[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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