[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4065 Introduced in Senate (IS)]

<DOC>






118th CONGRESS
  2d Session
                                S. 4065

To prohibit discrimination in health care and require the provision of 
             equitable health care, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 22, 2024

Mr. Padilla (for himself and Mr. Booker) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To prohibit discrimination in health care and require the provision of 
             equitable health care, 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 ``Equal Health Care for All Act''.

SEC. 2. 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 inequitable provision of 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, former 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. 3. DATA COLLECTION AND REPORTING.

    (a) Required Reporting.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary''), 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 determines would be useful for determining a 
        pattern of inequitable provision of health care.
            (2) Proposed regulations.--Not later than 90 days after the 
        date of enactment of this Act, the Secretary shall issue 
        proposed regulations to carry out paragraph (1).
    (b) Repository.--The Secretary 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); and
            (2) ensure that such repository does not contain any data 
        that is individually identifiable.

SEC. 4. 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 
2025, 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, such that the social determinants of health do not adversely 
affect hospitals if the inequitable outcomes are not caused by that 
hospital's provision of care.
    ``(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 inequitable 
provision of 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 2025, 
                        measures selected under subparagraph (A) shall 
                        include the equitable health care measures 
                        described in subsection 
                        (b)(3)(B)(viii)(XIII).''.

SEC. 5. INEQUITABLE PROVISION OF HEALTH CARE AS A BASIS FOR PERMISSIVE 
              EXCLUSION FROM MEDICARE AND OTHER FEDERAL 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) Inequitable provision of health care.--
                    ``(A) In general.--Subject to subparagraph (B), any 
                health care provider that the Secretary determines, 
                under section 7(b)(2) of the Equal Health Care for All 
                Act, has engaged in a pattern of inequitable provision 
                of health care (as defined in subsection (e)(7) of that 
                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. 6. 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. 7. 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 inequitable provision of 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, so that the health care provider 
                        named in the complaint is not held accountable 
                        for a factor outside of the control of the 
                        provider's provision of health care.
                            (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 each State licensing authority that 
                        is responsible for the licensing of the health 
                        care provider under investigation, 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) Reporting of agreement.--
                            (i) In general.--Subject to clause (ii), 
                        the Secretary shall make available to the State 
                        licensing authority described in paragraph 
                        (2)(B)(iv) 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 State licensing 
                        authority 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'' means 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)  Inequitable provision of health care.--The term 
        ``inequitable provision of 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. 2000d 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. 8. 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 
                        described 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 of the 
        Commission appointed under paragraph (2)(B) 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 1013 of title 5, United States 
Code, shall not apply to the Commission.
    (f) Authorization of Appropriations.--There are authorized to be 
appropriated for fiscal year 2025 and each fiscal year thereafter such 
sums as may be necessary to carry out the duties of the Commission.

SEC. 9. 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).
                                 <all>