
                    preventing the acquisition of HIV.
                (2) Enforcement.--A State insurance regulator may take such
            actions to enforce paragraph (1) as are specifically authorized
            under the laws of such State.
                (3) Definitions.--In this subsection:
                        (A) Disability insurance policy.--The term
                    ``disability insurance policy'' means a contract under
                    which an entity promises to pay a person a sum of money
                    in the event that an illness or injury resulting in a
                    disability prevents such person from working.
                        (B) Life insurance policy.--The term ``life
                    insurance policy'' means a contract under which an
                    entity promises to pay a designated beneficiary a sum
                    of money upon the death of the insured.
                        (C) Long-term care insurance policy.--The term
                    ``long-term care insurance policy'' means a contract
                    for which the only insurance protection provided under
                    the contract is coverage of qualified long-term care
                    services (as defined in section 7702B(c) of the
                    Internal Revenue Code of 1986).
        (c) Patient Confidentiality.--The Secretary of Health and Human
    Services shall amend the regulations promulgated under section 264(c)
    of the Health Insurance Portability and Accountability Act of 1996 (42
    U.S.C. 1320d-2 note), as necessary, to ensure that individuals are able
    to access the benefits described in section 2713(a)(6) under a family
    plan without any other individual enrolled in such family plan,
    including a primary subscriber of or policyholder, being informed of
    such use of such benefits.
        (d) Pre-Exposure Prophylaxis and Post-Exposure Prophylaxis
    Funding.--Part P of title III of the Public Health Service Act (42
    U.S.C. 280g et seq.), as amended by section 7153, is further amended by
    adding at the end the following:

    ``SEC. 399V-8. PRE-EXPOSURE PROPHYLAXIS AND POST-EXPOSURE PROPHYLAXIS
                  FUNDING.

        ``(a) In General.--Not later than 1 year after the date of
    enactment of this Act, the Secretary shall establish a program that
    awards grants to States, territories, Indian Tribes, and directly
    eligible entities for the establishment and support of pre-exposure
    prophylaxis (referred to in this section as `PrEP') and post-exposure
    prophylaxis (referred to in this section as `PEP') programs.
        ``(b) Applications.--To be eligible to receive a grant under
    subsection (a), a State, territory, Indian Tribe, or directly eligible
    entity shall--
                ``(1) submit an application to the Secretary at such time,
            in such manner, and containing such information as the
            Secretary may require, including a plan describing how any
            funds awarded will be used to increase access to PrEP for
            uninsured and underinsured individuals and reduce disparities
            in access to PrEP and PEP for uninsured and underinsured
            individuals and reduce disparities in access to PrEP and PEP;
            and
                ``(2) appoint a PrEP and PEP grant administrator to manage
            the program.
        ``(c) Directly Eligible Entity.--For purposes of this section, the
    term `directly eligible entity'--
                ``(1) means a Federally qualified health center or other
            nonprofit entity engaged in providing PrEP and PEP information
            and services; and
                ``(2) may include--
                        ``(A) a Federally qualified health center (as
                    defined in section 1861(aa)(4) of the Social Security
                    Act (42 U.S.C. 1395x(aa)(4)));
                        ``(B) a family planning grantee (other than States)
                    funded under section 1001 of the Public Health Service
                    Act (42 U.S.C. 300);
                        ``(C) a rural health clinic (as defined in section
                    1861(aa)(2) of the Social Security Act (42 U.S.C.
                    1395x(aa)(2));
                        ``(D) a health facility operated by or pursuant to
                    a contract with the Indian Health Service;
                        ``(E) a community-based organization, clinic,
                    hospital, or other health facility that provides
                    services to individuals at risk for or living with HIV;
                    and
                        ``(F) a nonprofit private entity providing
                    comprehensive primary care to populations at risk of
                    HIV, including faith-based and community-based
                    organizations.
        ``(d) Awards.--In determining whether to award a grant, and the
    grant amount for each grant awarded, the Secretary shall consider the
    grant application and the need for PrEP and PEP services in the area,
    the number of uninsured and underinsured individuals in the area, and
    how the State, territory, or Indian Tribe coordinates PrEP and PEP
    activities with the directly funded entity, if the State, territory, or
    Indian Tribe applies for the funds.
        ``(e) Use of Funds.--
                ``(1) In general.--Any State, territory, Indian Tribe, or
            directly eligible entity that is awarded funds under subsection
            (a) shall use such funds for eligible PrEP and PEP expenses.
                ``(2) Eligible prep expenses.--The Secretary shall publish
            a list of expenses that qualify as eligible PrEP and PEP
            expenses for purposes of this section, which shall include--
                        ``(A) any prescription drug approved by the Food
                    and Drug Administration for the prevention of HIV,
                    administrative fees for such drugs, laboratory and
                    other diagnostic procedures associated with the use of
                    such drugs, and clinical follow up and monitoring,
                    including any related services recommended in current
                    United States Public Health Service clinical practice
                    guidelines, without limitation;
                        ``(B) outreach and public education activities
                    directed toward populations overrepresented in the
                    domestic HIV epidemic that increase awareness about the
                    existence of PrEP and PEP, provide education about
                    access to and health care coverage of PrEP and PEP,
                    PrEP and PEP adherence programs, and counter stigma
                    associated with the use of PrEP and PEP; and
                        ``(C) outreach activities directed toward
                    physicians and other providers that provide education
                    about PrEP and PEP.
        ``(f) Report to Congress.--The Secretary shall, in each of the
    first 5 years beginning one year after the date of the enactment of
    this section, submit to Congress, and make public on the internet
    website of Department of Health and Human Services, a report on the
    impact of any grants provided to States, territories, and Indian Tribes
    and directly eligible entities for the establishment and support of
    pre-exposure prophylaxis programs under this section.
        ``(g) Authorization of Appropriations.--To carry out this section,
    there are authorized to be appropriated such sums as may be necessary
    for each of fiscal years 2023 through 2028.''.
        (e) Clarification.--This section, including the amendments made by
    this section, shall apply notwithstanding any other provision of law,
    including Public Law 103-141.
        (f) Private Right of Action.--Any person aggrieved by a violation
    of this section, including the amendments made by this section, may
    commence a civil action in an appropriate United States District Court
    or other court of competent jurisdiction to obtain relief as allowed by
    law as either an individual or member of a class. If the plaintiff is
    the prevailing party in such an action, the court shall order the
    defendant to pay the costs and reasonable attorney fees of the
    plaintiff.

                              Subtitle F--Diabetes

    SEC. 7251. RESEARCH, TREATMENT, AND EDUCATION.

        Subpart 3 of part C of title IV of the Public Health Service Act
    (42 U.S.C. 285c et seq.) is amended by adding at the end the following
    new section:

    ``SEC. 434B. DIABETES IN MINORITY POPULATIONS.

        ``(a) In General.--The Director of NIH shall expand, intensify, and
    support ongoing research and other activities with respect to
    prediabetes and diabetes, particularly type 2, in minority populations.
        ``(b) Research.--
                ``(1) Description.--Research under subsection (a) shall
            include investigation into--
                        ``(A) the causes of diabetes, including
                    socioeconomic, geographic, clinical, environmental,
                    genetic, and other factors that may contribute to
                    increased rates of diabetes in minority populations;
                    and
                        ``(B) the causes of increased incidence of diabetes
                    complications in minority populations, and possible
                    interventions to decrease such incidence.
                ``(2) Inclusion of minority participants.--In conducting
            and supporting research described in subsection (a), the
            Director of NIH shall seek to include minority participants as
            study subjects in clinical trials.
        ``(c) Report; Comprehensive Plan.--
                ``(1) In general.--The Diabetes Mellitus Interagency
            Coordinating Committee shall--
                        ``(A) prepare and submit to the Congress, not later
                    than 6 months after the date of enactment of this
                    section, a report on Federal research and public health
                    activities with respect to prediabetes and diabetes in
                    minority populations; and
                        ``(B) develop and submit to Congress, not later
                    than 1 year after the date of enactment of this
                    section, an effective and comprehensive Federal plan
                    (including all appropriate Federal health programs) to
                    address prediabetes and diabetes in minority
                    populations.
                ``(2) Contents.--The report under paragraph (1)(A) shall at
            minimum address each of the following:
                        ``(A) Research on diabetes and prediabetes in
                    minority populations, including such research on--
                                ``(i) genetic, behavioral, socioeconomic,
                            and environmental factors;
                                ``(ii) prevention of diabetes within these
                            populations and who have individuals at
                            increased risk of developing diabetes;
                                ``(iii) prevention of complications among
                            individuals in these populations who have
                            already developed diabetes; and
                                ``(iv) barriers to health care access and
                            diabetes treatment within populations at
                            increased risk of developing diabetes.
                        ``(B) Surveillance and data collection on diabetes
                    and prediabetes in minority populations, including with
                    respect to--
                                ``(i) efforts to better determine the
                            prevalence of diabetes among Asian-American and
                            Pacific Islander subgroups; and
                                ``(ii) efforts to coordinate data
                            collection on the American Indian population.
                        ``(C) Community-based interventions to address
                    diabetes and prediabetes targeting minority
                    populations, including--
                                ``(i) the evidence base for such
                            interventions;
                                ``(ii) the cultural appropriateness of such
                            interventions; and
                                ``(iii) efforts to educate the public on
                            the causes and consequences of diabetes.
                        ``(D) Education and training programs for health
                    professionals (including community health workers) on
                    the prevention and management of diabetes and its
                    related complications that is supported by the Health
                    Resources and Services Administration, including such
                    programs supported by--
                                ``(i) the National Health Service Corps; or
                                ``(ii) the community health centers program
                            under section 330.
        ``(d) Education.--The Director of NIH shall--
                ``(1) through the National Institute on Minority Health and
            Health Disparities and the National Diabetes Education
            Program--
                        ``(A) make grants to programs funded under section
                    464z-4 for the purpose of establishing a medical
                    education program for health care professionals to be
                    more involved in weight counseling, obesity research,
                    nutrition, and shared decision-making; and
                        ``(B) provide for the participation of minority
                    health professionals in diabetes-focused research
                    programs; and
                ``(2) make grants to programs that establish a professional
            pipeline that will increase the participation of minority
            individuals in diabetes-focused health fields by expanding
            Minority Access to Research Careers program internships and
            mentoring opportunities for the purposes of recruitment.
        ``(e) Definitions.--For purposes of this section:
                ``(1) Diabetes mellitus interagency coordinating
            committee.--The `Diabetes Mellitus Interagency Coordinating
            Committee' means the Diabetes Mellitus Interagency Coordinating
            Committee established under section 429.
                ``(2) Minority population.--The term `minority population'
            means a racial and ethnic minority group, as defined in section
            1707.''.

    SEC. 7252. RESEARCH, EDUCATION, AND OTHER ACTIVITIES.

        Part B of title III of the Public Health Service Act (42 U.S.C. 243
    et seq.), as amended by section 7101, is further amended by inserting
    after section 317V the following section:

    ``SEC. 317W. DIABETES IN MINORITY POPULATIONS.

        ``(a) Research and Other Activities.--
                ``(1) In general.--The Secretary, acting through the
            Director of the Centers for Disease Control and Prevention,
            shall conduct and support research and public health activities
            with respect to diabetes in minority populations.
                ``(2) Certain activities.--Activities under paragraph (1)
            regarding diabetes in minority populations shall include the
            following:
                        ``(A) Further enhancing the National Health and
                    Nutrition Examination Survey by oversampling Asian
                    Americans, Native Hawaiians, and Pacific Islanders in
                    appropriate geographic areas to better determine the
                    prevalence of diabetes in such populations as well as
                    to improve the data collection of diabetes penetration
                    disaggregated into major ethnic groups within such
                    populations. The Secretary shall ensure that any such
                    oversampling does not reduce the oversampling of other
                    minority populations including African-American and
                    Latino populations.
                        ``(B) Through the Division of Diabetes
                    Translation--
                                ``(i) providing for prevention research to
                            better understand how to influence health care
                            systems changes to improve quality of care
                            being delivered to such populations;
                                ``(ii) carrying out model demonstration
                            projects to design, implement, and evaluate
                            effective diabetes prevention and control
                            interventions for minority populations,
                            including culturally appropriate community-
                            based interventions;
                                ``(iii) developing and implementing a
                            strategic plan to reduce diabetes in minority
                            populations through applied research to reduce
                            disparities and culturally and linguistically
                            appropriate community-based interventions;
                                ``(iv) supporting, through the national
                            diabetes prevention program under section 399V-
                            3, diabetes prevention program sites in
                            underserved regions highly impacted by
                            diabetes; and
                                ``(v) implementing, through the national
                            diabetes prevention program under section 399V-
                            3, a demonstration program developing new
                            metrics measuring health outcomes related to
                            diabetes that can be stratified by specific
                            minority populations.
        ``(b) Education.--The Secretary, acting through the Director of the
    Centers for Disease Control and Prevention, shall direct the Division
    of Diabetes Translation to conduct and support both programs to educate
    the public on diabetes in minority populations and programs to educate
    minority populations about the causes and effects of diabetes.
        ``(c) Diabetes; Health Promotion, Prevention Initiatives, and
    Access.--The Secretary, acting through the Director of the Centers for
    Disease Control and Prevention and the National Diabetes Education
    Program, shall conduct and support programs to educate specific
    minority populations through culturally appropriate and linguistically
    appropriate information campaigns and initiatives about prevention of,
    and managing, diabetes.
        ``(d) Definition.--For purposes of this section, the term `minority
    population' means a racial and ethnic minority group, as defined in
    section 1707.''.

    SEC. 7253. PROGRAMS TO EDUCATE HEALTH PROVIDERS ON THE CAUSES AND
                  EFFECTS OF DIABETES IN MINORITY POPULATIONS.

        Part P of title III of the Public Health Service Act (42 U.S.C.
    280g et seq.), as amended by section 7220, is further amended by adding
    at the end the following new section:

    ``SEC. 399V-9. PROGRAMS TO EDUCATE HEALTH PROVIDERS ON THE CAUSES AND
                  EFFECTS OF DIABETES IN MINORITY POPULATIONS.

        ``(a) In General.--The Secretary, acting through the Director of
    the Health Resources and Services Administration, shall conduct and
    support programs described in subsection (b) to educate health
    professionals on the causes and effects of diabetes in minority
    populations.
        ``(b) Programs.--Programs described in this subsection, with
    respect to education on diabetes in minority populations, shall include
    the following:
                ``(1) Giving priority, under the primary care training and
            enhancement program under section 747--
                        ``(A) to awarding grants to focus on or address
                    diabetes; and
                        ``(B) to adding minority populations to the list of
                    vulnerable populations that should be served by such
                    grants.
                ``(2) Providing additional funds for the Health Careers
            Opportunity Program, the Centers for Excellence, and the
            Minority Faculty Fellowship Program to partner with the Office
            of Minority Health under section 1707 and the National
            Institutes of Health to strengthen programs for career
            opportunities focused on diabetes treatment and care within
            underserved regions highly impacted by diabetes.
                ``(3) Developing a diabetes focus within, and providing
            additional funds for, the National Health Service Corps
            scholarship program--
                        ``(A) to place individuals in areas that are
                    disproportionately affected by diabetes and to provide
                    diabetes treatment and care in such areas; and
                        ``(B) to provide such individuals continuing
                    medical education specific to diabetes care.''.

    SEC. 7254. RESEARCH, EDUCATION, AND OTHER ACTIVITIES REGARDING DIABETES
                  IN AMERICAN INDIAN POPULATIONS.

        Part P of title III of the Public Health Service Act (42 U.S.C.
    280g et seq.), as amended by section 7253, is further amended by adding
    at the end the following section:

    ``SEC. 399V-10. RESEARCH, EDUCATION, AND OTHER ACTIVITIES REGARDING
                  DIABETES IN AMERICAN INDIAN POPULATIONS.

        ``In addition to activities under sections 317W, 399V-9, and 434B,
    the Secretary, acting through the Indian Health Service and in
    collaboration with other appropriate Federal agencies, shall--
                ``(1) conduct and support research and other activities
            with respect to diabetes; and
                ``(2) coordinate the collection of data on clinically and
            culturally appropriate diabetes treatment, care, prevention,
            and services by health care professionals to the American
            Indian population.''.

    SEC. 7255. UPDATED REPORT ON HEALTH DISPARITIES.

        The Secretary of Health and Human Services shall seek to enter into
    an arrangement with the National Academy of Medicine under which the
    National Academy will--
                (1) not later than 1 year after the date of enactment of
            this Act, submit to Congress an updated version of the 2003
            report entitled ``Unequal Treatment: Confronting Racial and
            Ethnic Disparities in Health Care''; and
                (2) in such updated version, address how racial and ethnic
            health disparities have changed since the publication of the
            original report.

                            Subtitle G--Lung Disease

    SEC. 7301. NATIONAL ASTHMA BURDEN.

        Congress finds as follows:
                (1) The prevalence of asthma has increased since 1980 and
            affects more than 26,000,000 people in the United States.
                (2) Significant disparities in asthma morbidity and
            mortality exist for both adults and children particularly for
            low-income and minority populations, particularly African
            Americans and Puerto Ricans.
                (3) African-American children are twice as likely to have
            asthma as White children.
                (4) In 2016, almost 4,500,000 non-Hispanic African
            Americans reported having asthma. African Americans with asthma
            are 3 times as likely to visit the emergency department and
            twice as likely to get hospitalized as White patients with
            asthma.
                (5) Puerto Ricans are 3.4 times as likely to die from
            asthma compared with all other Hispanic or Latino groups.
            Overall Hispanic Americans are 30 percent more likely to be
            hospitalized for asthma than non-Hispanic Whites.
                (6) The majority of adults with asthma are women.

    SEC. 7302. ASTHMA-RELATED ACTIVITIES OF THE CENTERS FOR DISEASE CONTROL
                  AND PREVENTION.

        Section 317I of the Public Health Service Act (42 U.S.C. 247b-10)
    is amended to read as follows:

    ``SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS FOR DISEASE
                  CONTROL AND PREVENTION.

        ``(a) Program for Providing Information and Education to the
    Public.--The Secretary, acting through the Director of the Centers for
    Disease Control and Prevention, shall collaborate with State and local
    health departments to conduct activities, including the provision of
    information and education to the public regarding asthma including--
                ``(1) deterring the harmful consequences of uncontrolled
            asthma; and
                ``(2) disseminating health education and information
            regarding prevention of asthma episodes and strategies for
            managing asthma.
        ``(b) Development of State Asthma Plans.--The Secretary, acting
    through the Director of the Centers for Disease Control and Prevention,
    shall collaborate with State and local health departments to develop
    State plans incorporating public health responses to reduce the burden
    of asthma, particularly regarding disproportionately affected
    populations.
        ``(c) Compilation of Data.--The Secretary, acting through the
    Director of the Centers for Disease Control and Prevention, shall, in
    cooperation with State and local public health officials--
                ``(1) conduct asthma surveillance activities to collect
            data on the prevalence and severity of asthma, the
            effectiveness of public health asthma interventions, and the
            quality of asthma management, including--
                        ``(A) collection of data among people with asthma
                    to monitor the impact on health and quality of life;
                        ``(B) surveillance of health care facilities; and
                        ``(C) collection of data not containing
                    individually identifiable information from electronic
                    health records or other electronic communications;
                ``(2) compile and annually publish data regarding the
            prevalence and incidence of childhood asthma, the child
            mortality rate, and the number of hospital admissions and
            emergency department visits by children associated with asthma
            nationally and in each State and at the county level by age,
            sex, race, and ethnicity, as well as lifetime and current
            prevalence; and
                ``(3) compile and annually publish data regarding the
            prevalence and incidence of adult asthma, the adult mortality
            rate, and the number of hospital admissions and emergency
            department visits by adults associated with asthma nationally
            and in each State and at the county level by age, sex, race,
            ethnicity, industry, and occupation, as well as lifetime and
            current prevalence.
        ``(d) Coordination of Data Collection.--The Director of the Centers
    for Disease Control and Prevention, in conjunction with State and local
    health departments, shall coordinate data collection activities under
    paragraphs (2) and (3) of subsection (c) so as to maximize
    comparability of results.
        ``(e) Collaboration.--
                ``(1) In general.--The Centers for Disease Control and
            Prevention may collaborate with national, State, and local
            nonprofit organizations to provide information and education
            about asthma, and to strengthen such collaborations when
            possible.
                ``(2) Specific activities.--The Director of the Centers for
            Disease Control and Prevention, acting through the Division of
            Population Health of the Centers, may expand activities
            relating to asthma with non-Federal partners, especially State-
            level entities.
        ``(f) Reports to Congress.--
                ``(1) In general.--Not later than 3 years after the date of
            the enactment of the Health Equity and Accountability Act of
            2022, and once 2 years thereafter, the Secretary shall, in
            consultation with patient groups, nonprofit organizations,
            medical societies, and other relevant governmental and
            nongovernmental entities, submit to Congress a report that--
                        ``(A) catalogs, with respect to asthma prevention,
                    management, and surveillance--
                                ``(i) the activities of the Federal
                            Government, including an assessment of the
                            progress of the Federal Government and States,
                            with respect to achieving the goals of the
                            Healthy People 2030 initiative; and
                                ``(ii) the activities of other entities
                            that participate in the program under this
                            section, including nonprofit organizations,
                            patient advocacy groups, and medical societies;
                            and
                        ``(B) makes recommendations for the future
                    direction of asthma activities, in consultation with
                    researchers from the National Institutes of Health and
                    other member bodies of the Asthma Disparities
                    Subcommittee, including--
                                ``(i) a description of how the Federal
                            Government may improve its response to asthma,
                            including identifying any barriers that may
                            exist;
                                ``(ii) a description of how the Federal
                            Government may continue, expand, and improve
                            its private-public partnerships with respect to
                            asthma including identifying any barriers that
                            may exist;
                                ``(iii) identification of steps that may be
                            taken to reduce the--
                                        ``(I) morbidity, mortality, and
                                    overall prevalence of asthma;
                                        ``(II) financial burden of asthma
                                    on society;
                                        ``(III) burden of asthma on
                                    disproportionately affected areas,
                                    particularly those in medically
                                    underserved populations (as defined in
                                    section 330(b)(3)); and
                                        ``(IV) burden of asthma as a
                                    chronic disease that can be worsened by
                                    environmental exposures;
                                ``(iv) the identification of programs and
                            policies that have achieved the steps described
                            under clause (iii), and steps that may be taken
                            to expand such programs and policies to benefit
                            larger populations; and
                                ``(v) recommendations for future research
                            and interventions.
                ``(2) Subsequent reports.--
                        ``(A) Congressional request.--During the 5-year
                    period following the submission of the second report
                    under paragraph (1), the Secretary shall submit updates
                    and revisions of the report upon the request of the
                    Congress.
                        ``(B) Five-year reevaluation.--At the end of the 5-
                    year period referred to in subparagraph (A), the
                    Secretary shall--
                                ``(i) evaluate the analyses and
                            recommendations made in previous reports; and
                                ``(ii) determine whether an additional
                            report is needed and if so submit such an
                            updated report to the Congress, including
                            appropriate recommendations.
        ``(g) Authorization of Appropriations Funding.--In addition to any
    other authorization of appropriations that is available to the Centers
    for Disease Control and Prevention for the purpose of carrying out this
    section, there is authorized to be appropriated to such Centers
    $65,000,000 for the period of fiscal years 2023 through 2027 for the
    purpose of carrying out this section.''.

    SEC. 7303. INFLUENZA AND PNEUMONIA VACCINATION CAMPAIGN.

        (a) In General.--The Secretary of Health and Human Services shall--
                (1) enhance the annual campaign by the Department of Health
            and Human Services to increase the number of people vaccinated
            each year for influenza and pneumonia; and
                (2) include in such campaign the use of written educational
            materials, public service announcements, physician education,
            and any other means which the Secretary deems effective.
        (b) Materials and Announcements.--In carrying out the annual
    campaign described in subsection (a), the Secretary of Health and Human
    Services shall ensure that--
                (1) educational materials and public service announcements
            are readily and widely available in communities experiencing
            disparities in the incidence and mortality rates of influenza
            and pneumonia; and
                (2) the campaign uses targeted, culturally appropriate
            messages and messengers to reach underserved communities.
        (c) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section such sums as may be necessary
    for each of fiscal years 2023 through 2027.

    SEC. 7304. CHRONIC OBSTRUCTIVE PULMONARY DISEASE.

        (a) Findings.--Congress finds as follows:
                (1) Chronic obstructive pulmonary disease (referred to in
            this subsection as ``COPD'') refers to chronic bronchitis and
            emphysema, incurable diseases that make it difficult to exhale
            all the air from one's lungs, and that can cause persistent
            coughing, shortness of breath, and sputum.
                (2) COPD exacerbations--episodes of acute difficulty
            breathing and moderate to severe fatigue--are dangerous, and
            their treatment often requires hospitalization.
                (3) While smoking is the primary risk factor for COPD,
            other risk factors include air pollution, occupational
            exposures, heredity, a history of childhood respiratory
            infections, and socioeconomic status.
                (4) It is estimated that over 16,000,000 adults in the
            United States have COPD.
                (5) COPD is a leading cause of death in the United States,
            claiming over 156,000 lives in 2019.
                (6) Since 2000, deaths for women with COPD have exceeded
            deaths in men.
                (7) Although African Americans have a lower prevalence of
            COPD in the United States, researchers have shown that African
            Americans may be underdiagnosed. Furthermore, research has
            shown that African Americans develop COPD with less cumulative
            smoke exposure and at a younger age.
        (b) In General.--The Director of the Centers for Disease Control
    and Prevention shall conduct, support, and expand public health
    strategies, prevention, diagnosis, surveillance, and public and
    professional awareness activities regarding chronic obstructive
    pulmonary disease.
        (c) Chronic Disease Prevention Programs.--The Director of the
    National Heart, Lung, and Blood Institute shall carry out the
    following:
                (1) Conduct public education and awareness activities with
            patient and professional organizations to stimulate earlier
            diagnosis and improve patient outcomes from treatment of
            chronic obstructive pulmonary disease. To the extent known and
            relevant, such public education and awareness activities shall
            reflect differences in chronic obstructive pulmonary disease by
            cause (tobacco, environmental, occupational, biological, and
            genetic) and include a focus on outreach to undiagnosed and, as
            appropriate, minority populations.
                (2) Supplement and expand upon the activities of the
            National Heart, Lung, and Blood Institute by making grants to
            nonprofit organizations, State and local jurisdictions, and
            Indian Tribes for the purpose of reducing the burden of chronic
            obstructive pulmonary disease, especially in disproportionately
            impacted communities, through public health interventions and
            related activities.
                (3) Coordinate with the Centers for Disease Control and
            Prevention, the Indian Health Service, the Health Resources and
            Services Administration, and the Department of Veterans Affairs
            to develop pilot programs to demonstrate best practices for the
            diagnosis and management of chronic obstructive pulmonary
            disease.
                (4) Develop improved techniques and identify best
            practices, in coordination with the Secretary of Veterans
            Affairs, for assisting chronic obstructive pulmonary disease
            patients to successfully stop smoking, including identification
            of subpopulations with different needs. Initiatives under this
            paragraph may include research to determine whether successful
            smoking cessation strategies are different for chronic
            obstructive pulmonary disease patients compared to such
            strategies for patients with other chronic diseases.
        (d) Environmental and Occupational Health Programs.--The Director
    of the Centers for Disease Control and Prevention shall--
                (1) support research into the environmental and
            occupational causes and biological mechanisms that contribute
            to chronic obstructive pulmonary disease; and
                (2) develop and disseminate public health interventions
            that will lessen the impact of environmental and occupational
            causes of chronic obstructive pulmonary disease.
        (e) Data Collection.--Not later than 180 days after the enactment
    of this Act, the Director of the National Heart, Lung, and Blood
    Institute and the Director of the Centers for Disease Control and
    Prevention, acting jointly, shall assess the depth and quality of
    information on chronic obstructive pulmonary disease that is collected
    in surveys and population studies conducted by the Centers for Disease
    Control and Prevention, including whether there are additional
    opportunities for information to be collected in the National Health
    and Nutrition Examination Survey, the National Health Interview Survey,
    and the Behavioral Risk Factors Surveillance System surveys.
        (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 2023 through 2027.

                            Subtitle H--Tuberculosis

    SEC. 7351. ELIMINATION OF ALL FORMS OF TUBERCULOSIS.

        (a) Short Title.--This subtitle may be cited as the ``End
    Tuberculosis Act''.
        (b) Findings.--Congress makes the following findings:
                (1) In the United States, 7,174 people were diagnosed with
            tuberculosis (referred to in this section as ``TB'') in 2020.
                (2) Disparities in TB exist and significantly impact
            minority communities in the United States. The Centers for
            Disease Control and Prevention (referred to in this section as
            ``CDC'') finds that 89 percent of people diagnosed with TB
            disease in 2020 self-identified as racial and ethnic
            minorities.
                (3) African Americans comprised 19.6 percent of people
            diagnosed with TB disease during 2020. The population-adjusted
            rate of TB among African Americans is 1.5 times higher than the
            national total, and 8.0 times higher than among Whites.
                (4) Asian Americans, Native Hawaiians, and other Pacific
            Islanders comprised 37.4 percent of people diagnosed with TB
            disease during 2020. The population-adjusted rate of TB among
            Asian Americans is 6 times higher than the national total, and
            33.25 times higher than among Whites. The population-adjusted
            rate of TB among Native Hawaiians and other Pacific Islanders
            is 8.5 times higher than the national total, and 46.75 times
            higher than among Whites.
                (5) Hispanics and Latinos comprised 29.7 percent of people
            diagnosed with TB disease during 2020. The population-adjusted
            rate of TB among Hispanics and Latinos is 1.6 times higher than
            the national total, and 8.75 times higher than among Whites.
                (6) TB is both preventable and curable, but the current
            rate of decline of TB in the United States remains too slow to
            achieve TB elimination in this century.
                (7) TB is transmitted through the air when a person who has
            TB disease in their lungs coughs or sneezes. People who are in
            close proximity to the person with TB can breathe in the TB
            bacteria, and the bacteria will initially settle in their
            lungs. Living conditions related to poverty, such as crowded
            housing and poor ventilation, can greatly increase the risk of
            transmission. Without proper and timely diagnosis and access to
            treatment, the TB bacteria may grow and spread to other parts
            of their body.
                (8) As many as 13,000,000 people in the United States may
            have latent TB infection (referred to in this section as
            ``LTBI''). People with LTBI have TB bacteria in their bodies,
            but their immune system is containing the bacteria, and they
            are not sick, nor do they have any current risk of spreading TB
            to others. LTBI can activate into infectious, life-threatening
            TB if not treated. Modeling has shown that eliminating TB is
            not possible without addressing LTBI.
                (9) Comorbidities associated with TB include cancer,
            diabetes mellitus, and HIV. People with these medical
            conditions and compromised immune systems are more likely to
            develop active TB disease and to have worse outcomes from TB.
            Many of the communities placed at highest risk of other adverse
            health outcomes and injustices are also disproportionately
            impacted by TB, and these include people experiencing
            homelessness and housing instability, people in congregate
            living and carceral settings, and people born outside of the
            United States.
                (10) Forms of active TB that do not show drug resistance
            are classified as drug-susceptible TB (referred to in this
            section as ``DS-TB''). Drug-resistant TB (referred to in this
            section as ``DR-TB'') is a rising threat to the public health
            of the United States. DR-TB that exhibits resistance to two or
            more first-line drugs is referred to as multi-drug resistant TB
            (referred to in this section as ``MDR-TB''). MDR-TB that also
            is resistant to at least one fluoroquinolone, and at least one
            additional group A second-line medicine is classified as
            extensively drug-resistant TB (referred to in this section as
            ``XDR-TB'').
                (11) Approximately 56 people in the United States were
            diagnosed with MDR-TB in 2020. One person was diagnosed with
            XDR-TB in the same year.
                (12) In the United States, $503,000,000 was spent in 2020
            to treat TB; direct treatment costs average $20,211 to treat a
            patient with DS-TB, $182,186 to treat a patient with MDR-TB,
            and $567,708 to treat a patient with XDR-TB. When factoring in
            productivity losses during treatment, DS-TB averages $24,661,
            MDR-TB averages $347,324, and XDR-TB averages $729,039.
            Treatment is often difficult, with daily complex multi-pill
            regimens, with side-effects ranging from hearing and vision
            loss to mental health issues.
                (13) Recognizing the public health, economic, and societal
            costs to the threat of MDR-TB, the National Action Plan to
            Combat MDR-TB was developed by the White House to provide the
            United States with a comprehensive three-pronged strategy to
            address MDR-TB by strengthening domestic capacity to combat
            MDR-TB; improve international capacity and cooperation to
            combat MDR-TB; and accelerate basic and applied research and
            development for new therapies, diagnostics, and prevention
            strategies to combat MDR-TB.
                (14) Additional Federal support is necessary to expand TB
            control efforts in case finding and treatment to address LTBI
            in a national prevention initiative. Key policy and research
            breakthroughs increase the success of a TB prevention
            initiative: the U.S. Preventative Services Task Force
            recommendation's ``B'' rating, screening for LTBI among high-
            risk adults as a covered service increases the likelihood that
            impacted racial and ethnic minority groups can get tested for
            TB; a new, shorter course treatment regimen reduces the length
            of treatment for LTBI from every day for 6 to 9 months to one
            dose per week for 12 weeks, increasing the likelihood of
            treatment completion; and the use of blood-based diagnostic
            tests, Interferon-gamma release assays or IGRAs, increases the
            ability to detect LTBI among patients in affected communities.
                (15) The right to health, and the right to science as a
            necessary human right to help achieve the right to health, is
            enshrined in Articles 25 and 27 of the Universal Declaration of
            Human Rights. These fundamental human rights cannot be achieved
            when anyone lacks access to TB prevention or treatment, and
            when the benefits of scientific innovation are not extended to
            people with all forms of TB.

    SEC. 7352. ADDITIONAL FUNDING FOR STATES IN COMBATING AND ELIMINATING
                  TUBERCULOSIS.

        Section 317E(h) of the Public Health Act (42 U.S.C. 247b-6(h)) is
    amended by adding at the end the following:
                ``(3) Additional funding for states in combating and
            eliminating tuberculosis.--In addition to amounts otherwise
            authorized to be appropriated to carry out this section, there
            are authorized to be appropriated such sums as may be necessary
            to carry out this section for each of fiscal years 2023 through
            2024.''.

    SEC. 7353. STRENGTHENING CLINICAL RESEARCH FUNDING FOR TUBERCULOSIS.

        (a) In General.--The Secretary of Health and Human Services shall
    expand and intensify support for current and prospective research
    activities of the National Institutes of Health, the Biomedical
    Advanced Research and Development Authority, and the Centers for
    Disease Control and Prevention Division of Tuberculosis Elimination to
    develop new therapeutics, diagnostics, vaccines, and other prevention
    modalities in addressing all forms of tuberculosis (referred to in this
    section as ``TB'').
        (b) Included Research Activities.--Research activities under
    subsection (a) shall include--
                (1) research and development, and pathways to approval, for
            novel, safe drugs and drug regimens for the treatment of TB,
            including in adolescent and pediatric populations and in
            pregnant and lactating people;
                (2) research to develop rapid diagnostic tests for all
            forms of TB, including diagnostics that can be used for
            pediatric populations and people living with HIV, diagnostics
            that can detect extra pulmonary TB and drug resistance, and
            diagnostics that can be used at the point of care;
                (3) research to advance basic knowledge of the pathogenesis
            of TB and its major comorbidities, including HIV and diabetes
            mellitus;
                (4) research to improve knowledge and understandings of the
            role of latency in TB and the factors that increase the risk of
            latent TB infection progressing to active, symptomatic TB
            disease;
                (5) awarding grants and contracts to specifically develop
            new and needed vaccines to address TB;
                (6) awarding grants and contracts to support the training
            and development of clinical researchers whose research improves
            the landscape of tools to combat TB; and
                (7) awarding grants and contracts to support capacity-
            building and develop clinical trial site infrastructure in the
            United States and in TB endemic countries to support the
            aforementioned research activities.

            Subtitle I--Osteoarthritis and Musculoskeletal Diseases

    SEC. 7401. FINDINGS.

        Congress finds as follows:
                (1) Eighty percent of African-American women and nearly 74
            percent of Hispanic men are either overweight or obese,
            speeding the onset and progression of knee arthritis.
                (2) Arthritis affects 58,500,000 people in the United
            States, and that number will rise to 78,000,000 by the year
            2040.
                (3) 32,500,000 people in the United States suffer from
            osteoarthritis, the most common form of arthritis, making it
            the leading cause of disability in the United States.
            Osteoarthritis is sometimes referred to as degenerative joint
            disease.
                (4) Obesity accelerates the onset of arthritis: 70 percent
            of obese adults with mild osteoarthritis of the knee at age 60
            will develop advanced end-stage disease by age 80. In contrast,
            just 43 percent of non-obese adults will have end-stage disease
            over the same time period.
                (5) Arthritis affects 1 in 4 people in the United States
            and is the single greatest cause of chronic pain and disability
            in the United States.
                (6) Women, Black Americans, and Hispanics have more severe
            arthritis and functional limitations. These same individuals
            are more likely to be obese and diabetic, and have a higher
            incidence of heart diseases.
                (7) Arthritis costs $304,000,000,000 a year, including
            $140,000,000,000 in direct costs (medical) and $164,000,000,000
            in indirect costs (lost earnings).
                (8) Obesity and other chronic health conditions exacerbate
            the debilitating impact of arthritis, leading to inactivity,
            loss of independence, and a perpetual cycle of comorbid chronic
            conditions.
                (9) Sixty-one percent of arthritis sufferers are women, and
            women represent 64 percent of an estimated 43,000,000 annual
            visits to physicians' offices and outpatient clinics where
            arthritis was the primary diagnosis. Women also represented 60
            percent of approximately 1,000,000 hospitalizations that
            occurred in 2003 for which arthritis was the primary diagnosis.
                (10) Women ages 65 and older have up to 2\1/2\ times more
            disabilities than men of the same age. Higher rates of obesity
            and arthritis among this group explained up to 48 percent of
            the gender gap in disability, above all other common chronic
            health conditions.
                (11) The primary indication for total knee arthroplasty
            (referred to in this section as ``TKA''), also known as knee
            replacement, is relief of significant, disabling pain caused by
            severe arthritis.
                (12) Knee replacement is surgery for people with severe
            knee damage. Knee replacement can relieve pain and allow an
            individual to be more active. The process for a total knee
            replacement involves the surgeon removing damaged cartilage and
            bone from the surface of the knee joint and replacing the
            cartilage and bone with a man-made surface of metal and
            plastic. In a partial knee replacement, the surgeon only
            replaces part of the knee joint.
                (13) Total hip replacement, also called total hip
            arthroplasty (referred to in this section as ``THA''), is used
            if hip pain interferes with daily activities and more
            conservative treatments have not helped. Arthritis damage is
            the most common reason to need hip replacement.
                (14) The odds of a family practice physician recommending
            TKA to a male patient with moderate arthritis are twice that of
            a female patient, while the odds of an orthopedic surgeon
            recommending TKA to a male patient with moderate arthritis are
            22 times that of a female patient.
                (15) Black Americans with doctor-diagnosed arthritis have a
            higher prevalence of severe pain attributable to arthritis,
            compared with White Americans (34.0 percent versus 22.6
            percent). Black Americans, compared to White Americans, report
            a higher proportion of work limitations (39.5 percent versus
            28.0 percent) and a higher prevalence of arthritis-attributable
            work limitation (6.6 percent versus 4.6 percent).
                (16) Hispanics are 50 percent more likely than non-Hispanic
            Whites to report needing assistance with at least one
            instrumental activity of daily living and to have difficulty
            walking.
                (17) Black Americans and Hispanics were 1.3 times more
            likely to have activity limitation, 1.6 times more likely to
            have work limitations, and 1.9 times more likely to have severe
            joint pain than Whites.
                (18) In 2003, the National Academy of Medicine reported
            that the rates of TKA and THA among Black American and Hispanic
            patients are significantly lower than for Whites--even for
            those with equitable health care coverage such as through
            Medicare or the Department of Veterans Affairs.
                (19) According to the Centers for Disease Control and
            Prevention, in 2000, Black American Medicare enrollees were 37
            percent less likely than White Medicare enrollees to undergo
            total knee replacements. In 2006, the disparity increased to 39
            percent.
                (20) Even after adjusting for insurance and health access,
            Hispanics and Black Americans are almost 50 percent less likely
            to undergo total knee replacement than Whites.

    SEC. 7402. OSTEOARTHRITIS AND OTHER MUSCULOSKELETAL HEALTH-RELATED
                  ACTIVITIES OF THE CENTERS FOR DISEASE CONTROL AND
                  PREVENTION.

        (a) Education and Awareness Activities.--The Secretary of Health
    and Human Services, acting through the Director of the Centers for
    Disease Control and Prevention, shall direct the National Center for
    Chronic Disease Prevention and Health Promotion to conduct and expand
    the Health Community Program and Arthritis Program to educate the
    public on--
                (1) the causes of, preventive health actions for, and
            effects of arthritis, lupus, and other musculoskeletal
            conditions in minority patient populations; and
                (2) the effects of such conditions on other comorbidities
            including obesity, hypertension, and cardiovascular disease.
        (b) Programs on Arthritis and Musculoskeletal Conditions.--
    Education and awareness programs of the Centers for Disease Control and
    Prevention on arthritis and other musculoskeletal conditions in
    minority communities shall--
                (1) be culturally and linguistically appropriate to
            minority patients, targeting musculoskeletal health promotion
            and prevention programs of each major ethnic group, including--
                        (A) Native Americans and Alaska Natives;
                        (B) Asian Americans;
                        (C) African Americans and Blacks;
                        (D) Hispanic and Latino Americans; and
                        (E) Native Hawaiians and Pacific Islanders; and
                (2) include public awareness campaigns directed toward
            these patient populations that emphasize the importance of
            musculoskeletal health, physical activity, diet and healthy
            lifestyle, and weight reduction for overweight and obese
            patients.
        (c) Authorization of Appropriations.--To carry out this section,
    there are authorized to be appropriated such sums as are necessary for
    fiscal year 2023 and each subsequent fiscal year.

    SEC. 7403. GRANTS FOR COMPREHENSIVE OSTEOARTHRITIS AND MUSCULOSKELETAL
                  DISEASE HEALTH EDUCATION WITHIN HEALTH PROFESSIONS
                  SCHOOLS.

        (a) Program Authorized.--The Secretary of Health and Human Services
    (in this section referred to as the ``Secretary''), in coordination
    with the Secretary of Education, shall award grants, on a competitive
    basis, to academic health science centers, health professions schools,
    and institutions of higher education to enable such centers, schools,
    and institutions to provide people with comprehensive education on
    arthritis and musculoskeletal health, particularly--
                (1) obesity-related musculoskeletal diseases;
                (2) arthritis and osteoarthritis;
                (3) arthritis and musculoskeletal health disparities; and
                (4) the relationship between arthritis and musculoskeletal
            diseases and metabolic activity, psychological health, and
            comorbidities such as diabetes, cardiovascular disease, lupus,
            and hypertension.
        (b) Duration.--Grants awarded under this section shall be for a
    period of 5 years.
        (c) Applications.--An academic health science center, health
    professions school, or institution of higher education seeking a grant
    under this section shall submit an application to the Secretary at such
    time, in such manner, and containing such information as the Secretary
    may require.
        (d) Priority.--In awarding grants under this section, the Secretary
    shall give priority to an institution of higher education that--
                (1) has an enrollment of needy students, as defined in
            section 318(b) of the Higher Education Act of 1965 (20 U.S.C.
            1059e(b));
                (2) is a Hispanic-serving institution, as defined in
            section 502(a) of such Act (20 U.S.C. 1101a(a));
                (3) is a Tribal College or University, as defined in
            section 316(b) of such Act (20 U.S.C. 1059c(b));
                (4) is an Alaska Native-serving institution, as defined in
            section 317(b) of such Act (20 U.S.C. 1059d(b));
                (5) is a Native Hawaiian-serving institution, as defined in
            section 317(b) of such Act (20 U.S.C. 1059d(b));
                (6) is a Predominately Black Institution, as defined in
            section 318(b) of such Act (20 U.S.C. 1059e(b));
                (7) is a Native American-serving, non-Tribal institution,
            as defined in section 319(b) of such Act (20 U.S.C. 1059f(b));
                (8) is an Asian American and Native American Pacific
            Islander-serving institution, as defined in section 320(b) of
            such Act (20 U.S.C. 1059g(b)); or
                (9) is a minority institution, as defined in section 365 of
            such Act (20 U.S.C. 1067k), with an enrollment of needy
            students, as defined in section 312 of such Act (20 U.S.C.
            1058).
        (e) Uses of Funds.--An academic health science center, health
    professions school, or institution of higher education receiving a
    grant under this section may use grant funds to integrate issues
    relating to comprehensive arthritis and musculoskeletal health into the
    academic or support sectors of the center, school, or institution in
    order to reach a large number of students, by carrying out 1 or more of
    the following activities:
                (1) Developing educational content for issues relating to
            comprehensive arthritis and musculoskeletal health education
            that will be incorporated into first-year orientation or core
            courses.
                (2) Creating innovative technology-based approaches to
            deliver arthritis and musculoskeletal health education to
            students, faculty, and staff.
                (3) Developing and employing peer-outreach and education
            programs to generate discussion, educate, and raise awareness
            among students about issues relating to arthritis and
            musculoskeletal health disorders, and their relationship to
            diabetes, hypertension, cardiovascular disease, psychological
            health, and other comorbid conditions.
        (f) Report to Congress.--
                (1) In general.--Not later than 1 year after the date of
            the enactment of this Act, and annually thereafter for a period
            of 5 years, the Secretary shall prepare and submit to the
            appropriate committees of Congress a report on the activities
            to provide health professions students with comprehensive
            arthritis and musculoskeletal health education funded under
            this section.
                (2) Report elements.--The report described in paragraph (1)
            shall include information about--
                        (A) the number of entities that are receiving grant
                    funds;
                        (B) the specific activities supported by grant
                    funds;
                        (C) the number of students served by grant
                    programs; and
                        (D) the status of program evaluations.
        (g) Definition of Institution of Higher Education.--In this
    section, the term ``institution of higher education'' has the meaning
    given such term in section 101(b) of the Higher Education Act of 1965
    (20 U.S.C. 1001(b)).

                Subtitle J--Sleep and Circadian Rhythm Disorders

    SEC. 7451. SHORT TITLE; FINDINGS.

        (a) Short Title.--This subtitle may be cited as the ``Sleep and
    Circadian Rhythm Disorders Health Disparities Act''.
        (b) Findings.--Congress finds the following:
                (1) Decrements in sleep health such as sleep apnea,
            insufficient sleep time, and insomnia, affect 50,000,000 to
            70,000,000 adults in the United States. An estimated 25,000,000
            adults in the United States have sleep apnea, a chronic
            disorder characterized by one or more pauses in breathing which
            can last from a few seconds to minutes. They may occur 30 times
            or more an hour, disrupting sleep and resulting in excessive
            daytime sleepiness and loss in productivity.
                (2) Seventy percent of high school students are not getting
            enough sleep on school nights, while 35 percent of people in
            the United States get fewer than 7 hours of sleep per night,
            and roughly 1,550 fatal motor vehicle crashes are caused by
            drowsy drivers.
                (3) Insufficient sleep and insomnia are more prevalent in
            women. Women who are pregnant and have sleep apnea are at an
            increased risk of cardiovascular complications during
            pregnancy. The impact of disparities in sleep health is
            associated with a growing number of health problems, including
            the following:
                        (A) Hypertension.
                        (B) Cancer.
                        (C) Stroke.
                        (D) Cardiac arrhythmia.
                        (E) Chronic heart failure and heart disease.
                        (F) Diabetes.
                        (G) Cognitive functioning and behavior.
                        (H) Depression and bipolar disorder.
                        (I) Substance abuse.
                (4) A sleep disparity exists in that poor sleep quality is
            strongly associated with poverty, race, and social determinants
            of health. Factors such as employment, education, and health
            status, amongst others, significantly mediated this effect only
            in poor subjects, suggesting a differential vulnerability to
            these factors in poor relative to nonpoor individuals in the
            context of sleep quality.
                (5) Black Americans sleep worse than White Americans. Black
            Americans take longer to fall asleep, report poorer sleep
            quality, have more light and less deep sleep, and nap more
            often and longer.
                (6) Black Americans and individuals in lower socioeconomic
            status groups may be at an increased risk for sleep
            disturbances and associated health consequences.
                (7) Among young Black Americans, the likelihood of having
            sleep disordered breathing and exhibiting risk factors for poor
            sleep is twice that in young White Americans. Frequent snoring
            is more common among Black American and Hispanic women and
            Hispanic men compared to non-Hispanic White Americans,
            independent of other factors including obesity.
                (8) Black Americans with sleep-disordered breathing develop
            symptoms at a younger age than Caucasians but appear less
            likely to be diagnosed and treated in a timely manner. This
            delay may at least in part be due to reduced access to care.
                (9) Sleep loss contributes to increased risk for chronic
            conditions such as obesity, diabetes, and hypertension, all of
            which have increased prevalence in underserved,
            underrepresented minorities. Racial and ethnic disparities
            related to obesity may also contribute to disparities in health
            outcomes related to sleep-disordered breathing.
                (10) Underrepresented minorities in the United States
            report an insomnia rate of 12.9 percent compared to only 6.6
            percent for White Americans.
                (11) Black women have a higher incidence of insomnia than
            Black men, perhaps related in part to higher risk for chronic
            persisting symptoms.

    SEC. 7452. SLEEP AND CIRCADIAN RHYTHM DISORDERS RESEARCH ACTIVITIES OF
                  THE NATIONAL INSTITUTES OF HEALTH.

        (a) In General.--The Director of the National Institutes of Health,
    acting through the Director of the National Heart, Lung, and Blood
    Institute, shall--
                (1) continue to expand research activities addressing sleep
            health disparities; and
                (2) continue implementation of the NIH Sleep Disorders
            Research Plan across all institutes and centers of the National
            Institutes of Health to improve treatment and prevention of
            sleep health disparities.
        (b) Required Research Activities.--In conducting or supporting
    research relating to sleep and circadian rhythm, the Director of the
    National Heart, Lung, and Blood Institute shall--
                (1) advance epidemiology and clinical research to achieve a
            more complete understanding of disparities in domains of sleep
            health and across population subgroups for which cardiovascular
            and metabolic health disparities exist, including--
                        (A) prevalence and severity of sleep apnea;
                        (B) habitual sleep duration;
                        (C) sleep timing and regularity; and
                        (D) insomnia;
                (2) develop study designs and analytical approaches to
            explain and predict multilevel and life-course determinants of
            sleep health and to elucidate the sleep-related causes of
            cardiovascular and metabolic health disparities across the age
            spectrum, including such determinants and causes that are--
                        (A) environmental;
                        (B) biological or genetic;
                        (C) psychosocial;
                        (D) societal;
                        (E) political; or
                        (F) economic;
                (3) determine the contribution of sleep impairments such as
            sleep apnea, insufficient sleep duration, irregular sleep
            schedules, and insomnia to unexplained disparities in
            cardiovascular and metabolic risk and disease outcomes;
                (4) develop study designs, data sampling and collection
            tools, and analytical approaches to optimize understanding of
            mediating and moderating factors, and feedback mechanisms
            coupling sleep to cardiovascular and metabolic health
            disparities;
                (5) advance research to understand cultural and linguistic
            barriers (on the person, provider, or system level) to access
            to care, medical diagnosis, and treatment of sleep disorders in
            diverse population groups;
                (6) develop and test multilevel interventions (including
            sleep health education in diverse communities) to reduce
            disparities in sleep health that will impact ability to improve
            disparities in cardiovascular and metabolic risk or disease;
                (7) create opportunities to integrate sleep and health
            disparity science by strategically utilizing resources
            (existing or anticipated cohorts), exchanging scientific data
            and ideas (cross-over into scientific meetings), and develop
            multidisciplinary investigator-initiated grant applications;
            and
                (8) enhance the diversity and foster career development of
            young investigators involved in sleep and health disparities
            science.
        (c) Authorization of Appropriations.--To carry out this section,
    there are authorized to be appropriated such sums as may be necessary
    for fiscal year 2023 and each subsequent fiscal year.

    SEC. 7453. SLEEP AND CIRCADIAN RHYTHM HEALTH DISPARITIES-RELATED
                  ACTIVITIES OF THE CENTERS FOR DISEASE CONTROL AND
                  PREVENTION.

        (a) In General.--The Director of the Centers for Disease Control
    and Prevention shall conduct, support, and expand public health
    strategies and prevention, diagnosis, surveillance, and public and
    professional awareness activities regarding sleep and circadian rhythm
    disorders.
        (b) Findings.--Congress finds as follows:
                (1) Sleep disorders and sleep deficiency unrelated to a
            primary sleep disorder are underdiagnosed and are increasingly
            detrimental to health status.
                (2) The consequences to society include additional
            diseases, motor vehicle accidents, decreased longevity,
            elevated direct medical costs, and indirect costs related to
            work absenteeism and property damage.
        (c) Required Surveillance and Education Awareness Activities.--In
    conducting or supporting research relating to sleep and circadian
    rhythm disorders surveillance and education awareness activities, the
    Director of the Centers for Disease Control and Prevention shall--
                (1) ensure that such activities are culturally and
            linguistically appropriate to minority patients, targeting
            sleep and circadian rhythm health promotion and prevention
            programs of each major ethnic group, including--
                        (A) Native Americans and Alaska Natives;
                        (B) Asian Americans;
                        (C) African Americans and Blacks;
                        (D) Hispanic and Latino-Americans; and
                        (E) Native Hawaiians and Pacific Islanders;
                (2) collect and compile national and State surveillance
            data on sleep disorders health disparities;
                (3) continue to develop and implement new sleep questions
            in public health surveillance systems to increase public
            awareness of sleep health and sleep disorders and their impact
            on health;
                (4) publish monthly reports highlighting geographic,
            racial, and ethnic disparities in sleep health, as well as
            relationships between insufficient sleep and chronic disease,
            health risk behaviors, and other outcomes as determined
            necessary by the Director; and
                (5) include public awareness campaigns that inform patient
            populations from major ethnic groups about the prevalence of
            sleep and circadian rhythm disorders and emphasize the
            importance of sleep health.
        (d) Authorization of Appropriations.--To carry out this section,
    there are authorized to be appropriated such sums as may be necessary
    for fiscal year 2023 and each subsequent fiscal year.

    SEC. 7454. GRANTS FOR COMPREHENSIVE SLEEP AND CIRCADIAN HEALTH
                  EDUCATION WITHIN HEALTH PROFESSIONS SCHOOLS.

        (a) Program Authorized.--The Secretary of Health and Human Services
    (referred to in this section as the ``Secretary''), in coordination
    with the Secretary of Education, shall award grants, on a competitive
    basis, to academic health science centers, health professions schools,
    and institutions of higher education to enable such centers, schools,
    and institutions to provide people with comprehensive education on
    sleep and circadian health, particularly--
                (1) poor sleep health;
                (2) sleep disorders;
                (3) sleep health disparities; and
                (4) the relationship between sleep and circadian health on
            metabolic activity, neurological activity, comorbidities, and
            other diseases.
        (b) Duration.--Grants awarded under this section shall be for a
    period of 5 years.
        (c) Applications.--An academic health science center, health
    professions school, or institution of higher education seeking a grant
    under this section shall submit an application to the Secretary at such
    time, in such manner, and containing such information as the Secretary
    may require.
        (d) Priority.--In awarding grants under this section, the Secretary
    shall give priority to an institution of higher education that--
                (1) has an enrollment of needy students, as defined in
            section 318(b) of the Higher Education Act of 1965 (20 U.S.C.
            1059e(b));
                (2) is a Hispanic-serving institution, as defined in
            section 502(a) of such Act (20 U.S.C. 1101a(a));
                (3) is a Tribal College or University, as defined in
            section 316(b) of such Act (20 U.S.C. 1059c(b));
                (4) is an Alaska Native-serving institution, as defined in
            section 317(b) of such Act (20 U.S.C. 1059d(b));
                (5) is a Native Hawaiian-serving institution, as defined in
            section 317(b) of such Act (20 U.S.C. 1059d(b));
                (6) is a Predominately Black Institution, as defined in
            section 318(b) of such Act (20 U.S.C. 1059e(b));
                (7) is a Native American-serving, nontribal institution, as
            defined in section 319(b) of such Act (20 U.S.C. 1059f(b));
                (8) is an Asian American and Native American Pacific
            Islander-serving institution, as defined in section 320(b) of
            such Act (20 U.S.C. 1059g(b)); or
                (9) is a minority institution, as defined in section 365 of
            such Act (20 U.S.C. 1067k), with an enrollment of needy
            students, as defined in section 312 of such Act (20 U.S.C.
            1058).
        (e) Uses of Funds.--An academic health science center, health
    professions school, or institution of higher education receiving a
    grant under this section may use the grant funds to integrate issues
    relating to comprehensive sleep and circadian health into the academic
    or support sectors of the center, school, or institution, in order to
    reach a large number of students, by carrying out 1 or more of the
    following activities:
                (1) Developing educational content for issues relating to
            comprehensive sleep and circadian health education that will be
            incorporated into first-year orientation or core courses.
                (2) Creating innovative technology-based approaches to
            deliver sleep health education to students, faculty, and staff.
                (3) Developing and employing peer-outreach and education
            programs to generate discussion, educate, and raise awareness
            among students about issues relating to poor quality sleep,
            sleep and circadian disorders, and the role sleep health plays
            in other diseases and comorbidities.
        (f) Report to Congress.--
                (1) In general.--Not later than 1 year after the date of
            the enactment of this Act, and annually thereafter for a period
            of 5 years, the Secretary shall prepare and submit to the
            appropriate committees of Congress a report on the activities
            to provide health professions students with comprehensive sleep
            and circadian health education funded under this section.
                (2) Report elements.--The report described in paragraph (1)
            shall include information about--
                        (A) the number of entities that are receiving grant
                    funds;
                        (B) the specific activities supported by grant
                    funds;
                        (C) the number of students served by grant
                    programs; and
                        (D) the status of program evaluations.
        (g) Definition of Institution of Higher Education.--In this
    section, the term ``institution of higher education'' has the meaning
    given such term in section 101(b) of the Higher Education Act of 1965
    (20 U.S.C. 1001(b)).

    SEC. 7455. REPORT ON IMPACT OF SLEEP AND CIRCADIAN HEALTH DISORDERS IN
                  VULNERABLE AND RACIAL/ETHNIC POPULATIONS.

        (a) In General.--Not later than 1 year after the date of enactment
    of this Act, the Secretary of Health and Human Services shall submit to
    Congress and the President a report on the impact of sleep and
    circadian health disorders for racial and ethnic minority communities
    and other vulnerable populations.
        (b) Contents.--The report under subsection (a) shall include
    information on the--
                (1) progress that has been made in reducing the impact of
            sleep and circadian health disorders in such communities and
            populations;
                (2) opportunities that exist to make additional progress in
            reducing the impact of sleep and circadian health disorders in
            such communities and populations;
                (3) challenges that may impede such additional progress;
            and
                (4) Federal funding necessary to achieve substantial
            reductions in sleep and circadian health disorders in racial
            and ethnic minority communities.

      Subtitle K--Kidney Disease Research, Surveillance, Prevention, and
                                   Treatment

    SEC. 7501. KIDNEY DISEASE, RESEARCH, SURVEILLANCE, PREVENTION, AND
                  TREATMENT.

        (a) Short Title.--This section may be cited as the ``Kidney Disease
    Research, Surveillance, Prevention and Treatment Improvement Act of
    2022''.
        (b) Findings.--Congress makes the following findings:
                (1) Kidney diseases impact 37,000,000 individuals in the
            United States.
                (2) Black Americans comprise just 13 percent of the United
            States population, but 33 percent of the United States dialysis
            patient population. Compared to White Americans, kidney failure
            prevalence is about 3.7 times greater in Black Americans, 1.4
            times greater in Native Americans, and 1.5 times greater in
            Asian Americans.
                (3) Peritoneal dialysis and home hemodialysis use is 40-50
            percent lower among Black Americans and Hispanics.
                (4) Every racial and ethnic minority group in the United
            States is significantly less likely to be treated with home
            dialysis than Whites, and demographic and clinical
            characteristics are insufficient to explain this differential
            use.
                (5) Black Americans on dialysis, irrespective of dialysis
            modality, and Hispanics undergoing PD or in-center HD, are
            significantly less likely than their White counterparts to
            receive a kidney transplant.
                (6) Black Americans, Hispanics, and Asian Americans are
            less likely to receive living donor kidney transplants than
            Whites. Efforts to reduce disparities in live donor kidney
            transplantation for Black American, Hispanic, and Asian
            patients with kidney failure have been largely unsuccessful.
                (7) Medicare and Medicaid patients are less likely to
            receive a preemptive transplant from a deceased donor compared
            to private insurance patients (5 percent and 11 percent versus
            24 percent), and Black and Hispanic patients are less likely to
            receive a preemptive transplant from a deceased donor compared
            with White patients even after changes to the kidney allocation
            system (5 percent of Black patients and 5 percent of Hispanic
            patients compared with 18 percent of White patients).
                (8) Low-income populations are significantly more likely to
            progress to kidney failure.
                (9) Low socioeconomic status is associated with increased
            incidence of chronic kidney disease, progression to kidney
            failure, inadequate dialysis treatment, and reduced access to
            kidney transplantation.
                (10) The 3 goals of Executive Order 13879 of July 10, 2019
            (84 Fed. Reg. 33817; relating to Advancing American Kidney
            Health), recognize the need for more transplants, better
            prevention and education, and improved access to treatment
            modalities.

    SEC. 7502. KIDNEY DISEASE RESEARCH IN MINORITY POPULATIONS.

        (a) In General.--
                (1) Research and training centers.--Section 431(c)(3) of
            the Public Health Service Act (42 U.S.C. 285c-5(c)(3)) is
            amended--
                        (A) in subparagraph (B), by striking ``and'' at the
                    end;
                        (B) in subparagraph (C), by striking ``and'' at the
                    end; and
                        (C) by adding at the end the following:
                        ``(D) improving data science through improvement in
                    bioinformatics, data integration, and data sharing;
                        ``(E) defining the chronic kidney disease mechanism
                    and identifying new therapeutic targets for chronic
                    kidney disease using specific tools, including mapping
                    the genetic architecture of kidney function and disease
                    and translating genetic maps to disease-causing genes
                    and mechanisms, especially among minority populations;
                        ``(F) improving models of human disease including
                    better humanized animal models, improved
                    reproducibility, and functional characterization of
                    kidney organoids, and accelerating the development of
                    in vivo imaging technologies; and
                        ``(G) developing cell-specific drug delivery
                    systems and gene editing, including targeted systems
                    for the delivery of therapeutic compounds to specific
                    kidney compartments or cell types and accelerating the
                    implementation of gene editing and gene therapy for the
                    treatment of kidney diseases in vivo; and''.
                (2) Inclusion of minority participants.--In conducting and
            supporting research described in the amendment made by
            subsection (a), the Director of the National Institutes of
            Health shall work with the Director of the National Institute
            on Minority Health and Health Disparities to improve the number
            of minority participants as study subjects in clinical trials.
            Such work may include--
                        (A) developing and sustaining clinical trial
                    consortia that can recruit patients with chronic kidney
                    disease to ensure adequate capacity for assessment of
                    kidney outcomes and increase the enrollment of
                    underrepresented populations;
                        (B) encouraging the use of novel designs in
                    clinical trials to enhance the recruitment and
                    retention of underrepresented populations which will
                    enhance the generalizability of study findings;
                        (C) supporting outreach initiatives that
                    incorporate acknowledgment of both historical and
                    current grounds for participation reluctance, and that
                    prioritize demonstrating trustworthiness, in order to
                    enhance the ability to promote and effectively convey
                    the benefits of clinical research participation;
                        (D) completing clinical trials that test
                    interventions to improve patient quality of life and
                    address patient-reported outcomes; and
                        (E) encouraging inclusion of persons with chronic
                    kidney disease in clinical trials of treatments for
                    nonkidney diseases.
        (b) Report; Comprehensive Plan.--Section 429 of the Public Health
    Services Act (42 U.S.C. 285c-3) is amended by adding at the end the
    following:
        ``(c) Report by Kidney, Urologic, and Hematologic Diseases
    Coordinating Committee.--
                ``(1) In general.--The Kidney, Urologic, and Hematologic
            Diseases Coordinating Committee, in coordination with the
            Chronic Kidney Disease Initiative at the Centers for Disease
            Control and Prevention, shall--
                        ``(A) prepare and submit to the Congress, not later
                    than 6 months after the date of enactment of this
                    subsection, a report on Federal research and public
                    health activities with respect to kidney disease in
                    minority populations; and
                        ``(B) develop and submit to the Congress, the
                    Secretary, the Director of the National Institutes of
                    Health, and the Advisory Board established under
                    section 430 for the diseases for which the Committee
                    was established, not later than 1 year after the date
                    of enactment of this subsection, an effective and
                    comprehensive Federal plan (including all appropriate
                    Federal health programs) to address kidney disease in
                    minority populations.
                ``(2) Contents.--The report under paragraph (1)(A) shall at
            minimum address each of the following:
                        ``(A) Research on kidney disease in minority
                    populations, including such research on--
                                ``(i) genetic, behavioral, and
                            environmental factors;
                                ``(ii) prevention and complications among
                            individuals within these populations who have
                            already developed kidney disease;
                                ``(iii) the delivery of evidenced-based
                            care for all chronic kidney disease stages,
                            especially in underrepresented and underserved
                            populations;
                                ``(iv) expanding support for a root-cause
                            analysis approach to disparities, including
                            causes, detection, and management of chronic
                            kidney disease for underserved populations;
                                ``(v) developing research teams that engage
                            with community organizations to develop and
                            implement interventions which halt or delay
                            development and progression of chronic kidney
                            disease; and
                                ``(vi) continued support of observational
                            studies of kidney disease measures and
                            outcomes.
                        ``(B) Surveillance and data collection on kidney
                    disease in minority populations, including with respect
                    to--
                                ``(i) efforts to better determine the
                            prevalence of kidney disease among Asian-
                            American and Pacific Islander subgroups; and
                                ``(ii) efforts to coordinate data
                            collection on the American Indian population.
                        ``(C) Community-based interventions to address
                    kidney disease targeting minority populations,
                    including--
                                ``(i) the evidence bases for such
                            interventions;
                                ``(ii) the cultural appropriateness of such
                            interventions; and
                                ``(iii) efforts to educate the public on
                            the causes and consequences of kidney disease.
                        ``(D) Education and training programs for health
                    professionals (including community health workers) on
                    the prevention and management of kidney disease and its
                    related complications that are supported by the Health
                    Resources and Services Administration, including such
                    programs supported by the Bureau of Health Workforce,
                    the Bureau of Primary Health Care, and the Healthcare
                    Systems Bureau. This should include--
                                ``(i) identification of effective
                            strategies to increase implementation of proven
                            therapies to slow chronic kidney disease
                            incidence and progression, especially in high-
                            risk underrepresented populations; and
                                ``(ii) identification of effective practice
                            improvement strategies in large and small
                            health systems to reduce chronic kidney disease
                            incidence and progression.''.

    SEC. 7503. KIDNEY DISEASE ACTION PLAN.

        (a) In General.--The Director of the Centers for Disease Control
    and Prevention shall conduct, support, and expand public health
    strategies, prevention, diagnosis, surveillance, and public and
    professional awareness activities regarding kidney disease.
        (b) National Action Plan.--
                (1) Development.--Pursuant to section 464z-3 of the Public
            Health Service Act (42 U.S.C. 285t), not later than 2 years
            after the date of the enactment of this Act, the Director of
            the National Institute of Diabetes and Digestive and Kidney
            Diseases, in consultation with the Director of the National
            Institute on Minority Health and Health Disparities and the
            Director of the Centers for Disease Control and Prevention,
            shall develop a national action plan to address kidney disease
            in the United States with participation from patients,
            caregivers, health professionals, patient advocacy
            organizations, researchers, providers, public health
            professionals, and other stakeholders.
                (2) Contents.--At a minimum, such plan shall include
            recommendations for--
                        (A) public health interventions for the purpose of
                    implementation of the national plan;
                        (B) biomedical, health services, and public health
                    research on kidney disease; and
                        (C) inclusion of kidney disease in the health data
                    collections of all Federal agencies.
        (c) Kidney Disease Prevention Programs.--The Director of the
    Centers for Disease Control and Prevention, through the Chronic Kidney
    Disease Initiative, shall carry out the following:
                (1) Conduct public education and awareness activities with
            patient and professional organizations to stimulate earlier
            diagnosis and improve patient outcomes from treatment of kidney
            disease. To the extent known and relevant, such public
            education and awareness activities shall reflect differences in
            kidney disease by cause (such as hypertension, diabetes, lupus
            nephritis, COVID-19, and polycystic kidney disease) and include
            a focus on outreach to undiagnosed and, as appropriate,
            minority populations.
                (2) Supplement and expand upon the activities of the
            Centers for Disease Control and Prevention by making grants to
            nonprofit organizations, State and local jurisdictions, and
            Indian Tribes for the purpose of reducing the burden of kidney
            disease, especially in disproportionately impacted communities,
            through public health interventions and related activities.
                (3) Coordinate with the National Institute of Diabetes and
            Digestive and Kidney Diseases, the Indian Health Service, the
            Health Resources and Services Administration, and the
            Department of Veterans Affairs to develop pilot programs to
            demonstrate best practices for the diagnosis and management of
            kidney disease.
                (4) Develop improved techniques and identify best
            practices, in coordination with the Secretary of Veterans
            Affairs, for assisting kidney disease patients.
        (d) Data Collection.--Not later than 180 days after the date of
    enactment of this Act, the Director of the National Institute of
    Diabetes and Digestive and Kidney Diseases and the Director of the
    Centers for Disease Control and Prevention, acting jointly, shall
    assess the depth and quality of information on kidney disease that is
    collected in surveys and population studies conducted by the Centers
    for Disease Control and Prevention, including whether there are
    additional opportunities for information to be collected in the
    National Health and Nutrition Examination Survey, the National Health
    Interview Survey, and the Behavioral Risk Factor Surveillance System
    surveys. The Director of the National Institute of Diabetes and
    Digestive and Kidney Diseases shall include the results of such
    assessment in the national action plan under subsection (b).
        (e) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section $1,000,000 for fiscal year 2023,
    $1,000,000 for fiscal year 2024, $1,000,000 for fiscal year 2025,
    $1,000,000 for fiscal year 2026, and $1,000,000 for fiscal year 2027.

    SEC. 7504. HOME DIALYSIS AND INCREASING END-STAGE RENAL DISEASE
                  TREATMENT MODALITIES IN MINORITY COMMUNITIES ACTION PLAN.

        (a) In General.--Section 1881(b)(14) of the Social Security Act (42
    U.S.C. 1395rr(b)(14)) is amended by adding at the end the following new
    subparagraph:
                ``(J)(i) For services furnished on or after the date which
            is 1 year after the date of the enactment of this subparagraph
            which are staff-assisted home dialysis (as defined in clause
            (iv)(III)), the Secretary shall increase the single payment
            that would otherwise apply under this paragraph for renal
            dialysis services furnished to new and respite individuals in
            accordance with the payment system established under clause
            (iii) by qualified providers.
                ``(ii)(I) Subject to subclause (II), staff-assisted home
            dialysis may only be furnished during--
                        ``(aa) with respect to an individual described in
                    subclause (iv)(I)(aa), one 90-day period which may be
                    renewed up to two 30-day periods; and
                        ``(bb) with respect to an individual described in
                    subclause (iv)(I)(bb) and notwithstanding whether such
                    an individual receives any respite care under part A,
                    any 30-day period.
                ``(II) Notwithstanding the limits described in subclause
            (I), staff-assisted home dialysis may be furnished for as long
            as the Secretary determines appropriate to an individual who--
                        ``(aa) is blind;
                        ``(bb) has a cognitive or neurological impairment
                    (including a stroke, Alzheimer's, dementia, amyotrophic
                    lateral sclerosis, or any other impairment determined
                    by the Secretary); or
                        ``(cc) has any other illness or injury that reduces
                    mobility (including cerebral palsy, spinal cord
                    injuries, or any other illness or injury determined by
                    the Secretary).
                ``(iii) The Secretary shall establish an add-on to the
            single payment under this paragraph through regulations to
            determine the amounts payable to qualified providers for staff-
            assisted home dialysis. In establishing such system add-on
            payment, the Secretary may consider--
                        ``(I) the costs of furnishing staff-assisted home
                    dialysis;
                        ``(II) consultations with dialysis providers,
                    dialysis patients, private payers, and Medicare
                    Advantage plans;
                        ``(III) payment amounts for similar items and
                    services under parts A and B; and
                        ``(IV) payment amounts established by Medicare
                    Advantage plans under part C, group health plans, and
                    health insurance coverage offered by health insurance
                    issuers.
                ``(iv) In this subparagraph:
                        ``(I) The term `new and respite individual' means
                    an individual described in subsection (a) who is--
                                ``(aa) initiating either peritoneal or home
                            hemodialysis;
                                ``(bb) receiving home dialysis and is
                            unable to self-dialyze due to illness, injury,
                            caregiver issues, or other temporary
                            circumstances; or
                                ``(cc) returning to home dialysis after a
                            period of hospitalization.
                        ``(II) The term `qualified provider' means a
                    trained professional (as determined by the Secretary,
                    including nurses and certified patient technicians) who
                    furnishes renal dialysis services and--
                                ``(aa) meets requirements (as determined by
                            the Secretary) that ensures competency in
                            patient care and modality usage; and
                                ``(bb) provides in-person assistance to a
                            patient for an appropriate number of dialysis
                            sessions (as determined by the Secretary) at
                            least 75 percent of staff-assisted home
                            dialysis sessions during a period described in
                            clause (ii)(I).
                        ``(III)(aa) The term `staff-assisted home dialysis'
                    means home dialysis using trained professionals to
                    assist individuals who have been determined to have end
                    stage renal disease, and the frequency of such home
                    dialysis is determined by such professionals in
                    coordination with the patient and his or her care
                    partner, and outlined in a patient plan of care.
                        ``(bb) The term `care partner' means anyone who is
                    designated by the patient who assists the individual
                    with the furnishing of home dialysis.
                        ``(cc) The term `patient plan of care' has the
                    meaning given such term in section 494.90 of title 42,
                    Code of Federal Regulations.''.
        (b) Patient Education and Training Relating to Staff-Assisted Home
    Dialysis.--Section 1881(b)(5) of the Social Security Act (42 U.S.C.
    1395rr(b)(5)) is amended--
                (1) in subparagraph (C), by striking at the end ``and'';
                (2) in subparagraph (D), by striking the period at the end
            and inserting a semicolon; and
                (3) by adding at the end the following:
                        ``(E) educate patients of the opportunity to
                    receive staff-assisted home dialysis (as defined in
                    paragraph (14)(J)(iv)(III)) during the period beginning
                    30 days after the first day such facility furnishes
                    renal dialysis services to an individual and ending 60
                    days after such day; and
                        ``(F) provide for nurses, certified patient
                    technicians, social workers and or other professionals
                    to train patients and their care partners in skills and
                    procedures needed to perform home dialysis (as defined
                    in paragraph (14)(J)(iv)(III)) treatment--
                                ``(i) regularly and independently;
                                ``(ii) through telehealth services or
                            through group training (as described in the
                            interpretive guidance relating to tag number
                            V590 of `Advance Copy-End Stage Renal Disease
                            (ESRD) Program Interpretive Guidance Version
                            1.1' (published on October 3, 2008)) in
                            accordance with the Federal regulations
                            (concerning the privacy of individually
                            identifiable health information) promulgated
                            under section 264(c) of the Health Insurance
                            Portability and Accountability Act of 1996; and
                                ``(iii) in the home or residence of a
                            patient, in a dialysis facility, or in the
                            place in which the patient intends to receive
                            staff-assisted home dialysis.''.
        (c) National Action Plan.--
                (1) Development.--Not later than 2 years after the date of
            the enactment of this Act, the Director of the National
            Institute of Diabetes and Digestive and Kidney Diseases, in
            consultation with the Director of the Centers for Disease
            Control and Prevention, shall develop a national action plan to
            increase the number of home dialyzers and choice in dialysis
            treatment modality in the United States with participation from
            patients, caregivers, health professionals, patient advocacy
            organizations, researchers, providers, public health
            professionals, and other stakeholders in minority communities.
                (2) Contents.--At a minimum, such plan shall include
            recommendations for--
                        (A) public health officials for the purpose of
                    implementation of the national plan;
                        (B) biomedical, health services, and public health
                    research on home dialysis and modalities in minority
                    communities; and
                        (C) inclusion of dialysis location and modality in
                    the health data collections of all Federal agencies.
        (d) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section $1,000,000 for fiscal year 2023,
    $1,000,000 for fiscal year 2024, $1,000,000 for fiscal year 2025,
    $1,000,000 for fiscal year 2026, and $1,000,000 for fiscal year 2027.

    SEC. 7505. INCREASING KIDNEY TRANSPLANTS IN MINORITY POPULATIONS.

        (a) In General.--The Director of the National Institutes of Health
    shall expand, intensify, and support ongoing research and other
    activities with respect to kidney transplants in minority populations.
        (b) CMS Data Collection and Reporting.--The Centers for Medicare &
    Medicaid Services shall collect and report annual data on dialysis
    facility and nephrologist performance on transplant referral, with an
    emphasis on data relating to patients of color.
        (c) OPTN Data Collection and Reporting.--The Organ Procurement and
    Transplantation Network shall collect and the Scientific Registry of
    Transplant Recipients report annual data, broken down by demographic
    and socioeconomic characteristics, on individual transplant center
    performance as it relates to patients referred, evaluated, waitlisted,
    and successfully transplanted.
        (d) Transplant Center Data.--Each organ transplant center shall
    report on the percent of appropriate waitlisted patients (including
    socioeconomic and demographic data) giving and receiving annual
    informed consent for offers for suboptimal kidneys (such as kidneys
    with a kidney donor profile index of greater than 85 percent or kidney
    age 50 with diabetes, or age greater than 60).
        (e) Organ Procurement Organization Data.--Each organ procurement
    organization shall report annual data on referrals, refusals (patient
    or doctor), and acceptance of organs by hospital, ZIP Code, race,
    ethnicity, and age strata except as prohibited by need for
    confidentiality.
        (f) Data Transparency for Patients.--Each organ transplant center
    shall provide to each patient of such center, on an annual basis--
                (1) the number of times an organ was offered to the
            patient, declined, and transplanted into another patient from
            organs within a 500-mile radius; and
                (2) the number of times an organ was offered to and
            declined for the patient from a low risk donor which was
            subsequently transplanted into another patient.
        (g) Improved Transplantation Education.--The Centers for Medicare &
    Medicaid Services shall certify a nonbiased, third-party organization
    to accredit organ transplant education.
        (h) Research.--Research under subsection (a) shall include
    investigation into--
                (1) the causes of lower rates of kidney transplants in
            minority populations, including socioeconomic, geographic,
            clinical, environmental, genetic, and other factors that may
            contribute to lower rates of kidney transplants in minority
            populations; and
                (2) possible interventions to increase kidney transplants.
        (i) Report; Comprehensive Plan.--
                (1) In general.--The Secretary of Health and Human Services
            shall--
                        (A) prepare and submit to the Congress, not later
                    than 6 months after the date of enactment of this
                    section, a report on Federal research and public health
                    activities with respect to kidney transplants as a
                    treatment for end-stage renal disease in minority
                    populations; and
                        (B) develop and submit to the Congress, not later
                    than 1 year after the date of enactment of this
                    section, an effective and comprehensive Federal plan
                    (including all appropriate Federal health programs) to
                    increase the number of kidney transplants in minority
                    populations.
                (2) Contents.--The report under paragraph (1)(A) shall at a
            minimum address each of the following:
                        (A) Research on kidney transplants in minority
                    populations, including such research on financial,
                    insurance coverage, genetic, behavioral, and
                    environmental factors.
                        (B) Surveillance and data collection on kidney
                    transplants in minority populations, including with
                    respect to--
                                (i) efforts to increase kidney transplants
                            among Asian-American and Pacific Islander
                            subgroups with end-stage renal disease; and
                                (ii) efforts to increase kidney transplants
                            in the American Indian population.
                        (C) Community-based efforts to increase kidney
                    transplants targeting minority populations, including--
                                (i) the evidence base for such increases;
                                (ii) the cultural appropriateness of such
                            increases; and
                                (iii) efforts to educate the public on
                            kidney transplants.
                        (D) Education and training programs for health
                    professionals (including community health workers) on
                    the kidney transplants that are supported by the Health
                    Resources and Services Administration, including such
                    programs supported by the Bureau of Health Workforce,
                    the Bureau of Primary Health Care, and the Healthcare
                    Systems Bureau.

    SEC. 7506. ENVIRONMENTAL AND OCCUPATIONAL HEALTH PROGRAMS.

        The Director of the Centers for Disease Control and Prevention
    shall--
                (1) support research into the environmental and
            occupational causes and biological mechanisms that contribute
            to kidney disease; and
                (2) develop and disseminate public health interventions
            that will lessen the impact of environmental and occupational
            causes of kidney disease.

    SEC. 7507. UNDERSTANDING THE TREATMENT PATTERNS ASSOCIATED WITH
                  PROVIDING CARE AND TREATMENT OF KIDNEY FAILURE IN
                  MINORITY POPULATIONS.

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

    SEC. 7508. IMPROVING ACCESS IN UNDERSERVED AREAS.

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

    SEC. 7509. THE JACK REYNOLDS MEMORIAL MEDIGAP EXPANSION ACT; MEDIGAP
                  COVERAGE FOR BENEFICIARIES WITH END-STAGE RENAL DISEASE.

        (a) Guaranteed Availability of Medigap Policies to All ESRD
    Medicare Beneficiaries.--
                (1) In general.--Section 1882(s) of the Social Security Act
            (42 U.S.C. 1395ss(s)) is amended--
                        (A) in paragraph (2)--
                                (i) in subparagraph (A), by striking ``is
                            65'' and all that follows through the period at
                            the end and inserting the following: ``is--
                        ``(i) 65 years of age or older and is enrolled for
                    benefits under part B; or
                        ``(ii) is entitled to benefits under 226A(b) and is
                    enrolled for benefits under part B.''; and
                                (ii) in subparagraph (D), in the matter
                            preceding clause (i), by inserting ``(or is
                            entitled to benefits under 226A(b))'' after
                            ``is 65 years of age or older''; and
                        (B) in paragraph (3)(B)--
                                (i) in clause (ii), by inserting ``(or is
                            entitled to benefits under 226A(b))'' after
                            ``is 65 years of age or older''; and
                                (ii) in clause (vi), by inserting ``(or
                            under 226A(b))'' after ``at age 65''.
                (2) Effective date.--The amendments made by paragraph (1)
            shall apply to Medicare supplemental policies effective on or
            after January 1, 2023.
        (b) Additional Enrollment Period for Certain Individuals.--
                (1) One-time enrollment period.--
                        (A) In general.--In the case of an individual
                    described in paragraph (2), the Secretary of Health and
                    Human Services shall establish a one-time enrollment
                    period during which such an individual may enroll in
                    any Medicare supplemental policy under section 1882 of
                    the Social Security Act (42 U.S.C. 1395ss) of the
                    individual's choosing.
                        (B) Enrollment period.--The enrollment period
                    established under subparagraph (A) shall begin on
                    January 1, 2023, and shall end June 30, 2023.
                (2) Individual described.--An individual described in this
            paragraph is an individual who--
                        (A) is entitled to hospital insurance benefits
                    under part A of title XVIII of the Social Security Act
                    under section 226A(b) of such Act (42 U.S.C. 426-1(b));
                        (B) is enrolled for benefits under part B of such
                    title XVIII; and
                        (C) would not, but for the provisions of, and
                    amendments made by, subsection (a) be eligible for the
                    guaranteed issue of a Medicare supplemental policy
                    under paragraph (2) or (3) of section 1882(s) of such
                    Act (42 U.S.C. 1395ss(s)).
        (c) Allowing Individuals With Kidney Failure To Retain Access to
    Private Insurance.--
                (1) In general.--Section 1862(b)(1)(C) of the Social
            Security Act (42 U.S.C. 1395y(b)(1)(C)) is amended--
                        (A) in the last sentence, by inserting ``and before
                    January 1, 2023'' after ``prior to such date''; and
                        (B) by adding at the end the following new
                    sentence: ``Effective for items and services furnished
                    on or after January 1, 2023 (with respect to periods
                    beginning on or after the date that is 42 months prior
                    to such date), clauses (i) and (ii) shall be applied by
                    substituting `42-month' for `12-month' each place it
                    appears.''.
                (2) Effective date.--The amendments made by this subsection
            shall take effect on the date of enactment of this Act. For
            purposes of determining an individual's status under section
            1862(b)(1)(C) of the Social Security Act (42 U.S.C.
            1395y(b)(1)(C)), as amended by paragraph (1), an individual who
            is within the coordinating period as of the date of enactment
            of this Act shall have that period extended to the full 42
            months described in the last sentence of such section, as added
            by the amendment made by paragraph (1)(B).

                    Subtitle L--Diversity in Clinical Trials

    SEC. 7551. FDA REVIEW OF CLINICAL TRIAL BEST PRACTICES.

        The Commissioner of Food and Drugs shall--
                (1) aggregate information on the accumulated experience of
            sponsors of drugs that develop and execute clinical trial
            diversity plans during drug development;
                (2) include in such aggregated information an analysis from
            the perspectives of the Food and Drug Administration and such
            sponsors of which actions worked or which did not work to
            enhance clinical trial diversity;
                (3) not later than September 30, 2024, convene a public
            meeting, including representatives from the regulated industry
            and patient organizations, to discuss findings and
            recommendations for specific actions that have led to
            measurable improvements in the representation of racial and
            ethnic populations in clinical research; and
                (4) not later than September 30, 2025, update the guidance
            of the Food and Drug Administration titled ``Enhancing the
            Diversity of Clinical Trial Populations--Eligibility Criteria,
            Enrollment Practices, and Trial Designs'' to align such
            guidance with findings and recommendations that were discussed
            at the meeting under paragraph (3).

    SEC. 7552. DIVERSIFYING INVESTIGATIONS VIA EQUITABLE RESEARCH STUDIES
                  FOR EVERYONE TRIALS ACT.

        (a) Guidance on Decentralized Clinical Trials.--
                (1) Definition.--In this subsection, the term
            ``decentralized clinical trials'' includes clinical trials that
            are executed through a broad spectrum of options, such as
            telemedicine or other mobile or digital technologies, to allow
            for the remote collection and assessment of clinical trial data
            from participants, including in the home or office setting.
                (2) Guidance.--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 Commissioner of Food and Drugs (referred to
            in this section as the ``Commissioner''), shall issue a draft
            guidance that addresses how to conduct decentralized clinical
            trials with meaningful demographic diversity, including racial,
            ethnic, age, gender, and geographic diversity in patient
            engagement, enrollment, and participation, including how to
            appropriately use digital health technologies or other remote
            assessment options, such as telemedicine, to support such
            trials. Not later than 6 months after the date the public
            comment period for the draft guidance ends, the Secretary shall
            issue a final guidance.
                (3) Content of guidance.--The guidance under paragraph (2)
            shall address the following:
                        (A) Strategies to engage with prospective clinical
                    trial participants and community partners, such as
                    patient advocacy groups with diverse representation, to
                    incorporate input of such patients and partners into
                    the design of decentralized clinical trials.
                        (B) Recommendations for--
                                (i) protocol design approaches;
                                (ii) appropriate clinical endpoints;
                                (iii) institutional review board
                            composition and ensuring that such boards
                            include members with expertise in decentralized
                            clinical trials;
                                (iv) delegation of clinical research
                            organization responsibilities and suitable
                            proxies for clinical research organizations;
                            and
                                (v) simplifying informed consent.
                        (C) Recommendations for how digital health
                    technology or other remote assessment options, such as
                    telemedicine, could support decentralized clinical
                    trials, including guidance on appropriate technological
                    platforms and mediums, data collection and use, data
                    integrity, and communication to study participants
                    through digital technology.
                        (D) Recommendations for appropriate methods of
                    patient recruitment and retention, including
                    institutional review board oversight, patient
                    communication, and the role of study participants and
                    community partners as advocates to facilitate clinical
                    trial recruitment, particularly with respect to
                    underrepresented populations.
                        (E) Information regarding when and how a study
                    sponsor may solicit a meeting with the Secretary
                    regarding the issues described in subparagraphs (A)
                    through (D).
                (4) International harmonization.--After issuing the final
            guidance under paragraph (2), the Secretary, acting through the
            Commissioner, may work with foreign regulators pursuant to
            existing memoranda of understanding governing exchange of
            information to facilitate international harmonization of the
            regulation of decentralized clinical trials and use of digital
            health technology or other remote assessment options.
        (b) Encouragement of Clinical Trial Enrollment by Racially and
    Ethnically Diverse Populations.--
                (1) No cost provision of digital health technologies.--The
            free provision of digital health technologies by drug or device
            manufacturers to their clinical trial participants shall not be
            considered a violation of section 1128A of the Social Security
            Act (commonly known as the ``Civil Monetary Penalties Law'')
            (42 U.S.C. 1320a-7a), section 1128B of the Social Security Act
            (42 U.S.C. 1320a-7b), or sections 3729 through 3733 of title
            31, United States Code (commonly known as the ``False Claims
            Act''), provided that--
                        (A) the use of digital health technologies will
                    facilitate in any phase of clinical development the
                    inclusion of diversity of patient populations, such as
                    underrepresented racial and ethnic minorities, low-
                    income populations, and the elderly;
                        (B) the digital health technologies will facilitate
                    individuals' participation, or are necessary to such
                    participation;
                        (C) all features of the digital health technologies
                    that are unrelated to use in the clinical trial are
                    disabled or only allowed to remain activated to model
                    real-world usage of the digital technology; and
                        (D) the clinical trial sponsor requires
                    participants to return, purchase, or disable the
                    digital health technologies by the conclusion of the
                    trial.
                (2) Grants and contracts.--
                        (A) In general.--The Secretary may issue grants to,
                    and enter into contracts with, entities to support
                    community education, outreach, and recruitment
                    activities for clinical trials with respect to drugs,
                    including vaccines for diseases or conditions which
                    have a disproportionate impact on underrepresented
                    populations (including on racial and ethnic minority
                    populations), including for the diagnosis, prevention,
                    or treatment of COVID-19. Such activities may include--
                                (i) working with community clinical trial
                            sites, including community health centers,
                            academic health centers, and other facilities;
                                (ii) training health care personnel
                            including potential clinical trial
                            investigators, with a focus on significantly
                            increasing the number of underrepresented
                            racial and ethnic minority health care
                            personnel who are clinical trial investigators
                            at the community sites for ongoing clinical
                            trials;
                                (iii) engaging community stakeholders to
                            encourage participation in clinical trials,
                            especially in underrepresented racial and
                            ethnic minority communities; and
                                (iv) fostering partnerships with community-
                            based organizations serving underrepresented
                            racial and ethnical minority populations,
                            including employee unions and frontline health
                            care workers.
                        (B) Priority for grant and contract awards.--In
                    awarding grants and contracts under this paragraph, the
                    Secretary shall prioritize entities that--
                                (i) develop educational, recruitment, and
                            training materials in multiple languages; or
                                (ii) undertake clinical trial outreach
                            efforts in more diverse racial and ethnic
                            communities that are traditionally
                            underrepresented in clinical trials, such as
                            Tribal areas.
                        (C) Authorization of appropriations.--There is
                    authorized to be appropriated for fiscal years 2023 and
                    2024 such sums as may be necessary to carry out this
                    paragraph.
        (c) Clarification That Certain Remuneration Related to
    Participation in Clinical Trials Does Not Constitute Remuneration Under
    the Federal Civil Money Penalties Law.--
                (1) In general.--Section 1128A(i)(6)(F) of the Social
            Security Act (42 U.S.C. 1320a-7a(i)(6)(F)) is amended by
            inserting ``(including remuneration offered or transferred to
            an individual to promote the participation in an approved
            clinical trial, as defined in subsection (d) of the first
            section 2709 of the Public Health Service Act, that is
            registered with the database of clinical trials maintained by
            the National Library of Medicine (or any successor database),
            so long as such remuneration facilitates equitable inclusion of
            patients from all relevant demographic and socioeconomic
            populations and is related to patient participation in the
            approved clinical trial)'' after ``promotes access to care''.
                (2) Effective date.--The amendment made by paragraph (1)
            shall apply to remuneration provided on or after the date of
            the enactment of this Act.
        (d) National Academy of Medicine Study.--
                (1) In general.--The Secretary shall enter into an
            arrangement with the National Academy of Medicine under which
            the National Academy agrees to study and propose a design for a
            national interoperable data platform to improve access to
            health data, and other relevant data needs, during public
            health emergencies.
                (2) Report.--The arrangement under paragraph (1) shall
            provide for submission by the National Academy of Medicine to
            the Secretary and Congress, not later than 120 days after the
            date of enactment of this Act, of a report on the results of
            the study under paragraph (1) and the design proposed based on
            such study.

    SEC. 7553. CLINICAL TRIAL DIVERSITY.

        (a) Diversity Requirements for Applications for Federal Funding for
    Clinical Trials.--
                (1) Applications.--Beginning on the date of the enactment
            of this Act, the Secretary of Health and Human Services, acting
            through the Director of the National Institutes of Health (in
            this subsection referred to as the ``Secretary'') shall require
            that an entity seeking to conduct a clinical trial
            investigating a drug or device (as those terms are defined in
            section 201 of the Federal Food, Drug, and Cosmetic Act (21
            U.S.C. 321 et seq.)) or biological product (as defined in
            section 351(i) of the Public Health Service Act (42 U.S.C.
            262(i))), and funded by the National Institutes of Health and
            conducted at any national research institute or national
            center, submit an application (or renewal thereof) for such
            funding that includes--
                        (A) clear and measurable goals for the recruitment
                    and retention of participants that reflect--
                                (i) the race, ethnicity, age, and gender or
                            sex of patients with the disease or condition
                            being investigated; or
                                (ii) the race, ethnicity, age, and gender
                            or sex of the general population of the United
                            States if the prevalence of the disease or
                            condition is not known;
                        (B) a rationale for the goals specified under
                    subparagraph (A) that specifies--
                                (i) how investigators will calculate the
                            number of participants for each population
                            category that reflect the population groups
                            specified in subparagraph (A); and
                                (ii) strategies that will be used to enroll
                            and retain participants across the different
                            racial, ethnic, age, and gender or sex
                            categories;
                        (C) a detailed plan for how the clinical trial will
                    achieve the goals specified under subparagraph (A) that
                    specifies--
                                (i) the requirements for researchers, in
                            conducting the trial to analyze the population
                            groups specified in subparagraph (A)
                            separately;
                                (ii) the role of community partners or
                            community institutional review boards in
                            reviewing the plans; and
                                (iii) how the trial will recruit a study
                            population that is--
                                        (I) in proportion to the prevalence
                                    of the disease or condition in such
                                    groups relative to the prevalence of
                                    the disease or condition in the overall
                                    population of the United States;
                                        (II) in sufficient numbers to
                                    obtain clinically and statistically
                                    meaningful determinations of the safety
                                    and effectiveness of the drug being
                                    studied in the respective race,
                                    ethnicity, age, and gender or sex
                                    groups; and
                                        (III) consistent with the guidance
                                    under section 505(b)(1) of the Federal
                                    Food, Drug, and Cosmetic Act (21 U.S.C.
                                    355(b)(1)) and guidance issued by the
                                    National Institutes of Health on the
                                    inclusion of women and minorities in
                                    clinical trials;
                        (D) the entity's plan for implementing, or an
                    explanation of why the entity cannot implement,
                    alternative clinical trial follow-up requirements that
                    are less burdensome for trial participants, such as--
                                (i) requiring fewer follow-up visits;
                                (ii) allowing phone follow-up or home
                            visits by nurse trial coordinators (in lieu of
                            in-person visits by patients);
                                (iii) allowing for online follow-up
                            options;
                                (iv) permitting the patient's primary care
                            provider to perform some of the follow-up visit
                            requirements and to reimburse the patient for
                            any out-of-pocket costs incurred by the patient
                            for such follow-up visits;
                                (v) allowing for weekend hours for required
                            follow-up visits;
                                (vi) allowing virtual or telemedicine
                            visits;
                                (vii) use of wearable technology to record
                            key health parameters; and
                                (viii) use of alternate labs or imaging
                            centers, which may be closer to the residence
                            of the patients participating in the trial; and
                        (E) the entity's education and training
                    requirements for researchers and other individuals
                    conducting or supporting the clinical trial with
                    respect to diversity and health inequities in
                    underrepresented populations, including a requirement
                    to consult with, and review materials made available
                    by, such committees, task forces, and working groups
                    other entities the Director determines are appropriate,
                    including the following:
                                (i) The Equity Committee of the National
                            Institutes of Health.
                                (ii) The National Advisory Council on
                            Minority Health and Health Disparities.
                                (iii) The Advisory Committee on Research on
                            Women's Health.
                                (iv) The Sexual & Gender Minority Research
                            Coordinating Committee of the National
                            Institutes of Health.
                                (v) The Tribal Health Research Coordinating
                            Committee of the National Institutes of Health.
                (2) Terms.--
                        (A) In general.--As a condition on the receipt of
                    funding through the National Institutes of Health, as
                    described in paragraph (1), with respect to a clinical
                    trial, the sponsor of the clinical trial shall agree to
                    terms requiring that--
                                (i) the aggregate demographic information
                            of trial participants be shared on an annual
                            basis with the Secretary while participant
                            recruitment and data collection in such trial
                            is ongoing, and that such information is
                            provided with respect to--
                                        (I) underrepresented populations,
                                    including populations grouped by race,
                                    ethnicity, age, sex, gender identity
                                    and expression, geographic region,
                                    primary written and spoken language,
                                    disability status, sexual orientation,
                                    socioeconomic status, occupation, and
                                    other relevant factors; and
                                        (II) such populations that reflect
                                    the prevalence of the disease or
                                    condition that is the subject of the
                                    clinical trial involved (as available
                                    and as appropriate to the scientific
                                    objective for the study, as determined
                                    by the Director of the National
                                    Institutes of Health);
                                (ii) the sponsor submits to the program
                            officer and grants management specialist of the
                            specific National Institutes of Health national
                            research institute or national center, as
                            frequently as such officer or specialist
                            determines necessary, the retention rate of
                            participants in the clinical trial,
                            disaggregated by race, ethnicity, gender or
                            sex, and age;
                                (iii) both the clinical trial researchers
                            and the applicant reviewers to complete
                            education and training programs on diversity in
                            clinical trials; and
                                (iv) at the conclusion of the trial, the
                            sponsor submits to the Secretary the number of
                            participants in the trial, disaggregated by
                            race, ethnicity, age, and gender or sex.
                        (B) Privacy protections.--Any data shared under
                    subparagraph (A) may not include any individually
                    identifiable information or protected health
                    information with respect to clinical trial participants
                    and shall only be disclosed to the extent allowed under
                    Federal privacy laws.
                (3) Exception.--In lieu of submitting an application under
            paragraph (1) and documentation of goals as required by
            subparagraph (A) of such subsection, an applicant may provide
            reasoning (other than cost) for why the recruitment of each of
            the population groups specified in subparagraph (A) of
            paragraph (1) is not necessary and why such recruitment is not
            scientifically justified or possible.
                (4) Publication.--The Secretary shall--
                        (A) publish on a public website of the National
                    Institutes of Health, upon receipt of an application to
                    which paragraph (1) applies--
                                (i) a summary of the disease being targeted
                            in the clinical trial that is the subject of
                            the application and the prevalence of such
                            disease across race, ethnicity, gender or sex,
                            age, and clinical trial representation in each
                            such category;
                                (ii) the goals specified in such
                            application, as required by paragraph (1)(A);
                            or
                                (iii) the reasoning described in paragraph
                            (3); and
                        (B) ensure that, in publishing information relating
                    to an application under subparagraph (A), the design of
                    the study involved is not disclosed.
                (5) Remediation.--
                        (A) In general.--In the case of a clinical trial
                    subject to paragraph (1) that fails to meet the
                    condition specified pursuant to paragraph (1) by such
                    date as may be agreed upon by the sponsor of the trial
                    and the program officer and grants management
                    specialist of the specific National Institutes of
                    Health national research institute or national center,
                    the Secretary shall require the sponsor of that
                    clinical trial, not later than 60 days after such date
                    occurs--
                                (i) to develop, in consultation with the
                            Secretary and advocacy and community-based
                            organizations representing individuals who are
                            members of relevant demographic groups
                            specified in paragraph (1)(A), a strategic plan
                            to increase participation in such clinical
                            trial of such individuals; and
                                (ii) to submit to the Secretary, such
                            strategic plan.
                        (B) Publication.--The Secretary shall make publicly
                    available on the website of the National Institutes of
                    Health, the strategic plan received under subparagraph
                    (A) as soon as possible after receipt. The Secretary
                    shall ensure that, in publishing such plan under the
                    preceding sentence, the design of the study involved is
                    not disclosed.
                        (C) Implementation.--The sponsor of the clinical
                    trial that is the subject of the strategic plan
                    published under subparagraph (B), shall, not later than
                    60 days after such date as may be agreed upon by the
                    sponsor of the trial and the appropriate program
                    officer and grants management specialist of the
                    National Institutes of Health implement the strategic
                    plan.
                        (D) Technical assistance.--The Secretary may
                    provide technical assistance to a sponsor of a clinical
                    trial, as necessary for the sponsor to meet the
                    requirements of subparagraph (C).
                (6) Penalties in case of failure of remediation.--
                        (A) In general.--In the case of a clinical trial
                    subject to paragraph (1) that, after the close of the
                    60-day period specified in paragraph (5)(C), continues
                    to fail to meet the condition specified pursuant to
                    paragraph (1)(A), the Secretary shall--
                                (i) hold the noncompeting continuation of
                            funding received through the grant involved;
                                (ii) apply specific conditions on the award
                            of funds to such sponsor to conduct such
                            clinical trial; or
                                (iii) terminate such funding.
                        (B) Waiver.--
                                (i) In general.--In the case of a clinical
                            trial subject to the penalty under subparagraph
                            (A) that, after the close of the 60-day period
                            referred to in subparagraph (A), continues to
                            fail to meet the condition referred to in such
                            subparagraph, the sponsor of such clinical
                            trial may submit an application to the relevant
                            program officer and grants specialist
                            requesting a waiver of such condition. Such an
                            application shall specify reasoning for why the
                            recruitment of each of the population groups
                            specified in subparagraph (A) of paragraph (1)
                            is not necessary or why such recruitment is not
                            scientifically justified or possible.
                                (ii) Review.--Not later than 30 days after
                            a date agreed upon by the sponsor of the trial
                            and the appropriate program officer and grants
                            management specialist of the National
                            Institutes of Health, the Secretary shall--
                                        (I) complete the review of such
                                    application; and
                                        (II) make a determination to
                                    approve or deny the application.
                                (iii) No additional penalties.--No
                            additional penalties may be applied with
                            respect to a sponsor of a clinical trial under
                            subparagraph (A) during the 30-day period
                            specified in clause (ii).
                        (C) Termination of funding.--In the case of a
                    clinical trial described in subparagraph (B)(i), the
                    Secretary may elect to terminate funding described in
                    paragraph (1) for the clinical trial if no request for
                    a waiver under subparagraph (B) is received after the
                    60-day period referred to in subparagraph (A).
                (7) Waiver for certain clinical trials.--
                        (A) In general.--In the case of a clinical trial
                    that received funding through the National Institutes
                    of Health and is ongoing as of the date of the
                    enactment of this Act, the sponsor of such clinical
                    trial is exempt from the requirements of (and
                    associated penalties imposed by) this section.
                        (B) Report.--The Secretary shall include in the
                    triennial report required to be submitted under section
                    403 of the Public Health Service Act (42 U.S.C. 283), a
                    list of all clinical trials receiving funding through
                    the National Institutes of Health--
                                (i) that requested and received waivers
                            under this subsection; or
                                (ii) with respect to which funding has been
                            terminated pursuant to this subsection.
                (8) Study.--
                        (A) In general.--The Comptroller General of the
                    United States shall conduct a study that--
                                (i) examines which actions Federal agencies
                            have taken to address barriers to participation
                            in federally funded clinical trials by the
                            demographic groups specified in paragraph
                            (1)(A); and
                                (ii) identifies challenges, if any, in
                            implementing such actions.
                        (B) Report.--Not later than 1 year after the date
                    of the enactment of this Act, the Comptroller General
                    of the United States shall submit to Congress a report
                    on the findings of the study conducted under
                    subparagraph (A).
                (9) Nondiscrimination.--Section 1557 of the Patient
            Protection and Affordable Care Act (42 U.S.C. 18116) shall
            apply with respect to a clinical trial subject to paragraph
            (1).
        (b) Eliminating Cost Barriers.--
                (1) Study on modernization of human subject regulations.--
            Not later than 2 years after the date of the enactment of this
            Act, the Secretary of Health and Human Services, acting through
            the Director of the National Institutes of Health (referred to
            in this subsection as the ``Secretary''), shall conduct and
            complete a study on--
                        (A) the need for review of human subject
                    regulations specified in part 46 of title 45, Code of
                    Federal Regulations (or successor regulations), and
                    related guidance;
                        (B) the modernization of such regulations and
                    guidance to establish updated guidelines for
                    reimbursement of out-of-pocket expenses of human
                    subjects, compensation of human subjects for time spent
                    participating in the clinical trial, and incentives for
                    recruitment of human subjects; and
                        (C) the need for updated safe harbor rules under
                    section 1001.952 of title 42, Code of Federal
                    Regulations (or successor regulations) and section
                    1128B of the Social Security Act (commonly referred to
                    as the Federal Anti-Kickback Statute (42 U.S.C. 1320a-
                    7b)) with respect to the assistance provided under this
                    subsection.
                (2) Reimbursement for costs associated with clinical trial
            participation.--As a condition on receipt of any funding
            provided through the National Institutes of Health to conduct a
            clinical trial investigating a drug or device (as those terms
            are defined in section 201 of the Federal Food, Drug, and
            Cosmetic Act (21 U.S.C. 321 et seq.)) or biological product (as
            defined in section 351(i) of the Public Health Service Act (42
            U.S.C. 262(i))) the Secretary shall require that the sponsor of
            such clinical trial--
                        (A) works with institutional review boards and
                    program officers of the National Institutes of Health
                    to determine when reimbursement for the costs
                    associated with clinical trial participation is
                    warranted; and
                        (B) subject to paragraph (3), provides to clinical
                    trial participants reimbursement for expenses (using
                    funds other than funds supplied through the National
                    Institutes of Health) incurred as a result of that
                    participation, which may include--
                                (i) missed or forgone salary;
                                (ii) language assistance, including
                            interpreter services;
                                (iii) food expenses;
                                (iv) childcare expenses;
                                (v) lodging expenses;
                                (vi) transportation expenses; or
                                (vii) other expenses as identified by the
                            participant, subject to review by the clinical
                            trial sponsor, at its discretion, on a case-by-
                            case basis.
                (3) Provision of costs associated with clinical trial
            participation.--
                        (A) Application and documentation.--
                                (i) In general.--A sponsor of a clinical
                            trial to which subsection (a)(1) applies, may
                            require that, in order to receive payment or
                            reimbursement as described in such paragraph, a
                            participant complete an application and share
                            with the sponsor such documentation of expenses
                            described in such paragraph, as the sponsor may
                            require.
                                (ii) Timing.--Not later than 30 days after
                            the date on which a sponsor of a clinical trial
                            receives an application under clause (i), the
                            sponsor shall--
                                        (I) review the application; and
                                        (II) provide for reimbursement of
                                    eligible expenses documented in such
                                    application, as determined at the
                                    discretion of the clinical trial
                                    sponsor on a case-by-case basis.
                        (B) Enforcement.--A sponsor of a clinical trial to
                    which subsection (a)(1) applies, shall submit on an
                    annual basis, as part of the progress reports submitted
                    to the Secretary pursuant to section 402(j) of the
                    Public Health Service Act (42 U.S.C. 282(j)), during
                    the data collection period of the clinical trial, to
                    the Secretary an accounting of the payment or
                    reimbursements made to clinical trial participants
                    under subparagraph (A). Such data shall--
                                (i) include relevant aggregate data with
                            respect to each population group specified in
                            subsection (a)(2)(A)(i) when such data will not
                            compromise the identities of study participants
                            and in a manner consistent with applicable
                            privacy protections; and
                                (ii) not later than 6 months after receipt
                            by the Secretary, be published on a public
                            website of the National Institutes of Health.
        (c) Public Awareness and Education Campaign.--
                (1) National campaign.--The Secretary of Health and Human
            Services, acting through the Director of the National
            Institutes of Health and the Commissioner of Food and Drugs
            (referred to in this subsection as the ``Secretary''), in
            consultation with the stakeholders specified in paragraph (5),
            shall carry out a national campaign to increase the awareness
            and knowledge of individuals in the United States with respect
            to the need for diverse clinical trials among the demographic
            groups identified pursuant to subsection (a)(1)(A).
                (2) Requirements.--The national campaign conducted shall
            include--
                        (A) the development and distribution of written
                    educational materials, and the development and placing
                    of public service announcements, that are intended to
                    encourage individuals who are members of the
                    demographic groups identified pursuant to subsection
                    (a)(2)(A)(i)(I) to seek to participate in clinical
                    trials;
                        (B) such efforts as are reasonable and necessary to
                    ensure meaningful access by consumers with limited
                    English proficiency;
                        (C) the development and distribution of best
                    practices and training for recruiting underrepresented
                    study populations, including a method for sharing such
                    best practices among clinical trial sponsors,
                    providers, community-based organizations who assist
                    with recruitment, and with the public; and
                        (D) the conduct of focus groups to better
                    understand the concerns and fears of certain
                    underrepresented groups who may be reluctant to
                    participate in clinical trials.
                (3) Health inequities.--In developing the national campaign
            under paragraph (1), the Secretary shall recognize and
            address--
                        (A) health inequities among individuals who are
                    members of the population groups specified in
                    subsection (a)(2)(A)(i) with respect to access to care
                    and participation in clinical trials; and
                        (B) any barriers in access to care and
                    participation in clinical trials that are specific to
                    individuals who are members of such groups.
                (4) Grants.--The Secretary shall establish a program to
            award grants to nonprofit private entities, including
            community-based organizations and faith communities,
            institutions of higher education eligible to receive funds
            under section 371 of the Higher Education Act of 1965 (20
            U.S.C. 1067q) and national organizations that serve
            underrepresented populations and community pharmacies to enable
            such entities--
                        (A) to test alternative outreach and education
                    strategies to increase the awareness and knowledge of
                    individuals in the United States, with respect to the
                    need for diverse clinical trials that reflect the race,
                    ethnicity, age, and gender or sex of patients with the
                    disease or condition being investigated; and
                        (B) to cover administrative costs of such entities
                    in assisting in diversifying clinical trials subject to
                    subsection (a).
                (5) Stakeholders specified.--The stakeholders specified in
            this paragraph are the following:
                        (A) Representatives of the Health Resources
                    Services Administration, the Office on Minority Health
                    of the Department of Health and Human Services, the
                    Centers for Disease Control and Prevention, and the
                    National Institutes of Health.
                        (B) Community-based resources and advocates.
                (6) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this paragraph $10,000,000 for
            each of fiscal years 2023 through 2026.
        (d) Definitions.--In this section:
                (1) Clinical trial.--The term ``clinical trial'' means a
            research study in which one or more human subjects are
            prospectively assigned to one or more interventions (which may
            include placebo or other control) to evaluate the effects of
            those interventions on health-related biomedical or behavioral
            outcomes.
                (2) Sponsor.--The term ``sponsor'' has the meaning given
            such term in section 50.3 of title 21, Code of Federal
            Regulations (or successor regulations).

    SEC. 7554. PATIENT EXPERIENCE DATA.

        (a) Policy.--Section 569C of the Federal Food, Drug, and Cosmetic
    Act (21 U.S.C. 360bbb-8c) is amended--
                (1) by redesignating subsections (b) and (c) as subsections
            (c) and (d), respectively; and
                (2) by inserting after subsection (a) the following new
            subsection:
        ``(b) Collection, Submission, and Use of Data.--
                ``(1) In general.--The Secretary shall--
                        ``(A) for any drug for which an exemption is
                    granted for investigational use under section 505(i) of
                    this Act or section 351(a) of the Public Health Service
                    Act, require the sponsor of the drug to collect
                    standardized patient experience data as part of the
                    clinical trials conducted pursuant to such exemption;
                        ``(B) require any application for the approval or
                    licensing of such drug under section 505(b) of this Act
                    or section 351(a) of the Public Health Service Act to
                    include--
                                ``(i) the standardized patient experience
                            data so collected; and
                                ``(ii) such related information as the
                            Secretary may require; and
                        ``(C) consider patient experience data and related
                    information that is submitted pursuant to subparagraph
                    (B) in deciding whether to approve or license, as
                    applicable, the drug involved.
                ``(2) Applicability.--Paragraph (1) applies only with
            respect to drugs for which a request for an exemption described
            in paragraph (1)(A) is submitted on or after the date of the
            enactment of the Health Equity and Accountability Act of 2022,
            or an application under section 505(b) of this Act or section
            351(a) of the Public Health Service Act is filed, as
            applicable, on or after the day that is 2 years after the date
            of the enactment of the Health Equity and Accountability Act of
            2022.''.
        (b) Regulations.--Not later than 1 year after the date of the
    enactment of this Act, the Secretary of Health and Human Services,
    acting through the Commissioner of Food and Drugs, shall promulgate
    final regulations to implement section 569C(b) of the Federal Food,
    Drug, and Cosmetic Act, as added by this section.

       Subtitle M--Additional Provisions Addressing High Impact Minority
                                    Diseases

    SEC. 7601. MEDICARE COVERAGE OF MULTI-CANCER EARLY DETECTION SCREENING
                  TESTS.

        (a) Coverage.--Section 1861 of the Social Security Act (42 U.S.C.
    1395x) is amended--
                (1) in subsection (s)(2)--
                        (A) by striking ``and'' at the end of subparagraph
                    (GG);
                        (B) by striking the period at the end of
                    subparagraph (HH) and inserting ``; and''; and
                        (C) by adding at the end the following new
                    subparagraph:
                        ``(II) multi-cancer early detection screening tests
                    (as defined in subsection (lll));''; and
                (2) by adding at the end the following new subsection:
        ``(lll) Multi-Cancer Early Detection Screening Tests.--The term
    `multi-cancer early detection screening test' means any of the
    following tests, approved or cleared by the Food and Drug
    Administration, furnished to an individual for the purpose of early
    detection of cancer across many cancer types (as categorized in the
    Annual Report to the Nation on the Status of Cancer issued by the
    National Cancer Institute):
                ``(1) A genomic sequencing blood or blood product test that
            includes the analysis of cell-free nucleic acids.
                ``(2) Such other equivalent tests (which are based on urine
            or other sample of biological material) as the Secretary
            determines appropriate.''.
        (b) Payment and Frequency Limit.--
                (1) Payment under fee schedule.--Section 1833(h) of the
            Social Security Act (42 U.S.C. 1395l(h)) is amended--
                        (A) in paragraph (1)(A), by inserting after
                    ``(including'' the following: ``multi-cancer early
                    detection screening tests under section 1861(lll) and
                    including''; and
                        (B) by adding at the end the following new
                    paragraph:
                ``(10) No payment may be made under this part for a multi-
            cancer early detection screening test (as defined in section
            1861(lll)) for an individual if such a test was furnished to
            the individual during the previous 11 months.''.
                (2) Conforming amendment.--Section 1862(a) of the Social
            Security Act (42 U.S.C. 1395y(a)) is amended--
                        (A) in paragraph (1)--
                                (i) in subparagraph (O), by striking
                            ``and'' at the end;
                                (ii) in subparagraph (P), by striking the
                            semicolon at the end and inserting ``, and'';
                            and
                                (iii) by adding at the end the following
                            new subparagraph:
                        ``(Q) in the case of multi-cancer early detection
                    screening tests (as defined in section 1861(lll)),
                    which are performed more frequently than is covered
                    under section 1833(h)(10);''; and
                        (B) in paragraph (7), by striking ``or (P)'' and
                    inserting ``(P), or (Q)''.
        (c) Rule of Construction Relating to Other Cancer Screening
    Tests.--Nothing in this section, including the amendments made by this
    section, shall be construed--
                (1) in the case of an individual who undergoes a multi-
            cancer early detection screening test, to affect coverage under
            part B for other cancer screening tests covered under this
            section, such as screening tests for breast, cervical,
            colorectal, lung, or prostate cancer; or
                (2) in the case of an individual who undergoes another
            cancer screening test, to affect coverage for a multi-cancer
            early detection screening test or the use of such a test as a
            diagnostic or confirmatory test for a result of the other
            cancer screening test.

    SEC. 7602. AMPUTATION REDUCTION AND COMPASSION ACT.

        (a) Peripheral Artery Disease Education Program.--Part P of title
    III of the Public Health Service Act (42 U.S.C. 280g et seq.) is
    amended by adding at the end the following new section:

    ``SEC. 399V-7. PERIPHERAL ARTERY DISEASE EDUCATION PROGRAM.

        ``(a) Establishment.--The Secretary, acting through the Director of
    the Centers for Disease Control and Prevention, in collaboration with
    the Administrator of the Centers for Medicare & Medicaid Services and
    the Administrator of the Health Resources and Services Administration,
    shall establish and coordinate a peripheral artery disease education
    program to support, develop, and implement educational initiatives and
    outreach strategies that inform health care professionals and the
    public about the existence of peripheral artery disease and methods to
    reduce amputations related to such disease, particularly with respect
    to at-risk populations.
        ``(b) 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 2022 through 2026.''.
        (b) Medicare Coverage of Peripheral Artery Disease Screening Tests
    Furnished to At-Risk Beneficiaries Without Imposition of Cost Sharing
    Requirements.--
                (1) In general.--Section 1861 of the Social Security Act
            (42 U.S.C. 1395x) is amended--
                        (A) in subsection (s)(2)--
                                (i) in subparagraph (GG), by striking
                            ``and'' at the end;
                                (ii) in subparagraph (HH), by striking the
                            period at the end and inserting ``; and''; and
                                (iii) by adding at the end the following
                            new subparagraph:
                        ``(II) peripheral artery disease screening tests
                    furnished to at-risk beneficiaries (as such terms are
                    defined in subsection (lll)).''; and
                        (B) by adding at the end the following new
                    subsection:
        ``(lll) Peripheral Artery Disease Screening Test; At-Risk
    Beneficiary.--(1) The term `peripheral artery disease screening test'
    means--
                ``(A) noninvasive physiologic studies of extremity arteries
            (commonly referred to as ankle-brachial index testing);
                ``(B) arterial duplex scans of lower extremity arteries
            vascular; and
                ``(C) such other items and services as the Secretary
            determines, in consultation with relevant stakeholders, to be
            appropriate for screening for peripheral artery disease for at-
            risk beneficiaries.
        ``(2) The term `at-risk beneficiary' means an individual entitled
    to, or enrolled for, benefits under part A and enrolled for benefits
    under part B--
                ``(A) who is 65 years of age or older;
                ``(B) who is at least 50 years of age but not older than 64
            years of age with risk factors for atherosclerosis (such as
            diabetes mellitus, a history of smoking, hyperlipidemia, and
            hypertension) or a family history of peripheral artery disease;
                ``(C) who is younger than 50 years of age with diabetes
            mellitus and one additional risk factor for atherosclerosis; or
                ``(D) with a known atherosclerotic disease in another
            vascular bed such as coronary, carotid, subclavian, renal, or
            mesenteric artery stenosis, or abdominal aortic aneurysm.
        ``(3) The Secretary shall, in consultation with appropriate
    organizations, establish standards regarding the frequency for
    peripheral artery disease screening tests described in subsection
    (s)(2)(II) for purposes of coverage under this title.''.
                (2) Inclusion of peripheral artery disease screening tests
            in initial preventive physical examination.--Section
            1861(ww)(2) of the Social Security Act (42 U.S.C. 1395x(ww)(2))
            is amended--
                        (A) in subparagraph (N), by moving the margins of
                    such subparagraph 2 ems to the left;
                        (B) by redesignating subparagraph (O) as
                    subparagraph (P); and
                        (C) by inserting after subparagraph (N) the
                    following new subparagraph:
                        ``(O) Peripheral artery disease screening tests
                    furnished to at risk-beneficiaries (as such terms are
                    defined in subsection (lll)).''.
                (3) Payment.--
                        (A) In general.--Section 1833(a) of the Social
                    Security Act (42 U.S.C. 1395l(a)) is amended--
                                (i) in paragraph (1)--
                                        (I) in subparagraph (N), by
                                    inserting ``and other than peripheral
                                    artery disease screening tests
                                    furnished to at-risk beneficiaries (as
                                    such terms are defined in section
                                    1861(lll))'' after ``other than
                                    personalized prevention plan services
                                    (as defined in section 1861(hhh)(1))'';
                                        (II) by striking ``and'' before
                                    ``(DD)''; and
                                        (III) by striking ``such
                                    service,;'' at the end and inserting
                                    the following: ``, and (EE) with
                                    respect to peripheral artery disease
                                    screening tests furnished to at-risk
                                    beneficiaries (as such terms are
                                    defined in section 1861(lll)), the
                                    amount paid shall be 100 percent of the
                                    lesser of the actual charge for the
                                    services or the amount determined under
                                    the payment basis determined under
                                    section 1848''; and
                                (ii) in paragraph (2)--
                                        (I) in subparagraph (G), by
                                    striking ``and'' at the end;
                                        (II) in subparagraph (H), by
                                    striking the comma at the end and
                                    inserting ``; and''; and
                                        (III) by inserting after
                                    subparagraph (H) the following new
                                    subparagraph:
                ``(I) with respect to peripheral artery disease screening
            tests (as defined in paragraph (1) of section 1861(lll))
            furnished by an outpatient department of a hospital to at-risk
            beneficiaries (as defined in paragraph (2) of such section),
            the amount determined under paragraph (1)(EE),''.
                        (B) No deductible.--Section 1833(b) of the Social
                    Security Act (42 U.S.C. 1395l(b)) is amended, in the
                    first sentence--
                                (i) by striking ``and'' before ``(12)'';
                            and
                                (ii) by inserting ``, and (13) such
                            deductible shall not apply with respect to
                            peripheral artery disease screening tests
                            furnished to at-risk beneficiaries (as such
                            terms are defined in section 1861(lll))''
                            before the period at the end.
                        (C) Exclusion from prospective payment system for
                    hospital outpatient department services.--Section
                    1833(t)(1)(B)(iv) of the Social Security Act (42 U.S.C.
                    1395l(t)(1)(B)(iv)) is amended--
                                (i) by striking ``, or personalized'' and
                            inserting ``, personalized''; and
                                (ii) by inserting ``, or peripheral artery
                            disease screening tests furnished to at-risk
                            beneficiaries (as such terms are defined in
                            section 1861(lll))'' after ``personalized
                            prevention plan services (as defined in section
                            1861(hhh)(1))''.
                        (D) Conforming amendment.--Section 1848(j)(3) of
                    the Social Security Act (42 U.S.C. 1395w-4(j)(3)) is
                    amended by striking ``(2)(FF) (including administration
                    of the health risk assessment) ,'' and inserting
                    ``(2)(FF) (including administration of the health risk
                    assessment), (2)(II)''.
                (4) Exclusion from coverage and medicare as secondary payer
            for tests performed more frequently than allowed.--Section
            1862(a)(1) of the Social Security Act (42 U.S.C. 1395y(a)(1))
            is amended--
                        (A) in subparagraph (O), by striking ``and'' at the
                    end;
                        (B) in subparagraph (P), by striking the semicolon
                    at the end and inserting ``, and''; and
                        (C) by adding at the end the following new
                    subparagraph:
                        ``(Q) in the case of peripheral artery disease
                    screening tests furnished to at-risk beneficiaries (as
                    such terms are defined in section 1861(lll)), which are
                    performed more frequently than is covered under such
                    section;''.
                (5) Authority to modify or eliminate coverage of certain
            preventive services.--Section 1834(n) of the Social Security
            Act (42 U.S.C. 1395m(n)) is amended--
                        (A) by redesignating subparagraphs (A) and (B) of
                    paragraph (1) as clauses (i) and (ii), respectively,
                    and moving the margins of such clauses, as so
                    redesignated, 2 ems to the right;
                        (B) by redesignating paragraphs (1) and (2) as
                    subparagraphs (A) and (B), respectively, and moving the
                    margins of such subparagraphs, as so redesignated, 2
                    ems to the right;
                        (C) by striking ``Certain Preventive Services'' and
                    all that follows through ``any other provision of this
                    title'' and inserting: ``Certain Preventive Services.--
                ``(1) In general.--Notwithstanding any other provision of
            this title''; and
                        (D) by adding at the end the following new
                    paragraph:
                ``(2) Inapplicability.--The Secretarial authority described
            in paragraph (1) shall not apply with respect to preventive
            services described in section 1861(ww)(2)(O).''.
                (6) Effective date.--The amendments made by this subsection
            shall apply with respect to items and services furnished on or
            after January 1, 2022.
        (c) Medicaid Coverage of Peripheral Artery Disease Screening Tests
    Furnished to At-Risk Beneficiaries Without Imposition of Cost Sharing
    Requirements.--
                (1) In general.--Section 1905 of the Social Security Act
            (42 U.S.C. 1396d) is amended--
                        (A) in subsection (a)--
                                (i) in paragraph (30), by striking ``and''
                            at the end;
                                (ii) by redesignating paragraph (31) as
                            paragraph (32); and
                                (iii) by inserting after paragraph (30) the
                            following new paragraph:
                ``(31) peripheral artery disease screening tests furnished
            to at-risk beneficiaries (as such terms are defined in
            subsection (hh)); and''; and
                        (B) by adding at the end the following new
                    subsection:
        ``(hh) Peripheral Artery Disease Screening Test; At-Risk
    Beneficiary.--
                ``(1) Peripheral artery disease screening test.--The term
            `peripheral artery disease screening test' means--
                        ``(A) noninvasive physiologic studies of extremity
                    arteries (commonly referred to as ankle-brachial index
                    testing);
                        ``(B) arterial duplex scans of lower extremity
                    arteries vascular; and
                        ``(C) such other items and services as the
                    Secretary determines, in consultation with relevant
                    stakeholders, to be appropriate for screening for
                    peripheral artery disease for at-risk beneficiaries.
                ``(2) At-risk beneficiary.--The term `at-risk beneficiary'
            means an individual enrolled under a State plan (or a waiver of
            such plan)--
                        ``(A) who is 65 years of age or older;
                        ``(B) who is at least 50 years of age but not older
                    than 64 years of age with risk factors for
                    atherosclerosis (such as diabetes mellitus, a history
                    of smoking, hyperlipidemia, and hypertension) or a
                    family history of peripheral artery disease;
                        ``(C) who is younger than 50 years of age with
                    diabetes mellitus and one additional risk factor for
                    atherosclerosis; or
                        ``(D) with a known atherosclerotic disease in
                    another vascular bed such as coronary, carotid,
                    subclavian, renal, or mesenteric artery stenosis, or
                    abdominal aortic aneurysm.
                ``(3) Frequency.--The Secretary shall, in consultation with
            appropriate organizations, establish standards regarding the
            frequency for peripheral artery disease screening tests
            described in subsection (a)(31) for purposes of coverage under
            a State plan under this title.''.
                (2) No 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 ``, or''; and
                                (iii) by adding at the end the following
                            new subparagraph:
                        ``(H) peripheral artery disease screening tests
                    furnished to at-risk beneficiaries (as such terms are
                    defined in section 1905(hh)); 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 by adding at the
                    end the following new clause:
                                ``(xii) Peripheral artery disease screening
                            tests furnished to at-risk beneficiaries (as
                            such terms are defined in section 1905(hh)).''.
                (3) Mandatory coverage.--Section 1902(a)(10)(A) of the
            Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by
            striking ``and (30)'' and inserting ``(30), and (31)''.
                (4) Conforming amendments.--
                        (A) Section 1902(nn)(3) of the Social Security Act
                    (42 U.S.C. 1396a(nn)(3)) is amended by striking
                    ``following paragraph (30)'' and inserting ``following
                    paragraph (32)''.
                        (B) Section 1905(a) of the Social Security Act (42
                    U.S.C. 1396d(a)) is amended by striking ``following
                    paragraph (30)'' and inserting ``following paragraph
                    (32)''.
        (d) Requirement for Group Health Plans and Health Insurance Issuers
    Offering Group or Individual Health Insurance Coverage To Provide
    Coverage for Peripheral Artery Disease Screening Tests Furnished to At-
    Risk Enrollees Without Imposition of Cost Sharing Requirements.--
                (1) In general.--Subsection (a) of section 2713 of the
            Public Health Service Act (42 U.S.C. 300gg-13) is amended to
            read as follows:
        ``(a) Coverage of Preventive Health Services.--
                ``(1) In general.--A group health plan and a health
            insurance issuer offering group or individual health insurance
            coverage shall, at a minimum, provide coverage for and shall
            not impose any cost sharing requirements for--
                        ``(A) evidence-based items or services that have in
                    effect a rating of `A' or `B' in the current
                    recommendations of the United States Preventive
                    Services Task Force;
                        ``(B) immunizations that have in effect a
                    recommendation from the Advisory Committee on
                    Immunization Practices of the Centers for Disease
                    Control and Prevention with respect to the individual
                    involved;
                        ``(C) with respect to infants, children, and
                    adolescents, evidence-informed preventive care and
                    screenings provided for in the comprehensive guidelines
                    supported by the Health Resources and Services
                    Administration;
                        ``(D) with respect to women, such additional
                    preventive care and screenings not described in
                    subparagraph (A) as provided for in comprehensive
                    guidelines supported by the Health Resources and
                    Services Administration for purposes of this
                    subparagraph; and
                        ``(E) with respect to at-risk enrollees, peripheral
                    artery disease screening tests.
                ``(2) Peripheral artery disease screening test; at-risk
            enrollee.--For purposes of paragraph (1)(E):
                        ``(A) Peripheral artery disease screening test.--
                    The term `peripheral artery disease screening test'
                    means--
                                ``(i) noninvasive physiologic studies of
                            extremity arteries (commonly referred to as
                            ankle-brachial index testing);
                                ``(ii) arterial duplex scans of lower
                            extremity arteries vascular; and
                                ``(iii) such other items and services as
                            the Secretary determines, in consultation with
                            relevant stakeholders, to be appropriate for
                            screening for peripheral artery disease for at-
                            risk enrollees.
                        ``(B) At-risk enrollee.--The term `at-risk
                    enrollee' means an individual enrolled in a group
                    health plan or group or individual health insurance
                    coverage--
                                ``(i) who is 65 years of age or older;
                                ``(ii) who is at least 50 years of age but
                            not older than 64 years of age with risk
                            factors for atherosclerosis (such as diabetes
                            mellitus, a history of smoking, hyperlipidemia,
                            and hypertension) or a family history of
                            peripheral artery disease;
                                ``(iii) who is younger than 50 years of age
                            with diabetes mellitus and one additional risk
                            factor for atherosclerosis; or
                                ``(iv) with a known atherosclerotic disease
                            in another vascular bed such as coronary,
                            carotid, subclavian, renal, or mesenteric
                            artery stenosis, or abdominal aortic aneurysm.
                        ``(C) Frequency.--The Secretary shall, in
                    consultation with appropriate organizations, establish
                    standards regarding the frequency for peripheral artery
                    disease screening tests described in paragraph (1)(E)
                    for purposes of coverage under this section.
                ``(3) Clarification regarding breast cancer screening,
            mammography, and prevention recommendations.--For the purposes
            of this Act, and for the purposes of any other provision of
            law, the current recommendations of the United States
            Preventive Service Task Force regarding breast cancer
            screening, mammography, and prevention shall be considered the
            most current other than those issued in or around November
            2009.
                ``(4) Rule of construction.--Nothing in this subsection
            shall be construed to prohibit a plan or issuer from providing
            coverage for services in addition to those recommended by the
            United States Preventive Services Task Force or to deny
            coverage for services that are not recommended by such Task
            Force.''.
                (2) Effective date.--The amendment made by paragraph (1)
            shall apply with respect to plan years beginning on or after
            January 1, 2022.
        (e) Disallowance of Payment for Nontraumatic Amputation Services
    Furnished Without Anatomical Testing Services.--Section 1834 of the
    Social Security Act (42 U.S.C. 1395m) is amended by adding at the end
    the following new subsection:
        ``(z) Disallowance of Payment for Nontraumatic Amputation Services
    Furnished Without Anatomical Testing Services.--
                ``(1) In general.--In the case of nontraumatic amputation
            services furnished by a supplier on or after January 1, 2022,
            to an individual entitled to, or enrolled for, benefits under
            part A and enrolled for benefits under this part, for which
            payment is made under this part, payment may only be made under
            this part if--
                        ``(A) such supplier furnishes anatomical testing
                    services to such individual during the 3-month period
                    preceding the date on which such nontraumatic
                    amputation services is furnished; or
                        ``(B) such individual has a pre-existing
                    dysfunctional or unsalvageable limb, life-threatening
                    sepsis, intractable infection, extensive gangrene or
                    necrotic tissue loss beyond salvage, a poor functional
                    status, severe dementia, or a short life expectancy
                    after shared decision-making with a health care team
                    and patient, family, or caregiver.
                ``(2) Definitions.--In this subsection:
                        ``(A) Anatomical testing services.--The term
                    `anatomical testing services' means arterial duplex
                    scanning, computed tomography angiography, and magnetic
                    resonance angiography.
                        ``(B) Nontraumatic amputation services.--The term
                    `nontraumatic amputation services' means amputations as
                    a result of atherosclerotic vascular disease or a
                    related comorbidity of such disease (including
                    diabetes).''.
        (f) Development and Implementation of Quality Measures.--
                (1) Development.--The Secretary of Health and Human
            Services (referred to in this subsection as the ``Secretary'')
            shall, in consultation with relevant stakeholders, develop
            quality measures for nontraumatic, lower-limb, major amputation
            that utilize appropriate diagnostic screening (including
            peripheral artery disease screening) in order to encourage
            alternative treatments (including revascularization) in lieu of
            such an amputation.
                (2) Implementation.--After appropriate testing and
            validation of the measures developed under paragraph (1), the
            Secretary shall incorporate such measures in quality reporting
            programs for appropriate providers of services and suppliers
            under the Medicare program under title XVIII of the Social
            Security Act (42 U.S.C. 1395 et seq.), including for purposes
            of--
                        (A) the merit-based incentive payment system under
                    section 1848(q) of such Act (42 U.S.C. 1395w-4(q));
                        (B) incentive payments for participation in
                    eligible alternative payment models under section
                    1833(z) of such Act (42 U.S.C. 1395l(z));
                        (C) the shared savings program under section 1899
                    of such Act (42 U.S.C. 1395jjj);
                        (D) models under section 1115A of such Act (42
                    U.S.C. 1315a); and
                        (E) such other payment systems or models as the
                    Secretary may specify.

    SEC. 7603. ELIMINATING THE COINSURANCE REQUIREMENT FOR CERTAIN
                  COLORECTAL CANCER SCREENING TESTS FURNISHED UNDER THE
                  MEDICARE PROGRAM.

        Section 1833(dd) of the Social Security Act (42 U.S.C. 1395l(dd))
    is amended--
                (1) in paragraph (1), by striking ``and before January 1,
            2030,''; and
                (2) in paragraph (2)--
                        (A) in subparagraph (A), by adding ``and'' at the
                    end;
                        (B) in subparagraph (B), by striking ``through
                    2026, 85 percent; and'' and inserting ``and each
                    subsequent year, 100 percent.''; and
                        (C) by striking subparagraph (C).

    SEC. 7604. EXPANDING THE AVAILABILITY OF MEDICAL NUTRITION THERAPY
                  SERVICES UNDER THE MEDICARE PROGRAM.

        (a) In General.--Section 1861 of the Social Security Act (42 U.S.C.
    1395x) is amended--
                (1) in subsection (s)(2)(V), by striking ``in the case of''
            and all that follows through ``organizations''; and
                (2) in subsection (vv)--
                        (A) in paragraph (1)--
                                (i) by striking ``disease management'' and
                            inserting ``the prevention, management, or
                            treatment of a disease or condition specified
                            in paragraph (4)''; and
                                (ii) by striking ``by a physician'' and all
                            that follows through the period at the end and
                            inserting the following: ``by a--
                        ``(A) physician (as defined in subsection (r)(1));
                        ``(B) physician assistant;
                        ``(C) nurse practitioner;
                        ``(D) clinical nurse specialist (as defined in
                    subsection (aa)(5)(B)); or
                        ``(E) in the case of such services furnished to
                    manage such a disease or condition that is an eating
                    disorder, a clinical psychologist (as defined by the
                    Secretary).
            Such term shall not include any services furnished to an
            individual for the prevention, management, or treatment of a
            renal disease if such individual is receiving maintenance
            dialysis for which payment is made under section 1881.''; and
                        (B) by adding at the end the following new
                    paragraph:
        ``(4) For purposes of paragraph (1), the diseases and conditions
    specified in this paragraph are the following:
                ``(A) Diabetes and prediabetes.
                ``(B) A renal disease.
                ``(C) Obesity (as defined for purposes of subsection
            (yy)(2)(C) or as otherwise defined by the Secretary).
                ``(D) Hypertension.
                ``(E) Dyslipidemia.
                ``(F) Malnutrition.
                ``(G) Eating disorders.
                ``(H) Cancer.
                ``(I) Gastrointestinal diseases, including celiac disease.
                ``(J) HIV.
                ``(K) AIDS.
                ``(L) Cardiovascular disease.
                ``(M) Any other disease or condition--
                        ``(i) specified by the Secretary relating to
                    unintentional weight loss;
                        ``(ii) for which the Secretary determines the
                    services described in paragraph (1) to be medically
                    necessary and appropriate for the prevention,
                    management, or treatment of such disease or condition,
                    consistent with any applicable recommendations of the
                    United States Preventive Services Task Force; or
                        ``(iii) for which the Secretary determines the
                    services described in paragraph (1) are medically
                    necessary, consistent with either protocols established
                    by registered dietitians or nutrition professional
                    organizations or with accepted clinical guidelines
                    identified by the Secretary.''.
        (b) Exclusion Modification.--Section 1862(a)(1) is amended--
                (1) in subparagraph (O), by striking ``and'' at the end;
                (2) in subparagraph (P), by striking the semicolon at the
            end and inserting ``, and''; and
                (3) by adding at the end the following new subparagraph:
                ``(Q) in the case of medical nutrition therapy services (as
            defined in section 1861(vv)), which are not furnished for the
            prevention, management, or treatment of a disease or condition
            specified in paragraph (4) of such section;''.
        (c) Effective Date.--The amendments made by this section shall
    apply with respect to items and services furnished on or after January
    1, 2023.

    SEC. 7605. ENCOURAGING THE DEVELOPMENT AND USE OF DISARM ANTIMICROBIAL
                  DRUGS.

        (a) Additional Payment for DISARM Antimicrobial Drugs Under
    Medicare.--
                (1) In general.--Section 1886(d)(5) of the Social Security
            Act (42 U.S.C. 1395ww(d)(5)) is amended by adding at the end
            the following new subparagraph:
        ``(N)(i)(I) Effective for discharges beginning on or after October
    1, 2021, or such sooner date as specified by the Secretary, subject to
    subclause (II), the Secretary shall, after notice and opportunity for
    public comment (in the publications required by subsection (e)(5) for a
    fiscal year or otherwise), provide for an additional payment under a
    mechanism (separate from the mechanism established under subparagraph
    (K)), with respect to such discharges involving any DISARM
    antimicrobial drug, in an amount equal to--
                ``(aa) the amount payable under section 1847A for such drug
            during the calendar quarter in which the discharge occurred; or
                ``(bb) if no amount for such drug is determined under
            section 1847A, an amount to be determined by the Secretary in a
            manner similar to the manner in which payment amounts are
            determined under section 1847A based on information submitted
            by the manufacturer or sponsor of such drug (as required under
            clause (v)).
        ``(II) In determining the amount payable under section 1847A for
    purposes of items (aa) and (bb) of subclause (I), subparagraphs (A) and
    (B) of subsection (b)(1) of such section shall be applied by
    substituting `102 percent' for `106 percent' each place it appears and
    paragraph (8)(B) of such section shall be applied by substituting `2
    percent' for `6 percent'.
        ``(ii) For purposes of this subparagraph, a DISARM antimicrobial
    drug is--
                ``(I) a drug--
                        ``(aa) that--
                                ``(AA) is approved by the Food and Drug
                            Administration;
                                ``(BB) is designated by the Food and Drug
                            Administration as a qualified infectious
                            disease product under subsection (d) of section
                            505E of the Federal Food, Drug, and Cosmetic
                            Act; and
                                ``(CC) has received an extension of its
                            exclusivity period pursuant to subsection (a)
                            of such section; and
                        ``(bb) that has been designated by the Secretary
                    pursuant to the process established under clause
                    (iv)(I)(bb); or
                ``(II) an antibacterial or antifungal biological product--
                        ``(aa) that is licensed for use, or an
                    antibacterial or antifungal biological product for
                    which an indication is first licensed for use, by the
                    Food and Drug Administration on or after June 5, 2014,
                    under section 351(a) of the Public Health Service Act
                    for human use to treat serious or life-threatening
                    infections, as determined by the Food and Drug
                    Administration, including those caused by, or likely to
                    be caused by--
                                ``(AA) an antibacterial or antifungal
                            resistant pathogen, including novel or emerging
                            infectious pathogens; or
                                ``(BB) a qualifying pathogen (as defined
                            under section 505E(f) of the Federal Food,
                            Drug, and Cosmetic Act); and
                        ``(bb) has been designated by the Secretary
                    pursuant to the process established under clause
                    (iv)(I)(bb).
        ``(iii) The mechanism established pursuant to clause (i) shall
    provide that the additional payment under clause (i) shall--
                ``(I) with respect to a discharge, only be made to a
            subsection (d) hospital that, as determined by the Secretary--
                        ``(aa) is participating in the National Healthcare
                    Safety Network Antimicrobial Use and Resistance Module
                    of the Centers for Disease Control and Prevention; and
                        ``(bb) has an antimicrobial stewardship program
                    that aligns with the Core Elements of Hospital
                    Antibiotic Stewardship Programs of the Centers for
                    Disease Control and Prevention or the Antimicrobial
                    Stewardship Standard set by the Joint Commission; and
                ``(II) apply to discharges occurring on or after October 1
            of the year in which the drug or biological product is
            designated by the Secretary as a DISARM antimicrobial drug.
    For purposes of this clause, in the case of a similar reporting program
    described in item (aa), a subsection (d) hospital shall be treated as
    participating in such a program if the entity maintaining such program
    identifies to the Secretary such hospital as so participating.
        ``(iv)(I) The mechanism established pursuant to clause (i) shall
    provide for a process for--
                ``(aa) a manufacturer or sponsor of a drug or biological
            product to request the Secretary to designate the drug or
            biological product as a DISARM antimicrobial drug; and
                ``(bb) the designation (and removal of such designation) by
            the Secretary of drugs and biological products as DISARM
            antimicrobial drugs.
        ``(II) A designation of a drug or biological product as a DISARM
    antimicrobial drug may be revoked by the Secretary if the Secretary
    determines that--
                ``(aa) the drug or biological product no longer meets the
            requirements for a DISARM antimicrobial drug under clause (ii);
                ``(bb) the request for such designation contained an untrue
            statement of material fact; or
                ``(cc) clinical or other information that was not available
            to the Secretary at the time such designation was made shows
            that--
                        ``(AA) such drug or biological product is unsafe
                    for use or not shown to be safe for use for individuals
                    who are entitled to benefits under part A; or
                        ``(BB) an alternative to such drug or biological
                    product is an advance that substantially improves the
                    diagnosis or treatment of such individuals.
        ``(III) Not later than October 1, 2021, the Secretary shall publish
    in the Federal Register a list of the DISARM antimicrobial drugs
    designated under this subparagraph pursuant to the process established
    under subclause (I)(bb). The Secretary shall annually update such list.
        ``(v)(I) For purposes of determining additional payment amounts
    under clause (i), a manufacturer or sponsor of a drug or biological
    product that submits a request described in clause (iv)(I)(aa) shall
    submit to the Secretary information described in section
    1927(b)(3)(A)(iii).
        ``(II) The penalties for failure to provide timely information
    under clause (i) of subparagraph (C) section 1927(b)(3) and for
    providing false information under clause (ii) of such subparagraph
    shall apply to manufacturers and sponsors of a drug or biological
    product under this section with respect to information under subclause
    (I) in the same manner as such penalties apply to manufacturers under
    such clauses with respect to information under subparagraph (A) of such
    section.
        ``(vi)(I) The mechanism established pursuant to clause (i) shall
    provide that--
                ``(aa) except as provided in item (bb), no additional
            payment shall be made under this subparagraph for discharges
            involving a DISARM antimicrobial drug if any additional
            payments have been made for discharges involving such drug as a
            new medical service or technology under subparagraph (K);
                ``(bb) additional payments may be made under this
            subparagraph for discharges involving a DISARM antimicrobial
            drug if any additional payments have been made for discharges
            occurring prior to the date of enactment of this subparagraph
            involving such drug as a new medical service or technology
            under subparagraph (K); and
                ``(cc) no additional payment shall be made under
            subparagraph (K) for discharges involving a DISARM
            antimicrobial drug as a new medical service or technology if
            any additional payments for discharges involving such drug have
            been made under this subparagraph.''.
                (2) Conforming amendment.--Section 1886(d)(5)(K)(ii)(III)
            of the Social Security Act (42 U.S.C. 1395ww(d)(5)(K)(ii)(III))
            is amended by striking ``provide'' and inserting ``subject to
            subparagraph (N)(vii), provide''.
        (b) Authorization of Appropriations for the Centers for Disease
    Control and Prevention.--There is authorized to be appropriated to the
    Centers for Disease Control and Prevention $500,000,000, to remain
    available until expended, to support establishment and implementation
    of antimicrobial stewardship programs and data reporting capabilities
    to the Antimicrobial Use and Resistance option of the CDC National
    Healthcare Safety Network, especially in critical access hospitals,
    rural hospitals, and community hospitals, to support detection,
    surveillance, containment, and prevention of resistant pathogens in the
    United States and overseas.
        (c) Study and Reports on Removing Barriers to the Development of
    DISARM Antimicrobial Drugs.--
                (1) Study.--The Comptroller General of the United States
            (in this subsection referred to as the ``Comptroller General'')
            shall, in consultation with the Director of the National
            Institutes of Health, the Commissioner of Food and Drugs, the
            Administrator of the Centers for Medicare & Medicaid Services,
            and the Director of the Centers for Disease Control and
            Prevention, conduct a study over a 5-year period of the
            barriers that prevent the development of DISARM antimicrobial
            drugs (as defined in section 1886(d)(5)(N)(ii) of the Social
            Security Act, as added by subsection (a)), including--
                        (A) patient outcomes in conjunction with the use of
                    DISARM drugs, including--
                                (i) duration of stay in the intensive care
                            unit;
                                (ii) recidivism within 30 days; and
                                (iii) measures of additional follow up
                            care;
                        (B) the effectiveness of antimicrobial stewardship
                    and surveillance programs, including--
                                (i) changes in the percentage of hospitals
                            in the United States with an antimicrobial
                            stewardship program in place that aligns with
                            the Core Elements of Hospital Antibiotic
                            Stewardship Programs, as outlined by the
                            Centers for Disease Control and Prevention;
                                (ii) changes in inpatient care of
                            clostridioides difficile infection; and
                                (iii) changes in inpatient rates of
                            resistance to key pathogens; and
                        (C) considerations relating to Medicare payment
                    reform, including--
                                (i) changes in the number of qualified
                            antimicrobial products approved;
                                (ii) changes in wholesale acquisition cost
                            of individual qualified antimicrobial products
                            over time;
                                (iii) changes in year-over-year volume of
                            individual qualified antimicrobial products
                            sold; and
                                (iv) the overall cost of qualified
                            antimicrobial products to the Medicare program
                            as a proportion of total Medicare part A
                            spending.
                (2) Report.--Not later than 5 years after the date of the
            enactment of this section, the Comptroller General shall submit
            to Congress a report containing the results of the study
            conducted under paragraph (1), together with recommendations
            for such legislation and administrative action as the
            Comptroller General determines appropriate.

    SEC. 7606. TREAT AND REDUCE OBESITY ACT.

        (a) Authority To Expand Health Care Providers Qualified To Furnish
    Intensive Behavioral Therapy.--Section 1861(ddd) of the Social Security
    Act (42 U.S.C. 1395x(ddd)) is amended by adding at the end the
    following new paragraph:
                ``(4)(A) Subject to subparagraph (B), the Secretary may, in
            addition to qualified primary care physicians and other primary
            care practitioners, cover intensive behavioral therapy for
            obesity furnished by any of the following:
                        ``(i) A physician (as defined in subsection (r)(1))
                    who is not a qualified primary care physician.
                        ``(ii) Any other appropriate health care provider
                    (including a physician assistant, nurse practitioner,
                    or clinical nurse specialist (as those terms are
                    defined in subsection (aa)(5)), a clinical
                    psychologist, a registered dietitian or nutrition
                    professional (as defined in subsection (vv))).
                        ``(iii) An evidence-based, community-based
                    lifestyle counseling program approved by the Secretary.
                ``(B) In the case of intensive behavioral therapy for
            obesity furnished by a provider described in clause (ii) or
            (iii) of subparagraph (A), the Secretary may only cover such
            therapy if such therapy is furnished--
                        ``(i) upon referral from, and in coordination with,
                    a physician or primary care practitioner operating in a
                    primary care setting or any other setting specified by
                    the Secretary; and
                        ``(ii) in an office setting, a hospital outpatient
                    department, a community-based site that complies with
                    the Federal regulations concerning the privacy of
                    individually identifiable health information
                    promulgated under section 264(c) of the Health
                    Insurance Portability and Accountability Act of 1996,
                    or another setting specified by the Secretary.
                ``(C) In order to ensure a collaborative effort, the
            coordination described in subparagraph (B)(i) shall include the
            health care provider or lifestyle counseling program
            communicating to the referring physician or primary care
            practitioner any recommendations or treatment plans made
            regarding the therapy.''.
        (b) Medicare Part D Coverage of Obesity Medication.--
                (1) In general.--Section 1860D-2(e)(2)(A) of the Social
            Security Act (42 U.S.C. 1395w-102(e)(2)(A)) is amended, in the
            first sentence--
                        (A) by striking ``and other than'' and inserting
                    ``other than''; and
                        (B) by inserting after ``benzodiazepines),'' the
                    following: ``and other than subparagraph (A) of such
                    section if the drug is used for the treatment of
                    obesity (as defined in section 1861(yy)(2)(C)) or for
                    weight loss management for an individual who is
                    overweight (as defined in section 1861(yy)(2)(F)(i))
                    and has one or more related comorbidities,''.
                (2) Effective date.--The amendments made by paragraph (1)
            shall apply to plan years beginning on or after the date that
            is 2 years after the date of the enactment of this section.
        (c) Report to Congress.--Not later than the date that is 1 year
    after the date of the enactment of this section, and every 2 years
    thereafter, the Secretary of Health and Human Services shall submit a
    report to Congress describing the steps the Secretary has taken to
    implement the provisions of, and amendments made by, this section. Such
    report shall also include recommendations for better coordination and
    leveraging of programs within the Department of Health and Human
    Services and other Federal agencies that relate in any way to
    supporting appropriate research and clinical care (such as any
    interactions between physicians and other health care providers and
    their patients) to treat, reduce, and prevent obesity in the adult
    population.

    SEC. 7607. INCENTIVES, IMPROVEMENTS, AND OUTREACH TO INCREASE DIVERSITY
                  IN ALZHEIMER'S DISEASE RESEARCH.

        (a) Improving Access for and Outreach to Underrepresented
    Populations.--
                (1) Expanding access to alzheimer's research centers.--
                        (A) In general.--Section 445(a)(1) of the Public
                    Health Service Act (42 U.S.C. 285e-2(a)(1)) is
                    amended--
                                (i) by striking ``(a)(1) The Director of
                            the Institute may'' and inserting the
                            following:
        ``(a)(1) The Director of the Institute--
                ``(A) may'';
                                (ii) by striking ``disease.'' and inserting
                            ``disease; and''; and
                                (iii) by adding at the end the following:
                ``(B) beginning January 1, 2022, shall enter into
            cooperative agreements and make grants to public or private
            nonprofit entities under this subsection for the planning,
            establishment, and operation of new such centers that are
            located in areas with a higher concentration of minority groups
            (as determined under section 444(d)(3)(D)), such as entities
            that are historically Black colleges and universities,
            Hispanic-serving institutions, Tribal colleges and
            universities, or centers of excellence for other minority
            populations.''.
                        (B) Use of funding for clinics to operate clinical
                    trials.--Section 445(b) of the Public Health Service
                    Act (42 U.S.C. 285e-2(b)) is amended by adding at the
                    end the following:
        ``(3) Federal payments made under a cooperative agreement or grant
    under subsection (a) from funds made available under section 2(g) of
    the ENACT Act of 2021 shall, with respect to Alzheimer's disease, be
    used in part to establish and operate diagnostic and treatment clinics
    designed--
                ``(A) to meet the special needs of minority and rural
            populations and other underserved populations; and
                ``(B) to operate clinical trials''.
                (2) Outreach.--
                        (A) Alzheimer's disease centers.--Section 445(b) of
                    the Public Health Service Act (42 U.S.C. 285e-2(b)), as
                    amended by paragraph (1)(B), is further amended by
                    adding at the end the following new paragraph:
        ``(4) Federal payments made under a cooperative agreement or grant
    under subsection (a) shall be used to establish engagement centers to
    carry out public outreach, education efforts, and dissemination of
    information for members of minority groups about clinical trial
    participation. Activities funded pursuant to the preceding sentence
    shall include--
                ``(A) using established mechanisms to encourage members of
            minority groups to participate in clinical trials on
            Alzheimer's disease;
                ``(B) expanding education efforts to make members of
            minority groups aware of ongoing clinical trials;
                ``(C) working with trial sponsors to increase the number of
            recruitment events for members of minority groups;
                ``(D) conducting outreach to national, State, and local
            physician professional organizations, especially for members of
            such organizations who are primary care physicians or
            physicians who specialize in dementia, to increase awareness of
            clinical research opportunities for members of minority groups;
            and
                ``(E) using community-based participatory research
            methodologies to engage with minority populations.''.
                        (B) Resource centers for minority aging research.--
                    Section 444(c) of the Public Health Service Act (42
                    U.S.C. 285e-1(c)) is amended--
                                (i) by striking ``(c)'' and inserting
                            ``(c)(1)''; and
                                (ii) by adding at the end the following new
                            paragraph:
        ``(2) The Director, acting through the Resource Centers for
    Minority Aging Research of the Institute, shall carry out public
    outreach, education efforts, and dissemination of information for
    members of minority groups about participation in clinical research on
    Alzheimer's disease carried out or supported under this subpart.''.
        (b) Incentives To Increase Diversity in Alzheimer's Disease
    Research Through Principal Investigators and Researchers From
    Underrepresented Populations.--
                (1) Alzheimer's clinical research and training awards.--
            Section 445I of the Public Health Service Act (42 U.S.C. 285e-
            10a) is amended by adding at the end the following new
            subsection:
        ``(d) Enhancing the Participation of Principal Investigators and
    Researchers Who Are Members of Underrepresented Populations.--
                ``(1) In general.--The Director shall enhance diversity in
            the conduct or support of clinical research on Alzheimer's
            disease under this subpart by encouraging the participation of
            individuals from groups that are underrepresented in the
            biomedical, clinical, behavioral, and social sciences as
            principal investigators of such clinical research, as
            researchers for such clinical research, or both.
                ``(2) Training for principal investigators.--The Director
            of the Institute shall provide training for principal
            investigators who are members of a minority group with respect
            to skills for--
                        ``(A) the design and conduct of clinical research
                    and clinical protocols;
                        ``(B) applying for grants for clinical research;
                    and
                        ``(C) such other areas as the Director determines
                    to be appropriate.''.
                (2) Senior researcher awards.--Section 445B(a) of the
            Public Health Service Act (42 U.S.C. 285e-4(a)) is amended by
            inserting ``, including senior researchers who are members of a
            minority group'' before the period at the end of the first
            sentence.
        (c) Incentives To Increase Diversity in Alzheimer's Disease
    Research Through Trial Sites.--Section 444(d) of the Public Health
    Service Act (42 U.S.C. 285e-1(d)) is amended--
                (1) by striking ``(d)'' and inserting ``(d)(1)''; and
                (2) by adding at the end the following new paragraphs:
        ``(2) In conducting or supporting clinical research on Alzheimer's
    disease for purposes of this subpart, in addition to requirements
    otherwise imposed under this title, including under section 492B, the
    Director of the Institute shall increase the participation of members
    of minority groups in such clinical research through one or more of the
    activities described in paragraph (3).
        ``(3)(A) The Director of the Institute shall provide incentives for
    the support of clinical research on Alzheimer's disease with clinical
    trial sites established in areas with a higher concentration of
    minority groups, including rural areas if practicable.
        ``(B) In determining whether to conduct or support clinical
    research on Alzheimer's disease, the Director of the Institute shall
    encourage the conduct of clinical research with clinical trial sites in
    areas described in subparagraph (A) as a higher-level priority
    criterion among the criteria established to evaluate whether to conduct
    or support clinical research.
        ``(C) In determining the amount of funding to be provided for the
    conduct or support of such clinical research, the Director of the
    Institute shall provide additional funding for the conduct of such
    clinical research with clinical trial sites in areas described in
    subparagraph (A).
        ``(D) In determining whether an area is an area with a higher
    concentration of minority groups, the Director of the Institute--
                ``(i) shall consider the most recent data collected by the
            Bureau of the Census; and
                ``(ii) may also consider--
                        ``(I) data from the Centers for Medicare & Medicaid
                    Services on the incidence of Alzheimer's disease in the
                    United States by region; and
                        ``(II) such other data as the Director determines
                    appropriate.
        ``(4) In order to facilitate the participation of members of
    minority groups in clinical research supported under this subpart, in
    addition to activities described in paragraph (3), the Director of the
    Institute shall--
                ``(A) ensure that such clinical research uses community-
            based participatory research methodologies; and
                ``(B) encourage the use of remote health technologies,
            including telehealth, remote patient monitoring, and mobile
            technologies, that reduce or eliminate barriers to
            participation of members of minority groups in such clinical
            research.
        ``(5)(A) Clinical research on Alzheimer's disease conducted or
    supported under this subpart shall ensure that such research includes
    outreach activities designed to increase the participation of members
    of minority groups in such research.
        ``(B)(i) Each applicant for a grant under this subpart for clinical
    research on Alzheimer's disease shall submit to the Director of the
    Institute in the application for such grant--
                ``(I) a budget for outreach activities to members of
            minority populations with respect to participation in such
            clinical research; and
                ``(II) a description of the plan to conduct such outreach.
        ``(ii) The Director of the Institute shall encourage applicants
    for, and recipients of, grants under this subpart to conduct clinical
    research on Alzheimer's disease to engage with community-based
    organizations to increase participation of minority populations in such
    research.
        ``(6) For purposes of this subpart:
                ``(A) The term `clinical research' includes a clinical
            trial.
                ``(B) The term `minority group' has the meaning given such
            term by reason of section 492B(g).''.
        (d) Participant Eligibility Criteria.--Section 445I of the Public
    Health Service Act (42 U.S.C. 285e-10a), as amended by subsection
    (b)(1), is further amended by adding at the end the following new
    subsection:
        ``(e) Participant Eligibility Criteria.--The Director of the
    Institute shall take such actions as are necessary to ensure that
    clinical research on Alzheimer's disease conducted or supported under
    this subpart is designed with eligibility criteria that ensure the
    clinical trial population reflects the diversity of the prospective
    patient population. Such actions may include the following:
                ``(1) Examination of criteria.--
                        ``(A) In general.--An examination of each exclusion
                    criterion to determine if the criterion is necessary to
                    ensure the safety of trial participants or to achieve
                    the study objectives.
                        ``(B) Modification of criteria.--In the case of an
                    exclusion criterion that is not necessary to ensure the
                    safety of trial participants or to achieve the study
                    objectives--
                                ``(i) encouraging the modification or
                            elimination of the criterion; or
                                ``(ii) encouraging tailoring the criterion
                            as narrowly as possible to avoid unnecessary
                            limits to the population of the clinical study.
                ``(2) Requirement for strong justification for exclusion.--
            A review of each exclusion criterion to ensure that populations
            are included in clinical trials, such as older adults,
            individuals with a mild form of disease, individuals at the
            extremes of the weight range, or children, unless there is a
            strong clinical or scientific justification to exclude them.
                ``(3) Use of adaptive design.--Encouraging the use of an
            adaptive clinical trial design that--
                        ``(A) starts with a defined population where there
                    are concerns about safety; and
                        ``(B) may expand to a broader population based on
                    initial data from the trial and external data.''.
        (e) Resource Center for Successful Strategies To Increase
    Participation of Underrepresented Populations in Alzheimer's Disease
    Clinical Research.--Section 444 of the Public Health Service Act (42
    U.S.C. 285e-1) is amended by adding at the end the following new
    subsection:
        ``(e)(1) Acting through the Office of Special Populations and in
    consultation with the Division of Extramural Activities, the Director
    of the Institute shall support resource information and technical
    assistance to grantees under section 445 (relating to Alzheimer's
    disease centers), other grantees, and prospective grantees, designed to
    increase the participation of minority populations in clinical research
    on Alzheimer's disease conducted or supported under this subpart.
        ``(2) The resource information and technical assistance provided
    under paragraph (1) shall include the maintenance of a central resource
    library in order to collect, prepare, analyze, and disseminate
    information relating to strategies and best practices used by
    recipients of grants under this subpart and other researchers in the
    development of the clinical research designed to increase the
    participation of minority populations in such clinical research.''.
        (f) Annual Reports.--Section 444 of the Public Health Service Act
    (42 U.S.C. 285e-1), as amended by subsection (e), is further amended by
    adding at the end the following new subsection:
        ``(f)(1)(A) The Director of the Institute shall submit annual
    reports to the Congress on the impact of the amendments made to this
    subpart by the ENACT Act of 2021.
        ``(B) The Secretary shall transmit a copy of each such report to
    the Advisory Council on Alzheimer's Research, Care, and Services
    established under section 2(e) of the National Alzheimer's Project Act
    (Public Law 111-375).
        ``(2) In each report under paragraph (1), the Director of the
    Institute shall include information and data on the following matters
    with respect to clinical trials on Alzheimer's disease conducted during
    the preceding year:
                ``(A) The number of participants who are members of a
            minority group in such clinical trials.
                ``(B) The number of such clinical trials for which
            incentives under subsection (d)(3) were made available, the
            nature of such incentives, the amount of increased funding (if
            any) made available for research on Alzheimer's disease, and
            the training provided to principal investigators who are
            members of a minority group and the amount of funding (if any)
            for such training.
                ``(C) The number of such clinical trials for which the
            principal investigator is a member of a minority group.
                ``(D) The number of such clinical trials for which a
            significant percentage of researchers are members of a minority
            group.
                ``(E) Modifications to patient eligibility criteria in
            clinical trial designs under section 445I(e).
                ``(F) Outreach and education efforts conducted under
            section 445(b)(3).
        ``(3) The Director of the Institute shall make each report under
    paragraph (1) available to the public, including through posting on the
    appropriate website of the Department of Health and Human Services.''.
        (g) Authorization of Appropriations.--For each of fiscal years 2022
    through 2026, there is authorized to be appropriated to the Secretary
    of Health and Human Services $60,000,000 to carry out the amendments
    made by this section, to remain available until expended.

                   TITLE VIII--HEALTH INFORMATION TECHNOLOGY

    SEC. 8001. DEFINITIONS.

        In this title:
                (1) Certified electronic health record technology.--The
            term ``certified EHR technology'' has the meaning given such
            term in section 3000 of the Public Health Service Act (42
            U.S.C. 300jj).
                (2) EHR.--The term ``EHR'' means an electronic health
            record.
                (3) Interoperability.--The term ``interoperability'' has
            the meaning given such term in section 3000 of the Public
            Health Service Act (42 U.S.C. 300jj). Evaluation and
            measurement of interoperability shall consider exchange of
            electronic health information, usability of exchanged
            electronic health information, effective application and use of
            the exchanged electronic health information, and impact on
            outcomes of interoperability.
                (4) Access.--The term ``access'', with respect to health
            information, means access described in section 164.524 of title
            45, Code of Federal Regulations (or any successor regulations).
                (5) Certified electronic health record technology; ehr.--
            The terms ``certified electronic health record technology'' and
            ``EHR'' include the health information infrastructure for
            interoperability, access, exchange, and use of electronic
            health information required under title XXX of the Public
            Health Service Act (42 U.S.C. 300jj et seq.), and are not
            limited to electronic health records maintained by doctors.

           Subtitle A--Reducing Health Disparities Through Health IT

    SEC. 8101. 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. Funding initiatives may include establishing basic
    connectivity such as 5G internet for telemedicine capabilities, grant
    funding to implement the next generation EHR, and funding for
    technology hardware.

    SEC. 8102. ASSESSMENT OF IMPACT OF HEALTH IT ON RACIAL AND ETHNIC
                  MINORITY COMMUNITIES; OUTREACH AND ADOPTION OF HEALTH IT
                  IN SUCH COMMUNITIES.

        (a) National Coordinator for Health Information Technology.--
                (1) In general.--Not later than 18 months after the date of
            enactment of this Act, the National Coordinator for Health
            Information Technology (referred to in this title as the
            ``National Coordinator'') shall--
                        (A) 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--
                                (i) are participating in the Medicare
                            program under title XVIII of the Social
                            Security Act (42 U.S.C. 1395 et seq.) or a
                            State plan under title XIX of such Act (42
                            U.S.C. 1396 et seq.) (or a waiver of such
                            plan);
                                (ii) have received incentive payments or
                            incentive payment adjustments under Medicare
                            and Medicaid Electronic Health Records
                            Incentive Programs (as defined in subsection
                            (c)(2));
                                (iii) are MIPS eligible professionals, as
                            defined in paragraph (1)(C) of section 1848(q)
                            of the Social Security Act (42 U.S.C. 1395w-
                            4(q)), for purposes of the Merit-Based
                            Incentive Payment System under such section; or
                                (iv) have been recruited by any of the
                            Health Information Technology Regional
                            Extension Centers established under section
                            3012 of the Public Health Service Act (42
                            U.S.C. 300jj-32); and
                        (B) publish the results of such evaluation
                    including the race and ethnicity of such providers and
                    the populations served by such providers.
                (2) Certification criterion.--Not later than 1 year after
            the date of enactment of this Act, the National Coordinator
            shall--
                        (A) promulgate a certification criterion and module
                    of certified EHR technology that stratifies quality
                    measures for purposes of the Merit-Based Incentive
                    Payment System by disparity characteristics, including
                    race, ethnicity, language, gender, gender identity,
                    sexual orientation, socio-economic status, and
                    disability status, as such characteristics are defined
                    for purposes of certified EHR technology; and
                        (B) report to the Centers for Medicare & Medicaid
                    Services the quality measures stratified by race and at
                    least 2 other disparity characteristics.
        (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 such 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, private entities, national nonprofit
                            intermediaries, and community-based
                            organizations to expand outreach and education
                            for and the adoption of certified EHR
                            technology in communities with a high
                            proportion of individuals from racial and
                            ethnic minority groups (as defined in section
                            1707(g)), 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 8302 of the Health Equity
                                    and Accountability Act of 2022,
                                    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, publish
                                    the results of an evaluation of such
                                    impact.''.

    SEC. 8103. NONDISCRIMINATION AND HEALTH EQUITY IN HEALTH INFORMATION
                  TECHNOLOGY.

        (a) In General.--Covered entities shall ensure that electronic and
    information technology in their health programs or activities does not
    exclude individuals from participation in, deny individuals the
    benefits of, or subject individuals to discrimination under any health
    program or activity on the basis of race, color, national origin, sex,
    age, or disability.
        (b) Covered Entities.--In this section, the term ``covered entity''
    means--
                (1) an entity that operates a health program or activity,
            any part of which receives Federal financial assistance;
                (2) an entity established under title I of the Patient
            Protection and Affordable Care Act (Public Law 114-148) that
            administers a health program or activity; or
                (3) the Department of Health and Human Services.

    SEC. 8104. LANGUAGE ACCESS IN HEALTH INFORMATION TECHNOLOGY.

        The National Coordinator shall--
                (1) not later than 18 months after the date of enactment of
            this Act, propose a rule for providing access to patients,
            through certified EHR technology, to their personal health
            information in a computable format, including using patient
            portals or third-party applications (as described in section
            3009(e) of the Public Health Service Act (42 U.S.C. 300jj-
            19(e))), in the 10 most common non-English languages;
                (2) hold a public hearing to identify best practices for
            carrying out paragraph (1); and
                (3) not later than 6 months after the public hearing under
            paragraph (2), promulgate a final regulation with respect to
            paragraph (1).

        Subtitle B--Modifications To Achieve Parity in Existing Programs

    SEC. 8201. 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 at the end; 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. 8202. 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. 8203. 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 2023 through 2028''.

                  Subtitle C--Additional Research and Studies

    SEC. 8301. 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. 8302. 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. 8303. ASSESSMENT OF USE AND MISUSE OF DE-IDENTIFIED HEALTH DATA.

        (a) In General.--Not later than 18 months after the date of
    enactment of this Act, the Secretary of Health and Human Services
    shall--
                (1) enter into an agreement with the Office of the National
            Coordinator to conduct a study, in consultation with relevant
            stakeholders, on the impact of digital health technology on
            medically underserved areas (as described in section 8302(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) examine the overall prevalence, and historical and
            existing practices and their respective prevalence, of use and
            misuse of de-identified protected health information, as
            defined in section 160.103, title 45, Code of Federal
            Regulations (or any successor regulations), to discriminate
            against or benefit medically underserved areas;
                (2) identify best practices and tools to leverage the
            benefits and prevent misuse of de-identified protected health
            information to discriminate against medically underserved
            areas;
                (3) examine the overall prevalence, and historical and
            existing practices and their respective prevalence, of use and
            misuse of de-identified personal health information other than
            protected health information, as defined in section 160.103,
            title 45, Code of Federal Regulations (or any successor
            regulations), to discriminate against or benefit medically
            underserved areas; and
                (4) identify best practices and tools to leverage the
            benefits and prevent misuse of de-identified personal health
            information other than protected health information to
            discriminate against medically underserved areas.

          Subtitle D--Closing Gaps in Funding To Adopt Certified EHRs

    SEC. 8401. EXTENDING MEDICAID EHR INCENTIVE PAYMENTS TO REHABILITATION
                  FACILITIES, LONG-TERM CARE FACILITIES, AND HOME HEALTH
                  AGENCIES.

         (a) In General.--Section 1903(t)(2)(B) of the Social Security Act
    (42 U.S.C. 1396b(t)(2)(B)) is amended--
                (1) in clause (i), by striking ``, or'' and inserting a
            semicolon;
                (2) in clause (ii), by striking the period at the end and
            inserting a semicolon; and
                (3) by inserting after clause (ii) the following new
            clauses:
                ``(iii) a rehabilitation facility (as defined in section
            1886(j)(1)) that furnishes acute or subacute rehabilitation
            services;
                ``(iv) a long-term care hospital (as defined in section
            1886(d)(1)(B)(iv)); or
                ``(v) a home health agency (as defined in section
            1861(o)).''.
        (b) Effective Date.--The amendment made by subsection (a) shall
    apply with respect to amounts expended under section 1903(a)(3)(F) of
    the Social Security Act (42 U.S.C. 1396b(a)(3)(F)) for calendar
    quarters beginning on or after the date of the enactment of this Act.

    SEC. 8402. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY FOR MEDICAID
                  ELECTRONIC HEALTH RECORD INCENTIVE PAYMENTS.

        (a) In General.--Section 1903(t)(3)(B)(v) of the Social Security
    Act (42 U.S.C. 1396b(t)(3)(B)(v)) is amended to read as follows:
                        ``(v) physician assistant.''.
        (b) Effective Date.--The amendment made by subsection (a) shall
    apply with respect to amounts expended under section 1903(a)(3)(F) of
    the Social Security Act (42 U.S.C. 1396b(a)(3)(F)) for calendar
    quarters beginning on or after the date of the enactment of this Act.

              Subtitle E--Expanding Access to Telehealth Services

    SEC. 8501. REMOVING GEOGRAPHIC REQUIREMENTS FOR TELEHEALTH SERVICES.

        Section 1834(m)(4)(C) of the Social Security Act (42 U.S.C.
    1395m(m)(4)(C)) is amended--
                (1) in clause (i), in the matter preceding subclause (I),
            by inserting ``and clause (iii)'' after ``and (9)''; and
                (2) by adding at the end the following new clause:
                                ``(iii) Removal of geographic
                            requirements.--The geographic requirements
                            described in clause (i) shall not apply with
                            respect to telehealth services furnished on or
                            after the date of the enactment of this
                            clause.''.

    SEC. 8502. EXPANDING ORIGINATING SITES.

        (a) Expanding the Home as an Originating Site.--Section
    1834(m)(4)(C)(ii)(X) of the Social Security Act (42 U.S.C.
    1395m(m)(4)(C)(ii)(X)) is amended to read as follows:
                                        ``(X)(aa) Prior to the date of
                                    enactment of the Health Equity and
                                    Accountability Act of 2022, the home of
                                    an individual but only for purposes of
                                    section 1881(b)(3)(B) or telehealth
                                    services described in paragraph (7).
                                        ``(bb) On or after such date of
                                    enactment, the home of an
                                    individual.''.
        (b) Allowing Additional Originating Sites.--Section
    1834(m)(4)(C)(ii) of the Social Security Act (42 U.S.C.
    1395m(m)(4)(C)(ii)) is amended by adding at the end the following new
    subclause:
                                        ``(XII) Any other site determined
                                    appropriate by the Secretary at which
                                    an eligible telehealth individual is
                                    located at the time a telehealth
                                    service is furnished via a
                                    telecommunications system.''.
        (c) Parameters for New Originating Sites.--Section 1834(m)(4)(C) of
    the Social Security Act (42 U.S.C. 1395m(m)(4)(C)), as amended by
    section 102, is amended by adding at the end the following new clause:
                                ``(iv) Requirements for new sites.--
                                        ``(I) In general.--The Secretary
                                    may establish requirements for the
                                    furnishing of telehealth services at
                                    sites described in clause (ii)(XII) to
                                    provide for beneficiary and program
                                    integrity protections.
                                        ``(II) Clarification.--Nothing in
                                    this clause shall be construed to
                                    preclude the Secretary from
                                    establishing requirements for other
                                    originating sites described in clause
                                    (ii)''.
        (d) No Originating Site Facility Fee for New Sites.--Section
    1834(m)(2)(B)(ii) of the Social Security Act (42 U.S.C.
    1395m(m)(2)(B)(ii)) is amended--
                (1) in the heading, by striking ``if originating site is
            the home'' and inserting ``for certain sites''; and
                (2) by striking ``paragraph (4)(C)(ii)(X)'' and inserting
            ``subclause (X) or (XII) of paragraph (4)(C)''.

                    TITLE IX--ACCOUNTABILITY AND EVALUATION

    SEC. 9001. PROHIBITION ON DISCRIMINATION IN FEDERAL ASSISTED HEALTH
                  CARE SERVICES AND RESEARCH ON THE BASIS OF SEX (INCLUDING
                  SEXUAL ORIENTATION, GENDER IDENTITY, AND PREGNANCY,
                  INCLUDING TERMINATION OF PREGNANCY), RACE, COLOR,
                  NATIONAL ORIGIN, MARITAL STATUS, FAMILIAL STATUS, OR
                  DISABILITY STATUS.

        (a) In General.--No person in the United States shall, on the basis
    of sex (including sexual orientation, gender identity, and pregnancy,
    including termination of pregnancy), race, color, national origin,
    marital status, familial status, sexual orientation, gender identity,
    or disability status, be excluded from participation in, be denied the
    benefits of, or be subjected to discrimination under--
                (1) any health program or activity, including any health
            research program or activity, receiving Federal financial
            assistance, including credits, subsidies, or contracts of
            insurance; or
                (2) any health program or activity that is administered by
            an executive agency.
        (b) Definition.--In this section, the term ``familial status''
    means, with respect to one or more individuals--
                (1) being domiciled with any individual related by blood or
            affinity whose close association with the individual is the
            equivalent of a family relationship;
                (2) being in the process of securing legal custody of any
            individual; or
                (3) being pregnant.

    SEC. 9002. TREATMENT OF MEDICARE PAYMENTS UNDER TITLE VI OF THE CIVIL
                  RIGHTS ACT OF 1964.

        For the purposes of title VI of the Civil Rights Act of 1964 (42
    U.S.C. 2000d-1 et seq.), a payment made under part A, B, C, or D of
    title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) to a
    provider of services, physician, or other supplier (including a payment
    made to a subcontractor of the provider of services, physician, or
    other supplier) shall be deemed a grant, not a contract of insurance or
    guaranty.

    SEC. 9003. ACCOUNTABILITY AND TRANSPARENCY WITHIN THE DEPARTMENT OF
                  HEALTH AND HUMAN SERVICES.

        Title XXXIV of the Public Health Service Act, as amended by titles
    I, II, III, and IV of this Act, is further amended by inserting after
    subtitle C the following:

                   ``Subtitle E--Strengthening Accountability

    ``SEC. 3451. ELEVATION OF THE OFFICE FOR CIVIL RIGHTS AND HEALTH
                  EQUITY.

        ``(a) In General.--
                ``(1) Name of office.--Beginning on the date of enactment
            of this Act, the Office for Civil Rights of the Department of
            Health and Human Services shall be known as the `Office for
            Civil Rights and Health Equity' of the Department of Health and
            Human Services. Any reference to the Office for Civil Rights of
            the Department of Health and Human Services in any law,
            regulation, map, document, record, or other paper of the United
            States shall be deemed to be a reference to the Office for
            Civil Rights and Health Equity.
                ``(2) Head of office.--The head of the Office for Civil
            Rights and Health Equity shall be the Director for Civil Rights
            and Health Equity, to be appointed by the President. Any
            reference to the Director of the Office for Civil Rights of the
            Department of Health and Human Services in any law, regulation,
            map, document, record, or other paper of the United States
            shall be deemed to be a reference to the Director for Civil
            Rights and Health Equity.
        ``(b) Purpose.--The Director for Civil Rights and Health Equity
    shall ensure that the health programs, activities, policies, projects,
    procedures, and operations of health entities that receive Federal
    financial assistance are in compliance with title VI of the Civil
    Rights Act of 1964, including through the following activities:
                ``(1) The development and implementation of an action plan
            to address racial and ethnic health care disparities. Such plan
            shall--
                        ``(A) address concerns relating to the Office for
                    Civil Rights and Health Equity 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 existing
                    and future reports of the National Academy of Medicine
                    (formerly known as the Institute of Medicine) including
                    the reports titled `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 of the National Academies of Sciences,
                    Engineering, and Medicine;
                        ``(B) be issued in proposed form for public review
                    and comment; and
                        ``(C) be finalized taking into consideration any
                    comments or concerns that are received by the Office.
                ``(2) Investigative and enforcement actions against
            intentional or in effect discrimination and policies and
            practices that have a disparate impact on racial or ethnic
            minorities and communities of color pursuant to section 9007 of
            the Health Equity and Accountability Act of 2022.
                ``(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, including the
            process of filing a complaint.
                ``(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 3452.
                ``(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,
                            monitoring, 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 for Civil Rights and Health Equity 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) health equity;
                        ``(F) cultural and linguistic competency;
                        ``(G) civil rights; and
                        ``(H) social, political, mental, behavioral,
                    economic, and related determinants of health, including
                    education access and quality, health care access and
                    quality, neighborhood and built environment, and social
                    and community context.
        ``(d) Advisory Board.--
                ``(1) Establishment.--The Secretary, in collaboration with
            the Director Civil Rights and Health Equity and the Deputy
            Assistant Secretary for Minority Health, shall establish an
            advisory board (in this subsection referred to as the `advisory
            board') to report in accordance with paragraph (2).
                ``(2) Reports to congress.--Not later than December 31,
            2023, and annually thereafter, the advisory board shall publish
            and submit to the Office, other Federal agencies, and the
            Congress a report that includes--
                        ``(A) the number of complaints filed during the
                    reporting period under title VI of the Civil Rights
                    Act, broken down by category;
                        ``(B) the number of such complaints investigated
                    and closed by the Office;
                        ``(C) the outcomes of such complaints investigated;
                        ``(D) the staffing levels of the Office including
                    staff credentials;
                        ``(E) the number of such complaints that are
                    pending (including backlogged complaints) in which
                    civil rights inequities can be demonstrated and an
                    explanation of why such complaints remain pending; and
                        ``(F) trends among filed complaints and other
                    systemic patterns or themes, including an analysis from
                    the Department of Justice about litigation concerning
                    such complaints.
                ``(3) Composition.--The members of the advisory board shall
            include--
                        ``(A) representatives of stakeholders; and
                        ``(B) subject matter- and disciplinary-appropriate
                    experts.
        ``(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 2023 through 2027.

    ``SEC. 3452. ESTABLISHMENT OF HEALTH PROGRAM OFFICES FOR CIVIL RIGHTS
                  WITHIN AGENCIES OF DEPARTMENT OF HEALTH AND HUMAN
                  SERVICES.

        ``(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, and determine and
    implement policies, services, and activities, in a manner that--
                ``(1) does not discriminate, either intentionally or in
            effect, on the basis of race, color, national origin, language,
            ethnicity, sex, age, disability status, sexual orientation, or
            gender identity; and
                ``(2) promotes the reduction and elimination of disparities
            in health and health care based on race, color, national
            origin, language, ethnicity, sex, age, disability status,
            sexual orientation, or gender identity.
        ``(c) Powers and Duties.--The offices established in subsection (a)
    shall, with respect to the applicable agency, 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 agency,
            including the establishment of disparity reduction standards to
            encompass disparities in health and health care related to
            race, color, national origin, language, ethnicity, sex, age,
            disability, sexual orientation, or gender identity.
                ``(2) The development and implementation of policies,
            procedures, and 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--
                        ``(A) 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; and
                        ``(B) include an analysis of the intersecting forms
                    of discrimination.
                ``(4) Oversight of data collection, reporting, 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;
                        ``(B) the National Standards on Culturally and
                    Linguistically Appropriate Services of the Office of
                    Minority Health; and
                        ``(C) the disaggregation of all health and health
                    care data by racial and ethnic minority population
                    group.
                ``(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 each civil rights compliance
            office established under 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--
                        ``(A) provide Federal financial assistance for
                    health care, biomedical research, or health services
                    research; or
                        ``(B) are designed to improve the public's health,
                    including health service programs.''.

    SEC. 9004. UNITED STATES COMMISSION ON CIVIL RIGHTS.

        (a) Coordination Within Department of Justice of Activities
    Regarding Health Disparities.--Section 3(a) of the Civil Rights
    Commission Act of 1983 (42 U.S.C. 1975a(a)) is amended--
                (1) in paragraph (1), by striking ``and'' at the end;
                (2) in paragraph (2), by striking the period at the end and
            inserting ``; and''; and
                (3) by adding at the end the following:
                ``(3) shall, with respect to activities carried out in
            health care and correctional facilities toward the goal of
            eliminating health disparities between the general population
            and members of minority groups based on race or color, promote
            coordination of such activities of--
                        ``(A) the Office for Civil Rights within the Office
                    of Justice Programs of the Department of Justice;
                        ``(B) the Office of Justice Programs within the
                    Department of Justice;
                        ``(C) the Office for Civil Rights within the
                    Department of Health and Human Services; and
                        ``(D) the Office of Minority Health within the
                    Department of Health and Human Services (headed by the
                    Deputy Assistant Secretary for Minority Health).''.
        (b) Authorization of Appropriations.--Section 5 of the Civil Rights
    Commission Act of 1983 (42 U.S.C. 1975c) is amended by striking the
    first sentence and inserting the following: ``For the purpose of
    carrying out this Act, there are authorized to be appropriated
    $30,000,000 for fiscal year 2023, and such sums as may be necessary for
    each of the fiscal years 2024 through 2028.''.

    SEC. 9005. SENSE OF CONGRESS CONCERNING FULL FUNDING OF ACTIVITIES TO
                  ELIMINATE RACIAL AND ETHNIC HEALTH DISPARITIES.

        (a) Findings.--The Congress makes the following findings:
                (1) The health status of the population of the United
            States is declining, and the United States currently ranks
            below most industrialized nations in health status measured by
            longevity, sickness, and mortality.
                (2) Racial and ethnic minority populations tend to have the
            poorest health status and face substantial cultural, social,
            political, and economic barriers to obtaining high-quality
            health care.
                (3) Racial and ethnic minority populations experience and
            suffer from the extreme and egregious health disparities and
            inequities that are caused by racism, discrimination, and
            implicit racial and ethnic bias in and throughout the health
            care system.
                (4) Communities of color with intersecting identities and
            backgrounds, including children, older adults, women, people
            with disabilities, people with limited English proficiency,
            immigrants, lesbian, gay, bisexual, transgender, queer, and
            questioning populations, and people with lower incomes
            experience significant personal and structural barriers to
            obtaining affordable, high-quality health care.
                (5) Efforts to reduce and eliminate racial and ethnic
            health disparities and inequities, and improve minority health,
            have been limited by inadequate resources (funding, staffing,
            and stewardship), a lack of prioritization, and a lack of
            accountability from the Federal Government, particularly due to
            stagnant or declining appropriations that are not in line with
            the dire need faced by communities that are impacted.
        (b) Sense of Congress.--It is the sense of the Congress that--
                (1) health disparities negatively impact outcomes for
            health and human security of the Nation;
                (2) reducing racial, ethnic, age, sexual, and gender
            disparities in prevention and treatment are unique civil and
            human rights challenges and, as such, Federal agencies and
            health care entities and systems receiving Federal funds should
            be accountable for their role in causing disparities and
            inequity;
                (3) funding for the National Institute on Minority Health
            and Health Disparities, the Office of Civil Rights in the
            Department of Health and Human Services, the National Institute
            of Nursing Research, and the Office of Minority Health should
            be doubled by fiscal year 2023, to effectively address racial
            and ethnic disparities elimination in health and health care as
            a matter of health and national security;
                (4) adequate funding by fiscal year 2023, and subsequent
            funding increases, should be provided for health and human
            service professions training programs, the Racial and Ethnic
            Approaches to Community Health Initiative at the Centers for
            Disease Control and Prevention, the Minority HIV/AIDS
            Initiative, the Excellence Centers to Eliminate Ethnic/Racial
            Disparities Program at the Agency for Healthcare Research and
            Quality, and the National Health Service Corps Scholarship
            Program initiatives, programs, policies, projects, and
            activities that are the backbone of the Nation's agenda to
            eliminate racial and ethnic health disparities and inequities;
                (5) adequate funding for fiscal year 2023 and increased
            funding for future years should be provided for the Racial and
            Ethnic Approaches to Community Health Initiative's United
            States Risk Factor Survey to ensure adequate data collection to
            track health disparities, and there should be appropriate
            avenues provided to disseminate findings to the general public;
                (6) current and newly created health disparity elimination
            incentives, programs, agencies, and departments under this Act
            (and the amendments made by this Act) should receive adequate
            staffing and funding by fiscal year 2023; and
                (7) stewardship and accountability should be provided to
            the Congress and the President for measurable and sustainable
            progress toward health disparity elimination under programs
            under this Act, including increased data collection and
            reporting, capacity building for impacted communities,
            technical assistance, training programs, and avenues to
            disseminate program details and successes to the public and to
            policymakers.

    SEC. 9006. GAO AND NIH REPORTS.

        (a) GAO Report on NIH Grant Racial and Ethnic Diversity.--
                (1) In general.--The Comptroller General of the United
            States shall conduct a study on the racial and ethnic diversity
            among the following groups:
                        (A) All applicants for grants, contracts, and
                    cooperative agreements awarded by the National
                    Institutes of Health during the period beginning on
                    January 1, 2023, and ending December 31, 2032.
                        (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
            enactment of this Act, the Comptroller General shall complete
            the study under paragraph (1) and submit to the Congress a
            report containing the results of such study.
        (b) NIH Report on Certain Authority of National Institute on
    Minority Health and Health Disparities.--Not later than 6 months after
    the date of enactment of this Act, and biennially thereafter, the
    Director of the National Institutes of Health, in collaboration with
    the Director of the National Institute on Minority Health and Health
    Disparities, shall submit to the Congress a report that details and
    evaluates--
                (1) the steps taken during the applicable report period by
            the Director of the National Institutes of Health to plan,
            coordinate, review, and evaluate all minority health and health
            disparity research that is conducted or supported by the
            institutes and centers at the National Institutes of Health;
            and
                (2) the outcomes of such steps.
        (c) GAO Report Related to Recipients of PPACA Funding.--Not later
    than one year after the date of enactment of this Act and biennially
    thereafter, the Comptroller General of the United States shall submit
    to the Congress a report that identifies--
                (1) the racial and ethnic diversity of community-based
            organizations that applied for Federal enrollment funding
            provided pursuant to the Patient Protection and Affordable Care
            Act (Public Law 111-148) (including the amendments made by such
            Act);
                (2) the percentage of such organizations that were awarded
            such funding; and
                (3) the impact of such community-based organizations'
            enrollment efforts on the insurance status of their
            communities.
        (d) Annual Report on Activities of National Institute on Minority
    Health and Health Disparities.--The Director of the National Institute
    on Minority Health and Health Disparities shall prepare an annual
    report on the activities carried out or to be carried out by such
    institute, and shall submit each such report to the Committee on
    Health, Education, Labor, and Pensions of the Senate, the Committee on
    Energy and Commerce of the House of Representatives, the Secretary of
    Health and Human Services, and the Director of the National Institutes
    of Health. With respect to the fiscal year involved, the report shall--
                (1) describe and evaluate the progress made in health
            disparities research conducted or supported by institutes and
            centers of the National Institutes of Health;
                (2) summarize and analyze expenditures made for activities
            with respect to health disparities research conducted or
            supported by the National Institutes of Health;
                (3) include a separate statement applying the requirements
            of paragraphs (1) and (2) specifically to minority health
            disparities research; and
                (4) contain such recommendations as the Director of the
            Institute considers appropriate.

    SEC. 9007. INVESTIGATIVE AND ENFORCEMENT ACTIONS.

        (a) In General.--In carrying out the investigative and enforcement
    actions of section 3451(b)(2) of the Public Health Service Act, as
    added by section 9003 of this Act, the Director for Civil Rights and
    Health Equity shall pursue such investigative and enforcements actions
    pursuant to this section.
        (b) Administrative Complaint and Conciliation Process.--
                (1) Complaints and answers.--
                        (A) In general.--An aggrieved person may, not later
                    than 1 year after an alleged violation of subsection
                    (a) has occurred or concluded, file a complaint with
                    the Director alleging inequitable provision of health
                    care by a provider described in subsection (a).
                        (B) Complaint.--A complaint submitted pursuant to
                    subparagraph (A) shall be in writing and shall contain
                    such information and be in such form as the Director
                    requires.
                        (C) Oath or affirmation.--The complaint and any
                    answer made under this subsection shall be made under
                    oath or affirmation, and may be reasonably and fairly
                    modified at any time.
                (2) Response to complaints.--
                        (A) In general.--Upon the filing of a complaint
                    under this subsection, the following procedures shall
                    apply:
                                (i) Complainant notice.--The Director shall
                            serve notice upon the complainant acknowledging
                            receipt of such filing and advising the
                            complainant of the time limits and procedures
                            provided under this section.
                                (ii) Respondent notice.--The Director
                            shall, not later than 30 days after receipt of
                            such filing--
                                        (I) serve on the respondent a
                                    notice of the complaint, together with
                                    a copy of the original complaint; and
                                        (II) advise the respondent of the
                                    procedural rights and obligations of
                                    respondents under this section.
                                (iii) Answer.--The respondent may file, not
                            later than 60 days after receipt of the notice
                            from the Director, an answer to such complaint.
                                (iv) Investigative duties.--The Director
                            shall--
                                        (I) make an investigation of the
                                    alleged inequitable provision of health
                                    care; and
                                        (II) complete such investigation
                                    within 180 days (unless it is
                                    impracticable to complete such
                                    investigation within 180 days) after
                                    the filing of the complaint.
                        (B) Investigations.--
                                (i) Pattern or practice.--In the course of
                            investigating the complaint, the Director may
                            seek records of care provided to patients other
                            than the complainant if necessary to
                            demonstrate or disprove an allegation of
                            inequitable provision of health care or to
                            determine whether there is a pattern or
                            practice of such care.
                                (ii) Accounting for social determinants of
                            health.--In investigating the complaint and
                            reaching a determination on the validity of the
                            complaint, the Director shall account for
                            social determinants of health and the effect of
                            such social determinants on health care
                            outcomes.
                                (iii) Inability to complete
                            investigation.--If the Director is unable to
                            complete (or finds it is impracticable to
                            complete) the investigation within 180 days
                            after the filing of the complaint (or, if the
                            Secretary takes further action under paragraph
                            (6)(B) with respect to a complaint, within 180
                            days after the commencement of such further
                            action), the Director shall notify the
                            complainant and respondent in writing of the
                            reasons involved.
                                (iv) Report to state licensing
                            authorities.--On concluding each investigation
                            under this subparagraph, the Director shall
                            provide to the State licensing authorities that
                            were notified under subparagraph (A),
                            information specifying the results of the
                            investigation.
                        (C) Report.--
                                (i) Final report.--On completing each
                            investigation under this paragraph, the
                            Director shall prepare a final investigative
                            report.
                                (ii) Modification of report.--A final
                            report under this subparagraph may be modified
                            if additional evidence is later discovered.
                (3) Conciliation.--
                        (A) In general.--During the period beginning on the
                    date on which a complaint is filed under this
                    subsection and ending on the date of final disposition
                    of such complaint (including during an investigation
                    under paragraph (2)(B)), the Director shall, to the
                    extent feasible, engage in conciliation with respect to
                    such complaint.
                        (B) Conciliation agreement.--A conciliation
                    agreement arising out of such conciliation shall be an
                    agreement between the respondent and the complainant,
                    and shall be subject to approval by the Director.
                        (C) Rights protected.--The Director shall approve a
                    conciliation agreement only if the agreement protects
                    the rights of the complainant and other persons
                    similarly situated.
                        (D) Publicly available agreement.--
                                (i) In general.--Subject to clause (ii),
                            the Secretary shall make available to the
                            public a copy of a conciliation agreement
                            entered into pursuant to this subsection unless
                            the complainant and respondent otherwise agree,
                            and the Secretary determines, that disclosure
                            is not required to further the purposes of this
                            subsection.
                                (ii) Limitation.--A conciliation agreement
                            that is made available to the public pursuant
                            to clause (i) may not disclose individually
                            identifiable health information.
                (4) Failure to comply with conciliation agreement.--
            Whenever the Director has reasonable cause to believe that a
            respondent has breached a conciliation agreement, the Director
            shall refer the matter to the Attorney General to consider
            filing a civil action to enforce such agreement.
                (5) Written consent for disclosure of information.--Nothing
            said or done in the course of conciliation under this
            subsection may be made public, or used as evidence in a
            subsequent proceeding under this subsection, without the
            written consent of the parties to the conciliation.
                (6) Prompt judicial action.--
                        (A) In general.--If the Director determines at any
                    time following the filing of a complaint under this
                    subsection that prompt judicial action is necessary to
                    carry out the purposes of this subsection, the Director
                    may recommend that the Attorney General promptly
                    commence a civil action under subsection (d).
                        (B) Immediate suit.--If the Director determines at
                    any time following the filing of a complaint under this
                    subsection that the public interest would be served by
                    allowing the complainant to bring a civil action under
                    subsection (c) in a State or Federal court immediately,
                    the Director shall certify that the administrative
                    process has concluded and that the complainant may file
                    such a suit immediately.
                (7) Annual report.--Not later than 1 year after the date of
            enactment of this Act, and annually thereafter, the Director
            shall make publicly available a report detailing the activities
            of the Office for Civil Rights and Health Equity under this
            subsection, including--
                        (A) the number of complaints filed and the basis on
                    which the complaints were filed;
                        (B) the number of investigations undertaken as a
                    result of such complaints; and
                        (C) the disposition of all such investigations.
        (c) Enforcement by Private Persons.--
                (1) In general.--
                        (A) Civil action.--
                                (i) In suit.--A complainant under
                            subsection (b) may commence a civil action to
                            obtain appropriate relief with respect to an
                            alleged violation of subsection (a), or for
                            breach of a conciliation agreement under
                            subsection (b), in an appropriate district
                            court of the United States or State court--
                                        (I) not sooner than the earliest
                                    of--
                                                (aa) the date a
                                            conciliation agreement is
                                            reached under subsection (b);
                                                (bb) the date of a final
                                            disposition of a complaint
                                            under subsection (b); or
                                                (cc) 180 days after the
                                            first day of the alleged
                                            violation; and
                                        (II) not later than 2 years after
                                    the final day of the alleged violation.
                                (ii) Statute of limitations.--The
                            computation of such 2-year period shall not
                            include any time during which an administrative
                            proceeding (including investigation or
                            conciliation) under subsection (b) was pending
                            with respect to a complaint under such
                            subsection.
                        (B) Barring suit.--If the Director has obtained a
                    conciliation agreement under subsection (b) regarding
                    an alleged violation of subsection (a), no action may
                    be filed under this paragraph by the complainant
                    involved with respect to the alleged violation except
                    for the purpose of enforcing the terms of such an
                    agreement.
                (2) Relief which may be granted.--
                        (A) In general.--In a civil action under paragraph
                    (1), if the court finds that a violation of subsection
                    (a) or breach of a conciliation agreement has occurred,
                    the court may award to the plaintiff actual and
                    punitive damages, and may grant as relief, as the court
                    determines to be appropriate, any permanent or
                    temporary injunction, temporary restraining order, or
                    other order (including an order enjoining the defendant
                    from engaging in a practice violating subsection (a) or
                    ordering such affirmative action as may be
                    appropriate).
                        (B) Fees and costs.--In a civil action under
                    paragraph (1), the court, in its discretion, may allow
                    the prevailing party, other than the United States, a
                    reasonable attorney's fee and costs. The United States
                    shall be liable for such fees and costs to the same
                    extent as a private person.
                (3) Intervention by attorney general.--Upon timely
            application, the Attorney General may intervene in a civil
            action under paragraph (1), if the Attorney General certifies
            that the case is of general public importance.
        (d) Enforcement by the Attorney General.--
                (1) Commencement of actions.--
                        (A) Pattern or practice cases.--The Attorney
                    General may commence a civil action in any appropriate
                    district court of the United States if the Attorney
                    General has reasonable cause to believe that any health
                    care provider covered by subsection (a)--
                                (i) is engaged in a pattern or practice
                            that violates such subsection; or
                                (ii) is engaged in a violation of such
                            subsection that raises an issue of significant
                            public importance.
                        (B) Cases by referral.--The Director may determine,
                    based on a pattern of complaints, a pattern of
                    violations, a review of data reported by a health care
                    provider covered by subsection (a), or any other means,
                    that there is reasonable cause to believe a health care
                    provider is engaged in a pattern or practice that
                    violates subsection (a). If the Director makes such a
                    determination, the Director shall refer the related
                    findings to the Attorney General. If the Attorney
                    General finds that such reasonable cause exists, the
                    Attorney General may commence a civil action in any
                    appropriate district court of the United States.
                (2) Enforcement of subpoenas.--The Attorney General, on
            behalf of the Director, or another party at whose request a
            subpoena is issued under this subsection, may enforce such
            subpoena in appropriate proceedings in the district court of
            the United States for the district in which the person to whom
            the subpoena was addressed resides, was served, or transacts
            business.
                (3) Relief which may be granted in civil actions.--
                        (A) In general.--In a civil action under paragraph
                    (1), the court--
                                (i) may award such preventive relief,
                            including a permanent or temporary injunction,
                            temporary restraining order, or other order
                            against the person responsible for a violation
                            of subsection (a) as is necessary to assure the
                            full enjoyment of the rights granted by this
                            subsection;
                                (ii) may award such other relief as the
                            court determines to be appropriate, including
                            monetary damages, to aggrieved persons; and
                                (iii) may, to vindicate the public
                            interest, assess punitive damages against the
                            respondent--
                                        (I) in an amount not exceeding
                                    $500,000, for a first violation; and
                                        (II) in an amount not exceeding
                                    $1,000,000, for any subsequent
                                    violation.
                        (B) Fees and costs.--In a civil action under this
                    subsection, the court, in its discretion, may allow the
                    prevailing party, other than the United States, a
                    reasonable attorney's fee and costs. The United States
                    shall be liable for such fees and costs to the extent
                    provided by section 2412 of title 28, United States
                    Code.
                (4) Intervention in civil actions.--Upon timely
            application, any person may intervene in a civil action
            commenced by the Attorney General under paragraphs (1) and (2)
            if the action involves an alleged violation of subsection (a)
            with respect to which such person is an aggrieved person
            (including a person who is a complainant under subsection (b))
            or a conciliation agreement to which such person is a party.

    SEC. 9008. FEDERAL HEALTH EQUITY COMMISSION.

        (a) Establishment of Commission.--
                (1) In general.--There is established the Federal Health
            Equity Commission (hereinafter in this section referred to as
            the ``Commission'').
                (2) Membership.--
                        (A) In general.--The Commission shall be composed
                    of--
                                (i) 8 voting members appointed under
                            subparagraph (B); and
                                (ii) the nonvoting, ex officio members
                            listed in subparagraph (C).
                        (B) Voting members.--Not more than 4 of the members
                    described in subparagraph (A)(i) shall at any one time
                    be of the same political party. Such members shall have
                    recognized expertise in and personal experience with
                    racial and ethnic health inequities, health care needs
                    of vulnerable and marginalized populations, and health
                    equity as a vehicle for improving health status and
                    health outcomes. Such members shall be appointed to the
                    Commission as follows:
                                (i) Four members of the Commission shall be
                            appointed by the President.
                                (ii) Two members of the Commission shall be
                            appointed by the President pro tempore of the
                            Senate, upon the recommendations of the
                            majority leader and the minority leader of the
                            Senate. Each member appointed to the Commission
                            under this clause shall be appointed from a
                            different political party.
                                (iii) Two members of the Commission shall
                            be appointed by the Speaker of the House of
                            Representatives upon the recommendations of the
                            majority leader and the minority leader of the
                            House of Representatives. Each member appointed
                            to the Commission under this clause shall be
                            appointed from a different political party.
                        (C) Ex officio member.--The Commission shall have
                    the following nonvoting, ex officio members:
                                (i) The Director for Civil Rights and
                            Health Equity of the Department of Health and
                            Human Services.
                                (ii) The Deputy Assistant Secretary for
                            Minority Health of the Department of Health and
                            Human Services.
                                (iii) The Director of the National
                            Institute on Minority Health and Health
                            Disparities.
                                (iv) The Chairperson of the Advisory
                            Committee on Minority Health established under
                            section 1707(c) of the Public Health Service
                            Act (42 U.S.C. 300u-6(c)).
                (3) Terms.--The term of office of each member appointed
            under paragraph (2)(B) of the Commission shall be 6 years.
                (4) Chairperson; vice chairperson.--
                        (A) Chairperson.--The President shall, with the
                    concurrence of a majority of the members of the
                    Commission appointed under paragraph (2)(B), designate
                    a Chairperson from among the members of the Commission
                    appointed under such paragraph.
                        (B) Vice chairperson.--
                                (i) Designation.--The Speaker of the House
                            of Representatives shall, in consultation with
                            the majority leaders and the minority leaders
                            of the Senate and the House of Representatives
                            and with the concurrence of a majority of the
                            members of the Commission appointed under
                            paragraph (2)(B), designate a Vice Chairperson
                            from among the members of the Commission
                            appointed under such paragraph. The Vice
                            Chairperson may not be a member of the same
                            political party as the Chairperson.
                                (ii) Duty.--The Vice Chairperson shall act
                            in place of the Chairperson in the absence of
                            the Chairperson.
                (5) Removal of members.--The President may remove a member
            of the Commission only for neglect of duty or malfeasance in
            office.
                (6) Quorum.--A majority of members of the Commission
            appointed under paragraph (2)(B) shall constitute a quorum of
            the Commission, but a lesser number of members may hold
            hearings.
        (b) Duties of the Commission.--
                (1) In general.--The Commission shall--
                        (A) monitor and report on the implementation of
                    this Act; and
                        (B) investigate, monitor, and report on progress
                    towards health equity and the elimination of health
                    disparities.
                (2) Annual report.--The Commission shall--
                        (A) submit to the President and Congress at least
                    one report annually on health equity and health
                    disparities; and
                        (B) include in such report--
                                (i) a description of actions taken by the
                            Department of Health and Human Services and any
                            other Federal agency related to health equity
                            or health disparities; and
                                (ii) recommendations on ensuring equitable
                            health care and eliminating health disparities.
        (c) Powers.--
                (1) Hearings.--
                        (A) In general.--The Commission or, at the
                    direction of the Commission, any subcommittee or member
                    of the Commission, may, for the purpose of carrying out
                    this section, as the Commission or the subcommittee or
                    member considers advisable--
                                (i) hold such hearings, meet and act at
                            such times and places, take such testimony,
                            receive such evidence, and administer such
                            oaths; and
                                (ii) require, by subpoena or otherwise, the
                            attendance and testimony of such witnesses and
                            the production of such books, records,
                            correspondence, memoranda, papers, documents,
                            tapes, and materials.
                        (B) Limitation on hearings.--The Commission may
                    hold a hearing under subparagraph (A)(i) only if the
                    hearing is approved--
                                (i) by a majority of the members of the
                            Commission appointed under subsection
                            (a)(2)(B); or
                                (ii) by a majority of such members present
                            at a meeting when a quorum is present.
                (2) Issuance and enforcement of subpoenas.--
                        (A) Issuance.--A subpoena issued under paragraph
                    (1) shall--
                                (i) bear the signature of the Chairperson
                            of the Commission; and
                                (ii) be served by any person or class of
                            persons designated by the Chairperson for that
                            purpose.
                        (B) Enforcement.--In the case of contumacy or
                    failure to obey a subpoena issued under paragraph (1),
                    the United States district court for the district in
                    which the subpoenaed person resides, is served, or may
                    be found may issue an order requiring the person to
                    appear at any designated place to testify or to produce
                    documentary or other evidence.
                        (C) Noncompliance.--Any failure to obey the order
                    of the court may be punished by the court as a contempt
                    of court.
                (3) Witness allowances and fees.--
                        (A) In general.--Section 1821 of title 28, United
                    States Code, shall apply to a witness requested or
                    subpoenaed to appear at a hearing of the Commission.
                        (B) Expenses.--The per diem and mileage allowances
                    for a witness shall be paid from funds available to pay
                    the expenses of the Commission.
                (4) Postal services.--The Commission may use the United
            States mails in the same manner and under the same conditions
            as other agencies of the Federal Government.
                (5) Gifts.--The Commission may accept, use, and dispose of
            gifts or donations of services or property.
        (d) Administrative Provisions.--
                (1) Staff.--
                        (A) Director.--There shall be a full-time staff
                    director for the Commission who shall--
                                (i) serve as the administrative head of the
                            Commission; and
                                (ii) be appointed by the Chairperson with
                            the concurrence of the Vice Chairperson.
                        (B) Other personnel.--The Commission may--
                                (i) appoint such other personnel as it
                            considers advisable, subject to the provisions
                            of title 5, United States Code, governing
                            appointments in the competitive service, and
                            the provisions of chapter 51 and subchapter III
                            of chapter 53 of that title relating to
                            classification and General Schedule pay rates;
                            and
                                (ii) may procure temporary and intermittent
                            services under section 3109(b) of title 5,
                            United States Code, at rates for individuals
                            not in excess of the daily equivalent paid for
                            positions at the maximum rate for GS-15 of the
                            General Schedule under section 5332 of title 5,
                            United States Code.
                (2) Compensation of members.--
                        (A) Non-federal employees.--Each member of the
                    Commission who is not an officer or employee of the
                    Federal Government shall be compensated at a rate equal
                    to the daily equivalent of the annual rate of basic pay
                    prescribed for level IV of the Executive Schedule under
                    section 5315 of title 5, United States Code, for each
                    day (including travel time) during which the member is
                    engaged in the performance of the duties of the
                    Commission.
                        (B) Federal employees.--Each member of the
                    Commission who is an officer or employee of the Federal
                    Government shall serve without compensation in addition
                    to the compensation received for the services of the
                    member as an office or employee of the Federal
                    Government.
                        (C) Travel expenses.--A member of the Commission
                    shall be allowed travel expenses, including per diem in
                    lieu of subsistence, at rates authorized for an
                    employee of an agency under subchapter I of chapter 57
                    of title 5, United States Code, while away from the
                    home or regular place of business of the member in the
                    performance of the duties of the Commission.
                (3) Cooperation.--The Commission may secure directly from
            any Federal department or agency such information as the
            Commission considers necessary to carry out this Act. Upon
            request of the Chairman of the Commission, the head of such
            department or agency shall furnish such information to the
            Commission.
        (e) Permanent Commission.--Section 14 of the Federal Advisory
    Committee Act (5 U.S.C. App.) shall not apply to the Commission.
        (f) Authorization of Appropriations.--There are authorized to be
    appropriated for fiscal year 2022 and each fiscal year thereafter such
    sums as may be necessary to carry out the duties of the Commission.

      TITLE X--ADDRESSING SOCIAL DETERMINANTS AND IMPROVING ENVIRONMENTAL
                                    JUSTICE

                             Subtitle A--In General

    SEC. 10001. DEFINITIONS.

        In this title:
                (1) Administrator.--The term ``Administrator'' means the
            Administrator of the Environmental Protection Agency.
                (2) Agency.--The term ``Agency'' means the Environmental
            Protection Agency.
                (3) Built environment.--The term ``built environment''
            means the components of the environment, and the location of
            these components in a geographically defined space, that are
            created or modified by individuals to form the physical and
            social characteristics of a community or enhance quality of
            human life, including--
                        (A) homes, schools, and places of work and worship;
                        (B) parks, recreation areas, and greenways;
                        (C) transportation systems;
                        (D) business, industry, and agriculture; and
                        (E) land-use plans, projects, and policies that
                    impact the physical or social characteristics of a
                    community, including access to services and amenities.
                (4) Determinants of health.--The term ``determinants of
            health''--
                        (A) means the range of nonclinical factors
                    inclusive of personal, social, economic, and
                    environmental factors that directly influence health
                    status; and
                        (B) includes social determinants of health (which
                    are sometimes referred to as ``social and economic
                    determinants of health'', ``socioeconomic determinants
                    of health'', ``environmental determinants of health'',
                    ``social drivers of inequality'', or ``personal
                    determinants of health'').
                (5) Economic determinants of health.--The term ``economic
            determinants of health'' means income and social status.
                (6) Environmental determinants of health.--The term
            ``environmental determinants of health'' means the broad
            physical (including manmade and natural), psychological,
            social, spiritual, cultural, and aesthetic environment.
                (7) Personal determinants of health.--The term ``personal
            determinants of health'' means an individual's behavior,
            biology, and genetics.
                (8) Social determinants of health.--The term ``social
            determinants of health'' means a subset of determinants of the
            health of individuals and environments (such as communities,
            neighborhoods, and societies) that describe an individual's or
            group of people's social identity, describe the social and
            economic resources to which such individual or group has
            access, and describe the conditions in which an individual or
            group of people works, lives, and plays.

    SEC. 10002. FINDINGS.

        Congress finds as follows:
                (1) Social determinants of health are the greatest
            predictors of health outcomes.
                (2) Social determinants of health, including health-related
            behaviors, social and economic factors, and physical
            environment factors account for 80 percent of health outcomes,
            whereas clinical care accounts for 20 percent of improved
            health outcomes. Yet, in 2017, public health spending
            represented only 2.5 percent of all health spending in the
            United States.
                (3) There are more opportunities to improve health for
            everyone when we understand that health starts, first, not in a
            medical setting, but in our families, in our schools and
            workplaces, in our neighborhoods, in the air we breathe, and in
            the water we drink.
                (4)(A) Healthy People 2030 identifies health and health
            care quality as a function of not only access to health care,
            but also the social determinants of health, categorized into
            the following: neighborhoods and the built environment; social
            and community context; education; and economic stability.
                (B) The following examples illustrate the nexus between the
            unequal distribution of the social determinants of health and
            health inequities:
                        (i) The built environment influences residents'
                    level of physical activity. Neighborhoods with high
                    levels of poverty are significantly less likely to have
                    places where children can be physically active, such as
                    parks, green spaces, and bike paths and lanes.
                    Neighborhoods and communities can provide opportunities
                    for physical activity and support active lifestyles
                    through accessible and safe parks and open spaces and
                    through land use policy, zoning, and healthy community
                    design.
                        (ii) Emotional and physical health and well-being
                    are directly impacted by perceived levels of safety,
                    such as unlit streets at night. Community members have
                    expressed that safety is not only a barrier to
                    accessing programs and services that increase quality
                    of life, but also a barrier to accessing physical
                    activity in their community through the built
                    environment.
                        (iii) Historical and institutional racism in the
                    United States has shaped the way in which social and
                    economic resources and exposure to health promoting
                    environments are distributed. Income, education,
                    occupation, neighborhood conditions, schools,
                    workplaces, the use of health and social services, and
                    experiences with the criminal justice system are all
                    highly patterned by race, with people of color
                    experiencing more that is health harming. Finding ways
                    to uncouple the link between race and access to
                    resources and healthy environments is a principal means
                    of reducing health inequities. Additionally, the
                    anticipation of racism itself causes higher
                    psychological and cardiovascular stress levels that are
                    linked to poor health outcomes. Remedying
                    discriminatory practices at the individual and systemic
                    levels will likely reduce health inequities caused by
                    this unequal distribution of stress.
                        (iv) Poor health among Native Americans has largely
                    been driven by post-colonial oppression and historical
                    trauma. The expropriation of native lands and
                    territories to the American state had severe
                    consequences on Native American health. This resulted
                    in the deprivation of traditional food sources--and
                    nutrients--for Native Americans and also the
                    destruction of traditional economies and community
                    organization. Today, Native Americans have twice the
                    rate of diabetes of non-Hispanic Whites. Recognition of
                    the origins of diabetes as having a social and
                    community context, rather than just individual
                    responsibility and genetic predisposition, will shape
                    better policy to provide food security.
                        (v) In the context of prisons, overcrowding has led
                    to the deterioration of the physical and mental health
                    of individuals after they leave prison. In particular,
                    the mass incarceration of African-American males as a
                    result of inequities within and treatment in the
                    criminal justice system has contributed to an
                    overburdening of certain infectious diseases within the
                    African-American community. As a social institution,
                    incarceration amplifies existing adverse health
                    conditions by concentrating diseases and harmful health
                    behaviors such as tobacco use, drug use, and violence.
                        (vi) Educational attainment is the strongest
                    predictor of adult mortality. It is a basic component
                    of socioeconomic status that shapes earning potential
                    to access resources that promote health. People with
                    more education are less likely to report that they are
                    in poor health, and are also less likely to have
                    diabetes and other chronic diseases.
                        (vii) Individuals with lower levels of educational
                    attainment are much more likely to report to be current
                    smokers. In 2017, smoking prevalence was 36.8 percent
                    among adults with a GED diploma, 23.1 percent with less
                    than a high school diploma, and 18.7 percent with a
                    high school diploma, while dropping significantly to
                    7.1 percent among adults with an undergraduate college
                    degree and 4.1 percent with a postgraduate college
                    degree.
                        (viii) Income inequality differences account for a
                    large part of health inequities. For example, children
                    living in poverty experience poorer housing conditions,
                    increased exposure to indoor allergens and toxins (such
                    as pesticides, lead, mercury, radon, air pollution, and
                    carcinogens), increased food insecurity, and more
                    psychological stress. These experiences culminate in
                    worse adult health as compared with children with
                    higher socioeconomic status. Specifically, children
                    living in lower socioeconomic neighborhoods have higher
                    rates of asthma due to higher rates of psychological
                    stress resulting from higher rates of violence. Food
                    insecurity is associated with obesity and racial and
                    ethnic minorities have higher rates of food insecurity.
                        (ix) Lesbian, gay, bisexual, transgender, queer or
                    questioning, intersex, and asexual or allied (referred
                    to in this section as ``LGBTQIA+'') individuals face
                    health inequities linked to societal stigma,
                    discrimination, and denial of their civil and human
                    rights. Discrimination against LGBTQIA+ individuals has
                    been associated with high rates of psychiatric
                    disorders, substance abuse, and suicide. Experiences of
                    violence and victimization are frequent for LGBTQIA+
                    individuals, and have long-lasting effects on the
                    individual and the community. Personal, family, and
                    social acceptance of sexual orientation and gender
                    identity affects the mental health and personal safety
                    of LGBTQIA+ individuals.
                        (x) Individuals in older and cheaper housing are at
                    higher risks to be exposed to lead, particularly in
                    housing built prior to 1960. The threat of lead
                    poisoning disproportionally affects vulnerable
                    populations, with children living in poverty (5.6
                    percent) and Black children (5.6) experiencing the
                    highest rates. According to the Department of Housing
                    and Urban Development, about 3,600,000 homes nationwide
                    that house young children have lead hazards such as
                    contaminated drinking water, peeling paint,
                    contaminated dust, or toxic soil. The combined cost of
                    medical treatment and special education for lead
                    poisoned children averages about $5,600 per child per
                    year, and lead poisoning costs the United States an
                    estimated $50,000,000,000 annually.
                        (xi) According to the report Healthy People 2030,
                    individuals with disabilities, as a group, experience
                    health inequities in routine public health arenas such
                    as health behaviors, clinical preventive services, and
                    chronic conditions. Compared with individuals without
                    disabilities, individuals with disabilities are--
                                (I) less likely to receive recommended
                            preventive health care services, such as
                            routine teeth cleanings and cancer screenings;
                                (II) at a high risk for poor health
                            outcomes such as obesity, hypertension, falls-
                            related injuries, and mood disorders such as
                            depression; and
                                (III) more likely to engage in unhealthy
                            behaviors that put their health at risk, such
                            as cigarette smoking and inadequate physical
                            activity.
                (5) Laws and regulations that improve opportunities to live
            in safe neighborhoods with more social cohesion, attain higher
            education, sustain stable employment, and bridge class
            differences help foster the health and safety of individuals.
                (6) The global public health community has reached
            consensus through the Rio Political Declaration of Social
            Determinants of Health adopted by the World Health Organization
            in October 2011 that ``[c]ollaboration in coordinated and
            intersectoral policy actions has proven to be effective. Health
            in All Policies, an initiative of the American Public Health
            Association, together with intersectoral cooperation and
            action, is one promising approach to enhance accountability in
            other sectors of health, as well as the promotion of health
            equity and more inclusive and productive societies.''.

    SEC. 10003. 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 foster community leadership,
            ownership, and participation in decision-making processes.
                (3) Health impact assessments can build community support
            and reduce opposition to a project or policy, thereby
            facilitating economic growth by aiding the development of
            consensus regarding new development proposals.
                (4) Health impact assessments facilitate collaboration
            across sectors.
        (b) Purposes.--It is the purpose of this section to--
                (1) provide more information about the potential human
            health effects of policy decisions and the distribution of
            those effects;
                (2) improve how health is considered in planning and
            decision-making processes; and
                (3) build stronger, healthier communities through the use
            of health impact assessments.
        (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 7254
    of this Act, is further amended by adding at the end the following:

    ``SEC. 399V-11. 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 potential harms.
                ``(4) Health inequity.--The term `health inequity' 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, Indian Tribes, and Tribal organizations to
                    support subgrantees 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, Indian
            Tribes, and Tribal organizations to award subgrants to eligible
            entities to conduct health impact assessments.
        ``(c) Guidance.--
                ``(1) In general.--Not later than 1 year after the date of
            enactment of the Health Equity and Accountability Act of 2022,
            the Secretary, acting through the Director, shall issue final
            guidance for conducting health impact assessments. In
            developing such guidance the Secretary shall--
                        ``(A) consult with the Director of the National
                    Center for Environmental Health, 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, Indian Tribes, and
                    Tribal organizations to award subgrants to eligible
                    entities for capacity building or to prepare health
                    impact assessments; and
                        ``(B) ensure that States, Indian Tribes, and Tribal
                    organizations receiving a grant under this subsection
                    further support training and technical assistance for
                    subgrantees under subparagraph (A) by funding and
                    overseeing appropriate experts on health impact
                    assessments from local, State, and Tribal governments,
                    the Federal Government, institutions of higher
                    education, and nonprofit organizations to provide such
                    training and technical assistance.
                ``(2) Applications for subgrants.--
                        ``(A) In general.--To be eligible to receive a
                    subgrant under this section, an eligible entity shall--
                                ``(i) be a community-based organization
                            serving individuals or populations the health
                            of which are, or will be, affected by an
                            activity or a proposed activity; and
                                ``(ii) submit to the grantee an application
                            in accordance with this subsection, at such
                            time, in such manner, and containing such
                            additional information as the Secretary (acting
                            through the Director and in collaboration with
                            the Administrator) and the grantee may require.
                        ``(B) Inclusion.--An application for a subgrant
                    under this subsection shall include--
                                ``(i) a list of proposed activities that
                            require or would benefit from conducting a
                            health impact assessment within six months of
                            receiving the subgrant;
                                ``(ii) supporting documentation, including
                            letters of support, from potential conductors
                            of health impact assessments for the listed
                            proposed activities;
                                ``(iii) an assessment by the applicant of
                            the health of the population to be served
                            through the subgrant; and
                                ``(iv) a description of potential adverse
                            or positive effects on health that the proposed
                            activities may create.
                        ``(C) Preference.--In awarding subgrants under this
                    subsection, States may give preference 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.--A State, Indian Tribe, or Tribal
                    organization receiving a grant under this subsection
                    shall use such grant to conduct health impact
                    assessment capacity building in support of a subgrantee
                    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
                            provide them 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 funds under this section shall--
                        ``(A) take appropriate health factors into
                    consideration as early as practicable during the
                    planning, review, or decision-making processes;
                        ``(B) assess the effect on the health of
                    individuals and populations of proposed policies,
                    projects, or plans that result in modifications to the
                    built environment; and
                        ``(C) assess the distribution of health effects
                    across various factors, such as race, income,
                    ethnicity, age, disability status, gender, and
                    geography.
                ``(5) Eligible activities.--
                        ``(A) In general.--A State, Indian Tribe, or Tribal
                    organization receiving a grant under this section shall
                    conduct an evaluation of any activity proposed to be
                    funded through the grant, including through a subgrant,
                    to determine whether such activity will have a
                    significant adverse or positive effect on the health of
                    the affected population to be served, based on the
                    criteria described in subparagraph (B).
                        ``(B) Criteria.--The criteria described in this
                    subparagraph include, as applicable to the proposed
                    activity, the following:
                                ``(i) Any substantial adverse effect or
                            significant health benefit on health outcomes
                            or factors known to influence health, including
                            the following:
                                        ``(I) Physical activity.
                                        ``(II) Injury.
                                        ``(III) Mental health.
                                        ``(IV) Accessibility to health-
                                    promoting goods and services.
                                        ``(V) Respiratory health.
                                        ``(VI) Chronic disease.
                                        ``(VII) Nutrition.
                                        ``(VIII) Land use changes that
                                    promote local, sustainable food
                                    sources.
                                        ``(IX) Infectious disease.
                                        ``(X) Health inequities.
                                        ``(XI) Existing air quality, ground
                                    or surface water quality or quantity,
                                    or noise levels.
                                        ``(XII) Lead exposure.
                                        ``(XIII) Drinking water quality and
                                    accessibility.
                                ``(ii) Other factors that may be
                            considered, including--
                                        ``(I) the potential for a proposed
                                    activity to result in systems failure
                                    that leads to a public health
                                    emergency;
                                        ``(II) the probability that the
                                    proposed activity will result in a
                                    significant increase in tourism,
                                    economic development, or employment in
                                    the population to be served;
                                        ``(III) any other significant
                                    potential hazard or enhancement to
                                    human health, as determined by the
                                    grantee; 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), a grantee 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.--A subgrantee under this section shall develop
            and implement a plan, to be approved by the Secretary (acting
            through the Director and in collaboration with the
            Administrator) and the grantee, 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.--A grantee 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.--A subgrantee 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 funded under this subsection, a subgrantee under
            this section 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 subgrantees to conduct
            health impact assessments; and
                ``(3) guidance for subgrantees 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 and subgrantees with the provision of
            training and technical assistance in the conducting of health
            impact assessments;
                ``(2) evaluate the activities carried out with grants and
            subgrants under subsection (d); and
                ``(3) assist the Secretary in disseminating evidence, best
            practices, and lessons learned from grantees and subgrantees.
        ``(g) Report to Congress.--Not later than 1 year after the date of
    enactment of the Health Equity and Accountability Act of 2022, 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-12. 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;
                ``(10) transportation options; 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 impacts that
                    the built environment (including the various
                    characteristics of the built environment) has on 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. 10004. GRANT PROGRAM TO CONDUCT ENVIRONMENTAL HEALTH IMPROVEMENT
                  ACTIVITIES AND TO IMPROVE SOCIAL DETERMINANTS OF HEALTH.

        (a) Definitions.--In this section:
                (1) Director.--The term ``Director'' means the Director of
            the Centers for Disease Control and Prevention, acting in
            collaboration with the Administrator of the Environmental
            Protection Agency and the Director of the National Institute of
            Environmental Health Sciences.
                (2) Eligible entity.--The term ``eligible entity'' means a
            State, Indian Tribe, Tribal organization, or local community
            that--
                        (A) bears a disproportionate burden of exposure to
                    environmental health hazards;
                        (B) bears a disproportionate burden of exposure to
                    unhealthy living conditions, low standard housing
                    conditions, low socioeconomic status, poor nutrition,
                    less opportunity for educational attainment,
                    disproportionately high unemployment rates, or lower
                    literacy levels and access to information;
                        (C) has established a coalition--
                                (i) with not less than 1 community-based
                            organization or demonstration program; and
                                (ii) with not less than 1--
                                        (I) public health entity;
                                        (II) health care provider
                                    organization;
                                        (III) academic institution,
                                    including any minority-serving
                                    institution (including a Hispanic-
                                    serving institution, a historically
                                    Black college or university, or a
                                    Tribal College or University);
                                        (IV) child-serving institution; or
                                        (V) landlord or housing provider
                                    working on lead remediation;
                        (D) ensures planned activities and funding streams
                    are coordinated to improve community health; and
                        (E) submits an application in accordance with
                    subsection (c).
        (b) Establishment.--The Director shall establish a grant program
    under which eligible entities shall receive grants to conduct
    environmental health improvement activities and to improve social
    determinants of health.
        (c) Application.--To receive a grant under this section, an
    eligible entity shall submit an application to the Director at such
    time, in such manner, and accompanied by such information as the
    Director may require.
        (d) Use of Grant Funds.--An eligible entity may use a grant under
    this section--
                (1) to promote environmental health;
                (2) to address environmental health inequities among all
            populations, including children; and
                (3) to address racial and ethnic inequities in social
            determinants of health.
        (e) Amount of Cooperative Agreement.--The Director shall award
    grants to eligible entities at the following 3 funding levels:
                (1) Level 1 cooperative agreements.--
                        (A) In general.--An eligible entity awarded a grant
                    under this paragraph shall use the funds to identify
                    environmental health problems and solutions by--
                                (i) establishing a planning and
                            prioritizing council in accordance with
                            subparagraph (B); and
                                (ii) conducting an environmental health
                            assessment in accordance with subparagraph (C).
                        (B) Planning and prioritizing council.--
                                (i) In general.--A planning and
                            prioritizing council established under
                            subparagraph (A)(i) (referred to in this
                            paragraph as a ``PPC'') shall assist the
                            environmental health assessment process and
                            environmental health promotion activities of
                            the eligible entity.
                                (ii) Membership.--Membership of a PPC shall
                            consist of representatives from various
                            organizations within public health, planning,
                            development, and environmental services and
                            shall include stakeholders from vulnerable
                            groups such as children, the elderly, disabled,
                            and minority ethnic groups that are often not
                            actively involved in democratic or decision-
                            making processes.
                                (iii) Duties.--A PPC shall--
                                        (I) identify key stakeholders and
                                    engage and coordinate potential
                                    partners in the planning process;
                                        (II) establish a formal advisory
                                    group to plan for the establishment of
                                    services;
                                        (III) conduct an in-depth review of
                                    the nature and extent of the need for
                                    an environmental health assessment,
                                    including a local epidemiological
                                    profile, an evaluation of the service
                                    provider capacity of the community, and
                                    a profile of any target populations;
                                    and
                                        (IV) define the components of care
                                    and form essential programmatic
                                    linkages with related providers in the
                                    community.
                        (C) Environmental health assessment.--
                                (i) In general.--A PPC shall carry out an
                            environmental health assessment to identify
                            environmental health concerns.
                                (ii) Assessment process.--The PPC shall--
                                        (I) define the goals of the
                                    assessment;
                                        (II) generate the environmental
                                    health issue list;
                                        (III) analyze issues with a systems
                                    framework;
                                        (IV) develop appropriate community
                                    environmental health indicators;
                                        (V) rank the environmental health
                                    issues;
                                        (VI) set priorities for action;
                                        (VII) develop an action plan;
                                        (VIII) implement the plan; and
                                        (IX) evaluate progress and planning
                                    for the future.
                        (D) Evaluation.--Each eligible entity that receives
                    a grant under this paragraph shall evaluate, report,
                    and disseminate program findings and outcomes.
                        (E) Technical assistance.--The Director may provide
                    such technical and other non-financial assistance to
                    eligible entities as the Director determines to be
                    necessary.
                (2) Level 2 cooperative agreements.--
                        (A) Eligibility.--
                                (i) In general.--The Director shall award
                            grants under this paragraph to eligible
                            entities that have already--
                                        (I) established broad-based
                                    collaborative partnerships; and
                                        (II) completed environmental
                                    assessments.
                                (ii) No level 1 requirement.--To be
                            eligible to receive a grant under this
                            paragraph, an eligible entity is not required
                            to have successfully completed a Level 1
                            Cooperative Agreement (as described in
                            paragraph (1)).
                        (B) Use of grant funds.--An eligible entity awarded
                    a grant under this paragraph shall use the funds to
                    further activities to carry out environmental health
                    improvement activities, including--
                                (i) addressing community environmental
                            health priorities in accordance with paragraph
                            (1)(C)(ii), including--
                                        (I) geography;
                                        (II) the built environment;
                                        (III) air quality;
                                        (IV) water quality;
                                        (V) land use;
                                        (VI) solid waste;
                                        (VII) housing;
                                        (VIII) violence;
                                        (IX) socioeconomic status;
                                        (X) ethnicity, social construct,
                                    and language preference;
                                        (XI) educational attainment;
                                        (XII) employment;
                                        (XIII) food safety, accessibility,
                                    and affordability;
                                        (XIV) nutrition;
                                        (XV) health care services; and
                                        (XVI) injuries;
                                (ii) building partnerships between
                            planning, public health, and other sectors,
                            including child-serving institutions, to
                            address how the built environment impacts food
                            availability and access and physical activity
                            to promote healthy behaviors and lifestyles and
                            reduce overweight and obesity, musculoskeletal
                            diseases, respiratory conditions, infectious
                            diseases, dental, oral, and mental health
                            conditions, poverty, and related co-
                            morbidities;
                                (iii) establishing programs to address--
                                        (I) how environmental and social
                                    conditions of work and living choices
                                    influence physical activity and dietary
                                    intake; or
                                        (II) how the conditions described
                                    in subclause (I) influence the concerns
                                    and needs of people who have impaired
                                    mobility and use assistance devices,
                                    including wheelchairs, lower limb
                                    prostheses, and hip, knee, and other
                                    joint replacements; and
                                (iv) convening intervention and
                            demonstration programs that examine the role of
                            the social environment in connection with the
                            physical and chemical environment in--
                                        (I) determining access to
                                    nutritional food;
                                        (II) improving physical activity to
                                    reduce overweight, obesity, and co-
                                    morbidities and increase quality of
                                    life; and
                                        (III) location and access to
                                    medical facilities.
                (3) Level 3 cooperative agreements.--
                        (A) In general.--An eligible entity awarded a grant
                    under this paragraph shall use the funds to identify
                    and address racial and ethnic inequities in social
                    determinants of health by creating demonstration
                    programs that assess the feasibility of establishing a
                    federally funded comprehensive program and describe key
                    outcomes that address racial and ethnic inequities in
                    social determinants of health.
                        (B) Program design.--
                                (i) Evaluation.--No later than 1 year after
                            enactment of this Act, the Director shall
                            evaluate the best practices of existing
                            programs from the private, public, community
                            based, and academically supported initiatives
                            focused on reducing inequities in the social
                            determinants of health for racial and ethnic
                            populations.
                                (ii) Demonstration projects.--Not later
                            than two years after the date of enactment of
                            this Act, the Director shall implement at least
                            12 demonstration projects, including at least
                            one project for each major racial and ethnic
                            minority group, each of which is unique to the
                            cultural and linguistic needs of each of the
                            following groups:
                                        (I) Native Americans and Alaska
                                    Natives.
                                        (II) Asian Americans.
                                        (III) African Americans/Blacks.
                                        (IV) Hispanic/Latino-Americans.
                                        (V) Native Hawaiians and Pacific
                                    Islanders.
                                        (VI) Middle Eastern and Northern
                                    African communities.
                                (iii) Report to congress.--No later than 2
                            years after the implementation of the initial
                            demonstration projects under this paragraph,
                            the Director shall submit to Congress a report
                            which includes--
                                        (I) a description of each
                                    demonstration project and design;
                                        (II) an evaluation of the cost-
                                    effectiveness of each project's
                                    prevention and treatment efforts;
                                        (III) an evaluation of the cultural
                                    and linguistic appropriateness of each
                                    project by racial and ethnic group; and
                                        (IV) an evaluation of the
                                    beneficiary's health status improvement
                                    under the demonstration project.
                                (iv) Any other information deemed
                            appropriate by the director.--The Director
                            shall require eligible entities awarded a grant
                            under this paragraph to report any other
                            information the Director determines appropriate
                            to be shared by or developed by such entity,
                            including the following:
                                        (I) Developing models and
                                    evaluating methods that improve the
                                    cultural and linguistically appropriate
                                    services provided through the Centers
                                    for Disease Control and Prevention to
                                    target individuals impacted by health
                                    inequities based on their race,
                                    ethnicity, gender, and sexual
                                    orientation.
                                        (II) Promoting the collaboration
                                    between primary and specialty care
                                    health care providers and patients, to
                                    ensure patients impacted by health
                                    inequities based on race, ethnicity,
                                    gender, or sexual orientation are
                                    receiving comprehensive and organized
                                    treatment and care.
                                        (III) Educating health care
                                    professionals on the causes and effects
                                    of inequities in the social
                                    determinants of health in relation to
                                    minority and racial and ethnic
                                    communities and the need for culturally
                                    and linguistically appropriate care in
                                    the prevention and treatment of high-
                                    impact diseases.
                                        (IV) Encouraging collaboration
                                    among community- and patient-based
                                    organizations which work to address
                                    inequities in the social determinants
                                    of health in relation to high-impact
                                    diseases in minority and racial and
                                    ethnic populations.
        (f) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section--
                (1) $25,000,000 for fiscal year 2023; and
                (2) such sums as may be necessary for fiscal years 2024
            through 2026.

    SEC. 10005. ADDITIONAL RESEARCH ON THE RELATIONSHIP BETWEEN THE BUILT
                  ENVIRONMENT AND THE HEALTH OF COMMUNITY RESIDENTS.

        (a) Definition of Eligible Institution.--In this section, the term
    ``eligible institution'' means a public or private nonprofit
    institution that submits to the Secretary of Health and Human Services
    (in this section referred to as the ``Secretary'') and the
    Administrator of the Environmental Protection Agency (in this section
    referred to as the ``Administrator'') an application for a grant under
    the grant program authorized under subsection (b)(2) at such time, in
    such manner, and containing such agreements, assurances, and
    information as the Secretary and Administrator may require.
        (b) Research Grant Program.--
                (1) Definition of health.--In this section, the term
            ``health'' includes--
                        (A) levels of physical activity;
                        (B) degree of mobility due to factors such as
                    musculoskeletal diseases, arthritis, and obesity;
                        (C) consumption of nutritional foods;
                        (D) rates of crime;
                        (E) air, water, and soil quality;
                        (F) risk of injury;
                        (G) accessibility to health care services;
                        (H) levels of educational attainment; and
                        (I) other indicators as determined appropriate by
                    the Secretary.
                (2) Grants.--The Secretary, in collaboration with the
            Administrator, shall provide grants to eligible institutions to
            conduct and coordinate research on the built environment and
            its influence on individual and population-based health.
                (3) Research.--The Secretary shall support research that--
                        (A) investigates and defines the causal links
                    between all aspects of the built environment and the
                    health of residents;
                        (B) examines--
                                (i) the extent of the impact of the built
                            environment (including the various
                            characteristics of the built environment) on
                            the health of residents;
                                (ii) the variation in the health of
                            residents by--
                                        (I) location (such as inner cities,
                                    inner suburbs, outer suburbs,
                                    reservations, and rural areas); and
                                        (II) population subgroup (including
                                    children, young adults, the elderly,
                                    the disadvantaged); or
                                (iii) the importance of the built
                            environment to the total health of residents,
                            which is the primary variable of interest from
                            a public health perspective;
                        (C) is used to develop--
                                (i) measures to address health and the
                            connection of health to the built environment;
                            and
                                (ii) efforts to link the measures to travel
                            and health databases;
                        (D) distinguishes carefully between personal
                    attitudes and choices and external influences on
                    observed behavior to determine how much an observed
                    association between the built environment and the
                    health of residents, versus the lifestyle preferences
                    of the people that choose to live in the neighborhood,
                    reflects the physical characteristics of the
                    neighborhood; and
                        (E)(i) identifies or develops effective
                    intervention strategies to promote better health among
                    residents with a focus on behavioral interventions and
                    enhancements of the built environment that promote
                    increased use by residents; and
                        (ii) in developing the intervention strategies
                    under clause (i), ensures that the intervention
                    strategies will reach out to high-risk populations,
                    including racial and ethnic minorities, low-income
                    urban and rural communities, and children.
                (4) Priority.--In providing assistance under the grant
            program authorized under paragraph (2), the Secretary and the
            Administrator shall give priority to research that
            incorporates--
                        (A) minority-serving institutions as grantees;
                        (B) interdisciplinary approaches; or
                        (C) the expertise of the public health, physical
                    activity, nutrition and health care (including child
                    health), urban planning, and transportation research
                    communities in the United States and abroad.

    SEC. 10006. ENVIRONMENT AND PUBLIC HEALTH RESTORATION.

        (a) Findings.--Congress finds that--
                (1) humans share an environment with a wide variety of
            habitats and ecosystems that nurture and sustain a diversity of
            species;
                (2) the abundance of natural resources in the environment
            forms the basis for the economy and has greatly contributed to
            human development throughout history;
                (3) the accelerated pace of human development over the last
            several hundred years has significantly impacted--
                        (A) the natural environment and its resources;
                        (B) the health and diversity of plant and animal
                    life;
                        (C) the availability of critical habitats;
                        (D) the quality of the air and water; and
                        (E) the global climate;
                (4) the intervention of the Federal Government is necessary
            to minimize and mitigate human impact on the environment--
                        (A) for the benefit of public health;
                        (B) to maintain air quality and water quality;
                        (C) to sustain the diversity of plants and animals;
                        (D) to combat global climate change; and
                        (E) to protect the environment;
                (5) laws and regulations in the United States have been
            enacted and promulgated to minimize and mitigate human impact
            on the environment for the benefit of public health, to
            maintain air quality and water quality, to sustain wildlife,
            and to protect the environment; and
                (6) attempts to repeal or weaken key environmental
            safeguards pose dangers to the public health, air quality,
            water quality, wildlife, and the environment.
        (b) Statement of Policy.--It is the policy of the Federal
    Government to work in conjunction with States, territories, Tribal
    governments, international organizations, and foreign governments as a
    steward of the environment for the benefit of public health, to
    maintain air quality and water quality, to sustain the diversity of
    plant and animal species, to combat global climate change, and to
    protect the environment for future generations.
        (c) Study and Report on Public Health or Environmental Impact of
    Revised Rules, Regulations, Laws, or Other Agency Decisions.--
                (1) Study.--Not later than 30 days after the date of
            enactment of this Act, the President shall seek to enter into
            an arrangement under which the National Academy of Sciences
            shall conduct a study to determine the effects on public
            health, air quality, water quality, wildlife, and the
            environment of the following regulations, laws, and other
            agency decisions:
                        (A) Clean water.--
                                (i) The final rule of the Environmental
                            Protection Agency and the Corps of Engineers
                            entitled ``Final Revisions to the Clean Water
                            Act Regulatory Definitions of `Fill Material'
                            and `Discharge of Fill Material''' and
                            published in the Federal Register on May 9,
                            2002 (67 Fed. Reg. 31129).
                                (ii) The final rule of the Environmental
                            Protection Agency entitled ``National Pollutant
                            Discharge Elimination System Permit Regulation
                            for Concentrated Animal Feeding Operations:
                            Removal of Vacated Elements in Response to 2011
                            Court Decision'' and published in the Federal
                            Register on July 30, 2012 (77 Fed. Reg. 44494).
                                (iii) The final rule entitled ``Withdrawal
                            of Revisions to the Water Quality Planning and
                            Management Regulation and Revisions to the
                            National Pollutant Discharge Elimination System
                            Program in Support of Revisions to the Water
                            Quality Planning and Management Regulation''
                            and published in the Federal Register on March
                            19, 2003 (68 Fed. Reg. 13608).
                                (iv) The final rule of the Environmental
                            Protection Agency entitled ``Consolidated
                            Permit Regulations: RCRA Hazardous Waste; SDWA
                            Underground Injection Control; CWA National
                            Pollutant Discharge Elimination System; CWA
                            Section 404 Dredge or Fill Programs; and CAA
                            Prevention of Significant Deterioration'' and
                            published in the Federal Register on May 19,
                            1980 (45 Fed. Reg. 33290), with respect to the
                            definition of the ``waters of the United
                            States''.
                                (v) The final rule of the Corps of
                            Engineers and the Environmental Protection
                            Agency entitled ``Definition of `Waters of the
                            United States'--Recodification of Pre-Existing
                            Rules'' and published in the Federal Register
                            on October 22, 2019 (84 Fed. Reg. 56626).
                                (vi) The final rule of the Corps of
                            Engineers and the Environmental Protection
                            Agency entitled ``The Navigable Waters
                            Protection Rule: Definition of `Waters of the
                            United States''' and published in the Federal
                            Register on April 21, 2020 (85 Fed. Reg.
                            22250).
                        (B) Forests and land management.--
                                (i) The Healthy Forests Restoration Act of
                            2003 (16 U.S.C. 6501 et seq.).
                                (ii) The application of section 553(e) of
                            title 5, United States Code, such that a State
                            may petition for a special rule for the
                            National Forest System inventoried roadless
                            areas within the State.
                                (iii) The final rules entitled ``National
                            Forest System Land Management Planning'' (77
                            Fed. Reg. 21162) and ``National Forest System
                            Land Management Planning'' (81 Fed. Reg.
                            90723), published on April 19, 2013, and
                            December 15, 2016, respectively.
                                (iv) The final rule entitled ``Oil Shale
                            Management--General'' and published on January
                            15, 2009 (73 Fed. Reg. 69414).
                                (v) The record of decision described in the
                            notice of availability entitled ``Notice of
                            Availability of Approved Land Use Plan
                            Amendments/Record of Decision for Allocation of
                            Oil Shale and Tar Sands Resources on Lands
                            Administered by the Bureau of Land Management
                            in Colorado, Utah, and Wyoming and Final
                            Programmatic Environmental Impact Statement''
                            and published on April 1, 2013 (78 Fed. Reg.
                            19518).
                        (C) Scientific review.--The final rule entitled
                    ``Interagency Cooperation Under the Endangered Species
                    Act'' (December 16, 2008) (73 Fed. Reg. 76272), as
                    amended by the final rule entitled ``Endangered and
                    Threatened Wildlife and Plants; Regulations for
                    Interagency Cooperation'' (August 27, 2019) (84 Fed.
                    Reg. 44976).
                (2) Method.--In conducting the study under paragraph (1),
            the National Academy of Sciences may use and compare existing
            scientific studies regarding the regulations, laws, and other
            agency decisions described in paragraph (1).
                (3) Report.--Not later than 270 days after the date on
            which the President enters into the arrangement under paragraph
            (1), the National Academy of Sciences shall make publicly
            available and shall submit to Congress and to the head of each
            department and agency of the Federal Government that issued,
            implements, or would implement a regulation, law, or other
            agency decision described in paragraph (1), a report that
            includes--
                        (A) a description of the effects of each
                    regulation, law, or other agency decision described in
                    paragraph (1) on public health, air quality, water
                    quality, wildlife, and the environment, compared to the
                    impact of preexisting regulations, laws, or other
                    agency decisions in effect, as applicable, including--
                                (i) any negative impacts to air quality or
                            water quality;
                                (ii) any negative impacts to wildlife;
                                (iii) any delays in hazardous waste cleanup
                            that are projected to be hazardous to public
                            health; and
                                (iv) any other negative impact on public
                            health or the environment; and
                        (B) any recommendations that the National Academy
                    of Sciences considers appropriate to maintain, restore,
                    or improve in whole or in part protections for public
                    health, air quality, water quality, wildlife, and the
                    environment for each of the regulations, laws, and
                    other agency decisions described in paragraph (1),
                    which may include recommendations for the adoption of
                    any regulation or law in place or proposed prior to
                    January 1, 2001.
        (d) Department and Agency Revision of Existing Rules, Regulations,
    or Laws.--Not later than 180 days after the date on which the report is
    submitted pursuant to subsection (c)(3), the head of each department or
    agency that has issued or implemented a regulation, law, or other
    agency decision described in subsection (c)(1) shall submit to Congress
    a plan describing the steps the department or agency will take, or has
    taken, to restore or improve protections for public health and the
    environment in whole or in part that were in existence prior to the
    issuance of the applicable regulation, law, or other agency decision.

    SEC. 10007. GAO REPORT ON HEALTH EFFECTS OF DEEPWATER HORIZON OIL RIG
                  EXPLOSION IN THE GULF COAST.

        (a) Study.--The Comptroller General of the United States shall
    conduct a study on the type and scope of health care services
    administered through the Department of Health and Human Services
    addressing the provision of health care to racial and ethnic
    minorities, including residents, cleanup workers, and volunteers,
    affected by the blowout and explosion of the mobile offshore drilling
    unit Deepwater Horizon that occurred on April 20, 2010, and resulting
    hydrocarbon releases into the environment.
        (b) Specific Components.--In carrying out subsection (a), the
    Comptroller General of the United States shall--
                (1) assess the type, size, and scope of programs
            administered by the Secretary of Health and Human Services that
            focus on the provision of health care to communities on the
            Gulf Coast;
                (2) identify the merits and disadvantages associated with
            each of the programs;
                (3) perform an analysis of the costs and benefits of the
            programs; and
                (4) determine whether there is any duplication of programs.
        (c) Report.--Not later than 180 days after the date of enactment of
    this Act, the Comptroller General of the United States shall submit to
    Congress a report that includes--
                (1) the findings of the study conducted under subsection
            (a); and
                (2) recommendations for improving access to health care for
            racial and ethnic minorities.

    SEC. 10008. ESTABLISH AN INTERAGENCY COUNSEL AND GRANT PROGRAMS ON
                  SOCIAL DETERMINANTS OF HEALTH.

        (a) Findings; Purposes.--
                (1) Findings.--Congress finds the following:
                        (A) There is a significant body of evidence showing
                    that economic and social conditions have a powerful
                    impact on individual and population health outcomes and
                    well-being, as well as medical costs.
                        (B) State, local, and Tribal governments and the
                    service delivery partners of such governments face
                    significant challenges in coordinating benefits and
                    services delivered through the Medicaid program and
                    other social services programs because of the
                    fragmented and complex nature of Federal and State
                    funding and administrative requirements.
                        (C) The Federal Government should prioritize and
                    proactively assist State and local governments to
                    strengthen the capacity of State and local governments
                    to improve health and social outcomes for individuals,
                    thereby improving cost-effectiveness and return on
                    investment.
                (2) Purposes.--The purposes of this section 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.
        (b) Social Determinants Accelerator Council.--
                (1) Establishment.--The Secretary of Health and Human
            Services (referred to in this section as the ``Secretary''), in
            coordination with the Administrator of the Centers for Medicare
            & Medicaid Services (referred to in this section as the
            ``Administrator''), shall establish an interagency council, to
            be known as the Social Determinants Accelerator Interagency
            Council (referred to in this section as the ``Council'') to
            achieve the purposes listed in subsection (b)(2).
                (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 described in clause (ii)
                            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 conduct 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 3 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 subparagraph
                    (B)(ii).
                        (D) OMB role.--The Director of the Office of
                    Management and Budget shall facilitate the timely
                    resolution of Federal Government-wide 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 section 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.
        (c) 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 subsection,
            for the development of social determinants accelerator plans,
            as described in this subsection.
                (2) Eligible applicant.--An eligible applicant described in
            this subsection 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
            subsection.
                (4) Application.--An eligible applicant seeking a grant
            under this subsection 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, and Tribal governments,
                    academic institutions, nonprofit organizations,
                    community-based organizations, and other public and
                    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
                    section.
                (5) Use of funds.--A recipient of a grant under this
            subsection 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 subsection 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, and Tribal
                    governments, academic institutions, nonprofit
                    organizations, or any other public or 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.
        (d) Funding.--
                (1) In general.--Out of any money in the Treasury not
            otherwise appropriated, there is appropriated to carry out this
            section $25,000,000 to remain available for obligation until
            the date that is 5 years after the date of enactment of this
            section.
                (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 subsection (d) 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 section 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. 10009. CORRECTING HURTFUL AND ALIENATING NAMES IN GOVERNMENT
                  EXPRESSION (CHANGE).

        (a) Short Title.--This section may be cited as the ``Correcting
    Hurtful and Alienating Names in Government Expression (CHANGE) Act''.
        (b) Definitions.--In this section:
                (1) Employee.--The term ``employee'' has the meaning given
            the term in section 2105 of title 5, United States Code.
                (2) Executive agency.--The term ``Executive agency'' has
            the meaning given the term in section 105 of title 5, United
            States Code.
                (3) Officer.--The term ``officer'' has the meaning given
            the term in section 2104 of title 5, United States Code.
                (4) Prohibited term.--The term ``prohibited term'' means--
                        (A) the term ``alien'', when used to refer to an
                    individual who is not a citizen or national of the
                    United States; and
                        (B) the term ``illegal alien'', when used to refer
                    to an individual who--
                                (i) is unlawfully present in the United
                            States; or
                                (ii) lacks a lawful immigration status in
                            the United States.
        (c) Modernization of Language Referring to Individuals Who Are Not
    Citizens or Nationals of the United States.--
                (1) In general.--Except as provided in paragraph (2), on
            and after the date of enactment of this Act, an Executive
            agency may not use a prohibited term in any proposed or final
            rule, regulation, interpretation, publication, other document,
            display, or sign issued by the Executive agency.
                (2) Exception.--An Executive agency may use a prohibited
            term under paragraph (1) if the Executive agency uses the
            prohibited term while quoting or reproducing text written by a
            source that is not an officer or employee of the Executive
            agency.
        (d) Uniform Definition.--
                (1) In general.--Chapter 1 of title 1, United States Code,
            is amended by adding at the end the following:
    ``Sec. 9. Definition of `foreign national'
        ``In determining the meaning of any Act of Congress or any ruling,
    regulation, or interpretation of an administrative bureau or agency of
    the United States, the term `foreign national' means any individual
    that is not an individual who--
                ``(1) is a citizen of the United States; or
                ``(2) though not a citizen of the United States, owes
            permanent allegiance to the United States.''.
                (2) Technical amendment.--The table of sections for chapter
            1 of title 1, United States Code, is amended by adding at the
            end the following:

    ``9. Definition of `foreign national'.''.
        (e) References.--Any reference in any Federal statute, rule,
    regulation, Executive order, publication, or other document of the
    United States--
                (1) to the term ``alien'', when used to refer to an
            individual who is not a citizen or national of the United
            States, is deemed to refer to the term ``foreign national'';
            and
                (2) to the term ``illegal alien'' is deemed to refer to the
            term ``undocumented foreign national'', when used to refer to
            an individual who--
                        (A) is unlawfully present in the United States; or
                        (B) lacks a lawful immigration status in the United
                    States.

    SEC. 10010. ANDREW KEARSE ACCOUNTABILITY FOR DENIAL OF MEDICAL CARE.

        (a) In General.--Chapter 13 of title 18, United States Code, is
    amended by adding at the end the following:
    ``Sec. 250. Medical attention for individuals in Federal custody
                  displaying medical distress
        ``(a) Definitions.--In this section--
                ``(1) the term `appropriate Inspector General', with
            respect to a covered official, means--
                        ``(A) the Inspector General of the Federal agency
                    that employs the covered official; or
                        ``(B) in the case of a covered official employed by
                    a Federal agency that does not have an Inspector
                    General, the Inspector General of the Department of
                    Justice;
                ``(2) the term `covered official' means--
                        ``(A) a Federal law enforcement officer (as defined
                    in section 115);
                        ``(B) an officer or employee of the Bureau of
                    Prisons; or
                        ``(C) an officer or employee of the United States
                    Marshals Service; and
                ``(3) the term `medical distress' includes breathing
            difficulties.
        ``(b) Requirement.--
                ``(1) Offense.--It shall be unlawful for a covered official
            to negligently fail to obtain or provide immediate medical
            attention to an individual in Federal custody who displays
            medical distress in the presence of the covered official, if
            the individual suffers unnecessary pain, injury, or death as a
            result of that failure.
                ``(2) Penalty.--A covered official who violates paragraph
            (1) shall be fined under this title, imprisoned for not more
            than 1 year, or both.
                ``(3) State civil enforcement.--Whenever an attorney
            general of a State has reasonable cause to believe that a
            resident of the State has been aggrieved by a violation of
            paragraph (1) by a covered official, the attorney general, or
            another official, agency, or entity designated by the State,
            may bring a civil action in any appropriate district court of
            the United States to obtain appropriate equitable and
            declaratory relief.
        ``(c) Inspector General Investigation.--
                ``(1) In general.--The appropriate Inspector General shall
            investigate any instance in which--
                        ``(A) a covered official fails to obtain or provide
                    immediate medical attention to an individual in Federal
                    custody who displays medical distress in the presence
                    of the covered official; and
                        ``(B) the individual suffers unnecessary pain,
                    injury, or death as a result of the failure to obtain
                    or provide immediate medical attention.
                ``(2) Referral for prosecution.--If an Inspector General,
            in conducting an investigation under paragraph (1), concludes
            that the covered official acted negligently in failing to
            obtain or provide immediate medical attention to the individual
            in Federal custody, the Inspector General shall refer the case
            to the Attorney General for prosecution under this section.
                ``(3) Confidential complaint process.--The Inspector
            General of a Federal agency that employs covered officials
            shall establish a process under which an individual may
            confidentially submit a complaint to the Inspector General
            regarding an incident described in paragraph (1) involving a
            covered official employed by the Federal agency (or, in the
            case of the Inspector General of the Department of Justice,
            involving a covered official employed by a Federal agency that
            does not have an Inspector General).
        ``(d) Training.--The head of an agency that employs covered
    officials shall provide training to each such covered official on
    obtaining or providing medical assistance to individuals in medical
    distress.''.
        (b) Technical and Conforming Amendment.--The table of sections for
    chapter 13 of title 18, United States Code, is amended by adding at the
    end the following:

    ``250. Medical attention for individuals in Federal custody displaying
                                medical distress.''.

    SEC. 10011. INVESTING IN COMMUNITY HEALING.

        (a) Findings.--Congress finds the following:
                (1) According to the Bureau of Justice Statistics, African
            Americans are more likely to have face-to-face contact with law
            enforcement and are 2.5 times more likely to experience a
            threat or use of nonfatal force by police.
                (2) Research shows that young men who have experienced
            these law enforcement practices display higher levels of
            stress, anxiety, and trauma associated with the interaction.
                (3) Witnessing or experiencing invasive encounters with law
            enforcement can also be an everyday stressor for racial and
            ethnic minorities, leading to physiological and psychological
            strain.
                (4) Racial and ethnic minorities face inequities in
            accessing mental health services.
                (5) Addressing the stigma in some communities of color
            associated with receiving mental health services and informing
            individuals about available treatment can encourage better
            utilization of these services.
        (b) Sense of Congress.--It is the sense of the Congress that it is
    imperative that a comprehensive public health approach to addressing
    trauma and mental health care be focused on care delivery that is
    culturally sensitive and competent.
        (c) Research on Adverse Health Effects Associated With Interactions
    With Law Enforcement.--
                (1) In general.--The Secretary of Health and Human Services
            (in this section referred to as the ``Secretary''), acting
            through the Director of the Office of Minority Health of the
            Centers for Disease Control and Prevention (established
            pursuant to section 1707A of the Public Health Service Act (42
            U.S.C. 300u-6a)), shall conduct research on the adverse health
            effects associated with interactions with law enforcement.
                (2) Effects among racial and ethnic minorities.--The
            research under paragraph (1) shall include research on--
                        (A) the health consequences, both individual and
                    community-wide, of trauma related to violence committed
                    by law enforcement among racial and ethnic minorities;
                    and
                        (B) the disproportionate burden of morbidity and
                    mortality associated with such trauma.
                (3) Report.--Not later than 1 year after the date of
            enactment of this Act, the Secretary shall--
                        (A) complete the research under this subsection;
                    and
                        (B) submit to the Congress a report on the
                    findings, conclusions, and recommendations resulting
                    from such research.
        (d) Grants for Increasing Racial and Ethnic Minority Access to
    High-Quality Trauma Support Services and Mental Health Care.--
                (1) In general.--The Secretary, acting through the
            Assistant Secretary for Mental Health and Substance Use, shall
            award grants to eligible entities to establish or expand
            programs for the purpose of increasing racial and ethnic
            minority access to high-quality trauma support services and
            mental health care.
                (2) Eligible entities.--To seek a grant under this
            subsection, an entity shall be a community-based program or
            organization that--
                        (A) provides culturally competent programs and
                    resources that are aligned with evidence-based
                    practices for trauma-informed care; and
                        (B) has demonstrated expertise in serving
                    communities of color or can partner with a program that
                    has such demonstrated expertise.
                (3) Use of funds.--As a condition on receipt of a grant
            under this subsection, a grantee shall agree to use the grant
            to increase racial and ethnic minority access to high-quality
            trauma support services and mental health care, such as by--
                        (A) establishing and maintaining community-based
                    programs providing evidence-based services in trauma-
                    informed care and culturally specific services and
                    other resources;
                        (B) developing innovative culturally specific
                    strategies and projects to enhance access to trauma-
                    informed care and resources for racial and ethnic
                    minorities who face obstacles to using more traditional
                    services and resources (such as obstacles in geographic
                    access to providers, insurance coverage, and access to
                    audio and video technologies);
                        (C) working with State and local governments and
                    social service agencies to develop and enhance
                    effective strategies to provide culturally specific
                    services to racial and ethnic minorities;
                        (D) increasing communities' capacity to provide
                    culturally specific resources and support for
                    communities of color;
                        (E) working in cooperation with the community to
                    develop education and prevention strategies
                    highlighting culturally specific issues and resources
                    regarding racial and ethnic minorities;
                        (F) providing culturally specific programs for
                    racial and ethnic minorities exposed to law enforcement
                    violence; and
                        (G) examining the dynamics of culture and its
                    impact on victimization and healing.
                (4) Priority.--In awarding grants under this subsection,
            the Secretary shall give priority to eligible entities
            proposing to serve communities that have faced high rates of
            community trauma, including from exposure to law enforcement
            violence, intergenerational poverty, civil unrest,
            discrimination, or oppression.
                (5) Grant period.--The period of a grant under this
            subsection shall be 4 years.
                (6) Evaluation.--Not later than 6 months after the end of
            the period of all grants under this subsection, the Secretary
            shall--
                        (A) conduct an evaluation of the programs funded by
                    a grant under this subsection;
                        (B) include in such evaluation an assessment of the
                    outcomes of each such program; and
                        (C) submit a report on the results of such
                    evaluation to the Congress.
                (7) Authorization of appropriations.--To carry out this
            subsection, there is authorized to be appropriated $20,000,000
            for each of fiscal years 2023 through 2027.
        (e) Behavioral and Mental Health Outreach Education Strategy.--
                (1) In general.--The Secretary shall, in coordination with
            advocacy and behavioral and mental health organizations serving
            racial and ethnic minority groups, develop and implement an
            outreach and education strategy to promote behavioral and
            mental health, and reduce stigma associated with mental health
            conditions, among racial and ethnic minorities.
                (2) Design.--The strategy under this subsection shall be
            designed to--
                        (A) meet the diverse cultural and language needs of
                    racial and ethnic minority groups;
                        (B) provide information on evidence-based,
                    culturally and linguistically appropriate and adapted
                    interventions and treatments;
                        (C) increase awareness of symptoms of mental
                    illness among racial and ethnic minority groups; and
                        (D) ensure full participation of, and engage, both
                    consumers and community members in the development and
                    implementation of materials.
                (3) Report.--Not later than 1 year after the date of
            enactment of this Act, the Secretary shall submit to the
            Congress, and make publicly available, a report detailing the
            outreach and education strategy that is developed and
            implemented under this subsection and the results of such
            implementation.

    SEC. 10012. ENVIRONMENTAL JUSTICE MAPPING AND DATA COLLECTION.

        (a) Findings.--Congress finds that--
                (1) environmental hazards causing adverse health outcomes
            have disproportionately affected environmental justice
            communities as a result of systemic injustices relating to
            factors that include race and income;
                (2) environmental justice communities have increased
            vulnerability to the adverse effects of climate change and need
            significant investment to face current and future environmental
            hazards;
                (3) the Federal Government has lacked a cohesive and
            consistent strategy to carry out the responsibilities of
            Federal agencies described in Executive Order 12898 (42 U.S.C.
            4321 note; relating to Federal actions to address environmental
            justice in minority populations and low-income populations);
                (4) it is necessary that the Federal Government
            meaningfully engage environmental justice communities in the
            process of developing a robust strategy to address
            environmental justice, including high levels of review, input,
            and consent;
                (5) there is a lack of nationwide high-quality data
            relating to environmental justice concerns, such as
            socioeconomic factors, air pollution, water pollution, soil
            pollution, and public health, and a failure to update the
            existing data with adequate frequency;
                (6) there is no nationally consistent method to identify
            environmental justice communities based on the cumulative
            effects of socioeconomic factors, pollution burden, and public
            health;
                (7) a method described in paragraph (6) is needed to
            correct for racist and unjust practices leading to historical
            and current environmental injustices through the targeted
            investment in environmental justice communities of at least 40
            percent of the funds provided for a clean energy transition and
            other related investments, including transportation
            infrastructure, housing infrastructure, and water quality
            infrastructure;
                (8) funds targeted for environmental justice communities
            should include set-asides for technical assistance and capacity
            building for environmental justice communities to access the
            funds;
                (9) particular oversight and care are necessary when
            investing in environmental justice communities to ensure that
            existing issues are not exacerbated and new issues are not
            created, particularly issues relating to pollution burden and
            the displacement of residents;
                (10) several States, academic institutions, and nonprofit
            organizations have engaged in cumulative impact environmental
            justice mapping efforts that can serve as references for a
            Federal mapping effort;
                (11) many environmental justice communities, such as
            communities in ``Cancer Alley'' in the State of Louisiana, have
            been clearly affected by extreme environmental hazards such
            that the communities--
                        (A) are identifiable before the establishment of
                    the tool under paragraph (2) of subsection (d) and the
                    completion of the data gap audit under paragraph (4) of
                    that subsection; and
                        (B) should be eligible for programs targeted toward
                    environmental justice communities that have faced
                    extreme environmental hazards before the establishment
                    of that tool and the completion of that audit;
                (12) in addition to investment in environmental justice
            communities, pollution reduction is essential to achieving
            equitable access to a healthy and clean environment and an
            equitable energy system; and
                (13) specific policy and permitting decisions and
            investments may rely on different combinations of data sets and
            indicators relating to environmental justice, and race alone
            may be considered a criterion when assessing the susceptibility
            of a community to environmental injustice.
        (b) Definitions.--In this section:
                (1) Administrator.--The term ``Administrator'' means the
            Administrator of the Environmental Protection Agency.
                (2) Advisory council.--The term ``advisory council'' means
            the advisory council established under subsection (c)(4)(B)(i).
                (3) Committee.--The term ``Committee'' means the
            Environmental Justice Mapping Committee established by
            subsection (c)(1).
                (4) Environmental justice.--The term ``environmental
            justice'' means the fair treatment and meaningful involvement
            of all people regardless of race, color, culture, national
            origin, or income, with respect to the development,
            implementation, and enforcement of environmental laws,
            regulations, and policies to ensure that each person enjoys--
                        (A) the same degree of protection from
                    environmental and health hazards; and
                        (B) equal access to any Federal agency action
                    relating to the development, implementation, and
                    enforcement of environmental laws, regulations, and
                    policies for the purpose of having a healthy
                    environment in which to live, learn, work, and
                    recreate.
                (5) Environmental justice community.--The term
            ``environmental justice community'' means a community with
            significant representation of communities of color, low-income
            communities, or Tribal and indigenous communities, that
            experiences, or is at risk of experiencing, higher or more
            adverse human health or environmental effects, as compared to
            other communities.
                (6) Ground-truthing.--The term ``ground-truthing'' means a
            community fact-finding process by which residents of a
            community supplement technical information with local knowledge
            for the purpose of better informing policy and project
            decisions.
                (7) Relevant stakeholder.--The term ``relevant
            stakeholder'' means--
                        (A) a representative of a regional, State, Tribal,
                    or local government agency;
                        (B) a representative of a nongovernmental
                    organization with experience in areas that may include
                    Tribal relations, environmental conservation, city and
                    regional planning, and public health;
                        (C) a representative of a labor union;
                        (D) a representative or member of--
                                (i) an environmental justice community; or
                                (ii) a community-based organization for an
                            environmental justice community;
                        (E) an individual with expertise in cumulative
                    impacts, geospatial data, and environmental justice,
                    particularly such an individual from an academic or
                    research institution; and
                        (F) an advocate with experience in environmental
                    justice who represents an environmental justice
                    community.
        (c) Establishment of Committee.--
                (1) In general.--There is established a committee, to be
            known as the ``Environmental Justice Mapping Committee''.
                (2) Membership.--
                        (A) In general.--The Committee shall be composed of
                    not fewer than 1 representative of each of the
                    following:
                                (i) Of the Environmental Protection
                            Agency--
                                        (I) the Office of Air and
                                    Radiation;
                                        (II) the Office of Chemical Safety
                                    and Pollution Prevention;
                                        (III) the Office of International
                                    and Tribal Affairs;
                                        (IV) the Office of Land and
                                    Emergency Management;
                                        (V) the Office of Water;
                                        (VI) the Office of Environmental
                                    Justice;
                                        (VII) the Office of Research and
                                    Development; and
                                        (VIII) the Office of Public
                                    Engagement and Environmental Education.
                                (ii) The Council on Environmental Quality.
                                (iii) Of the Department of Commerce--
                                        (I) the Office of Oceanic and
                                    Atmospheric Research, including not
                                    fewer than 1 representative of the
                                    Climate Program Office;
                                        (II) the Economics and Statistics
                                    Administration, including not fewer
                                    than 1 representative of the Bureau of
                                    Economic Analysis; and
                                        (III) the National Institute of
                                    Standards and Technology.
                                (iv) Of the Department of Health and Human
                            Services--
                                        (I) the Centers for Disease Control
                                    and Prevention, not including the
                                    Agency for Toxic Substances and Disease
                                    Registry;
                                        (II) the Agency for Toxic
                                    Substances and Disease Registry;
                                        (III) the Administration for
                                    Children and Families;
                                        (IV) of the National Institutes of
                                    Health--
                                                (aa) the National Institute
                                            of Environmental Health
                                            Sciences;
                                                (bb) the National Institute
                                            of Mental Health; and
                                                (cc) the National Institute
                                            on Minority Health and Health
                                            Disparities; and
                                        (V) the Office for Civil Rights.
                                (v) Of the Department of the Interior--
                                        (I) the Bureau of Indian Affairs;
                                        (II) the Office of Civil Rights;
                                    and
                                        (III) the United States Geological
                                    Survey.
                                (vi) The Forest Service.
                                (vii) The Department of Housing and Urban
                            Development.
                                (viii) The Department of Energy.
                                (ix) The Department of Transportation.
                                (x) The Department of Justice.
                                (xi) The Federal Energy Regulatory
                            Commission.
                                (xii) The Department of the Treasury.
                                (xiii) Such other Federal departments,
                            agencies, and offices as the Administrator
                            determines to be appropriate, particularly
                            offices relating to public engagement.
                        (B) Selection of representatives.--The head of a
                    department or agency described in subparagraph (A)
                    shall, in appointing to the Committee a representative
                    of the department or agency, select a representative--
                                (i) of a component of the department or
                            agency that is among the components that are
                            the most relevant to the responsibilities of
                            the Committee; or
                                (ii) who has expertise in areas relevant to
                            those responsibilities, such as demographic
                            indicators relating to socioeconomic hardship,
                            environmental justice, public engagement,
                            public health, exposure to pollution, future
                            climate and extreme weather mapping, affordable
                            energy, sustainable transportation, and access
                            to water, food, and green space.
                        (C) Co-chairs.--
                                (i) In general.--The members of the
                            Committee shall select 3 members to serve as
                            co-chairs of the Committee--
                                        (I) 1 of whom shall be a
                                    representative of the Environmental
                                    Protection Agency;
                                        (II) 1 of whom shall be a
                                    representative of the Council on
                                    Environmental Quality; and
                                        (III) 1 of whom shall have
                                    substantial experience in public
                                    engagement.
                                (ii) Terms.--Each co-chair shall serve for
                            a term of not more than 3 years.
                                (iii) Responsibilities of co-chairs.--The
                            co-chairs of the Committee shall--
                                        (I) determine the agenda of the
                                    Committee, in consultation with other
                                    members of the Committee;
                                        (II) direct the work of the
                                    Committee, including the oversight of a
                                    meaningful public engagement process;
                                    and
                                        (III) convene meetings of the
                                    Committee not less frequently than once
                                    each fiscal quarter.
                (3) Administrative support.--
                        (A) In general.--The Administrator shall provide
                    technical and administrative support to the Committee.
                        (B) Funding.--The Administrator may carry out
                    subparagraph (A) using, in addition to any amounts made
                    available under subsection (f), amounts authorized to
                    be appropriated to the Administrator before the date of
                    enactment of this Act and available for obligation as
                    of that date of enactment.
                (4) Consultation.--
                        (A) In general.--In carrying out the duties of the
                    Committee, the Committee shall consult with relevant
                    stakeholders.
                        (B) Advisory council.--
                                (i) In general.--The Committee shall
                            establish an advisory council composed of a
                            balanced proportion of relevant stakeholders,
                            at least \1/2\ of whom shall represent
                            environmental justice communities.
                                (ii) Chair.--The advisory council shall be
                            chaired by an environmental justice advocate or
                            other relevant stakeholder with substantial
                            experience in environmental justice.
                                (iii) Requirements.--Consultation described
                            in subparagraph (A) shall include--
                                        (I) early and regular engagement
                                    with the advisory council, including in
                                    carrying out public engagement under
                                    subparagraph (C); and
                                        (II) consideration of the
                                    recommendations of the advisory
                                    council.
                                (iv) Recommendations not used.--If the
                            Committee does not use a recommendation of the
                            advisory council, not later than 60 days after
                            the date on which the Committee receives notice
                            of the recommendation, the Committee shall--
                                        (I) make available to the public on
                                    an internet website of the
                                    Environmental Protection Agency a
                                    written report describing the rationale
                                    of the Committee for not using the
                                    recommendation; and
                                        (II) submit the report described in
                                    subclause (I) to the Committee on
                                    Environment and Public Works of the
                                    Senate and the Committee on Energy and
                                    Commerce of the House of
                                    Representatives.
                                (v) Outreach.--The advisory council may
                            carry out public outreach activities using
                            amounts made available under subsection (f) to
                            supplement public engagement carried out by the
                            Committee under subparagraph (C).
                        (C) Public engagement.--
                                (i) In general.--The Committee shall,
                            throughout the process of carrying out the
                            duties of the Committee described in subsection
                            (d)--
                                        (I) meaningfully engage with
                                    relevant stakeholders, particularly--
                                                (aa) members and
                                            representatives of
                                            environmental justice
                                            communities;
                                                (bb) environmental justice
                                            advocates; and
                                                (cc) individuals with
                                            expertise in cumulative impacts
                                            and geospatial data; and
                                        (II) ensure that the input of the
                                    stakeholders described in subclause (I)
                                    is central to the activities of the
                                    Committee.
                                (ii) Plan.--
                                        (I) In general.--In carrying out
                                    clause (i), the Committee shall develop
                                    a plan, in consultation with the
                                    advisory council, for comprehensive
                                    public engagement with, and
                                    incorporation of feedback from,
                                    environmental justice advocates and
                                    members of environmental justice
                                    communities.
                                        (II) Strategies to overcome
                                    barriers to public engagement.--The
                                    plan developed under subclause (I)
                                    shall include strategies to overcome
                                    barriers to public engagement,
                                    including--
                                                (aa) language barriers;
                                                (bb) transportation
                                            barriers;
                                                (cc) economic barriers; and
                                                (dd) lack of internet
                                            access.
                                        (III) Consideration.--In developing
                                    the plan under subclause (I), the
                                    Committee shall consider the diverse
                                    and varied experiences of environmental
                                    justice communities relating to the
                                    scope and types of environmental
                                    hazards and socioeconomic injustices.
                                (iii) Consultation and solicitation of
                            public comment.--
                                        (I) In general.--In carrying out
                                    clause (i), not less frequently than
                                    once each fiscal quarter, the Committee
                                    shall consult with the advisory council
                                    and solicit meaningful public comment,
                                    particularly from relevant
                                    stakeholders, on the activities of the
                                    Committee.
                                        (II) Requirements.--The Committee
                                    shall carry out subclause (I) through
                                    means including--
                                                (aa) public notice of a
                                            meeting of the Committee
                                            occurring during the applicable
                                            fiscal quarter, which shall
                                            include--

                                                        (AA) notice in
                                                    publications relevant
                                                    to environmental
                                                    justice communities;

                                                        (BB) notification
                                                    to environmental
                                                    justice communities
                                                    through direct means,
                                                    such as community
                                                    centers and schools;
                                                    and

                                                        (CC) direct
                                                    outreach to known
                                                    environmental justice
                                                    groups;

                                                (bb) public broadcast of
                                            that meeting, including
                                            soliciting and receiving
                                            comments by virtual means; and
                                                (cc) public availability of
                                            a transcript of that meeting
                                            through publication on an
                                            accessible website.
                                        (III) Languages.--The Committee
                                    shall provide each notice,
                                    notification, direct outreach,
                                    broadcast, and transcript described in
                                    subclause (II) in each language
                                    commonly used in the applicable
                                    environmental justice community,
                                    including through oral interpretation,
                                    if applicable.
                                (iv) Funding.--Of amounts made available
                            under subsection (f), the Administrator shall
                            make available to the Committee such sums as
                            are necessary for participation by relevant
                            stakeholders in public engagement under this
                            paragraph, as determined by the Administrator,
                            in consultation with the advisory council.
        (d) Duties of Committee.--
                (1) In general.--The Committee shall--
                        (A) establish a tool described in paragraph (2) to
                    identify environmental justice communities, including
                    the identification of--
                                (i) criteria to be used in the tool; and
                                (ii) a methodology to determine the
                            cumulative impacts of those criteria;
                        (B) assess and address data gaps in accordance with
                    paragraph (4); and
                        (C) collect data for the environmental justice data
                    repository established under subsection (e).
                (2) Establishment of tool.--
                        (A) In general.--The Committee, in consultation
                    with relevant stakeholders and the advisory council,
                    shall establish an interactive, transparent,
                    integrated, and Federal Government-wide tool for
                    assessing and mapping environmental justice communities
                    based on the cumulative impacts of all indicators
                    selected by the Committee to be integrated into the
                    tool.
                        (B) Requirements.--In establishing the tool under
                    subparagraph (A), the Committee shall--
                                (i) integrate into the tool multiple data
                            layers of indicators that fall into categories
                            including--
                                        (I) demographics, particularly
                                    relating to socioeconomic hardship and
                                    social stressors, such as--
                                                (aa) race and ethnicity;
                                                (bb) low income;
                                                (cc) high unemployment;
                                                (dd) low levels of home
                                            ownership;
                                                (ee) high rent burden;
                                                (ff) high transportation
                                            burden;
                                                (gg) low levels of
                                            educational attainment;
                                                (hh) linguistic isolation;
                                                (ii) energy insecurity or
                                            high utility rate burden;
                                                (jj) food insecurity;
                                                (kk) health insurance
                                            status and access to
                                            healthcare; and
                                                (ll) membership in an
                                            Indian Tribe;
                                        (II) public health, particularly
                                    data that are indicative of sensitive
                                    populations, such as--
                                                (aa) rates of asthma;
                                                (bb) rates of
                                            cardiovascular disease;
                                                (cc) child leukemia or
                                            other cancers that correlate
                                            with environmental hazards;
                                                (dd) low birth weight;
                                                (ee) maternal mortality;
                                                (ff) rates of lead
                                            poisoning; and
                                                (gg) rates of diabetes;
                                        (III) pollution burdens, such as
                                    pollution burdens created by--
                                                (aa) toxic chemicals;
                                                (bb) air pollutants;
                                                (cc) water pollutants;
                                                (dd) soil contaminants; and
                                                (ee) perfluoroalkyl and
                                            polyfluoroalkyl substances; and
                                        (IV) environmental effects, such as
                                    effects created by proximity to--
                                                (aa) risk management plan
                                            sites;
                                                (bb) hazardous waste
                                            facilities;
                                                (cc) sites on the National
                                            Priorities List developed by
                                            the President in accordance
                                            with section 105(a)(8)(B) of
                                            the Comprehensive Environmental
                                            Response, Compensation, and
                                            Liability Act of 1980 (42
                                            U.S.C. 9605(a)(8)(B)); and
                                                (dd) fossil fuel
                                            infrastructure;
                                (ii) investigate how further indicators of
                            vulnerability to the impacts of climate change
                            (including proximity and exposure to sea level
                            rise, wildfire smoke, flooding, drought, rising
                            average temperatures, extreme storms, and
                            extreme heat, and financial burdens from flood
                            and fire insurance) should be incorporated into
                            the tool as an additional set of layers;
                                (iii) identify and consider the effects of
                            other indicators relating to environmental
                            justice for integration into the tool as
                            layers, including--
                                        (I) safe, sufficient, and
                                    affordable drinking water, sanitation,
                                    and stormwater services;
                                        (II) access to and the quality of--
                                                (aa) green space and tree
                                            canopy cover;
                                                (bb) healthy food;
                                                (cc) affordable energy and
                                            water;
                                                (dd) transportation;
                                                (ee) reliable communication
                                            systems, such as broadband
                                            internet;
                                                (ff) child care;
                                                (gg) high-quality public
                                            schools, early childhood
                                            education, and child care; and
                                                (hh) health care
                                            facilities;
                                        (III) length of commute;
                                        (IV) indoor air quality in
                                    multiunit dwellings;
                                        (V) mental health;
                                        (VI) labor market categories,
                                    particularly relating to essential
                                    workers; and
                                        (VII) each type of utility expense;
                                (iv) consider the implementation of
                            specific regional indicators, with the
                            potential--
                                        (I) to create regionally and
                                    locally downscaled maps in addition to
                                    a national map;
                                        (II) to provide incentives for
                                    States to collect data and conduct
                                    additional analyses to capture
                                    conditions specific to their
                                    localities;
                                        (III) to provide resources for and
                                    engage in ground-truthing to identify
                                    and verify important data with
                                    community members; and
                                        (IV) to develop companion resources
                                    for, and provide technical support to,
                                    regional, State, local, or Tribal
                                    governments to create their own maps
                                    and environmental justice scores with
                                    relevant regional, State, local, and
                                    Tribal data;
                                (v) identify a methodology to account for
                            the cumulative impacts of all indicators
                            selected by the Committee under clause (i), in
                            addition to other indicators as the Committee
                            determines to be necessary, to provide relative
                            environmental justice scores for regions that
                            are--
                                        (I) as small as practicable to
                                    identify communities; and
                                        (II) not larger than a census
                                    tract;
                                (vi) ensure that the tool is capable of
                            providing maps of environmental justice
                            communities based on environmental justice
                            scores described in clause (v);
                                (vii) ensure that users of the tool are
                            able to map available layers together or
                            independently as desired;
                                (viii) implement a method for users of the
                            tool to generate a map and environmental
                            justice score based on a subset of indicators,
                            particularly for the purpose of using the tool
                            in addressing various policy needs, permitting
                            processes, and investment goals;
                                (ix) make the tool customizable to address
                            specific policy needs, permitting processes,
                            and investment goals;
                                (x) account for conditions that are not
                            captured by the quantitative data used to
                            develop the 1 or more maps and environmental
                            justice scores comprising the tool, by--
                                        (I) developing and executing a plan
                                    to perform outreach to relevant
                                    communities; and
                                        (II) establishing a mechanism by
                                    which communities can self-identify as
                                    environmental justice communities to be
                                    included in the tool, which may include
                                    citing qualitative data on conditions
                                    for which quantitative data are
                                    lacking, such as cultural loss in
                                    Tribal communities;
                                (xi) consider that the tool--
                                        (I) will be used across the Federal
                                    Government in screening Federal
                                    policies, permitting processes, and
                                    investments for environmental and
                                    climate justice impacts; and
                                        (II) may be used to assess
                                    communities for pollution reduction
                                    programs; and
                                (xii) carry out such other activities as
                            the Committee determines to be appropriate.
                (3) Transparency and updates.--
                        (A) In general.--
                                (i) Notice and comment.--The Committee
                            shall establish the tool described in paragraph
                            (2) after providing notice and an opportunity
                            for public comment.
                                (ii) Hearings.--In carrying out clause (i),
                            the Committee shall hold hearings, which shall
                            be time- and language-appropriate, in
                            communities affected by environmental justice
                            issues in geographically disparate States and
                            Tribal areas.
                        (B) Updates.--
                                (i) Annual updates.--The Committee shall
                            update the tool described in paragraph (2) not
                            less frequently than annually to account for
                            data sets that are updated annually.
                                (ii) Other updates.--Not less frequently
                            than once every 3 years, the Committee shall--
                                        (I) update the indicators,
                                    methodology, or both for the tool
                                    described in paragraph (2); and
                                        (II) reevaluate data submitted by
                                    Federal departments and agencies that
                                    is used for the tool.
                                (iii) Reports.--After the initial
                            establishment of the tool described in
                            paragraph (2) and each update under clause (i)
                            or (ii), the Committee shall publish a report
                            describing--
                                        (I) the process for identifying
                                    indicators relating to environmental
                                    justice in the development of the tool;
                                        (II) the methodology described in
                                    paragraph (2)(B)(v); and
                                        (III) the use of public input and
                                    community engagement in that process.
                        (C) Training tutorials and sessions.--
                                (i) In general.--The Committee shall--
                                        (I) develop virtual training
                                    tutorials and sessions for
                                    environmental justice communities for
                                    the use of the tool described in
                                    paragraph (2); and
                                        (II) where practicable, provide in-
                                    person training sessions for
                                    environmental justice communities for
                                    the use of that tool.
                                (ii) Languages.--The tutorials and sessions
                            under clause (i) shall be made available in
                            each language commonly used in the applicable
                            environmental justice community.
                        (D) Public availability.--
                                (i) In general.--The Committee shall make
                            available to the public on an internet website
                            of the Environmental Protection Agency--
                                        (I) the tool described in paragraph
                                    (2);
                                        (II) each update under clauses (i)
                                    and (ii) of subparagraph (B);
                                        (III) each report under
                                    subparagraph (B)(iii); and
                                        (IV) the training tutorials and
                                    sessions developed under subparagraph
                                    (C)(i)(I).
                                (ii) Accessibility.--The Committee shall
                            make the tool, updates, and reports described
                            in clause (i) accessible to the public by
                            publication in relevant languages and with
                            accessibility functions, as appropriate.
                                (iii) Requirement.--In carrying out clause
                            (i)(I), the Committee shall take measures to
                            prevent the tool from being misused to
                            discriminate against environmental justice
                            communities, such as by providing safeguards
                            against the use of downscaled data that may
                            enable the identification of individuals.
                (4) Data gap audit.--
                        (A) In general.--In establishing the tool described
                    in paragraph (2), the Committee shall direct relevant
                    Federal departments and agencies to conduct an audit of
                    data collected by the department or agency to identify
                    any data that are relevant to environmental justice
                    concerns, including data relating to--
                                (i) public health metrics;
                                (ii) toxic chemicals;
                                (iii) socioeconomic demographics;
                                (iv) air quality;
                                (v) water quality; and
                                (vi) killings of individuals by law
                            enforcement officers.
                        (B) Requirements.--An audit described in
                    subparagraph (A) shall--
                                (i) examine the granularity and
                            accessibility of the data;
                                (ii) address the need for improved air
                            quality monitoring; and
                                (iii) include recommendations to other
                            Federal departments and agencies on means to
                            improve the quality, granularity, and
                            transparency of, and public involvement in,
                            data collection and dissemination.
                        (C) Improvements.--The Committee shall direct a
                    Federal department or agency, in conducting an audit
                    under subparagraph (A), to address gaps in existing
                    data collection that will assist the Committee in
                    establishing and operating the tool described in
                    paragraph (2), including by providing to the department
                    or agency--
                                (i) benchmarks to meet in addressing the
                            gaps;
                                (ii) instructions for consistency in data
                            formatting that will allow for inclusion of
                            data in the environmental justice data
                            repository described in subsection (e); and
                                (iii) best practices for collecting data in
                            collaboration with local organizations and
                            partners, such as engaging in ground-truthing.
                        (D) Reports.--Not later than 180 days after a
                    Federal department or agency has conducted an audit
                    under subparagraph (A), the Committee shall--
                                (i) make available to the public on an
                            internet website of the Environmental
                            Protection Agency a report describing the
                            findings and conclusions of the audit,
                            including the progress made by the Federal
                            department or agency in addressing
                            environmental justice data gaps; and
                                (ii) submit the report described in clause
                            (i) to--
                                        (I) the Committee on Environment
                                    and Public Works of the Senate;
                                        (II) the Committee on Health,
                                    Education, Labor, and Pensions of the
                                    Senate;
                                        (III) the Committee on Energy and
                                    Commerce of the House of
                                    Representatives; and
                                        (IV) the Committee on Education and
                                    Labor of the House of Representatives.
        (e) Environmental Justice Data Repository.--
                (1) In general.--The Administrator shall establish an
            environmental justice data repository to maintain--
                        (A) the data collected by the Committee through the
                    establishment of the tool described in subsection
                    (d)(2) and the audits conducted under subsection
                    (d)(4)(A); and
                        (B) any subnational data collected under paragraph
                    (3)(B).
                (2) Updates.--The Administrator shall update the data in
            the data repository described in paragraph (1) as frequently as
            practicable, including every year if practicable, but not less
            frequently than once every 3 years.
                (3) Availability; inclusion of subnational data.--The
            Administrator--
                        (A) shall make the data repository described in
                    paragraph (1) available to regional, State, local, and
                    Tribal governments; and
                        (B) may collaborate with the governments described
                    in subparagraph (A) to include within that data
                    repository subnational data in existence before the
                    establishment of the tool described in subsection
                    (e)(2) and the completion of the audits under
                    subsection (e)(4)(A).
                (4) Requirement.--The Administrator shall take measures to
            prevent the data in the data repository described in paragraph
            (1) from being misused to discriminate against environmental
            justice communities, such as by providing safeguards against
            the use of downscaled data that may enable the identification
            of individuals.
        (f) Authorization of Appropriations.--There are authorized to be
    appropriated to the Administrator to carry out this section, including
    any necessary administrative costs of the Committee--
                (1) $20,000,000 for each of fiscal years 2023 and 2024; and
                (2) $18,000,000 for each of fiscal years 2025 through 2027.
        (g) Effect.--Nothing in any provision of this section relating to
    the tool described in subsection (d)(2) prohibits a State from
    developing a map relating to environmental justice or pollution burden
    that relies on different data, or analyzes data differently, than that
    tool.

    SEC. 10013. ANTIRACISM IN PUBLIC HEALTH.

        (a) Findings.--Congress makes the following findings:
                (1) For centuries, structural racism, defined by the
            National Museum of African American History and Culture as an
            ``overarching system of racial bias across institutions and
            society,'' in the United States has negatively affected
            communities of color, especially Black, Latinx, Asian American,
            Pacific Islander, and American Indian and Alaska Native people,
            to expand and reinforce White supremacy.
                (2) Structural racism determines the conditions in which
            people are born, grow, work, live, and age and determine
            people's access to quality housing, education, food,
            transportation, and political power, and other social
            determinants of health.
                (3) Structural racism serves as a major barrier to
            achieving health equity and eliminating racial and ethnic
            inequities in health outcomes that exist at alarming rates and
            are determined by a wider set of forces and systems.
                (4) Due to structural racism in the United States, people
            of color are more likely to suffer from chronic health
            conditions (such as heart disease, diabetes, asthma, hepatitis,
            and hypertension) and infectious diseases (such as HIV/AIDS,
            and COVID-19) compared to their White counterparts.
                (5) Due to structural racism in maternal health care in the
            United States, Black and American Indian and Alaska Native
            infants are more than twice as likely to die than White
            infants, Black women are 3 to 4 times more likely to die from
            pregnancy-related causes than White women, and American Indian
            and Alaska Native women are 5 times more likely to die from
            pregnancy-related causes than White women. This trend persists
            even when adjusting for income and education.
                (6) Due to structural racism in the United States, Non-
            Hispanic Black women have the highest rates for 22 of 25 severe
            morbidity indicators used by the Center for Disease Control and
            Prevention (CDC).
                (7) Due to structural racism in the United States, people
            of color comprise a disproportionate percentage of persons with
            disabilities in the United States.
                (8) Due to structural racism in the United States, Black
            men are up to three and a half times as likely to be killed by
            police as White men, and 1 in every 1,000 Black men will die as
            a result of police violence. Policing has adverse effects on
            mental health in Black communities.
                (9) Due to the confluence of structural racism and factors
            such as gender, class, and sexual orientation or gender
            identity, commonly referred to as intersectionality, Black and
            Latinx transgender women are more likely to die due to violence
            and homicide than their White counterparts.
                (10) Due to structural racism, inequitable access to
            quality health care and long-term services and supports also
            disproportionately burdens communities of color; people of
            color and immigrants are less likely to be insured and are more
            likely to live in medically underserved areas.
                (11) Due to structural racism, older adults of color are
            also more likely to be admitted to nursing homes and assisted
            living facilities and to reside in those of poor quality, and
            when older adults of color do receive home and community based
            services, Medicaid spends less money on their services and they
            are more likely to be hospitalized than older White adults.
                (12) In addition, the Federal Government's failure to honor
            the unique political status of American Indian and Alaska
            Native people, to respect the inherent sovereignty of Tribal
            Nations, and to uphold its trust and treaty obligations to
            Tribal Nations and American Indian and Alaska Native people, is
            an ongoing and unjust manifestation of centuries of oppression,
            with the consequence of adverse health outcomes for Native
            peoples.
                (13) The COVID-19 pandemic has exposed the devastating
            impact of structural racism on the United States ability to
            ensure equitable health outcomes for people of color, and made
            these communities more likely to suffer from severe outcomes
            due to the coronavirus infection.
                (14) Racial and ethnic inequity in public health is a
            result of systematic, personally mediated, and internalized
            racism and racist public and private policies and practices,
            and dismantling structural racism is integral to addressing
            public health.
        (b) Definitions.--In this section:
                (1) Antiracism.--The term ``antiracism'' is a collection of
            antiracist policies that lead to racial equity, and are
            substantiated by antiracist ideas.
                (2) Antiracist.--The term ``antiracist'' is any measure
            that produces or sustains racial equity between racial groups.
        (c) Public Health Research and Investment in Dismantling Structural
    Racism.--Part B of title III of the Public Health Service Act (42
    U.S.C. 243 et seq.) is amended by adding at the end the following:

    ``SEC. 320B. NATIONAL CENTER ON ANTIRACISM AND HEALTH.

        ``(a) In General.--
                ``(1) National center.--There is established within the
            Centers for Disease Control and Prevention a center to be known
            as the `National Center on Antiracism and Health' (referred to
            in this section as the `Center'). The Director of the Centers
            for Disease Control and Prevention shall appoint a director to
            head the Center who has experience living in and working with
            racial and ethnic minority communities. The Center shall
            promote public health by--
                        ``(A) declaring racism a public health crisis and
                    naming racism as an historical and present threat to
                    the physical and mental health and well-being of the
                    United States and world;
                        ``(B) aiming to develop new knowledge in the
                    science and practice of antiracism, including by
                    identifying the mechanisms by which racism operates in
                    the provision of health care and in systems that impact
                    health and well-being;
                        ``(C) transferring that knowledge into practice,
                    including by developing interventions that dismantle
                    the mechanisms of racism and replace such mechanisms
                    with equitable structures, policies, practices, norms,
                    and values so that a healthy society can be realized;
                    and
                        ``(D) contributing to a national and global
                    conversation regarding the impacts of racism on the
                    health and well-being of the United States and world.
                ``(2) General duties.--The Secretary, acting through the
            Center, shall undertake activities to carry out the mission of
            the Center as described in paragraph (1), such as the
            following:
                        ``(A) Conduct research into, collect, analyze and
                    make publicly available data on, and provide leadership
                    and coordination for the science and practice of
                    antiracism, the public health impacts of structural
                    racism, and the effectiveness of intervention
                    strategies to address these impacts. Topics of research
                    and data collection under this subparagraph may include
                    identifying and understanding--
                                ``(i) policies and practices that have a
                            disparate impact on the health and well-being
                            of communities of color;
                                ``(ii) the public health impacts of
                            implicit racial bias, White supremacy,
                            weathering, xenophobia, discrimination, and
                            prejudice;
                                ``(iii) the social determinants of health
                            resulting from structural racism, including
                            poverty, housing, employment, political
                            participation, and environmental factors; and
                                ``(iv) the intersection of racism and other
                            systems of oppression, including as related to
                            age, sexual orientation, gender identity, and
                            disability status.
                        ``(B) Award noncompetitive grants and cooperative
                    agreements to eligible public and nonprofit private
                    entities, including State, local, territorial, and
                    Tribal health agencies and organizations, for the
                    research and collection, analysis, and reporting of
                    data on the topics described in subparagraph (A).
                        ``(C) Establish, through grants or cooperative
                    agreements, at least 3 regional centers of excellence,
                    located in racial and ethnic minority communities, in
                    antiracism for the purpose of developing new knowledge
                    in the science and practice of antiracism in health by
                    researching, understanding, and identifying the
                    mechanisms by which racism operates in the health
                    space, racial and ethnic inequities in health care
                    access and outcomes, the history of successful
                    antiracist movements in health, and other antiracist
                    public health work.
                        ``(D) Establish a clearinghouse within the Centers
                    for Disease Control and Prevention for the collection
                    and storage of data generated under the programs
                    implemented under this section for which there is not
                    an otherwise existing surveillance system at the
                    Centers for Disease Control and Prevention. Such data
                    shall--
                                ``(i) be comprehensive and disaggregated,
                            to the extent practicable, by including racial,
                            ethnic, primary language, sex, gender identity,
                            sexual orientation, age, socioeconomic status,
                            and disability disparities;
                                ``(ii) be made publicly available;
                                ``(iii) protect the privacy of individuals
                            whose information is included in such data; and
                                ``(iv) comply with privacy protections
                            under the regulations promulgated under section
                            264(c) of the Health Insurance Portability and
                            Accountability Act of 1996.
                        ``(E) Provide information and education to the
                    public on the public health impacts of structural
                    racism and on antiracist public health interventions.
                        ``(F) Consult with other Centers and National
                    Institutes within the Centers for Disease Control and
                    Prevention, including the Office of Minority Health and
                    Health Equity and the Center for State, Tribal, Local,
                    and Territorial Support, to ensure that scientific and
                    programmatic activities initiated by the agency
                    consider structural racism in their designs,
                    conceptualizations, and executions, which shall
                    include--
                                ``(i) putting measures of racism in
                            population-based surveys;
                                ``(ii) establishing a Federal Advisory
                            Committee on racism and health for the Centers
                            for Disease Control and Prevention;
                                ``(iii) developing training programs,
                            curricula, and seminars for the purposes of
                            training public health professionals and
                            researchers around issues of race, racism, and
                            antiracism;
                                ``(iv) providing standards and best
                            practices for programming and grant recipient
                            compliance with Federal data collection
                            standards, including section 4302 of the
                            Patient Protection and Affordable Care Act; and
                                ``(v) establishing leadership and
                            stakeholder councils with experts and leaders
                            in racism and public health disparities.
                        ``(G) Coordinate with the Indian Health Service and
                    with the Centers for Disease Control and Prevention's
                    Tribal Advisory Committee to ensure meaningful Tribal
                    consultation, the gathering of information from Tribal
                    authorities, and respect for Tribal data sovereignty.
                        ``(H) Engage in government to government
                    consultation with Indian Tribes and Tribal
                    organizations.
                        ``(I) At least every 2 years, produce and publicly
                    post on the Centers for Disease Control and
                    Prevention's website a report on antiracist activities
                    completed by the Center, which may include newly
                    identified antiracist public health practices.
        ``(b) Authorization of Appropriations.--There is authorized to be
    appropriated such sums as may be necessary to carry out this
    section.''.
        (d) Public Health Research and Investment in Police Violence.--
                (1) In general.--The Secretary of Health and Human Services
            shall establish within the National Center for Injury
            Prevention and Control of the Centers for Disease Control and
            Prevention (referred to in this subsection as the ``Center'') a
            law enforcement violence prevention program.
                (2) General duties.--In implementing the program under
            paragraph (1), the Center shall conduct research into, and
            provide leadership and coordination for--
                        (A) the understanding and promotion of knowledge
                    about the public health impacts of uses of force by law
                    enforcement, including police brutality and violence;
                        (B) developing public health interventions and
                    perspectives for eliminating deaths, injury, trauma,
                    and negative mental health effects from police presence
                    and interactions, including police brutality and
                    violence; and
                        (C) ensuring comprehensive data collection,
                    analysis, and reporting regarding police violence and
                    misconduct in consultation with the Department of
                    Justice and independent researchers.
                (3) Functions.--Under the program under paragraph (1), the
            Center shall--
                        (A) summarize and enhance the knowledge of the
                    distribution, status, and characteristics of law
                    enforcement-related death, trauma, and injury;
                        (B) conduct research and prepare, with the
                    assistance of State public health departments--
                                (i) statistics on law enforcement-related
                            death, injury, and brutality;
                                (ii) studies of the factors, including
                            legal, socioeconomic, discrimination, and other
                            factors that correlate with or influence police
                            brutality;
                                (iii) public information about uses of
                            force by law enforcement, including police
                            brutality and violence, for the practical use
                            of the public health community, including
                            publications that synthesize information
                            relevant to the national goal of understanding
                            police violence and methods for its control;
                                (iv) information to identify socioeconomic
                            groups, communities, and geographic areas in
                            need of study, and a strategic plan for
                            research necessary to comprehend the extent and
                            nature of police uses of force by law
                            enforcement, including police brutality and
                            violence, and determine what options exist to
                            reduce or eradicate death and injury that
                            result; and
                                (v) best practices in police violence
                            prevention in other countries;
                        (C) award grants, contracts, and cooperative
                    agreements to provide for the conduct of epidemiologic
                    research on uses of force by law enforcement, including
                    police brutality and violence, by Federal, State,
                    local, and private agencies, institutions,
                    organizations, and individuals;
                        (D) award grants, contracts, and cooperative
                    agreements to community groups, independent research
                    organizations, academic institutions, and other
                    entities to support, execute, or conduct research on
                    interventions to reduce or eliminate uses of force by
                    law enforcement, including police brutality and
                    violence;
                        (E) coordinate with the Department of Justice, and
                    other Federal, State, and local agencies on the
                    standardization of data collection, storage, and
                    retrieval necessary to collect, evaluate, analyze, and
                    disseminate information about the extent and nature of
                    uses of force by law enforcement, including police
                    brutality and violence, as well as options for the
                    eradication of such practices;
                        (F) submit an annual report to Congress on research
                    findings with recommendations to improve data
                    collection and standardization and to disrupt processes
                    in policing that preserve and reinforce racism and
                    racial disparities in public health;
                        (G) conduct primary research and explore uses of
                    force by law enforcement, including police brutality
                    and violence, and options for its control; and
                        (H) study alternatives to law enforcement response
                    as a method of reducing police violence.
                (4) Authorization of appropriations.--There is authorized
            to be appropriated, such sums as may be necessary to carry out
            this subsection.

    SEC. 10014. LGBTQ ESSENTIAL DATA.

        (a) Improving Data Collection on the Sexual Orientation and Gender
    Identity of Deceased Individuals Through the National Violent Death
    Reporting System.--
                (1) Collection of sexual orientation and gender identity
            data.--
                        (A) In general.--Not later than 120 days after the
                    date of enactment of this Act, the Director of the
                    Centers for Disease Control and Prevention shall take
                    measures to improve the incidence of the collection of
                    information on the sexual orientation and gender
                    identity of deceased individuals through the National
                    Violent Death Reporting System or any successor
                    programs.
                        (B) Confidentiality.--Any information collected
                    relating to the sexual orientation or gender identity
                    of a decedent shall be maintained in accordance with
                    the confidentiality and privacy standards and policies
                    for the protection of individuals applicable to all
                    other data collected for purposes of the National
                    Violent Death Reporting System.
                (2) Definitions.--In this subsection:
                        (A) Gender identity.--The term ``gender identity''
                    means an individual's sense of being male, female,
                    transgender, or another gender, as distinct from the
                    individual's sex assigned at birth.
                        (B) Sexual orientation.--The term ``sexual
                    orientation'' means how a person identifies in terms of
                    their emotional, romantic, or sexual attractions, and
                    includes identification as straight, heterosexual, gay,
                    lesbian, or bisexual, among other terms.
                (3) Authorization.--There is authorized to be appropriated
            $25,000,000 for fiscal year 2023 to carry out this subsection.
        (b) Sense of Congress.--It is the sense of the Congress that--
                (1) the Centers for Disease Control and Prevention has made
            significant efforts to encourage States and other jurisdictions
            to collect data on sexual orientation and gender identity
            through the National Violent Death Reporting System; and
                (2) jurisdictions that participate in the collection of
            such data through the National Violent Death Reporting System
            should be commended for their participation.

    SEC. 10015. SOCIAL DETERMINANTS ACCELERATOR.

        (a) Findings; Purposes.--
                (1) Findings.--Congress finds the following:
                        (A) There is a significant body of evidence showing
                    that economic and social conditions have a powerful
                    impact on individual and population health outcomes and
                    well-being, as well as medical costs.
                        (B) State, local, and Tribal governments and the
                    service delivery partners of such governments face
                    significant challenges in coordinating benefits and
                    services delivered through the Medicaid program and
                    other social services programs because of the
                    fragmented and complex nature of Federal and State
                    funding and administrative requirements.
                        (C) The Federal Government should prioritize and
                    proactively assist State and local governments to
                    strengthen the capacity of State and local governments
                    to improve health and social outcomes for individuals,
                    thereby improving cost-effectiveness and return on
                    investment.
                (2) Purposes.--The purposes of this section 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.
        (b) Social Determinants Accelerator Council.--
                (1) Establishment.--The Secretary of Health and Human
            Services (referred to in this section as the ``Secretary''), in
            coordination with the Administrator of the Centers for Medicare
            & Medicaid Services (referred to in this section as the
            ``Administrator''), shall establish an interagency council, to
            be known as the Social Determinants Accelerator Interagency
            Council (referred to in this section as the ``Council'') to
            achieve the purposes listed in subsection (a)(2).
                (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 described in clause (ii)
                            to serve as a member of the Council.
                                (ii) Responsibilities.--An employee
                            described in this subparagraph 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 subparagraph
                    (B)(ii).
                        (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 paragraph (3)(A).
                        (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 subsection (c);
                        (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 described in subsection (a), 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 subsection (c), 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 paragraph (4);
                        (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 section 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
                    subsection (c); 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
            paragraph (3), including solicitation of applications for the
            grants under subsection (c).
                (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 subsection (c),
                    including--
                                (i) the best practices and evidence-based
                            approaches such governments plan to employ to
                            achieve the purposes listed in subsection
                            (a)(2); 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 (c), 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.
        (c) 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 paragraph (2),
            for the development of social determinants accelerator plans,
            as described in paragraph (6).
                (2) Eligible applicant.--An eligible applicant described in
            this subsection 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
            subsection.
                (4) Application.--An eligible applicant seeking a grant
            under this subsection 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
                    section.
                (5) Use of funds.--A recipient of a grant under this
            subsection 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 subsection 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 paragraph (2)(A) 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.
        (d) Funding.--
                (1) In general.--Out of any money in the Treasury not
            otherwise appropriated, there is appropriated to carry out this
            section $25,000,000, of which up to $5,000,000 may be used to
            carry out this section, 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 subsection (c) 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 subsection (c) 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 section 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. 10016. IMPROVING SOCIAL DETERMINANTS OF HEALTH.

        (a) Findings.--Congress finds the following:
                (1) Healthy People 2030 defines social determinants of
            health as conditions in the environments where people are born,
            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 2030 is
            to ``create social, physical, and economic environments that
            promote attaining the full potential for health and well-being
            for all''.
                (3) Healthy People 2030 developed a ``place-based''
            organizing framework, reflecting five key areas of social
            determinants of health namely--
                        (A) economic stability;
                        (B) education access and quality;
                        (C) social and community context;
                        (D) health care access and quality; 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.
        (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 food insecurity;
                                (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 section.
        (e) Funding.--
                (1) In general.--There is authorized to be appropriated to
            carry out this section, $50,000,000 for each of fiscal years
            2023 through 2028.
                (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).

                            Subtitle B--Gun Violence

    SEC. 10101. REAFFIRMING RESEARCH AUTHORITY OF THE CENTERS FOR DISEASE
                  CONTROL AND PREVENTION.

        (a) In General.--Section 391 of the Public Health Service Act (42
    U.S.C. 280b) is amended--
                (1) in subsection (a)(1), by striking ``research relating
            to the causes, mechanisms, prevention, diagnosis, treatment of
            injuries, and rehabilitation from injuries;'' and inserting the
            following: ``research, including data collection, relating to--
                        ``(A) the causes, mechanisms, prevention,
                    diagnosis, and treatment of injuries, including with
                    respect to gun violence; and
                        ``(B) rehabilitation from such injuries;''; and
                (2) by adding at the end the following new subsection:
        ``(c) No Advocacy or Promotion of Gun Control.--Nothing in this
    section shall be construed to--
                ``(1) authorize the Secretary to give assistance, make
            grants, or enter into cooperative agreements or contracts for
            the purpose of advocating or promoting gun control; or
                ``(2) permit a recipient of any assistance, grant,
            cooperative agreement, or contract under this section to use
            such assistance, grant, agreement, or contract for the purpose
            of advocating or promoting gun control.''.

    SEC. 10102. NATIONAL VIOLENT DEATH REPORTING SYSTEM.

        The Secretary of Health and Human Services, acting through the
    Director of the Centers for Disease Control and Prevention, shall
    improve the National Violent Death Reporting System (as authorized by
    sections 301(a) and 391(a) of the Public Service Health Act (42 U.S.C.
    241(a), 280(b))), particularly through the inclusion of additional
    States and activities to increase the quality, type, and timeliness of
    reported data. Participation in the System by the States shall be
    voluntary.

    SEC. 10103. REPORT ON EFFECTS OF GUN VIOLENCE ON PUBLIC HEALTH.

        Not later than one year after the date of the enactment of this
    Act, and annually thereafter, the Surgeon General shall submit to
    Congress a report on the effects on public health, including mental
    health, of gun violence in the United States during the preceding year,
    and the status of actions taken to address such effects.

    SEC. 10104. REPORT ON EFFECTS OF GUN VIOLENCE ON MENTAL HEALTH IN
                  MINORITY COMMUNITIES.

        Not later than one year after the date of the enactment of this
    Act, the Deputy Assistant Secretary for Minority Health in the Office
    of the Secretary of Health and Human Services shall submit to the
    Congress a report on the effects of gun violence on public health,
    including mental health, in minority communities in the United States,
    and the status of actions taken to address such effects.
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