[Congressional Record Volume 148, Number 121 (Monday, September 23, 2002)]
[Senate]
[Pages S9033-S9048]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN:
  S. 2990. A bill to provide for programs and activities to improve the 
health of Hispanic individuals, and for other purposes; to the 
Committee on Finance.
  Mr. BINGAMAN. Mr. President, today I am introducing a bill that will 
be jointly introduced by Representative Ciro Rodriguez tomorrow when 
the House of Representatives comes into session entitled the ``Hispanic 
Health Improvement Act of 2002.'' This bill builds upon legislation 
that Representative Rodriguez introduced in the last Congress and 
addresses the tremendous health disparities that confront the Hispanic 
community in our Nation.

[[Page S9034]]

  Even if you know the statistics, they remain shocking. Over one-
third, or 35 percent of Hispanic adults lack health insurance. Despite 
the passage of the Children's Health Insurance Program, 27 percent of 
Latino children remain uninsured, which is sharp comparison to 9 
percent of white, 18 percent of black and 17 percent of Asian/Pacific 
Islander children.
  In testimony before the Senate Health, Education, Labor and Pensions 
Committee earlier today on Hispanic health issues, Dr. Glenn Flores, 
chair of the Latino Consortium of the American Academy of Pediatrics 
Center for Child Health Research, added:

       Among uninsured poor children in the U.S., Latinos 
     outnumber all other racial/ethnic groups, including whites: 
     there are 1 million poor, uninsured Latino children, compared 
     with 766,000 white, and 533,000 African-American poor, 
     uninsured children. . . . Although 1999 marked the first time 
     in many years that the proportion of uninsured Latino 
     children actually decreased (from 30% to 27%), recent 
     national data suggest that outreach efforts to enroll Latino 
     children have largely been unsuccessful. A Kaiser Commission 
     report found that only 26% of parents of eligible uninsured 
     children said that they had ever talked to someone or 
     received information about Medicaid enrollment, and 46% of 
     Spanish-speaking parents were unsuccessful at enrolling their 
     uninsured children in Medicaid because materials were 
     unavailable in Spanish.

  In order to address the lack of health care coverage, the legislation 
would expand CHIP to cover pregnant women and parents of children 
enrolled in CHIP. The legislation provides $50 million in grants to 
community-based groups to improve outreach and enrollment of children 
in Medicaid and CHIP with the grants targeted to Hispanic communities.
  In addition, the bill eliminates a number of enrollment barriers 
within Medicaid.
  And finally, it provides States the option to enroll legal immigrant 
pregnant women and children in Medicaid or CHIP. This comes from 
legislation introduced by Senator Graham earlier in this Congress.
  In addition to poor coverage rates, according to the Centers for 
Disease Control and Prevention, or CDC, the Hispanic population has 
morbidity and mortality rates that more often than not exceed that of 
any other ethnic groups. For example, age-adjusted mortality rates for 
diabetes are over 50 percent higher among Hispanic persons than non-
Hispanic whites. HIV infection rates are over 3 times those of non-
Hispanic whites. Tuberculosis rates among Latino children are 13 times 
that of whites.
  The legislation addresses these problems in a number of ways. In the 
area of access and affordability, our bill requires an annual report to 
Congress on how federal programs are responding to improve the health 
status of Hispanic individuals with respect to diabetes, cancer, 
asthma, HIV infection, AIDS, substance abuse, and mental health. The 
bill provides $100 million for targeted diabetes prevention, education, 
school-based programs, and screening activities in the Hispanic 
community.
  In addition, the legislation specifically addresses the problems 
facing communities along the U.S.-Mexico border, a 2,000-mile stretch 
of land that contains 11 million people, 5 of the 7 poorest 
metropolitan statistical areas in the country, and disease rates in 
some areas that are extraordinary. If the region were a State, the 
border would rank 1st in the number of uninsured, last in terms of per 
capita income, and 1st in a number of diseases.
  As Dr. Francisco Cigarroa, president of the University of Texas 
Health Sciences Center at San Antonio, noted in testimony at today's 
earlier hearing on Hispanic health, ``Germs respect no INS regulations. 
We truly must work with our neighbors to the South if we are to avoid a 
major influx of new conditions and diseases. It can be seen so clearly 
on a map. Just as there are 'rivers of commerce' there are 'rivers of 
infectious disease' and though they may start at the Border, they are 
eventually seen all the way to the northern Border that we share with 
Canada.''
  In response, the bill provides $200 million to border communities to 
improve health services and infrastructure along the U.S.-Mexico 
border.
  The numbers I have cited thus far indicates what we do know. Almost 
as much of a concern is what we do not know with respect to the status 
of Hispanic health in this Nation. According to one study, only 22 
percent of all articles published in major medical journals included 
non-English-speaking patients.
  The bill provides funding to do additional research and work on 
reducing health disparities in this Nation. Among the various 
provisions include efforts to improve the recruitment and retention of 
Hispanic health professionals and programs that support the training 
health professionals who can provide culturally competent and 
linguistically appropriate care. With respect to training more minority 
health professionals, Dr. Cigarroa said at today's hearing, ``We should 
do this because it is the smart thing to do. If we fail to take steps 
to address the gap between the health of the majority population and 
the health of the nation's rapidly growing minority populations, we are 
on a course leading to a collision. We are far too great a nation to 
allow this to happen.''
  Representative Ciro Rodriguez, the forthcoming chairman of the 
Congressional Hispanic Caucus, and I have worked together on this 
legislation to respond to the challenge before us with regard to 
coverage, access, and health disparities entitled the ``Hispanic Health 
Improvement Act of 2002.''
  While the legislation puts forth a number of initiatives to address 
what are disproportionately Hispanic problems, it must be noted that 
each section of the bill, including those to reduce the number of 
uninsured and to improve access to care, would improve the overall 
health of our entire Nation regardless of race or ethnicity.
  Over the coming months, I look forward to working with my colleagues 
to revise and improve upon this legislation for reintroduction in the 
108th Congress.
  Mr. President, I request unanimous consent that the text of the bill 
be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2990

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Hispanic 
     Health Improvement Act of 2002''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.

                     TITLE I--HEALTH CARE COVERAGE

          Subtitle A--Coverage for Parents and Pregnant Women

Sec. 101. Coverage of parents and pregnant women under the medicaid 
              program and title XXI.
Sec. 102. Automatic enrollment of children born to title XXI parents.
Sec. 103. Optional coverage of children through age 20 under the 
              medicaid program and title XXI.
Sec. 104. Technical and conforming amendments to authority to pay 
              medicaid expansion costs from title XXI appropriation.

                  Subtitle B--Outreach and Enrollment

Sec. 111. Grants to promote innovative outreach and enrollment efforts 
              under SCHIP.

           Subtitle C--Immigrant Children and Pregnant Women

Sec. 121. Optional coverage of legal immigrants under the medicaid 
              program and SCHIP.
Sec. 122. Permitting States and localities to provide health care to 
              all individuals.

                 Subtitle D--Eligibility Simplification

Sec. 131. State option to provide for simplified determinations of a 
              child's financial eligibility for medical assistance 
              under medicaid.
Sec. 132. Application of simplified title XXI procedures under the 
              medicaid program.

                 Subtitle E--SCHIP Wrap-Around Benefits

Sec. 141. Requiring coverage of substantially equivalent dental 
              services under SCHIP.
Sec. 142. State option to provide wrap-around SCHIP coverage to 
              children who have other health coverage.

            Subtitle F--Immunization Coverage Through SCHIP

Sec. 151. Eligibility of children enrolled in the State Children's 
              Health Insurance Program for the pediatric vaccine 
              distribution program.

           Subtitle G--Limited English Proficient Communities

Sec. 161. Increased Federal reimbursement for language services under 
              the medicaid program and the State Children's Health 
              Insurance Program.

[[Page S9035]]

                Subtitle H--Binational Health Insurance

Sec. 171. Binational health insurance.

                   TITLE II--ACCESS AND AFFORDABILITY

   Subtitle A--Report on Programs for Improving the Health Status of 
                          Hispanic Individuals

Sec. 201. Annual report regarding diabetes, HIV/AIDS, substance abuse, 
              and mental health.

              Subtitle B--Diabetes Control and Prevention

Sec. 211. National diabetes education program of Centers for Disease 
              Control and Prevention; increased authorization of 
              appropriations for activities regarding Hispanic 
              individuals.
Sec. 212. National Institutes of Health; implementation of 
              recommendations of diabetes research working group.

  Subtitle C--HIV Prevention Activities Regarding Hispanic Individuals

Sec. 221. Programs of Centers for Disease Control and Prevention; 
              representation of Hispanic individuals in membership of 
              community planning groups.
Sec. 222. AIDS education and training centers funded by Health 
              Resources and Services Administration; establishment of 
              center directed toward minority populations with hiv.

          Subtitle D--Prevention of Latina Adolescent Suicides

Sec. 231. Short title.
Sec. 232. Establishment of program for prevention of Latina adolescent 
              suicides.

                   Subtitle E--Dental Health Services

Sec. 241. Grants to improve the provision of dental health services 
              through community health centers and public health 
              departments.
Sec. 242. School-based dental sealant program.

                       Subtitle F--Border Health

Sec. 251. Short title.
Sec. 252. Definitions.
Sec. 253. Border health services grants.
Sec. 254. United States-Mexico Border Health Commission.

                  Subtitle G--Community Health Workers

Sec. 261. Short title.
Sec. 262. Grants to promote positive health behaviors in women.

Subtitle H--Patient Navigator, Outreach, and Chronic Disease Prevention

Sec. 271. Short title.
Sec. 272. HRSA grants for model community cancer and chronic disease 
              care and prevention; HRSA grants for patient navigators.
Sec. 273. NCI grants for model community cancer and chronic disease 
              care and prevention; NCI grants for patient navigators.

                     TITLE III--HEALTH DISPARITIES

        Subtitle A--Hispanic-Serving Health Professions Schools

Sec. 301. Hispanic-serving health professions schools.

             Subtitle B--Health Career Opportunity Program

Sec. 311. Educational assistance regarding undergraduates.
Sec. 312. Centers of excellence.

               Subtitle C--Bilingual Health Professionals

Sec. 321. Training of bilingual health professionals with respect to 
              minority health conditions.

                    Subtitle D--Cultural Competence

Sec. 331. Definition.
Sec. 332. Activities of Office of Minority Health; Center for 
              Linguistic and Cultural Competence in Health Care.
Sec. 333. Cultural competence demonstration projects.

             Subtitle E--Data Regarding Race and Ethnicity

Sec. 341. Collection of data.
Sec. 342. Development of standards; study to measure patient outcomes 
              under medicare and medicaid programs.

       Subtitle F--National Assessment of Status of Latino Health

Sec. 351. National assessment of status of Latino health.

                 Subtitle G--Office of Minority Health

Sec. 361. Revision and extension of programs of Office of Minority 
              Health.
Sec. 362. Establishment of individual Offices of Minority Health within 
              agencies of Public Health Service.
Sec. 363. Assistant Secretary of Health and Human Services for Civil 
              Rights.

                     TITLE I--HEALTH CARE COVERAGE

          Subtitle A--Coverage for Parents and Pregnant Women

     SEC. 101. COVERAGE OF PARENTS AND PREGNANT WOMEN UNDER THE 
                   MEDICAID PROGRAM AND TITLE XXI.

       (a) Incentives To Implement Coverage of Parents and 
     Pregnant Women.--
       (1) Under medicaid.--
       (A) Establishment of new optional eligibility category.--
     Section 1902(a)(10)(A)(ii) of the Social Security Act (42 
     U.S.C. 1396a(a)(10)(A)(ii)) is amended--
       (i) by striking ``or'' at the end of subclause (XVII);
       (ii) by adding ``or'' at the end of subclause (XVIII); and
       (iii) by adding at the end the following:

       ``(XIX) who are individuals described in subsection (k)(1) 
     (relating to parents of categorically eligible children);''.

       (B) Parents described.--Section 1902 of the Social Security 
     Act is further amended by inserting after subsection (j) the 
     following:
       ``(k)(1)(A) Individuals described in this paragraph are 
     individuals--
       ``(i) who are the parents of an individual who is under 19 
     years of age (or such higher age as the State may have 
     elected under section 1902(l)(1)(D)) and who is eligible for 
     medical assistance under subsection (a)(10)(A);
       ``(ii) who are not otherwise eligible for medical 
     assistance under such subsection or under a waiver approved 
     under section 1115 or otherwise (except under section 1931 or 
     under subsection (a)(10)(A)(ii)(XIX)); and
       ``(iii) whose family income exceeds the effective income 
     level or resource level applicable under the State plan under 
     part A of title IV as in effect as of July 16, 1996, but does 
     not exceed the highest effective income level applicable to a 
     child in the family under this title.
       ``(B) In establishing an income eligibility level for 
     individuals described in this paragraph, a State may vary 
     such level consistent with the various income levels 
     established under subsection (l)(2) based on the ages of 
     children described in subsection (l)(1) in order to ensure, 
     to the maximum extent possible, that such individuals shall 
     be enrolled in the same program as their children.
       ``(C) An individual may not be treated as being described 
     in this paragraph unless, at the time of the individual's 
     enrollment under this title, the child referred to in 
     subparagraph (A)(i) of the individual is also enrolled under 
     this title.
       ``(D) In this subsection, the term `parent' has the meaning 
     given the term `caretaker relative' for purposes of carrying 
     out section 1931.
       ``(2) In the case of a parent described in paragraph (1) 
     who is also the parent of a child who is eligible for child 
     health assistance under title XXI, the State may elect (on a 
     uniform basis) to cover all such parents under section 2111 
     or under this title.''.
       (C) Enhanced matching funds available if certain conditions 
     met.--Section 1905 of the Social Security Act (42 U.S.C. 
     1396d) is amended--
       (i) in the fourth sentence of subsection (b), by striking 
     ``or subsection (u)(3)'' and inserting ``, (u)(3), or 
     (u)(4)''; and
       (ii) in subsection (u)--

       (I) by redesignating paragraph (4) as paragraph (6), and
       (II) by inserting after paragraph (3) the following:

       ``(4) For purposes of subsection (b) and section 
     2105(a)(1):
       ``(A) Parents and pregnant women.--The expenditures 
     described in this subparagraph are the expenditures described 
     in the following clauses (i) and (ii):
       ``(i) Parents.--If the conditions described in clause (iii) 
     are met, expenditures for medical assistance for parents 
     described in section 1902(k)(1) and for parents who would be 
     described in such section but for the fact that they are 
     eligible for medical assistance under section 1931 or under a 
     waiver approved under section 1115.
       ``(ii) Certain pregnant women.--If the conditions described 
     in clause (iv) are met, expenditures for medical assistance 
     for pregnant women described in subsection (n) or under 
     section 1902(l)(1)(A) in a family the income of which exceeds 
     the effective income level applicable under subsection 
     (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902 to a family 
     of the size involved as of January 1, 2002.
       ``(iii) Conditions for expenditures for parents.--The 
     conditions described in this clause are the following:
       ``(I) The State has a State child health plan under title 
     XXI which (whether implemented under such title or under this 
     title) has an effective income level for children that is at 
     least 200 percent of the poverty line.
       ``(II) State child health plan does not limit the 
     acceptance of applications, does not use a waiting list for 
     children who meet eligibility standards to qualify for 
     assistance, and provides benefits to all children in the 
     State who apply for and meet eligibility standards.
       ``(III) The State plans under this title and title XXI do 
     not provide coverage for parents with higher family income 
     without covering parents with a lower family income.
       ``(IV) The State does not apply an income level for parents 
     that is lower than the effective income level (expressed as a 
     percent of the poverty line) that has been specified under 
     the State plan under title XIX (including under a waiver 
     authorized by the Secretary or under section 1902(r)(2)), as 
     of January 1, 2002, to be eligible for medical assistance as 
     a parent under this title.
       ``(iv) Conditions for expenditures for certain pregnant 
     women.--The conditions described in this clause are the 
     following:
       ``(I) The State has established an effective income 
     eligibility level for pregnant women under subsection 
     (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902 that is at 
     least 185 percent of the poverty line.
       ``(II) The State plans under this title and title XXI do 
     not provide coverage for pregnant women described in 
     subparagraph

[[Page S9036]]

     (A)(ii) with higher family income without covering such 
     pregnant women with a lower family income.
       ``(III) The State does not apply an income level for 
     pregnant women that is lower than the effective income level 
     (expressed as a percent of the poverty line and considering 
     applicable income disregards) that has been specified under 
     the State plan under subsection (a)(10)(A)(i)(III) or 
     (l)(2)(A) of section 1902, as of January 1, 2002, to be 
     eligible for medical assistance as a pregnant woman.
       ``(IV) The State satisfies the conditions described in 
     subclauses (I) and (II) of clause (iii).
       ``(v) Definitions.--For purposes of this subsection:
       ``(I) The term `parent' has the meaning given such term for 
     purposes of section 1902(k)(1).
       ``(II) The term `poverty line' has the meaning given such 
     term in section 2110(c)(5).''.
       (D) Appropriation from title xxi allotment for medicaid 
     expansion costs for parents; elimination of counting medicaid 
     child presumptive eligibility costs against title xxi 
     allotment.--Subparagraph (B) of section 2105(a)(1) of the 
     Social Security Act, as amended by section 104(a), is amended 
     to read as follows:
       ``(B) Parents and pregnant women.--Expenditures for medical 
     assistance that are attributable to expenditures described in 
     section 1905(u)(4)(A).''.
       (E) Only counting enhanced portion for coverage of 
     additional pregnant women.--Section 1905 of the Social 
     Security Act (42 U.S.C. 1396d) is amended--
       (i) in the fourth sentence of subsection (b), by inserting 
     ``(except in the case of expenditures described in subsection 
     (u)(5))'' after ``do not exceed'';
       (ii) in subsection (u), by inserting after paragraph (4) 
     (as inserted by subparagraph (C)), the following:
       ``(5) For purposes of the fourth sentence of subsection (b) 
     and section 2105(a), the following payments under this title 
     do not count against a State's allotment under section 2104:
       ``(A) Regular fmap for expenditures for pregnant women with 
     income above january 1, 2002 income level and below 185 
     percent of poverty.--The portion of the payments made for 
     expenditures described in paragraph (4)(A)(ii) that 
     represents the amount that would have been paid if the 
     enhanced FMAP had not been substituted for the Federal 
     medical assistance percentage.''.
       (2) Under title xxi.--
       (A) Parents and pregnant women coverage.--Title XXI of the 
     Social Security Act (42 U.S.C. 1397aa et seq.) is amended by 
     adding at the end the following:

     ``SEC. 2111. OPTIONAL COVERAGE OF PARENTS OF TARGETED LOW-
                   INCOME CHILDREN OR TARGETED LOW-INCOME PREGNANT 
                   WOMEN.

       ``(a) Optional Coverage.--Notwithstanding any other 
     provision of this title, a State may provide for coverage, 
     through an amendment to its State child health plan under 
     section 2102, of parent health assistance for targeted low-
     income parents, pregnancy-related assistance for targeted 
     low-income pregnant women, or both, in accordance with this 
     section, but only if--
       ``(1) with respect to the provision of parent health 
     assistance, the State meets the conditions described in 
     clause (iii) of section 1905(u)(4)(A);
       ``(2) with respect to the provision of pregnancy-related 
     assistance, the State meets the conditions described in 
     clause (iv) of section 1905(u)(4)(A); and
       ``(3) in the case of parent health assistance for targeted 
     low-income parents, the State elects to provide medical 
     assistance under section 1902(a)(10)(A)(ii)(XIX), under 
     section 1931, or under a waiver under section 1115 to 
     individuals described in section 1902(k)(1)(A)(i) and elects 
     an effective income level that, consistent with paragraphs 
     (1)(B) and (2) of section 1902(k), ensures to the maximum 
     extent possible, that such individuals shall be enrolled in 
     the same program as their children if their children are 
     eligible for coverage under title XIX (including under a 
     waiver authorized by the Secretary or under section 
     1902(r)(2)).''.
       ``(b) Definitions.--For purposes of this title:
       ``(1) Parent health assistance.--The term `parent health 
     assistance' has the meaning given the term child health 
     assistance in section 2110(a) as if any reference to targeted 
     low-income children were a reference to targeted low-income 
     parents.
       ``(2) Parent.--The term `parent' has the meaning given the 
     term `caretaker relative' for purposes of carrying out 
     section 1931.
       ``(3) Pregnancy-related assistance.--The term `pregnancy-
     related assistance' has the meaning given the term child 
     health assistance in section 2110(a) as if any reference to 
     targeted low-income children were a reference to targeted 
     low-income pregnant women, except that the assistance shall 
     be limited to services related to pregnancy (which include 
     prenatal, delivery, and postpartum services) and to other 
     conditions that may complicate pregnancy.
       ``(4) Targeted low-income parent.--The term `targeted low-
     income parent' has the meaning given the term targeted low-
     income child in section 2110(b) as if the reference to a 
     child were deemed a reference to a parent (as defined in 
     paragraph (3)) of the child; except that in applying such 
     section--
       ``(A) there shall be substituted for the income level 
     described in paragraph (1)(B)(ii)(I) the applicable income 
     level in effect for a targeted low-income child;
       ``(B) in paragraph (3), January 1, 2002, shall be 
     substituted for July 1, 1997; and
       ``(C) in paragraph (4), January 1, 2002, shall be 
     substituted for March 31, 1997.
       ``(5) Targeted low-income pregnant woman.--The term 
     `targeted low-income pregnant woman' has the meaning given 
     the term targeted low-income child in section 2110(b) as if 
     any reference to a child were a reference to a woman during 
     pregnancy and through the end of the month in which the 60-
     day period beginning on the last day of her pregnancy ends; 
     except that in applying such section--
       ``(A) there shall be substituted for the income level 
     described in paragraph (1)(B)(ii)(I) the applicable income 
     level in effect for a targeted low-income child;
       ``(B) in paragraph (3), January 1, 2002, shall be 
     substituted for July 1, 1997; and
       ``(C) in paragraph (4), January 1, 2002, shall be 
     substituted for March 31, 1997.
       ``(6) Parent.--The term `parent' has the meaning given the 
     term `caretaker relative' for purposes of carrying out 
     section 1931.
       ``(c) References to Terms and Special Rules.--In the case 
     of, and with respect to, a State providing for coverage of 
     parent health assistance to targeted low-income parents or 
     pregnancy-related assistance to targeted low-income pregnant 
     women under subsection (a), the following special rules 
     apply:
       ``(1) Any reference in this title (other than in subsection 
     (b)) to a targeted low-income child is deemed to include a 
     reference to a targeted low-income parent or a targeted low-
     income pregnant woman (as applicable).
       ``(2) Any such reference to child health assistance--
       ``(A) with respect to such parents is deemed a reference to 
     parent health assistance; and
       ``(B) with respect to such pregnant women, is deemed a 
     reference to pregnancy-related assistance.
       ``(3) In applying section 2103(e)(3)(B) in the case of a 
     family or pregnant woman provided coverage under this 
     section, the limitation on total annual aggregate cost-
     sharing shall be applied to the entire family or such 
     pregnant woman.
       ``(4) In applying section 2110(b)(4), any reference to 
     `section 1902(l)(2) or 1905(n)(2) (as selected by a State)' 
     is deemed a reference to the effective income level 
     applicable to parents under section 1931 or under a waiver 
     approved under section 1115, or, in the case of a pregnant 
     woman, the income level established under section 
     1902(l)(2)(A).
       ``(5) In applying section 2102(b)(3)(B), any reference to 
     children found through screening to be eligible for medical 
     assistance under the State medicaid plan under title XIX is 
     deemed a reference to parents and pregnant women.''.
       (B) Additional allotment for states providing coverage of 
     parents or pregnant women.--
       (i) In general.--Section 2104 of the Social Security Act 
     (42 U.S.C. 1397dd) is amended by inserting after subsection 
     (c) the following:
       ``(d) Additional Allotments for State Coverage of Parents 
     or Pregnant Women.--
       ``(1) Appropriation; total allotment.--For the purpose of 
     providing additional allotments to States under this title, 
     there is appropriated, out of any money in the Treasury not 
     otherwise appropriated--
       ``(A) for fiscal year 2002, $2,000,000,000;
       ``(B) for fiscal year 2003, $2,000,000,000;
       ``(C) for fiscal year 2004, $3,000,000,000;
       ``(D) for fiscal year 2005, $3,000,000,000;
       ``(E) for fiscal year 2006, $5,000,000,000;
       ``(F) for fiscal year 2007, $5,000,000,000;
       ``(G) for fiscal year 2008, $5,000,000,000;
       ``(H) for fiscal year 2009, $5,000,000,000;
       ``(I) for fiscal year 2010, $5,000,000,000; and
       ``(J) for fiscal year 2011 and each fiscal year thereafter, 
     the amount of the allotment provided under this paragraph for 
     the preceding fiscal year increased by the percentage 
     increase (if any) in the medical care expenditure category of 
     the Consumer Price Index for All Urban Consumers (United 
     States city average).
       ``(2) State and territorial allotments.--
       ``(A) In general.--In addition to the allotments provided 
     under subsections (b) and (c), subject to paragraphs (3) and 
     (4), of the amount available for the additional allotments 
     under paragraph (1) for a fiscal year, the Secretary shall 
     allot to each State with a State child health plan approved 
     under this title--
       ``(i) in the case of such a State other than a commonwealth 
     or territory described in subparagraph (B), the same 
     proportion as the proportion of the State's allotment under 
     subsection (b) (determined without regard to subsection (f)) 
     to the total amount of the allotments under subsection (b) 
     for such States eligible for an allotment under this 
     paragraph for such fiscal year; and
       ``(ii) in the case of a commonwealth or territory described 
     in subsection (c)(3), the same proportion as the proportion 
     of the commonwealth's or territory's allotment under 
     subsection (c) (determined without regard to subsection (f)) 
     to the total amount of the allotments under subsection (c) 
     for commonwealths and territories eligible for an allotment 
     under this paragraph for such fiscal year.
       ``(B) Availability and redistribution of unused 
     allotments.--In applying subsections (e) and (f) with respect 
     to additional allotments made available under this 
     subsection, the procedures established under such subsections 
     shall ensure such additional

[[Page S9037]]

     allotments are only made available to States which have 
     elected to provide coverage under section 2111.
       ``(3) Use of additional allotment.--Additional allotments 
     provided under this subsection are not available for amounts 
     expended before October 1, 2002. Such amounts are available 
     for amounts expended on or after such date for child health 
     assistance for targeted low-income children, as well as for 
     parent health assistance for targeted low-income parents, and 
     pregnancy-related assistance for targeted low-income pregnant 
     women.
       ``(4) Requiring election to provide coverage.--No payments 
     may be made to a State under this title from an allotment 
     provided under this subsection unless the State has made an 
     election to provide parent health assistance for targeted 
     low-income parents, or pregnancy-related assistance for 
     targeted low-income pregnant women.''.
       (ii) Conforming amendments.--Section 2104 of the Social 
     Security Act (42 U.S.C. 1397dd) is amended--

       (I) in subsection (a), by inserting ``subject to subsection 
     (d),'' after ``under this section,'';
       (II) in subsection (b)(1), by inserting ``and subsection 
     (d)'' after ``Subject to paragraph (4)''; and
       (III) in subsection (c)(1), by inserting ``subject to 
     subsection (d),'' after ``for a fiscal year,''.

       (C) No cost-sharing for pregnancy-related benefits.--
     Section 2103(e)(2) of the Social Security Act (42 U.S.C. 
     1397cc(e)(2)) is amended--
       (i) in the heading, by inserting ``and pregnancy-related 
     services'' after ``preventive services''; and
       (ii) by inserting before the period at the end the 
     following: ``and for pregnancy-related services''.
       (3) Effective date.--The amendments made by this subsection 
     apply to items and services furnished on or after October 1, 
     2002, without regard to whether regulations implementing such 
     amendments have been issued.
       (b) Making Title XXI Base Allotments Permanent.--Section 
     2104(a) of the Social Security Act (42 U.S.C. 1397dd(a)) is 
     amended--
       (1) by striking ``and'' at the end of paragraph (9);
       (2) by striking the period at the end of paragraph (10) and 
     inserting ``; and''; and
       (3) by adding at the end the following:
       ``(11) for fiscal year 2008 and each fiscal year 
     thereafter, the amount of the allotment provided under this 
     subsection for the preceding fiscal year increased by the 
     percentage increase (if any) in the medical care expenditure 
     category of the Consumer Price Index for All Urban Consumers 
     (United States city average).''.
       (c) Optional Application of Presumptive Eligibility 
     Provisions to Parents.--Section 1920A of the Social Security 
     Act (42 U.S.C. 1396r-1a) is amended by adding at the end the 
     following:
       ``(e) A State may elect to apply the previous provisions of 
     this section to provide for a period of presumptive 
     eligibility for medical assistance for a parent (as defined 
     for purposes of section 1902(k)(1)) of a child with respect 
     to whom such a period is provided under this section.''.
       (d) Conforming Amendments.--
       (1) Eligibility categories.--Section 1905(a) of the Social 
     Security Act (42 U.S.C. 1396d(a)) is amended, in the matter 
     before paragraph (1)--
       (A) by striking ``or'' at the end of clause (xii);
       (B) by inserting ``or'' at the end of clause (xiii); and
       (C) by inserting after clause (xiii) the following:
       ``(xiv) who are parents described (or treated as if 
     described) in section 1902(k)(1),''.
       (2) Income limitations.--Section 1903(f)(4) of the Social 
     Security Act (42 U.S.C. 1396b(f)(4)) is amended by inserting 
     ``1902(a)(10)(A)(ii)(XIX),'' after 
     ``1902(a)(10)(A)(ii)(XVIII),''.
       (3) Conforming amendment relating to no waiting period for 
     pregnant women.--Section 2102(b)(1)(B) of the Social Security 
     Act (42 U.S.C. 1397bb(b)(1)(B)) is amended--
       (A) by striking ``, and'' at the end of clause (i) and 
     inserting a semicolon;
       (B) by striking the period at the end of clause (ii) and 
     inserting ``; and''; and
       (C) by adding at the end the following:
       ``(iii) may not apply a waiting period (including a waiting 
     period to carry out paragraph (3)(C)) in the case of a 
     targeted low-income parent who is pregnant.''.

     SEC. 102. AUTOMATIC ENROLLMENT OF CHILDREN BORN TO TITLE XXI 
                   PARENTS.

       (a) Title XXI.--Section 2102(b)(1) (42 U.S.C. 1397bb(b)(1)) 
     is amended by adding at the end the following:
       ``(C) Automatic eligibility of children born to pregnant 
     women.--Such eligibility standards shall provide for 
     automatic coverage of a child born to an individual who is 
     provided assistance under this title in the same manner as 
     medical assistance would be provided under section 1902(e)(4) 
     to a child described in such section.''.
       (b) Conforming Amendment to Medicaid.--Section 1902(e)(4) 
     (42 U.S.C. 1396a(e)(4)) is amended in the first sentence by 
     striking ``so long as the child is a member of the woman's 
     household and the woman remains (or would remain if pregnant) 
     eligible for such assistance''.

     SEC. 103. OPTIONAL COVERAGE OF CHILDREN THROUGH AGE 20 UNDER 
                   THE MEDICAID PROGRAM AND TITLE XXI.

       (a) Medicaid.--
       (1) In general.--Section 1902(l)(1)(D) of the Social 
     Security Act (42 U.S.C. 1396a(l)(1)(D)) is amended by 
     inserting ``(or, at the election of a State, 20 or 21 years 
     of age)'' after ``19 years of age''.
       (2) Conforming amendments.--
       (A) Section 1902(e)(3)(A) of the Social Security Act (42 
     U.S.C. 1396a(e)(3)(A)) is amended by inserting ``(or 1 year 
     less than the age the State has elected under subsection 
     (l)(1)(D))'' after ``18 years of age''.
       (B) Section 1902(e)(12) of the Social Security Act (42 
     U.S.C. 1396a(e)(12)) is amended by inserting ``or such higher 
     age as the State has elected under subsection (l)(1)(D)'' 
     after ``19 years of age''.
       (C) Section 1920A(b)(1) of the Social Security Act (42 
     U.S.C. 1396r-1a(b)(1)) is amended by inserting ``or such 
     higher age as the State has elected under section 
     1902(l)(1)(D)'' after ``19 years of age''.
       (D) Section 1928(h)(1) of the Social Security Act (42 
     U.S.C. 1396s(h)(1)) is amended by inserting ``or 1 year less 
     than the age the State has elected under section 
     1902(l)(1)(D)'' before the period at the end.
       (E) Section 1932(a)(2)(A) of the Social Security Act (42 
     U.S.C. 1396u-2(a)(2)(A)) is amended by inserting ``(or such 
     higher age as the State has elected under section 
     1902(l)(1)(D))'' after ``19 years of age''.
       (b) Title XXI.--Section 2110(c)(1) of the Social Security 
     Act (42 U.S.C. 1397jj(c)(1)) is amended by inserting ``(or 
     such higher age as the State has elected under section 
     1902(l)(1)(D))''.
       (c) Effective Date.--The amendments made by this section 
     take effect on October 1, 2002, and apply to medical 
     assistance and child health assistance provided on or after 
     such date, whether or not regulations implementing such 
     amendments have been issued.

     SEC. 104. TECHNICAL AND CONFORMING AMENDMENTS TO AUTHORITY TO 
                   PAY MEDICAID EXPANSION COSTS FROM TITLE XXI 
                   APPROPRIATION.

       (a) Authority To Pay Medicaid Expansion Costs From Title 
     XXI Appropriation.--Section 2105(a) of the Social Security 
     Act (42 U.S.C. 1397ee(a)) is amended to read as follows:
       ``(a) Allowable Expenditures.--
       ``(1) In general.--Subject to the succeeding provisions of 
     this section, the Secretary shall pay to each State with a 
     plan approved under this title, from its allotment under 
     section 2104, an amount for each quarter equal to the 
     enhanced FMAP of the following expenditures in the quarter:
       ``(A) Child health assistance under medicaid.--Expenditures 
     for child health assistance under the plan for targeted low-
     income children in the form of providing medical assistance 
     for expenditures described in the fourth sentence of section 
     1905(b).
       ``(B) Reserved.--[reserved].
       ``(C) Child health assistance under this title.--
     Expenditures for child health assistance under the plan for 
     targeted low-income children in the form of providing health 
     benefits coverage that meets the requirements of section 
     2103.
       ``(D) Assistance and administrative expenditures subject to 
     limit.--Expenditures only to the extent permitted consistent 
     with subsection (c)--
       ``(i) for other child health assistance for targeted low-
     income children;
       ``(ii) for expenditures for health services initiatives 
     under the plan for improving the health of children 
     (including targeted low-income children and other low-income 
     children);
       ``(iii) for expenditures for outreach activities as 
     provided in section 2102(c)(1) under the plan; and
       ``(iv) for other reasonable costs incurred by the State to 
     administer the plan.
       ``(2) Order of payments.--Payments under a subparagraph of 
     paragraph (1) from a State's allotment for expenditures 
     described in each such subparagraph shall be made on a 
     quarterly basis in the order of such subparagraph in such 
     paragraph.
       ``(3) No duplicative payment.--In the case of expenditures 
     for which payment is made under paragraph (1), no payment 
     shall be made under title XIX.''.
       (b) Conforming Amendments.--
       (1) Section 1905(u).--Section 1905(u)(1)(B) of the Social 
     Security Act (42 U.S.C. 1396d(u)(1)(B)) is amended by 
     inserting ``and section 2105(a)(1)'' after ``subsection 
     (b)''.
       (2) Section 2105(c).--Section 2105(c)(2)(A) of the Social 
     Security Act (42 U.S.C. 1397ee(c)(2)(A)) is amended by 
     striking ``subparagraphs (A), (C), and (D) of''.
       (c) Effective Date.--The amendments made by this section 
     shall be effective as if included in the enactment of the 
     Balanced Budget Act of 1997 (Public Law 105-33; 111 Stat. 
     251), whether or not regulations implementing such amendments 
     have been issued.

                  Subtitle B--Outreach and Enrollment

     SEC. 111. GRANTS TO PROMOTE INNOVATIVE OUTREACH AND 
                   ENROLLMENT EFFORTS UNDER SCHIP.

       (a) In General.--Section 2104(f) of the Social Security Act 
     (42 U.S.C. 1397dd(f)) is amended--
       (1) by striking ``The Secretary'' and inserting the 
     following:
       ``(1) In general.--Subject to paragraph (2), the 
     Secretary''; and
       (2) by adding at the end the following:
       ``(2) Grants to promote innovative outreach and enrollment 
     efforts.--
       ``(A) In general.--Prior to any redistribution under 
     paragraph (1) of unexpended allotments made to States under 
     subsection (b) or

[[Page S9038]]

     (c) for fiscal year 2000 and any fiscal year thereafter, the 
     Secretary shall--
       ``(i) reserve from such unexpended allotments the lesser of 
     $50,000,000 or the total amount of such unexpended allotments 
     for grants under this paragraph for the fiscal year in which 
     the redistribution occurs; and
       ``(ii) subject to subparagraph (B), use such reserved funds 
     to make grants to local and community-based public or 
     nonprofit organizations (including organizations involved in 
     women's health, pediatric advocacy, local and county 
     governments, public health departments, Federally-qualified 
     health centers, children's hospitals, and hospitals defined 
     as disproportionate share hospitals under the State plan 
     under title XIX) to conduct innovative outreach and 
     enrollment efforts that are consistent with section 2102(c) 
     and to promote understanding of the importance of health 
     insurance coverage for prenatal care and children.
       ``(B) Priority for grants in certain areas.--In making 
     grants under subparagraph (A)(ii), the Secretary shall give 
     priority to grant applicants that propose to target the 
     outreach and enrollment efforts funded under the grant to 
     geographic areas--
       ``(i) with high rates of eligible but unenrolled children, 
     including such children who reside in rural areas; or
       ``(ii) with high rates of families for whom English is not 
     their primary language.
       ``(C) Applications.--An organization that desires to 
     receive a grant under this paragraph shall submit an 
     application to the Secretary in such form and manner, and 
     containing such information, as the Secretary may decide.''.
       (b) Extending Use of Outstationed Workers To Accept Title 
     XXI Applications.--Section 1902(a)(55) of such Act (42 U.S.C. 
     1396a(a)(55)) is amended by inserting ``, and applications 
     for child health assistance under title XXI'' after 
     ``(a)(10)(A)(ii)(IX)''.

           Subtitle C--Immigrant Children and Pregnant Women

     SEC. 121. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS UNDER THE 
                   MEDICAID PROGRAM AND SCHIP.

       (a) Medicaid Program.--Section 1903(v) of the Social 
     Security Act (42 U.S.C. 1396b(v)) is amended--
       (1) in paragraph (1), by striking ``paragraph (2)'' and 
     inserting ``paragraphs (2) and (4)''; and
       (2) by adding at the end the following:
       ``(4)(A) A State may elect (in a plan amendment under this 
     title) to provide medical assistance under this title for 
     aliens who are lawfully residing in the United States 
     (including battered aliens described in section 431(c) of the 
     Personal Responsibility and Work Opportunity Reconciliation 
     Act of 1996) and who are otherwise eligible for such 
     assistance, within any of the following eligibility 
     categories:
       ``(i) Pregnant women.--Women during pregnancy (and during 
     the 60-day period beginning on the last day of the 
     pregnancy).
       ``(ii) Children.--Children (as defined under such plan), 
     including optional targeted low-income children described in 
     section 1905(u)(2)(B).
       ``(B)(i) In the case of a State that has elected to provide 
     medical assistance to a category of aliens under subparagraph 
     (A), no debt shall accrue under an affidavit of support 
     against any sponsor of such an alien on the basis of 
     provision of assistance to such category and the cost of such 
     assistance shall not be considered as an unreimbursed cost.
       ``(ii) The provisions of sections 401(a), 402(b), 403, and 
     421 of the Personal Responsibility and Work Opportunity 
     Reconciliation Act of 1996 shall not apply to a State that 
     makes an election under subparagraph (A).''.
       (b) Title XXI.--Section 2107(e)(1) of the Social Security 
     Act (42 U.S.C. 1397gg(e)(1)) is amended by adding at the end 
     the following:
       ``(E) Section 1903(v)(4) (relating to optional coverage of 
     permanent resident alien children), but only if the State has 
     elected to apply such section to that category of children 
     under title XIX.''.
       (c) Effective Date.--The amendments made by this section 
     take effect on October 1, 2002, and apply to medical 
     assistance and child health assistance furnished on or after 
     such date.

     SEC. 122. PERMITTING STATES AND LOCALITIES TO PROVIDE HEALTH 
                   CARE TO ALL INDIVIDUALS.

       (a) In General.--Section 411 of the Personal Responsibility 
     and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 
     1621) is amended--
       (1) in subsection (b)--
       (A) by striking paragraphs (1) and (3); and
       (B) by redesignating paragraphs (2) and (4) as paragraphs 
     (1) and (2), respectively; and
       (2) in subsection (c)--
       (A) in paragraph (1)--
       (i) in the matter preceding subparagraph (A), by striking 
     ``(2) and (3)'' and inserting ``(2), (3), and (4)''; and
       (ii) in subparagraph (B), by striking ``health,''; and
       (B) by adding at the end the following new paragraph
       ``(4) Such term does not include any health benefit for 
     which payments or assistance are provided to an individual, 
     household, or family eligibility unit by an agency of a State 
     or local government or by appropriated funds of a State or 
     local government.''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply to health care furnished before, on, or after the 
     date of the enactment of this Act.

                 Subtitle D--Eligibility Simplification

     SEC. 131. STATE OPTION TO PROVIDE FOR SIMPLIFIED 
                   DETERMINATIONS OF A CHILD'S FINANCIAL 
                   ELIGIBILITY FOR MEDICAL ASSISTANCE UNDER 
                   MEDICAID.

       (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:
       ``(13)(A) At the option of the State, the plan may provide 
     that financial eligibility requirements for medical 
     assistance are met for an individual who is under an age 
     specified by the State (not to exceed 19 years of age) based 
     on a determination, during the 12 months prior to applying 
     for such assistance, of the individual's family or household 
     income or resources by a Federal or State agency (or a public 
     or private entity making such determination on behalf of such 
     agency) specified by the plan, provided that such agency has 
     fiscal liabilities or responsibilities affected or 
     potentially affected by such determinations, and provided 
     that all information furnished by such agency pursuant to 
     this subparagraph is used solely for purposes of determining 
     eligibility for medical assistance under the State plan 
     approved under this title or for child health assistance 
     under a State plan approved under title XXI.
       ``(B) Nothing in subparagraph (A) shall be construed to 
     authorize the denial of medical assistance under a State plan 
     approved under this title or of child health assistance under 
     a State plan approved under title XXI to an individual under 
     19 years of age who, without regard to the application of 
     this paragraph or an option exercised thereunder, would 
     qualify for such assistance.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     takes effect on October 1, 2002.

     SEC. 132. APPLICATION OF SIMPLIFIED TITLE XXI PROCEDURES 
                   UNDER THE MEDICAID PROGRAM.

       (a) Application Under Medicaid.--
       (1) In general.--Section 1902(l) of the Social Security Act 
     (42 U.S.C. 1396a(l)) is amended--
       (A) in paragraph (3), by inserting ``subject to paragraph 
     (5)'', after ``Notwithstanding subsection (a)(17),''; and
       (B) by adding at the end the following:
       ``(5) With respect to determining the eligibility of 
     individuals under 19 years of age (or such higher age as the 
     State has elected under paragraph (1)(D)) for medical 
     assistance under subsection (a)(10)(A) and, separately, with 
     respect to determining the eligibility of individuals for 
     medical assistance under subsection (a)(10)(A)(i)(VIII) or 
     (a)(10)(A)(ii)(XIX), notwithstanding any other provision of 
     this title, if the State has established a State child health 
     plan under title XXI--
       ``(A) the State may not apply a resource standard;
       ``(B) the State shall use the same simplified eligibility 
     form (including, if applicable, permitting application other 
     than in person) as the State uses under such State child 
     health plan with respect to such individuals;
       ``(C) the State shall provide for initial eligibility 
     determinations and redeterminations of eligibility using 
     verification policies, forms, and frequency that are no less 
     restrictive than the policies, forms, and frequency the State 
     uses for such purposes under such State child health plan 
     with respect to such individuals; and
       ``(D) the State shall not require a face-to-face interview 
     for purposes of initial eligibility determinations and 
     redeterminations unless the State requires such an interview 
     for such purposes under such child health plan with respect 
     to such individuals.''.
       (2) Effective date.--The amendments made by paragraph (1) 
     apply to determinations of eligibility made on or after the 
     date that is 1 year after the date of the enactment of this 
     Act, whether or not regulations implementing such amendments 
     have been issued.
       (b) Presumptive Eligibility.--
       (1) In general.--Section 1920A(b)(3)(A)(i) of the Social 
     Security Act (42 U.S.C. 1396r-1a(b)(3)(A)(i)) is amended by 
     inserting ``a child care resource and referral agency,'' 
     after ``a State or tribal child support enforcement 
     agency,''.
       (2) Application to presumptive eligibility for pregnant 
     women under medicaid.--Section 1920(b) of the Social Security 
     Act (42 U.S.C. 1396r-1(b)) is amended by adding at the end 
     after and below paragraph (2) the following flush sentence:

     ``The term `qualified provider' includes a qualified entity 
     as defined in section 1920A(b)(3).''.
       (3) Application under title xxi.--
       (A) In general.--Section 2107(e)(1)(D) of the Social 
     Security Act (42 U.S.C. 1397gg(e)(1)) is amended to read as 
     follows:
       ``(D) Sections 1920 and 1920A (relating to presumptive 
     eligibility).''.
       (B) Conforming elimination of resource test.--Section 
     2102(b)(1)(A) of such Act (42 U.S.C. 1397bb(b)(1)(A)) is 
     amended--
       (i) by striking `` and resources (including any standards 
     relating to spenddowns and disposition of resources)''; and
       (ii) by adding at the end the following: ``Effective 1 year 
     after the date of the enactment of the Hispanic Health 
     Improvement Act 2002, such standards may not include the 
     application of a resource standard or test.''.
       (c) Automatic Reassessment of Eligibility for Title XXI and 
     Medicaid Benefits for Children Losing Medicaid or Title XXI 
     Eligibility.--
       (1) Loss of medicaid eligibility.--Section 1902(a) of the 
     Social Security Act (42 U.S.C. 1396a(a)) is amended--

[[Page S9039]]

       (A) by striking the period at the end of paragraph (65) and 
     inserting ``; and'', and
       (B) by inserting after paragraph (65) the following:
       ``(66) provide, in the case of a State with a State child 
     health plan under title XXI, that before medical assistance 
     to a child (or a parent of a child) is discontinued under 
     this title, a determination of whether the child (or parent) 
     is eligible for benefits under title XXI shall be made and, 
     if determined to be so eligible, the child (or parent) shall 
     be automatically enrolled in the program under such title 
     without the need for a new application.''.
       (2) Loss of title xxi eligibility and coordination with 
     medicaid.--Section 2102(b) (42 U.S.C. 1397bb(b)) is amended--
       (A) in paragraph (3), by redesignating subparagraphs (D) 
     and (E) as subparagraphs (E) and (F), respectively, and by 
     inserting after subparagraph (C) the following:
       ``(D) that before health assistance to a child (or a parent 
     of a child) is discontinued under this title, a determination 
     of whether the child (or parent) is eligible for benefits 
     under title XIX is made and, if determined to be so eligible, 
     the child (or parent) is automatically enrolled in the 
     program under such title without the need for a new 
     application;'';
       (B) by redesignating paragraph (4) as paragraph (5); and
       (C) by inserting after paragraph (3) the following new 
     paragraph:
       ``(4) Coordination with medicaid.--The State shall 
     coordinate the screening and enrollment of individuals under 
     this title and under title XIX consistent with the following:
       ``(A) Information that is collected under this title or 
     under title XIX which is needed to make an eligibility 
     determination under the other title shall be transmitted to 
     the appropriate administering entity under such other title 
     in a timely manner so that coverage is not delayed and 
     families do not have to submit the same information twice. 
     Families shall be provided the information they need to 
     complete the application process for coverage under both 
     titles and be given appropriate notice of any determinations 
     made on their applications for such coverage.
       ``(B) If a State does not use a joint application under 
     this title and such title, the State shall--
       ``(i) promptly inform a child's parent or caretaker in 
     writing and, if appropriate, orally, that a child has been 
     found likely to be eligible under title XIX;
       ``(ii) provide the family with an application for medical 
     assistance under such title and offer information about what 
     (if any) further information, documentation, or other steps 
     are needed to complete such application process;
       ``(iii) offer assistance in completing such application 
     process; and
       ``(iv) promptly transmit the separate application under 
     this title or the information obtained through such 
     application, and all other relevant information and 
     documentation, including the results of the screening 
     process, to the State agency under title XIX for a final 
     determination on eligibility under such title.
       ``(C) Applicants are notified in writing of--
       ``(i) benefits (including restrictions on cost-sharing) 
     under title XIX; and
       ``(ii) eligibility rules that prohibit children who have 
     been screened eligible for medical assistance under such 
     title from being enrolled under this title, other than 
     provisional temporary enrollment while a final eligibility 
     determination is being made under such title.
       ``(D) If the agency administering this title is different 
     from the agency administering a State plan under title XIX, 
     such agencies shall coordinate the screening and enrollment 
     of applicants for such coverage under both titles.
       ``(E) The coordination procedures established between the 
     program under this title and under title XIX shall apply not 
     only to the initial eligibility determination of a family but 
     also to any renewals or redeterminations of such 
     eligibility.''.
       (3) Effective date.--The amendments made by paragraphs (1) 
     and (2) apply to individuals who lose eligibility under the 
     medicaid program under title XIX, or under a State child 
     health insurance plan under title XXI, respectively, of the 
     Social Security Act on or after October 1, 2002 (or, if 
     later, 60 days after the date of the enactment of this Act), 
     whether or not regulations implementing such amendments have 
     been issued.
       (d) Provision of Medicaid and CHIP Applications and 
     Information Under the School Lunch Program.--Section 
     9(b)(2)(B) of the Richard B. Russell National School Lunch 
     Act (42 U.S.C. 1758(b)(2)(B)) is amended--
       (1) by striking ``(B) Applications'' and inserting ``(B)(i) 
     Applications''; and
       (2) by adding at the end the following:
       ``(ii)(I) Applications for free and reduced price lunches 
     that are distributed pursuant to clause (i) to parents or 
     guardians of children in attendance at schools participating 
     in the school lunch program under this Act shall also contain 
     information on the availability of medical assistance under 
     title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) 
     and of child health and other assistance under title XXI of 
     such Act, including information on how to obtain an 
     application for assistance under such programs.
       ``(II) Information on the programs referred to in subclause 
     (I) shall be provided on a form separate from the application 
     form for free and reduced price lunches under clause (i).''.
       (e) 12-Months Continuous Eligibility.--
       (1) Medicaid.--Section 1902(e)(12) of the Social Security 
     Act (42 U.S.C. 1396a(e)(12)) is amended--
       (A) by striking ``At the option of the State, the plan 
     may'' and inserting ``The plan shall'';
       (B) by striking ``an age specified by the State (not to 
     exceed 19 years of age)'' and inserting ``19 years of age (or 
     such higher age as the State has elected under subsection 
     (l)(1)(D)) or, at the option of the State, who is eligible 
     for medical assistance as the parent of such a child''; and
       (C) in subparagraph (A), by striking ``a period (not to 
     exceed 12 months) '' and inserting ``the 12-month period 
     beginning on the date''.
       (2) Title xxi.--Section 2102(b)(2) of such Act (42 U.S.C. 
     1397bb(b)(2)) is amended by adding at the end the following: 
     ``Such methods shall provide 12-months continuous eligibility 
     for children under this title in the same manner that section 
     1902(e)(12) provides 12-months continuous eligibility for 
     children described in such section under title XIX. If a 
     State has elected to apply section 1902(e)(12) to parents, 
     such methods may provide 12-months continuous eligibility for 
     parents under this title in the same manner that such section 
     provides 12-months continuous eligibility for parents 
     described in such section under title XIX.''.
       (3) Effective date.--
       (A) In general.--The amendments made by this subsection 
     shall take effect on October 1, 2002 (or, if later, 60 days 
     after the date of the enactment of this Act), whether or not 
     regulations implementing such amendments have been issued.

                 Subtitle E--SCHIP Wrap-Around Benefits

     SEC. 141. REQUIRING COVERAGE OF SUBSTANTIALLY EQUIVALENT 
                   DENTAL SERVICES UNDER SCHIP.

       (a) 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:
       ``(E) Dental services.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall take effect on January 1, 2003.

     SEC. 142. STATE OPTION TO PROVIDE WRAP-AROUND SCHIP COVERAGE 
                   TO CHILDREN WHO HAVE OTHER HEALTH COVERAGE.

       (a) In General.--
       (1) SCHIP.--
       (A) State option to provide wrap-around coverage.--Section 
     2110(b) of the Social Security Act (42 U.S.C. 1397jj(b)) is 
     amended--
       (i) in paragraph (1)(C), by inserting ``, subject to 
     paragraph (5),'' after ``under title XIX or''; and
       (ii) by adding at the end the following new paragraph:
       ``(5) State option to provide wrap-around coverage.--A 
     State may waive the requirement of paragraph (1)(C) that a 
     targeted low-income child may not be covered under a group 
     health plan or under health insurance coverage, if the State 
     satisfies the conditions described in subsection (c)(8). The 
     State may waive such requirement in order to provide--
       ``(A) dental services;
       ``(B) cost-sharing protection; or
       ``(C) all services.

     In waiving such requirement, a State may limit the 
     application of the waiver to children whose family income 
     does not exceed a level specified by the State, so long as 
     the level so specified does not exceed the maximum income 
     level otherwise established for other children under the 
     State child health plan.''; and
       (B) Conditions described.--Section 2105(c) of such Act (42 
     U.S.C. 1397ee(c)) is amended by adding at the end the 
     following new paragraph:
       ``(8) Conditions for provision of wrap around coverage.--
     For purposes of section 2110(b)(5), the conditions described 
     in this paragraph are the following:
       ``(A) Income eligibility.--The State child health plan 
     (whether implemented under title XIX or this XXI)--
       ``(i) has an income eligibility standard not less than that 
     described in paragraph (4) of such section;
       ``(ii) subject to subparagraph (B), does not limit the 
     acceptance of applications for children; and
       ``(iii) provides benefits to all children in the State who 
     apply for and meet eligibility standards.
       ``(B) No waiting list imposed.--With respect to children 
     whose family income is at or below 200 percent of the poverty 
     line, the State does not impose any numerical limitation, 
     waiting list, or similar limitation on the eligibility of 
     such children for child health assistance under such State 
     plan.
       ``(C) No more favorable treatment.--The State child health 
     plan may not provide more favorable coverage of dental 
     services to the children covered under section 2110(b)(5) 
     than to children otherwise covered under this title.''.
       (C) State option to waive waiting period.--Section 
     2102(b)(1)(B) of such Act (42 U.S.C. 1397bb(b)(1)(B)) is 
     amended--
       (i) in clause (i), by striking ``and'' at the end;
       (ii) in clause (ii), by striking the period and inserting 
     ``; and''; and
       (iii) by adding at the end the following new clause:

[[Page S9040]]

       ``(iii) at State option, may not apply a waiting period in 
     the case of child described in section 2110(b)(5), if the 
     State satisfies the requirements of section 2105(c)(8).''.
       (2) Application of enhanced match under medicaid.--Section 
     1905 of such Act (42 U.S.C. 1396d) is amended--
       (A) in subsection (b), in the fourth sentence, by striking 
     ``or subsection (u)(3)'' and inserting ``(u)(3), or (u)(4)''; 
     and
       (B) in subsection (u)--
       (i) by redesignating paragraph (4) as paragraph (5); and
       (ii) by inserting after paragraph (3) the following new 
     paragraph:
       ``(4) For purposes of subsection (b), the expenditures 
     described in this paragraph are expenditures for items and 
     services for children described in section 2110(b)(5), but 
     only in the case of a State that satisfies the requirements 
     of section 2105(c)(8).''.
       (3) Application of secondary payor provisions.--Section 
     2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)), as amended 
     by section 121(b), is amended--
       (A) by redesignating subparagraphs (B) through (E) as 
     subparagraphs (C) through (F), respectively; and
       (B) by inserting after subparagraph (A) the following new 
     subparagraph:
       ``(B) Section 1902(a)(25) (relating to coordination of 
     benefits and secondary payor provisions) with respect to 
     children covered under a waiver described in section 
     2110(b)(5).''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall take effect on January 1, 2003, and shall apply to 
     child health assistance and medical assistance provided on or 
     after that date.

            Subtitle F--Immunization Coverage Through SCHIP

     SEC. 151. ELIGIBILITY OF CHILDREN ENROLLED IN THE STATE 
                   CHILDREN'S HEALTH INSURANCE PROGRAM FOR THE 
                   PEDIATRIC VACCINE DISTRIBUTION PROGRAM.

       (a) In General.--Section 1928(b)(2)(B)(ii)(I) of the Social 
     Security Act (42 U.S.C. 1396s(b)(2)(B)(ii)(I)) is amended by 
     inserting ``(other than a State child health plan under title 
     XXI)'' after ``policy or plan''.
       (b) Effective Date.--The amendment made by subsection (a) 
     applies with respect to vaccines administered on or after the 
     date of the enactment of this Act.

           Subtitle G--Limited English Proficient Communities

     SEC. 161. INCREASED FEDERAL REIMBURSEMENT FOR LANGUAGE 
                   SERVICES UNDER THE MEDICAID PROGRAM AND THE 
                   STATE CHILDREN'S HEALTH INSURANCE PROGRAM.

       (a) Medicaid.--Section 1903(a)(3) of the Social Security 
     Act (42 U.S.C. 1396b(a)(3)) is amended--
       (1) in subparagraph (D), by striking ``plus'' at the end 
     and inserting ``and''; and
       (2) by adding at the end the following:
       ``(E) 90 percent of the sums expended with respect to costs 
     incurred during such quarter as are attributable to the 
     provision of language services, including oral 
     interpretation, translations of written materials, and other 
     language services, for individuals with limited English 
     proficiency who apply for, or receive, medical assistance 
     under the State plan; plus''.
       (b) SCHIP.--Section 2105(a)(1) of the Social Security Act 
     (42 U.S.C.1397ee(a)(1)) is amended--
       (1) in the matter preceding subparagraph (A), by striking 
     ``section 1905(b))'' and inserting ``section 1905(b)) or, in 
     the case of expenditures described in subparagraph (D)(iv), 
     90 percent''; and
       (2) in subparagraph (D)--
       (A) in clause (iii), by striking ``and'' at the end;
       (B) be redesignating clause (iv) as clause (v); and
       (C) by inserting after clause (iii) the following:
       ``(iv) for expenditures attributable to the provision of 
     language services, including oral interpretation, 
     translations of written materials, and other language 
     services, for individuals with limited English proficiency 
     who apply for, or receive, child health assistance under the 
     plan; and''.
       (c) Nonapplication of Limit on Administrative 
     Expenditures.--Section 2105(a) of the Social Security Act (42 
     U.S.C.1397ee(a)) is amended by adding at the end the 
     following:
       ``(3) Nonapplication of limit on administrative 
     expenditures.--The 10 percent limitation on expenditures not 
     used for medicaid or health assistance imposed under 
     subsection (c)(2)(A) shall not apply to payments made under 
     this subsection for expenditures described in paragraph 
     (1).''.
       (d) Effective Date.--The amendments made by this section 
     shall take effect on October 1, 2003.

                Subtitle H--Binational Health Insurance

     SEC. 171. BINATIONAL HEALTH INSURANCE.

       (a) In General.--The Secretary of Health and Human Services 
     shall enter into a contract with the Institute of Medicine 
     for the conduct of a study concerning binational health 
     insurance efforts. In conducting such study, the Institute 
     shall solicit input from border health experts and health 
     insurance companies.
       (b) Report.--Not later than 1 year after the date on which 
     the Secretary of Health and Human Services enters into the 
     contract under subsection (a), the Institute of Medicine 
     shall submit to the Secretary and the appropriate committees 
     of Congress a report concerning the study conducted under 
     subsection (a). Such report shall include the recommendations 
     of the Institute on ways to expand or improve binational 
     health insurance efforts.

                   TITLE II--ACCESS AND AFFORDABILITY

   Subtitle A--Report on Programs for Improving the Health Status of 
                          Hispanic Individuals

     SEC. 201. ANNUAL REPORT REGARDING DIABETES, HIV/AIDS, 
                   SUBSTANCE ABUSE, AND MENTAL HEALTH.

       (a) In General.--The Secretary of Health and Human Services 
     (in this Act referred to as the ``Secretary'') shall annually 
     submit to Congress a report on programs carried out through 
     the Public Health Service with respect to improving the 
     health status of Hispanic individuals regarding diabetes, 
     cancer, asthma, HIV infection, AIDS, substance abuse, and 
     mental health, including--
       (1) prevention programs carried out through the Centers for 
     Disease Control and Prevention and the Substance Abuse and 
     Mental Health Services Administration;
       (2) treatment programs carried out through the Health 
     Resources and Services Administration and the Substance Abuse 
     and Mental Health Services Administration;
       (3) research programs carried out through the National 
     Institutes of Health; and
       (4) activities of the Office of Public Health and Science, 
     including activities of the Office of Minority Health.
       (b) Data Collection.--Each report under subsection (a) 
     shall include information on programs carried out through the 
     Public Health Service to collect data that relates to the 
     health status of Hispanic individuals regarding diabetes, HIV 
     infection, AIDS, substance abuse, and mental health.

              Subtitle B--Diabetes Control and Prevention

     SEC. 211. NATIONAL DIABETES EDUCATION PROGRAM OF CENTERS FOR 
                   DISEASE CONTROL AND PREVENTION; INCREASED 
                   AUTHORIZATION OF APPROPRIATIONS FOR ACTIVITIES 
                   REGARDING HISPANIC INDIVIDUALS.

       (a) In General.--For the purpose of carrying out the 
     activities described in subsection (b) through the Division 
     of Diabetes Translation of the Centers for Disease Control 
     and Prevention, there are authorized to be appropriated 
     $100,000,000 for fiscal year 2003, and such sums as may be 
     necessary for each of the fiscal years 2004 through 2007. 
     Such authorization of appropriations is in addition to other 
     authorizations of appropriations that are available for such 
     purpose.
       (b) Increase in Prevention Activities.--The activities 
     referred to in subsection (a) are--
       (1) identifying geographic areas in which the incidence of 
     or mortality from diabetes in Hispanic individuals is 
     significantly above the national average for such 
     individuals;
       (2) carrying out in such areas prevention activities 
     regarding diabetes that are directed toward Hispanic 
     individuals, including education programs and screening 
     programs;
       (3) designing and assisting with the implementation of 
     school-based programs aimed at modifying environmental risk 
     factors and access to care for high-risk and diagnosed 
     Hispanic youth; and
       (4) designing and assisting with the implementation of 
     diabetes-specific programs to improve diagnosis, treatment, 
     and self-management training in community health clinics.

     SEC. 212. NATIONAL INSTITUTES OF HEALTH; IMPLEMENTATION OF 
                   RECOMMENDATIONS OF DIABETES RESEARCH WORKING 
                   GROUP.

       For the purpose of carrying out the plan to implement the 
     recommendations of the Diabetes Research Working Group of the 
     National Institute on Diabetes and Digestive and Kidney 
     Diseases (which plan was developed and submitted to the 
     Congress pursuant to the Department of Health and Human 
     Services Appropriations Act, 2000), which most impact the 
     Hispanic community, including research into obesity, 
     behavioral and environmental risk factors, and special needs 
     of minority women, children and the elderly, there are 
     authorized to be appropriated $363,000,000 for fiscal year 
     2003, and such sums as may be necessary for each of the 
     fiscal years 2004 through 2007.

  Subtitle C--HIV Prevention Activities Regarding Hispanic Individuals

     SEC. 221. PROGRAMS OF CENTERS FOR DISEASE CONTROL AND 
                   PREVENTION; REPRESENTATION OF HISPANIC 
                   INDIVIDUALS IN MEMBERSHIP OF COMMUNITY PLANNING 
                   GROUPS.

       (a) In General.--With respect to community planning groups 
     that the Centers for Disease Control and Prevention utilizes 
     in carrying out programs for the prevention of HIV infection, 
     the Secretary, acting through the Director of such Centers, 
     shall carry out the following:
       (1) The Secretary shall identify community planning groups 
     for which Hispanic individuals are underrepresented as 
     members in relation to the number of Hispanic individuals 
     with HIV who reside in the communities involved.
       (2) The Secretary shall develop a plan to increase the 
     representation of Hispanic individuals in the membership of 
     the community planning groups identified under paragraph (1). 
     Such plan may provide for facilitating the participation of 
     Hispanic individuals as members in such groups by assisting 
     the individuals with the incidental costs incurred

[[Page S9041]]

     by the individuals in being such members, such as the costs 
     of transportation and child-care services.
       (3) The plan shall include a strategy and detailed timeline 
     for implementing the plan.
       (b) Definition.--In this section, the term ``community 
     planning group'' has the meaning that applies for purposes of 
     programs established pursuant to the Ryan White Comprehensive 
     AIDS Resources Emergency Act of 1990 (including title XXVI of 
     the Public Health Service Act).

     SEC. 222. AIDS EDUCATION AND TRAINING CENTERS FUNDED BY 
                   HEALTH RESOURCES AND SERVICES ADMINISTRATION; 
                   ESTABLISHMENT OF CENTER DIRECTED TOWARD 
                   MINORITY POPULATIONS WITH HIV.

       (a) In General.--In carrying out section 2692 of the Public 
     Health Service Act (42 U.S.C. 300ff-111), the Secretary, 
     acting through the Administrator of the Health Resources and 
     Services Administration, shall make grants to eligible 
     Hispanic-serving institutions for the purpose of carrying out 
     projects under such section with respect to HIV in racial and 
     ethnic minority groups.
       (b) Cultural Competence.--A condition for grants under 
     subsection (a) is that the applicants involved agree that the 
     education and training provided through projects under such 
     subsection will be provided in a culturally competent manner 
     (as defined in section 331).
       (c) Eligible Institutions.--In this section:
       (1) Eligible hispanic-serving institution.--The term 
     ``eligible Hispanic-serving institution'' means a Hispanic-
     serving institution that has a record of carrying out HIV-
     related activities with respect to Hispanic individuals.
       (2) Hispanic-serving institution.--The term ``Hispanic-
     serving institution'' has the meaning given such term in 
     section 502 of the Higher Education Act of 1965 (20 U.S.C. 
     1101a).

          Subtitle D--Prevention of Latina Adolescent Suicides

     SEC. 231. SHORT TITLE.

       This subtitle may be cited as the ``Latina Adolescent 
     Suicide Prevention Act''.

     SEC. 232. ESTABLISHMENT OF PROGRAM FOR PREVENTION OF LATINA 
                   ADOLESCENT SUICIDES.

       Title V of the Public Health Service Act (42 U.S.C. 290aa 
     et seq.) is amended by inserting after section 520A the 
     following section:

     ``SEC. 520B. PREVENTION OF LATINA ADOLESCENT SUICIDES.

       ``(a) In General.--The Secretary shall carry out a program 
     to make awards of grants, cooperative agreements, or 
     contracts to public and nonprofit private entities for the 
     purpose of reducing suicide attempts and deaths among Latina 
     adolescents and for the purpose of dealing with depression 
     and other related emotional conditions which may contribute 
     to suicide.
       ``(b) Collaboration.--The Secretary shall ensure that the 
     program carried out under this section is developed in 
     collaboration with the relevant institutes at the National 
     Institutes of Health, the Health Resources and Services 
     Administration, the Centers for Disease Control and 
     Prevention, and the Administration on Children and Families.
       ``(c) Preference.--In making awards under subsection (a), 
     the Secretary shall give preference to applicants that--
       ``(1) demonstrate a strong linkage with schools and are 
     actually supported by and operated within a school facility 
     or associated setting;
       ``(2) provide direct services to Latina adolescents and 
     their family members when appropriate; and
       ``(3) serve geographic areas that already have a high 
     concentration of underserved adolescent Latinas or a rapidly 
     growing Hispanic population, based on the latest census data.
       ``(d) Requirements.--A condition for the receipt of an 
     award under subsection (a) is that the applicant involved 
     demonstrate that the project to be carried out with the award 
     will--
       ``(1) provide for the timely assessment and treatment of 
     Latina adolescents at risk for suicide;
       ``(2) use evidenced-based strategies;
       ``(3) be based on exemplary practices that are adapted to 
     the unique characteristics and needs of the local community;
       ``(4) be integrated into the existing health care system in 
     the community, including primary health care, mental health 
     services, and substance abuse services as appropriate;
       ``(5) be integrated into other systems in the community to 
     address the needs of Latina adolescents including the 
     educational system, juvenile justice, and recreation;
       ``(6) provide support services to the families and friends 
     of those who plan, attempt, or actually commit suicide;
       ``(7) provide culturally, linguistically, and 
     developmentally appropriate services;
       ``(8) agree to outcomes evaluation to determine the success 
     of the program and the possibility of replication to other 
     adolescent girls at risk of suicide;
       ``(9) provide or ensure referral for mental health and 
     substance abuse services as needed; and
       ``(10) ensure that staff used in the program are trained in 
     suicide prevention and in the identification of conditions 
     which left untreated may lead to suicide, are capable of 
     providing culturally and linguistically appropriate services, 
     and that professionals involved in the system of care are 
     given training in identifying persons at risk of suicide.
       ``(e) Coordination.--A condition for the receipt of an 
     award under subsection (a) is that the applicant involved 
     demonstrate that--
       ``(1) the application has the support of the local 
     communities and the approval of the political subdivision to 
     be served by the project to be carried out under the award; 
     and
       ``(2) the applicant has discussed the application with 
     local and State mental health officials.
       ``(f) Matching Requirement.--With respect to the costs to 
     be incurred by an applicant in carrying out a project under 
     subsection (a), the Secretary may require as a condition of 
     the receipt of the award that the applicant make available 
     (directly or through donations from public or private 
     entities) non-Federal contributions toward such costs in an 
     amount that is not less than 25 percent of such costs ($1 for 
     each $3 of Federal funds provided under the award).
       ``(g) Evaluation.--The Secretary shall ensure that entities 
     receiving awards under subsection (a) submit an evaluation of 
     the project carried out under the award that includes an 
     evaluation of--
       ``(1) the efficacy of project strategies; and
       ``(2) short, intermediate, and long-term outcomes, 
     including the overall impact of the project on the self-
     esteem of Latina adolescents, their emotional well-being and 
     development, ability to deal in a positive and confident 
     manner with their families, peers, and social environment, 
     and to make constructive and personally fulfilling life 
     choices.
       ``(h) Dissemination and Education.--The Secretary shall 
     ensure that the findings from the program carried out under 
     this section are disseminated to State and local governmental 
     agencies and private providers of mental health and substance 
     abuse services.
       ``(i) Duration of Projects.--With respect to an award under 
     subsection (a), the period during which payments under such 
     award are made may not exceed 5 years.
       ``(j) Definition.--In this section, the term `adolescent' 
     means an individual between the ages of 11 and 17 
     (inclusive).
       ``(k) Funding.--
       ``(1) Authorization of appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated $10,000,000 for fiscal year 2003, and such sums 
     as may be necessary for each of the fiscal years 2004 and 
     2005.
       ``(2) Allocation for program management.--Of the amount 
     appropriated under paragraph (1) for a fiscal year, the 
     Secretary may reserve not more than 1 percent for 
     administering the program under this section.''.

                   Subtitle E--Dental Health Services

     SEC. 241. GRANTS TO IMPROVE THE PROVISION OF DENTAL HEALTH 
                   SERVICES THROUGH COMMUNITY HEALTH CENTERS AND 
                   PUBLIC HEALTH DEPARTMENTS.

       Part D of title III of the Public Health Service Act (42 
     U.S.C. 254b et seq.) is amended by inserting before section 
     330, the following:

     ``SEC. 329. GRANT PROGRAM TO EXPAND THE AVAILABILITY OF 
                   SERVICES.

       ``(a) In General.--The Secretary, acting through the Health 
     Resources and Services Administration, shall establish a 
     program under which the Secretary may award grants to 
     eligible entities and eligible individuals to expand the 
     availability of primary dental care services in dental health 
     professional shortage areas or medically underserved areas.
       ``(b) Eligibility.--
       ``(1) Entities.--To be eligible to receive a grant under 
     this section an entity--
       ``(A) shall be--
       ``(i) a health center receiving funds under section 330 or 
     designated as a Federally qualified health center;
       ``(ii) a county or local public health department, if 
     located in a federally-designated dental health professional 
     shortage area;
       ``(iii) an Indian tribe or tribal organization (as defined 
     in section 4 of the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450b)); or
       ``(iv) a dental education program accredited by the 
     Commission on Dental Accreditation; and
       ``(B) shall prepare and submit to the Secretary an 
     application at such time, in such manner, and containing such 
     information as the Secretary may require.
       ``(2) Individuals.--To be eligible to receive a grant under 
     this section an individual shall--
       ``(A) be a dental health professional licensed or certified 
     in accordance with the laws of State in which such individual 
     provides dental services;
       ``(B) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require; and
       ``(C) provide assurances that--
       ``(i) the individual will practice in a federally-
     designated dental health professional shortage area; and
       ``(ii) not less than 33 percent of the patients of such 
     individual are--

       ``(I) receiving assistance under a State plan under title 
     XIX of the Social Security Act (42 U.S.C. 1396 et seq.);
       ``(II) receiving assistance under a State plan under title 
     XXI of the Social Security Act (42 U.S.C. 1397aa et seq.); or
       ``(III) uninsured.

       ``(c) Use of Funds.--
       ``(1) Entities.--An entity shall use amounts received under 
     a grant under this

[[Page S9042]]

     section to provide for the increased availability of primary 
     dental services in the areas described in subsection (a). 
     Such amounts may be used to supplement the salaries offered 
     for individuals accepting employment as dentists in such 
     areas.
       ``(2) Individuals.--A grant to an individual under 
     subsection (a) shall be in the form of a $1,000 bonus payment 
     for each month in which such individual is in compliance with 
     the eligibility requirements of subsection (b)(2)(C).
       ``(d) Authorization of Appropriations.--
       ``(1) In general.--Notwithstanding any other amounts 
     appropriated under section 330 for health centers, there is 
     authorized to be appropriated $40,000,000 for each of fiscal 
     years 2003 through 2007 to hire and retain dental health care 
     providers under this section.
       ``(2) Use of funds.--Of the amount appropriated for a 
     fiscal year under paragraph (1), the Secretary shall use--
       ``(A) not less than 75 percent of such amount to make 
     grants to eligible entities; and
       ``(B) not more than 25 percent of such amount to make 
     grants to eligible individuals.''.

     SEC. 242. SCHOOL-BASED DENTAL SEALANT PROGRAM.

       Section 317M(c) of the Public Health Service Act (42 U.S.C. 
     247b-14) is amended--
       (1) in paragraph (1), by inserting ``and school-linked'' 
     after ``school-based'';
       (2) in the first sentence of paragraph (2)--
       (A) by inserting ``and school-linked'' after ``school-
     based''; and
       (B) by inserting ``or Indian tribe'' after ``State''; and
       (3) by striking paragraph (3) and inserting the following:
       ``(3) Eligibility.--To be eligible to receive funds under 
     paragraph (1), an entity shall--
       ``(A) prepare and submit to the State or Indian tribe an 
     application at such time, in such manner and containing such 
     information as the State or Indian tribe may require; and
       ``(B) be a--
       ``(i) public elementary or secondary school--

       ``(I) that is located in an urban area in which and more 
     than 50 percent of the student population is participating in 
     Federal or State free or reduced meal programs; or
       ``(II) that is located in a rural area and, with respect to 
     the school district in which the school is located, the 
     district involved has a median income that is at or below 235 
     percent of the poverty line, as defined in section 673(2) of 
     the Community Services Block Grant Act (42 U.S.C. 9902(2)); 
     or

       ``(ii) public or non-profit health organization, including 
     a grantee under section 330, that is under contract with an 
     elementary or secondary school described in subparagraph (B) 
     to provide dental services to school-age children.''.

                       Subtitle F--Border Health

     SEC. 251. SHORT TITLE.

       This subtitle may be cited as the ``Border Health Security 
     Act of 2002''.

     SEC. 252. DEFINITIONS.

       In this subtitle:
       (1) Border area.--The term ``border area'' has the meaning 
     given the term ``United States-Mexico Border Area'' in 
     section 8 of the United States-Mexico Border Health 
     Commission Act (22 U.S.C. 290n-6).
       (2) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.

     SEC. 253. BORDER HEALTH SERVICES GRANTS.

       (a) In General.--The Secretary, acting through the United 
     States-Mexico Border Health Commission and in consultation 
     the State border health offices, shall award grants to 
     States, local governments, and non-profit health 
     organizations along the border of the United States and 
     Mexico to address priorities and recommendations established 
     by--
       (1) the United States-Mexico Border Health Commission and 
     the United States Section Commission outreach offices in each 
     of the United States border States; and
       (2) the Secretary to improve the health of border region 
     residents.
       (b) Application.--To be eligible for a grant under 
     subsection (a), a State, local government, or non-profit 
     health organization shall prepare and 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 
     this section shall be used for programs relating to maternal 
     and child health, public health, health promotion, oral 
     health, behavioral and mental health, substance abuse, 
     conditions that have high prevalence along the United States-
     Mexico border, medical and health services research, 
     promotoras or community health workers, health care 
     infrastructure problems in the border region (including 
     planning and construction grants), health disparities along 
     the United States-Mexico border environmental health, health 
     education, outreach and enrollment services with respect to 
     Federal programs (including the programs under titles XIX and 
     XXI of the Social Security Act (42 U.S.C. 1396 and 1397aa et 
     seq.), and other programs determined appropriate by the 
     Secretary.
       (d) Supplement Not Supplant.--Amounts provided to a grantee 
     under a grant awarded under this section shall be used to 
     supplement and not supplant other funds available to the 
     grantee to carry out the activities described in subsection 
     (c).
       (e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $200,000,000 
     for fiscal year 2003, and such sums as may be necessary for 
     each fiscal year thereafter.

     SEC. 254. UNITED STATES-MEXICO BORDER HEALTH COMMISSION.

       The United States-Mexico Border Health Commission Act (22 
     U.S.C. 290n et seq)) is amended--
       (1) in section 2, by inserting ``, within the Office of 
     Border Health of the Department of Health and Human 
     Services,'' after ``to establish''; and
       (2) by adding at the end the following:

     ``SEC. 9. AUTHORIZATION OF APPROPRIATIONS.

       ``There is authorized to be appropriated to carry out this 
     Act, $10,000,000 for fiscal year 2003, and such sums as may 
     be necessary for each fiscal year thereafter.''.

                  Subtitle G--Community Health Workers

     SEC. 261. SHORT TITLE.

       This subtitle may be cited as the ``Community Health 
     Workers Act of 2002''.

     SEC. 262. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS IN 
                   WOMEN.

       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. 399O. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS IN 
                   WOMEN.

       ``(a) Grants Authorized.--The Secretary, in collaboration 
     with the Director of the Centers for Disease Control and 
     Prevention and other Federal officials determined appropriate 
     by the Secretary, is authorized to award grants to States or 
     local or tribal units, to promote positive health behaviors 
     for women in target populations, especially racial and ethnic 
     minority women in medically underserved communities.
       ``(b) Use of Funds.--Grants awarded pursuant to subsection 
     (a) may be used to support community health workers--
       ``(1) to educate, guide, and provide outreach in a 
     community setting regarding health problems prevalent among 
     women and especially among racial and ethnic minority women;
       ``(2) to educate, guide, and provide experiential learning 
     opportunities that target behavioral risk factors including--
       ``(A) poor nutrition;
       ``(B) physical inactivity;
       ``(C) obesity;
       ``(D) tobacco use;
       ``(E) alcohol and substance use;
       ``(F) injury and violence;
       ``(G) risky sexual behavior; and
       ``(H) mental health problems;
       ``(3) to educate and guide regarding effective strategies 
     to promote positive health behaviors within the family;
       ``(4) 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;
       ``(5) to promote community wellness and awareness; and
       ``(6) 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 State or local or tribal unit 
     (including federally recognized tribes and Alaska native 
     villages) 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 training and supervision 
     to community health workers to enable such workers to provide 
     authorized program services;
       ``(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 
     services in the cultural context most appropriate for the 
     individuals served by the program;
       ``(E) contain a plan to document and disseminate project 
     description 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, that 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--

[[Page S9043]]

       ``(A) with a high percentage of residents who are eligible 
     for health insurance but are uninsured or underinsured;
       ``(B) with a high percentage of families for whom English 
     is not their primary language; and
       ``(C) that encompass the United States-Mexico border 
     region;
       ``(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. Nothing in this section shall be 
     construed to require such collaboration.
       ``(f) Quality Assurance and Cost-Effectiveness.--The 
     Secretary shall establish guidelines for assuring the quality 
     of the training and supervision of community health workers 
     under the programs funded under this section and for assuring 
     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 (e).
       ``(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 the project 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 or 
     nutrition needs; and
       ``(F) by providing referral and followup services.
       ``(2) Community setting.--The term `community setting' 
     means a home or a community organization located in the 
     neighborhood in which a participant resides.
       ``(3) Medically underserved community.--The term `medically 
     underserved community' means a community identified by a 
     State--
       ``(A) that has a substantial number of individuals who are 
     members of a medically underserved population, as defined by 
     section 330(b)(3); and
       ``(B) a significant portion of which is a health 
     professional shortage area as designated under section 332.
       ``(4) 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.
       ``(5) Target population.--The term `target population' 
     means women of reproductive age, regardless of their current 
     childbearing status.
       ``(k) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $5,000,000 for each of fiscal years 2003, 2004, and 2005.''.

Subtitle H--Patient Navigator, Outreach, and Chronic Disease Prevention

     SEC. 271. SHORT TITLE.

       This Act may be cited as the ``Patient Navigator, Outreach, 
     and Chronic Disease Prevention Act of 2002''.

     SEC. 272. HRSA GRANTS FOR MODEL COMMUNITY CANCER AND CHRONIC 
                   DISEASE CARE AND PREVENTION; HRSA GRANTS FOR 
                   PATIENT NAVIGATORS.

       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. 330I. MODEL COMMUNITY CANCER AND CHRONIC DISEASE CARE 
                   AND PREVENTION; PATIENT NAVIGATORS.

       ``(a) Model Community Cancer and Chronic Disease Care and 
     Prevention.--
       ``(1) In general.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, may make grants to public and nonprofit 
     private health centers (including health centers under 
     section 330, Indian Health Service Centers, and rural health 
     clinics) for the development and operation of model programs 
     that--
       ``(A) provide to individuals of health disparity 
     populations prevention, early detection, treatment, and 
     appropriate follow-up care services for cancer and chronic 
     diseases;
       ``(B) ensure that the health services are provided to such 
     individuals in a culturally competent manner; and
       ``(C) assign patient navigators, in accordance with 
     applicable criteria of the Secretary, for individuals of 
     health disparity populations to--
       ``(i) accomplish, to the extent possible, the follow-up and 
     diagnosis of an abnormal finding and the treatment and 
     appropriate follow-up care of cancer or other chronic 
     disease; and
       ``(ii) facilitate access to appropriate health care 
     services within the health care system to ensure optimal 
     patient utilization of such services.
       ``(2) Outreach services.--A condition for the receipt of a 
     grant under paragraph (1) is that the applicant involved 
     agree to provide ongoing outreach activities while receiving 
     the grant, in a manner that is culturally competent for the 
     health disparity population served by the program, to inform 
     the public of the services of the model program under the 
     grant. Such activities shall include facilitating access to 
     appropriate health care services and patient navigators 
     within the health care system to ensure optimal patient 
     utilization of these services.
       ``(3) Application for grant.--A grant may be made under 
     paragraph (1) only if an application for the grant is 
     submitted to the Secretary and the application is in such 
     form, is made in such manner, and contains such agreements, 
     assurances, and information as the Secretary determines to be 
     necessary to carry out this section.
       ``(4) Evaluations.--
       ``(A) In general.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, shall, directly or through grants or 
     contracts, provide for evaluations to determine which 
     outreach activities under paragraph (2) were most effective 
     in informing the public of the model program services and to 
     determine the extent to which such programs were effective in 
     providing culturally competent services to the health 
     disparity population served by the programs.
       ``(B) Dissemination of findings.--The Secretary shall as 
     appropriate disseminate to public and private entities the 
     findings made in evaluations under subparagraph (A).
       ``(5) Coordination with other programs.--The Secretary 
     shall coordinate the program under this subsection with the 
     program under subsection (b), with the program under section 
     417D, and to the extent practicable, with programs for 
     prevention centers that are carried out by the Director of 
     the Centers for Disease Control and Prevention.
       ``(b) Program for Patient Navigators.--
       ``(1) In general.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, may make grants to public and nonprofit 
     private health centers (including health centers under 
     section 330, Indian Health Service Centers, and rural health 
     clinics) for the development and operation of programs to pay 
     the costs of such health centers in--
       ``(A) assigning patient navigators, in accordance with 
     applicable criteria of the Secretary, for individuals of 
     health disparity populations for the duration of receiving 
     health services from the health centers;
       ``(B) ensuring that the services provided by the patient 
     navigators to such individuals include case management and 
     psychosocial assessment and care or information and referral 
     to such services;
       ``(C) ensuring that the patient navigators provide services 
     to such individuals in a culturally competent manner; and
       ``(D) developing model practices for patient navigators, 
     including with respect to--
       ``(i) coordination of health services, including 
     psychosocial assessment and care;
       ``(ii) appropriate follow-up care, including psychosocial 
     assessment and care; and
       ``(iii) determining coverage under health insurance and 
     health plans for all services.
       ``(2) Outreach services.--A condition for the receipt of a 
     grant under paragraph (1) is that the applicant involved 
     agree to provide ongoing outreach activities while receiving 
     the grant, in a manner that is culturally competent for the 
     health disparity population served by the program, to inform 
     the public of the services of the model program under the 
     grant.
       ``(3) Application for grant.--A grant may be made under 
     paragraph (1) only if an application for the grant is 
     submitted to the Secretary and the application is in such 
     form, is made in such manner, and contains such agreements, 
     assurances, and information as the Secretary determines to be 
     necessary to carry out this section.
       ``(4) Evaluations.--
       ``(A) In general.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, shall, directly or through grants or 
     contracts, provide for evaluations to determine the effects 
     of the services of patient navigators on the individuals of 
     health disparity populations for whom the services were 
     provided, taking

[[Page S9044]]

     into account the matters referred to in paragraph (1)(C).
       ``(B) Dissemination of findings.--The Secretary shall as 
     appropriate disseminate to public and private entities the 
     findings made in evaluations under subparagraph (A).
       ``(5) Coordination with other programs.--The Secretary 
     shall coordinate the program under this subsection with the 
     program under subsection (a) and with the program under 
     section 417D.
       ``(c) Requirements Regarding Fees.--A condition for the 
     receipt of a grant under subsection (a)(1) or (b)(1) is that 
     the program for which the grant is made have in effect--
       ``(1) a schedule of fees or payments for the provision of 
     its services that is consistent with locally prevailing rates 
     or charges and is designed to cover its reasonable costs of 
     operation; and
       ``(2) a corresponding schedule of discounts to be applied 
     to the payment of such fees or payments, which discounts are 
     adjusted on the basis of the ability of the patient to pay.
       ``(d) Model.--Not later than three years after the date of 
     the enactment of this section, the Secretary shall develop a 
     peer-reviewed model of systems for the services provided by 
     this section. The Secretary shall update such model as may be 
     necessary to ensure that the best practices are being 
     utilized.
       ``(e) Duration of Grant.--The period during which payments 
     are made to an entity from a grant under subsection (a)(1) or 
     (b)(1) may not exceed five years. The provision of such 
     payments are subject to annual approval by the Secretary of 
     the payments and subject to the availability of 
     appropriations for the fiscal year involved to make the 
     payments. This subsection may not be construed as 
     establishing a limitation on the number of grants under such 
     subsection that may be made to an entity.
       ``(f) Definitions.--For purposes of this section:
       ``(1) The term `culturally competent', with respect to 
     providing health-related services, means services that, in 
     accordance with standards and measures of the Secretary, are 
     designed to effectively and efficiently respond to the 
     cultural and linguistic needs of patients.
       ``(2) The term `appropriate follow-up care' includes 
     palliative and end-of-life care.
       ``(3) The term `health disparity population' means a 
     population where there exists a significant disparity in the 
     overall rate of disease incidence, morbidity, mortality, or 
     survival rates in the population as compared to the health 
     status of the general population. Such term includes--
       ``(A) racial and ethnic minority groups as defined in 
     section 1707; and
       ``(B) medically underserved groups, such as rural and low-
     income individuals and individuals with low levels of 
     literacy.
       ``(4)(A) The term `patient navigator' means an individual 
     whose functions include--
       ``(i) assisting and guiding patients with a symptom or an 
     abnormal finding or diagnosis of cancer or other chronic 
     disease within the health care system to accomplish the 
     follow-up and diagnosis of an abnormal finding as well as the 
     treatment and appropriate follow-up care of cancer or other 
     chronic disease; and
       ``(ii) identifying, anticipating, and helping patients 
     overcome barriers within the health care system to ensure 
     prompt diagnostic and treatment resolution of an abnormal 
     finding of cancer or other chronic disease.
       ``(B) Such term includes representatives of the target 
     health disparity population, such as nurses, social workers, 
     cancer survivors, and patient advocates.
       ``(g) Authorization of Appropriations.--
       ``(1) In general.--
       ``(A) Model programs.--For the purpose of carrying out 
     subsection (a) (other than the purpose described in paragraph 
     (2)(A)), there are authorized to be appropriated such sums as 
     may be necessary for each of the fiscal years 2003 through 
     2007.
       ``(B) Patient navigators.--For the purpose of carrying out 
     subsection (b) (other than the purpose described in paragraph 
     (2)(B)), there are authorized to be appropriated such sums as 
     may be necessary for each of the fiscal years 2003 through 
     2007.
       ``(C) Bureau of primary health care.--Amounts appropriated 
     under subparagraph (A) or (B) shall be administered through 
     the Bureau of Primary Health Care.
       ``(2) Programs in rural areas.--
       ``(A) Model programs.--For the purpose of carrying out 
     subsection (a) by making grants under such subsection for 
     model programs in rural areas, there are authorized to be 
     appropriated such sums as may be necessary for each of the 
     fiscal years 2003 through 2007.
       ``(B) Patient navigators.--For the purpose of carrying out 
     subsection (b) by making grants under such subsection for 
     programs in rural areas, there are authorized to be 
     appropriated such sums as may be necessary for each of the 
     fiscal years 2003 through 2007.
       ``(C) Office of rural health policy.--Amounts appropriated 
     under subparagraph (A) or (B) shall be administered through 
     the Office of Rural Health Policy.
       ``(3) Relation to other authorizations.--Authorizations of 
     appropriations under paragraphs (1) and (2) are in addition 
     to other authorizations of appropriations that are available 
     for the purposes described in such paragraphs.''.

     SEC. 273. NCI GRANTS FOR MODEL COMMUNITY CANCER AND CHRONIC 
                   DISEASE CARE AND PREVENTION; NCI GRANTS FOR 
                   PATIENT NAVIGATORS.

       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 following section:

     ``SEC. 417D. MODEL COMMUNITY CANCER AND CHRONIC DISEASE CARE 
                   AND PREVENTION; PATIENT NAVIGATORS.

       ``(a) Model Community Cancer and Chronic Disease Care and 
     Prevention.--
       ``(1) In general.--The Director of the Institute may make 
     grants to eligible entities for the development and operation 
     of model programs that--
       ``(A) provide to individuals of health disparity 
     populations prevention, early detection, treatment, and 
     appropriate follow-up care services for cancer and chronic 
     diseases;
       ``(B) ensure that the health services are provided to such 
     individuals in a culturally competent manner; and
       ``(C) assign patient navigators, in accordance with 
     applicable criteria of the Secretary, for individuals of 
     health disparity populations to--
       ``(i) accomplish, to the extent possible, the follow-up and 
     diagnosis of an abnormal finding and the treatment and 
     appropriate follow-up care of cancer or other chronic 
     disease; and
       ``(ii) facilitate access to appropriate health care 
     services within the health care system to ensure optimal 
     patient utilization of such services.
       ``(2) Eligible entities.--For purposes of this section, an 
     eligible entity is a designated cancer center of the 
     Institute, an academic institution, a hospital, a nonprofit 
     organization, or any other public or private entity 
     determined to be appropriate by the Director of the 
     Institute, that provides services described in paragraph 
     (1)(A) for cancer or chronic diseases.
       ``(3) Outreach services.--A condition for the receipt of a 
     grant under paragraph (1) is that the applicant involved 
     agree to provide ongoing outreach activities while receiving 
     the grant, in a manner that is culturally competent for the 
     health disparity population served by the program, to inform 
     the public of the services of the model program under the 
     grant. Such activities shall include facilitating access to 
     appropriate health care services and patient navigators 
     within the health care system to ensure optimal patient 
     utilization of these services.
       ``(4) Application for grant.--A grant may be made under 
     paragraph (1) only if an application for the grant is 
     submitted to the Director of the Institute and the 
     application is in such form, is made in such manner, and 
     contains such agreements, assurances, and information as the 
     Director determines to be necessary to carry out this 
     section.
       ``(5) Evaluations.--
       ``(A) In general.--The Director of the Institute, directly 
     or through grants or contracts, shall provide for evaluations 
     to determine which outreach activities under paragraph (3) 
     were most effective in informing the public of the model 
     program services and to determine the extent to which such 
     programs were effective in providing culturally competent 
     services to the health disparity population served by the 
     programs.
       ``(B) Dissemination of findings.--The Director of the 
     Institute shall as appropriate disseminate to public and 
     private entities the findings made in evaluations under 
     subparagraph (A).
       ``(6) Coordination with other programs.--The Secretary 
     shall coordinate the program under this subsection with the 
     program under subsection (b), with the program under section 
     330I, and to the extent practicable, with programs for 
     prevention centers that are carried out by the Director of 
     the Centers for Disease Control and Prevention.
       ``(b) Program for Patient Navigators.--
       ``(1) In general.--The Director of the Institute may make 
     grants to eligible entities for the development and operation 
     of programs to pay the costs of such entities in--
       ``(A) assigning patient navigators, in accordance with 
     applicable criteria of the Secretary, for individuals of 
     health disparity populations for the duration of receiving 
     health services from the health centers;
       ``(B) ensuring that the services provided by the patient 
     navigators to such individuals include case management and 
     psychosocial assessment and care or information and referral 
     to such services;
       ``(C) ensuring that the patient navigators provide services 
     to such individuals in a culturally competent manner; and
       ``(D) developing model practices for patient navigators, 
     including with respect to--
       ``(i) coordination of health services, including 
     psychosocial assessment and care;
       ``(ii) follow-up services, including psychosocial 
     assessment and care; and
       ``(iii) determining coverage under health insurance and 
     health plans for all services.
       ``(2) Outreach services.--A condition for the receipt of a 
     grant under paragraph (1) is that the applicant involved 
     agree to provide ongoing outreach activities while receiving 
     the grant, in a manner that is culturally competent for the 
     health disparity population served by the program, to inform 
     the public of the services of the model program under the 
     grant.
       ``(3) Application for grant.--A grant may be made under 
     paragraph (1) only if an application for the grant is 
     submitted to the Director of the Institute and the 
     application is in such form, is made in such manner, and 
     contains such agreements, assurances, and information as the 
     Director determines to be necessary to carry out this 
     section.
       ``(4) Evaluations.--

[[Page S9045]]

       ``(A) In general.--The Director of the Institute, directly 
     or through grants or contracts, shall provide for evaluations 
     to determine the effects of the services of patient 
     navigators on the health disparity population for whom the 
     services were provided, taking into account the matters 
     referred to in paragraph (1)(C).
       ``(B) Dissemination of findings.--The Director of the 
     Institute shall as appropriate disseminate to public and 
     private entities the findings made in evaluations under 
     subparagraph (A).
       ``(5) Coordination with other programs.--The Secretary 
     shall coordinate the program under this subsection with the 
     program under subsection (a) and with the program under 
     section 330I.
       ``(c) Requirements Regarding Fees.--A condition for the 
     receipt of a grant under subsection (a)(1) or (b)(1) is that 
     the program for which the grant is made have in effect--
       ``(1) a schedule of fees or payments for the provision of 
     its services that is consistent with locally prevailing rates 
     or charges and is designed to cover its reasonable costs of 
     operation; and
       ``(2) a corresponding schedule of discounts to be applied 
     to the payment of such fees or payments, which discounts are 
     adjusted on the basis of the ability of the patient to pay.
       ``(d) Model.--Not later than three years after the date of 
     the enactment of this section, the Director of the Institute 
     shall develop a peer-reviewed model of systems for the 
     services provided by this section. The Director shall update 
     such model as may be necessary to ensure that the best 
     practices are being utilized.
       ``(e) Duration of Grant.--The period during which payments 
     are made to an entity from a grant under subsection (a)(1) or 
     (b)(1) may not exceed five years. The provision of such 
     payments are subject to annual approval by the Director of 
     the Institute of the payments and subject to the availability 
     of appropriations for the fiscal year involved to make the 
     payments. This subsection may not be construed as 
     establishing a limitation on the number of grants under such 
     subsection that may be made to an entity.
       ``(f) Definitions.--For purposes of this section:
       ``(1) The term `culturally competent', with respect to 
     providing health-related services, means services that, in 
     accordance with standards and measures of the Secretary, are 
     designed to effectively and efficiently respond to the 
     cultural and linguistic needs of patients.
       ``(2) the term `appropriate follow-up care' includes 
     palliative and end-of-life care.
       ``(3) the term `health disparity population' means a 
     population where there exists a significant disparity in the 
     overall rate of disease incidence, morbidity, mortality, or 
     survival rates in the population as compared to the health 
     status of the general population. Such term includes--
       ``(A) racial and ethnic minority groups as defined in 
     section 1707; and
       ``(B) medically underserved groups, such as rural and low-
     income individuals and individuals with low levels of 
     literacy.
       ``(4)(A) the term `patient navigator' means an individual 
     whose functions include--
       ``(i) assisting and guiding patients with a symptom or an 
     abnormal finding or diagnosis of cancer or other chronic 
     disease within the health care system to accomplish the 
     follow-up and diagnosis of an abnormal finding as well as the 
     treatment and appropriate follow-up care of cancer or other 
     chronic disease; and
       ``(ii) identifying, anticipating, and helping patients 
     overcome barriers within the health care system to ensure 
     prompt diagnostic and treatment resolution of an abnormal 
     finding of cancer or other chronic disease.
       ``(B) Such term includes representatives of the target 
     health disparity population, such as nurses, social workers, 
     cancer survivors, and patient advocates.
       ``(g) Authorization of Appropriations.--
       ``(1) Model programs.--For the purpose of carrying out 
     subsection (a), there are authorized to be appropriated such 
     sums as may be necessary for each of the fiscal years 2003 
     through 2007.
       ``(2) Patient navigators.--For the purpose of carrying out 
     subsection (b), there are authorized to be appropriated such 
     sums as may be necessary for each of the fiscal years 2003 
     through 2007.
       ``(3) Relation to other authorizations.--Authorizations of 
     appropriations under paragraphs (1) and (2) are in addition 
     to other authorizations of appropriations that are available 
     for the purposes described in such paragraphs.''.

                     TITLE III--HEALTH DISPARITIES

        Subtitle A--Hispanic-Serving Health Professions Schools

     SEC. 301. HISPANIC-SERVING HEALTH PROFESSIONS SCHOOLS.

       (a) In General.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, shall make grants to Hispanic-serving health 
     professions schools for the purpose of carrying out programs 
     to recruit Hispanic individuals to enroll in and graduate 
     from the schools, which may include providing scholarships 
     and other financial assistance as appropriate.
       (b) Eligibility.--For purposes of subsection (a), an entity 
     is a Hispanic-serving health professions school if the 
     entity--
       (1) is a school or program under section 799B of the Public 
     Health Service Act (42 U.S.C. 295p);
       (2) has an enrollment of full-time equivalent students that 
     is at least 5 percent Hispanic students;
       (3) has been effective in carrying out programs to recruit 
     Hispanic individuals to enroll in and graduate from the 
     school;
       (4) has been effective in recruiting and retaining Hispanic 
     faculty members; and
       (5) has a significant number of graduates who are providing 
     health services to medically underserved populations or to 
     individuals in health professional shortage areas.
       (c) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated such sums as may be necessary for each of the 
     fiscal years 2003 through 2007.

             Subtitle B--Health Career Opportunity Program

     SEC. 311. EDUCATIONAL ASSISTANCE REGARDING UNDERGRADUATES.

       (a) In General.--Subpart 2 of part E of title VII of the 
     Public Health Service Act (42 U.S.C. 295 et seq) is amended 
     by adding at the end the following:

     ``SEC. 771. HEALTH CAREERS OPPORTUNITY PROGRAM.

       ``(a) In General.--Subject to the provisions of this 
     section, the Secretary may make grants and enter into 
     cooperative agreements and contracts for any of the following 
     purposes:
       ``(1) Identifying and recruiting individuals who--
       ``(A) are students of elementary schools, or students or 
     graduates of secondary schools or of institutions of higher 
     education;
       ``(B) are from disadvantaged backgrounds; and
       ``(C) are interested in a career in the health professions.
       ``(2) Facilitating the entry of such individuals into a 
     health professions school.
       ``(3) Providing counseling or other services designed to 
     assist such individuals in successfully completing their 
     education at such a school.
       ``(4) Providing, for a period prior to the entry of such 
     individuals into the regular course of education of such a 
     school, preliminary education designed to assist the 
     individuals in successfully completing such regular course of 
     education at such a school, or referring such individuals to 
     institutions providing such preliminary education.
       ``(5) Paying such stipends as the Secretary may approve for 
     such individuals for any period of education in student-
     enhancement programs (other than regular courses) at a health 
     professions schools, except that such a stipend may not be 
     provided to an individual for more than 12 months, and such a 
     stipend may not exceed $25 per day (notwithstanding any other 
     provision of law regarding the amount of stipends).
       ``(6) Carrying out programs under which such individuals 
     both--
       ``(A) gain experience regarding a career in a field of 
     primary health care through working at facilities of 
     nonprofit private community-based providers of primary health 
     services; and
       ``(B) receive academic instruction to assist in preparing 
     the individuals to enter health professions schools in such 
     fields.
       ``(b) Receipt of Award.--
       ``(1) Eligible entities; requirement of consortium.--The 
     Secretary may make an award under subsection (a) only if the 
     following conditions are met:
       ``(A) The applicant for the award is a public or nonprofit 
     private entity, and the applicant has established a 
     consortium consisting of nonprofit private community-based 
     organizations and health professions schools.
       ``(B) The health professions schools of the consortium are 
     schools of medicine or osteopathic medicine, public health, 
     dentistry, veterinary medicine, optometry, pharmacy, allied 
     health, chiropractic, or podiatric medicine, or graduate 
     programs in mental health practice (including such programs 
     in clinical psychology).
       ``(C) Except as provided in subparagraph (D), the 
     membership of the consortium includes not less than one 
     nonprofit private community-based organization and not less 
     than three health professions schools.
       ``(D) In the case of an applicant whose exclusive activity 
     under the award will be carrying out one or more programs 
     described in subsection (a)(6), the membership of the 
     consortium includes not less than one nonprofit private 
     community-based organization and not less than one health 
     professions schools.
       ``(E) The members of the consortium have entered into an 
     agreement specifying--
       ``(i) that each of the members will comply with the 
     conditions upon which the award is made; and
       ``(ii) whether and to what extent the award will be 
     allocated among the members.
       ``(2) Requirement of competitive awards.--Awards under 
     subsection (a) shall be made only on a competitive basis.
       ``(c) Financial Requirements.--
       ``(1) Assurances regarding capacity.--The Secretary may 
     make an award under subsection (a) only if the Secretary 
     determines that, in the case of activities carried out under 
     the award that prove to be effective toward achieving the 
     purposes of the activities--
       ``(A) the members of the consortium involved have or will 
     have the financial capacity to continue the activities, 
     regardless of whether financial assistance under subsection 
     (a) continues to be available; and
       ``(B) the members of the consortium demonstrate to the 
     satisfaction of the Secretary a commitment to continue such 
     activities,

[[Page S9046]]

     regardless of whether such assistance continues to be 
     available.
       ``(2) Matching funds.--
       ``(A) In general.--With respect to the costs of the 
     activities to be carried out under subsection (a) by an 
     applicant, the Secretary may make an award under such 
     subsection only if the applicant agrees to make available in 
     cash (directly or through donations from public or private 
     entities) non-Federal contributions toward such costs in an 
     amount that, for any fourth or subsequent fiscal year for 
     which the applicant receives such an award, is not less than 
     50 percent of such costs.
       ``(B) Federal amounts.--Amounts provided by the Federal 
     Government may not be included in determining the amount of 
     non-Federal contributions required in subparagraph (A).
       ``(C) Limitation.--The Secretary may not require non-
     Federal contributions for the first three fiscal years for 
     which an applicant receives a grant under subsection (a).
       ``(d) Preference in Making Awards.--
       ``(1) In general.--
       ``(A) Requirement.--In making awards under subsection (a), 
     the Secretary shall, subject to paragraph (3), give 
     preference to any applicant that, for the purpose described 
     in subparagraph (B), has made an arrangement with not less 
     than one entity from each of the following categories of 
     entities: Community-based organizations, elementary schools, 
     secondary schools, institutions of higher education, and 
     health professions schools.
       ``(B) Purpose.--The purpose of arrangements under 
     subparagraph (A) is to establish a program for individuals 
     identified under subsection (a) under which--
       ``(i) the activities described in such subsection are 
     carried out on behalf of the individuals; and
       ``(ii) health professions schools make a commitment to 
     admit as students of the schools such individuals who 
     participate in the program, subject to the individuals 
     meeting reasonable academic standards for admission to the 
     schools.
       ``(2) Additional preferences.--Of the applicants under 
     subsection (a) that are receiving preference for purposes of 
     paragraph (1), the Secretary shall, subject to paragraph (3), 
     give additional preference to applicants whose consortium 
     under subsection (b) includes as members one or more health 
     professions schools that have not previously received any 
     award under this section (including this section as in effect 
     prior to fiscal year 1997).
       ``(3) Limitation.--An applicant may not receive preference 
     for purposes of paragraph (1) or (2) unless the consortium 
     under subsection (b) includes not less than one health 
     professions school that has demonstrated success in enrolling 
     students from disadvantaged backgrounds.
       ``(e) Objectives Under Awards.--
       ``(1) Establishment of objectives.--Before making a first 
     award to an applicant under subsection (a), the Secretary 
     shall establish objectives regarding the activities to be 
     carried out under the award, which objectives are applicable 
     until the next fiscal year for which such award is made after 
     a competitive process of review. In making an award after 
     such a review, the Secretary shall establish additional 
     objectives for the applicant.
       ``(2) Precondition for subsequent awards.--In the case of 
     an applicant seeking an award under subsection (a) pursuant 
     to a competitive process of review, the Secretary may make 
     the award only if the applicant demonstrates to the 
     satisfaction of the Secretary that the applicant has met the 
     objectives that were applicable under paragraph (1) to the 
     preceding awards under such subsection.
       ``(f) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated $33,000,000 for fiscal year 2003, $40,000,000 
     for fiscal year 2004, and such sums as may be necessary for 
     each subsequent fiscal year.''.
       (b) Technical Amendment.--Section 770(a) of the Public 
     Health Service Act (42 U.S.C. 295e(a)) is amended by 
     inserting ``(other than section 771)'' after ``this 
     subpart''.

     SEC. 312. CENTERS OF EXCELLENCE.

       ``For the purpose of establishing and operating health 
     careers centers of excellence, there are authorized to be 
     appropriated $40,000,000 for fiscal year 2003, and such sums 
     as may be necessary for each subsequent fiscal year.

               Subtitle C--Bilingual Health Professionals

     SEC. 321. TRAINING OF BILINGUAL HEALTH PROFESSIONALS WITH 
                   RESPECT TO MINORITY HEALTH CONDITIONS.

       (a) In General.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, shall (directly or through awards of grants 
     or contracts to public or nonprofit private entities) carry 
     out a program--
       (1) to identify health professionals who speak both English 
     and a language used by racial or ethnic minority groups in 
     the United States; and
       (2) to train such health professionals with respect to the 
     treatment of minority health conditions, such as diabetes, 
     HIV infection, substance abuse, and conditions regarding 
     mental health.
       (b) Authorization of Appropriations.--For the purpose of 
     carrying out subsection (a), there are authorized to be 
     appropriated such sums as may be necessary for each of the 
     fiscal years 2003 through 2007.

                    Subtitle D--Cultural Competence

     SEC. 331. DEFINITION.

       (a) In General.--In this Act, the term ``culturally 
     competent'', with respect to the manner in which health-
     related services, education, and training are provided, means 
     providing the services, education, and training in the 
     language and cultural context that is most appropriate for 
     the individuals for whom the services, education, and 
     training are intended, including as necessary the provision 
     of bilingual services.
       (b) Modification.--The definition established in subsection 
     (a) may be modified as needed at the discretion of the 
     Secretary after providing a 30-day notice to Congress.

     SEC. 332. ACTIVITIES OF OFFICE OF MINORITY HEALTH; CENTER FOR 
                   LINGUISTIC AND CULTURAL COMPETENCE IN HEALTH 
                   CARE.

       (a) Educational Materials; Technical Assistance.--
       (1) In general.--The Secretary, acting through the Office 
     of Minority Health under section 1707 of the Public Health 
     Service Act (42 U.S.C. 300u-6), shall--
       (A) provide for the development of educational materials on 
     providing health services in a culturally competent manner;
       (B) provide technical assistance in carrying out programs 
     that use such materials; and
       (C) provide technical assistance on other matters regarding 
     the provision of health services in a culturally competent 
     manner.
       (2) Authorization of appropriations.--For the purpose of 
     carrying out paragraph (1), there are authorized to be 
     appropriated $1,000,000 for fiscal year 2003, and such sums 
     as may be necessary for each of the fiscal years 2004 through 
     2007.
       (b) Center for Linguistic and Cultural Competence in Health 
     Care.--
       (1) In general.--The Secretary, acting through the Office 
     of Minority Health under section 1707 of the Public Health 
     Service Act (42 U.S.C. 300u-6), shall provide for a Center 
     for Linguistic and Cultural Competence in Health Care to 
     carry out programs to promote and facilitate the provision of 
     health-related services, education, and training in a 
     culturally competent manner.
       (2) Authorization of appropriations.--For the purpose of 
     carrying out paragraph (1), there are authorized to be 
     appropriated $5,000,000 for fiscal year 2003, and such sums 
     as may be necessary for each of the fiscal years 2004 through 
     2007.

     SEC. 333. CULTURAL COMPETENCE DEMONSTRATION PROJECTS.

       (a) In General.--The Secretary, acting through the 
     Administrator of the Health Care Financing Administration, 
     shall conduct a cultural competence demonstration project 
     under which grants are made to two hospitals with a history 
     in the medicare program to enable them to implement standards 
     for the culturally competent provision of services to address 
     the specific needs of any population that constitutes at 
     least 5 percent of the population served by the hospital 
     involved.
       (b) Number and Type.--Of the hospitals provided grants 
     under this section, one shall be located in an urban and the 
     other in a rural area (as defined in section 1886(d)(2)(D) of 
     the Social Security Act (42 U.S.C. 1395ww(d)(2)(d)). The 
     urban hospital shall serve a significant limited English 
     proficient population and be within 175 miles of the border 
     with Mexico. In selecting such hospitals, the Secretary shall 
     give preference to hospitals that serve large immigrant 
     populations.
       (c) Amount and Duration of Grant.--A grant under this 
     section for a hospital shall be in the amount of $5,000,000 
     and shall be for a period of 5 years.
       (d) Evaluation and Report.--
       (1) Evaluation.--The Secretary shall also provide for a 
     grant to an appropriate qualified entity in an amount not to 
     exceed $1,000,000 to evaluate the demonstration projects 
     conducted under this section.
       (2) Report.--The Secretary shall submit to Congress a 
     report on the projects conducted under this section. The 
     Secretary shall include in such report the results of the 
     evaluation conducted under paragraph (1) and recommendations 
     on whether on going medicare funding should be provided for 
     implementation of standards for cultural competency in 
     hospitals.
       (e) Authorization of Appropriations.--There are authorized 
     to be appropriated from the Federal Hospital Insurance Trust 
     Fund (under section 1817 of the Social Security Act (42 
     U.S.C. 1395i) to carry out this section, $11,000,000, which 
     shall remain available until expended.

             Subtitle E--Data Regarding Race and Ethnicity

     SEC. 341. COLLECTION OF DATA.

       Part A of title III of the Public Health Service Act (42 
     U.S.C. 241 et seq.) is amended by inserting after section 306 
     the following:

     ``SEC. 306A. DATA ON RACE AND ETHNICITY.

       ``(a) In General.--The Secretary shall by regulation 
     provide for the following:
       ``(1) Health data collected under programs carried out by 
     the Secretary (whether collected directly or pursuant to 
     grants, cooperative agreements, or contracts) shall include 
     data on race, ethnicity, and spoken and written language and 
     shall, at a minimum, use the categories for race and 
     ethnicity described in OMB Directive 15.
       ``(2) Data collected by the Secretary pursuant to title VI 
     of the Civil Rights Act of 1964 shall include data on race 
     and ethnicity and shall, at a minimum, use such categories.
       ``(3) Data on race and ethnicity that is collected under 
     paragraph (1) or (2) shall use the

[[Page S9047]]

     procedures described in such Directive for collecting data 
     from an individual, and shall be maintained and presented 
     (including for reporting purposes) in accordance with such 
     Directive.
       ``(4) For health encounters that require the presence of a 
     legal parent or guardian who does not speak English or who is 
     limited English proficient, health data collected by the 
     Secretary pursuant to this section shall also include data on 
     the of the accompanying adult or guardian.
       ``(5) Such other data as the Secretary may designate 
     (including administrative records) shall be collected, 
     maintained, and presented in accordance with such Directive, 
     to the extent that such data are collected by the Secretary 
     and relate to health-related programs that are carried out by 
     the Secretary.
       ``(b) Definition.--In this section, the term `OMB Directive 
     15' means Statistical Policy Directive No. 15, Race and 
     Ethnic Standards for Federal Statistics and Administrative 
     Reporting, as established by the Director of the Office of 
     Management and Budget through the notice issued October 30, 
     1997 (62 FR 58782). Such term includes any subsequent 
     revisions to such Directive.''.

     SEC. 342. DEVELOPMENT OF STANDARDS; STUDY TO MEASURE PATIENT 
                   OUTCOMES UNDER MEDICARE AND MEDICAID PROGRAMS.

       (a) Development of Standards.--Not later than 1 year after 
     the date of the enactment of this Act, the Secretary, acting 
     through the Administrator of the Health Care Financing 
     Administration, shall develop outcome measures to evaluate, 
     by race and ethnicity, the performance of health care 
     programs and projects that provide health care to individuals 
     under the medicare and medicaid programs (under titles XVIII 
     and XIX, respectively, of the Social Security Act (42 U.S.C. 
     1395 et seq.; 1396 et seq.).
       (b) Study.--After the Secretary develops the outcome 
     measures under subsection (a), the Secretary shall conduct a 
     study that evaluates, by race and ethnicity, the performance 
     of health care programs and projects referred to in 
     subsection (a).
       (c) Report to Congress.--Not later that 2 years after the 
     date of the enactment of this Act, the Secretary shall submit 
     to Congress a report describing the outcome measures 
     developed under subsection (a), and the results of the study 
     conducted pursuant to subsection (b).

       Subtitle F--National Assessment of Status of Latino Health

     SEC. 351. NATIONAL ASSESSMENT OF STATUS OF LATINO HEALTH.

       (a) In General.--The Secretary of Health and Human Services 
     shall establish a national assessment of the status of Latino 
     health to be known as the ``Hispanic Health and Nutrition 
     Examination Survey'' or ``HHANES II''.
       (b) Goal.--The goal of the national assessment under 
     subsection (a) shall be to produce estimates of health and 
     nutritional status for Mexican Americans, Puerto Ricans, 
     Cuban Americans, and other Hispanic subpopulations.
       (c) Authorization of Appropriations.--There is authorized 
     to be appropriated such sums as may be necessary in each of 
     fiscal years 2003 through 2005 to carry out this section.

                 Subtitle G--Office of Minority Health

     SEC. 361. REVISION AND EXTENSION OF PROGRAMS OF OFFICE OF 
                   MINORITY HEALTH.

       Section 1707 of the Public Health Service Act (42 U.S.C. 
     300u-6) is amended by striking subsection (b) and all that 
     follows and inserting the following:
       ``(b) Duties.--With respect to improving the health of 
     racial and ethnic minority groups, the Secretary, acting 
     through the Deputy Assistant Secretary for Minority Health 
     (in this section referred to as the `Deputy Assistant 
     Secretary'), shall carry out the following:
       ``(1) Establish short-range and long-range goals and 
     objectives and coordinate all other activities within the 
     Public Health Service that relate to disease prevention, 
     health promotion, service delivery, and research concerning 
     such individuals. The heads of each of the agencies of the 
     Service shall consult with the Deputy Assistant Secretary to 
     ensure the coordination of such activities.
       ``(2) Carry out the following types of activities by 
     entering into interagency agreements with other agencies of 
     the Public Health Service:
       ``(A) Support research, demonstrations and evaluations to 
     test new and innovative models.
       ``(B) Increase knowledge and understanding of health risk 
     factors.
       ``(C) Develop mechanisms that support better information 
     dissemination, education, prevention, and service delivery to 
     individuals from disadvantaged backgrounds, including 
     individuals who are members of racial or ethnic minority 
     groups.
       ``(D) Ensure that the National Center for Health Statistics 
     collects data on the health status of each minority group.
       ``(E) With respect to individuals who lack proficiency in 
     speaking the English language, enter into contracts with 
     public and nonprofit private providers of primary health 
     services for the purpose of increasing the access of the 
     individuals to such services by developing and carrying out 
     programs to provide bilingual or interpretive services.
       ``(3) Support a national minority health resource center to 
     carry out the following:
       ``(A) Facilitate the exchange of information regarding 
     matters relating to health information and health promotion, 
     preventive health services, and education in the appropriate 
     use of health care.
       ``(B) Facilitate access to such information.
       ``(C) Assist in the analysis of issues and problems 
     relating to such matters.
       ``(D) Provide technical assistance with respect to the 
     exchange of such information (including facilitating the 
     development of materials for such technical assistance).
       ``(4) Carry out programs to improve access to health care 
     services for individuals with limited proficiency in speaking 
     the English language by facilitating the removal of 
     impediments to the receipt of health care that result from 
     such limitation. Activities under the preceding sentence 
     shall include conducting research and developing and 
     evaluating model projects.
       ``(5) Not later than June 8 of each year, the Deputy 
     Assistant Secretary shall submit to the Secretary a report 
     summarizing the activities of each of the minority health 
     offices under section 1707A.
       ``(c) Advisory Committee.--
       ``(1) In general.--The Secretary shall establish an 
     advisory committee to be known as the Advisory Committee on 
     Minority Health (in this subsection referred to as the 
     `Committee'). The Deputy Assistant Secretary shall consult 
     with the Committee in carrying out this section.
       ``(2) Duties.--The Committee shall provide advice to the 
     Deputy Assistant Secretary carrying out this section, 
     including advice on the development of goals and specific 
     program activities under paragraphs (1) and (2) of subsection 
     (b) for each racial and ethnic minority group.
       ``(3) Chair.--The Deputy Assistant Secretary shall serve as 
     the chair of the Committee.
       ``(4) Composition.--
       ``(A) The Committee shall be composed of 12 voting members 
     appointed in accordance with subparagraph (B), and nonvoting, 
     ex officio members designated in subparagraph (C).
       ``(B) The voting members of the Committee shall be 
     appointed by the Secretary from among individuals who are not 
     officers or employees of the Federal Government and who have 
     expertise regarding issues of minority health. The racial and 
     ethnic minority groups shall be equally represented among 
     such members.
       ``(C) The nonvoting, ex officio members of the Committee 
     shall be the directors of each of the minority health offices 
     established under section 1707A, and such additional 
     officials of the Department of Health and Human Services as 
     the Secretary determines to be appropriate.
       ``(5) Terms.--Each member of the Committee shall serve for 
     a term of 4 years, except that the Secretary shall initially 
     appoint a portion of the members to terms of 1 year, 2 years, 
     and 3 years.
       ``(6) Vacancies.--If a vacancy occurs on the Committee, a 
     new member shall be appointed by the Secretary within 90 days 
     from the date that the vacancy occurs, and serve for the 
     remainder of the term for which the predecessor of such 
     member was appointed. The vacancy shall not affect the power 
     of the remaining members to execute the duties of the 
     Committee.
       ``(7) Compensation.--Members of the Committee who are 
     officers or employees of the United States shall serve 
     without compensation. Members of the Committee who are not 
     officers or employees of the United States shall receive, for 
     each day (including travel time) they are engaged in the 
     performance of the functions of the Committee. Such 
     compensation may not be in an amount in excess of the daily 
     equivalent of the annual maximum rate of basic pay payable 
     under the General Schedule (under title 5, United States 
     Code) for positions above GS-15.
       ``(d) Certain Requirements Regarding Duties.--
       ``(1) Recommendations regarding language as impediment to 
     health care.--The Secretary, acting through the Director of 
     the Office of Refugee Health, the Director of the Office of 
     Civil Rights, and the Director of the Office of Minority 
     Health of the Health Resources and Services Administration, 
     shall make recommendations to the Deputy Assistant Secretary 
     regarding activities under subsection (b)(4).
       ``(2) Equitable allocation regarding activities.--
       ``(A) In making awards of grants, cooperative agreements, 
     or contracts under this section or section 338A, 338B, 724, 
     736, 737, 738, or 740, the Secretary, acting as appropriate 
     through the Deputy Assistant Secretary or the Administrator 
     of the Health Resources and Services Administration, shall 
     ensure that such awards are equitably allocated with respect 
     to the various racial and minority populations.
       ``(B) With respect to grants, cooperative agreements, and 
     contracts that are available under the sections specified in 
     subparagraph (A), the Secretary shall--
       ``(i) carry out activities to inform entities, as 
     appropriate, that the entities may be eligible for awards of 
     such assistance;
       ``(ii) provide technical assistance to such entities in the 
     process of preparing and submitting applications for the 
     awards in accordance with the policies of the Secretary 
     regarding such application; and

[[Page S9048]]

       ``(iii) inform populations, as appropriate, that members of 
     the populations may be eligible to receive services or 
     otherwise participate in the activities carried out with such 
     awards.
       ``(3) Cultural competency of services.--The Secretary shall 
     ensure that information and services provided pursuant to 
     subsection (b) are provided in the language and cultural 
     context that is most appropriate for the individuals for whom 
     the information and services are intended.
       ``(e) Grants and Contracts Regarding Duties.--
       ``(1) In general.--In carrying out subsection (b), the 
     Deputy Assistant Secretary may make awards of grants, 
     cooperative agreements, and contracts to public and nonprofit 
     private entities.
       ``(2) Process for making awards.--The Deputy Assistant 
     Secretary shall ensure that awards under paragraph (1) are 
     made only on a competitive basis, and that an award is made 
     for a proposal only if the proposal has been recommended for 
     such an award through a process of peer review and has been 
     so recommended by the advisory committee established under 
     subsection (c).
       ``(3) Evaluation and dissemination.--The Deputy Assistant 
     Secretary, directly or through contracts with public and 
     private entities, shall provide for evaluations of projects 
     carried out with awards made under paragraph (1) during the 
     preceding 2 fiscal years. The report shall be included in the 
     report required under subsection (f) for the fiscal year 
     involved.
       ``(f) Biennial Reports.--Not later than February 1 of 
     fiscal year 1998 and of each second year thereafter, the 
     Deputy Assistant Secretary shall submit to the Committee on 
     Energy and Commerce of the House of Representatives, and to 
     the Committee on Labor and Human Resources of the Senate, a 
     report describing the activities carried out under this 
     section during the preceding 2 fiscal years and evaluating 
     the extent to which such activities have been effective in 
     improving the health of racial and ethnic minority groups. 
     Each such report shall include the biennial reports submitted 
     to the Deputy Assistant Secretary under section 1707A(e) for 
     such years by the heads of the minority health offices.
       ``(g) Definition.--For purposes of this section:
       ``(1) Racial and ethnic minority group.--The term `racial 
     and ethnic minority group' means American Indians (including 
     Alaskan Natives, Eskimos, and Aleuts); Asian Americans and 
     Pacific Islanders; Blacks; and Hispanics.
       ``(2) Hispanic.--The term `Hispanic' means individuals 
     whose origin is Mexican, Puerto Rican, Cuban, Central or 
     South American, or any other Spanish-speaking country.
       ``(h) Funding.--
       ``(1) Authorization of appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated $21,000,000 for fiscal year 2003, $25,000,000 
     for fiscal year 2004, and $28,000,000 for fiscal year 2005.
       ``(2) Allocation of funds by secretary.--Of the amounts 
     appropriated under paragraph (1) for a fiscal year in excess 
     of $15,000,000, the Secretary shall make available not less 
     than $3,000,000 for carrying out subsection (b)(2)(E).''.

     SEC. 362. ESTABLISHMENT OF INDIVIDUAL OFFICES OF MINORITY 
                   HEALTH WITHIN AGENCIES OF PUBLIC HEALTH 
                   SERVICE.

       Title XVII of the Public Health Service Act (42 U.S.C. 300u 
     et seq.) is amended by inserting after section 1707 the 
     following section:

     ``SEC. 1707A. INDIVIDUAL OFFICES OF MINORITY HEALTH WITHIN 
                   PUBLIC HEALTH SERVICE.

       ``(a) In General.--The head of each agency specified in 
     subsection (b)(1) shall establish within the agency an office 
     to be known as the Office of Minority Health. Each such 
     Office shall be headed by a director, who shall be appointed 
     by the head of the agency within which the Office is 
     established, and who shall report directly to the head of the 
     agency. The head of such agency shall carry out this section 
     (as this section relates to the agency) acting through such 
     Director.
       ``(b) Specified Agencies.--
       ``(1) In general.--The agencies referred to in subsection 
     (a) are the following:
       ``(A) The Centers for Disease Control and Prevention.
       ``(B) The Agency for Healthcare Research and Quality.
       ``(C) The Health Resources and Services Administration.
       ``(D) The Substance Abuse and Mental Health Services 
     Administration.
       ``(2) National institutes of health.--For purposes of 
     subsection (c) and the subsequent provisions of this section, 
     the term `minority health office' includes the Office of 
     Research on Minority Health established within the National 
     Institutes of Health. The Director of the National Institutes 
     of Health shall carry out this section (as this section 
     relates to the agency) acting through the Director of such 
     Office.
       ``(c) Composition.--The head of each specified agency shall 
     ensure that the officers and employees of the minority health 
     office of the agency are, collectively, experienced in 
     carrying out community-based health programs for each of the 
     various racial and ethnic minority groups that are present in 
     significant numbers in the United States. The head of such 
     agency shall ensure that, of such officers and employees who 
     are members of racial and ethnic minority groups, no such 
     group is disproportionately represented.
       ``(d) Duties.--Each Director of a minority health office 
     shall monitor the programs of the specified agency of such 
     office in order to carry out the following:
       ``(1) Determine the extent to which the purposes of the 
     programs are being carried out with respect to racial and 
     ethnic minority groups;
       ``(2) Determine the extent to which members of such groups 
     are represented among the Federal officers and employees who 
     administer the programs; and
       ``(3) Make recommendations to the head of such agency on 
     carrying out the programs with respect to such groups. In the 
     case of programs that provide services, such recommendations 
     shall include recommendations toward ensuring that--
       ``(A) the services are equitably delivered with respect to 
     racial and ethnic minority groups;
       ``(B) the programs provide the services in the language and 
     cultural context that is most appropriate for the individuals 
     for whom the services are intended; and
       ``(C) the programs utilize racial and ethnic minority 
     community-based organizations to deliver the services.
       ``(e) Biennial Reports to Secretary.--The head of each 
     specified agency shall submit to the Secretary for inclusion 
     in each biennial report under section 1707(g) (without 
     change) a biennial report describing--
       ``(1) the extent to which the minority health office of the 
     agency employs individuals who are members of racial and 
     ethnic minority groups, including a specification by minority 
     group of the number of such individuals employed by such 
     office; and
       ``(2) the manner in which the agency is complying with 
     Public Law 94-311 (relating to data on Americans of Spanish 
     origin or descent).
       ``(f) Definitions.--For purposes of this section:
       ``(1) Minority health office.--The term `minority health 
     office' means an office established under subsection (a), 
     subject to subsection (b)(2).
       ``(2) Racial and ethnic minority group.--The term `racial 
     and ethnic minority group' has the meaning given such term in 
     section 1707(g).
       ``(3) Specified agency.--The term `specified agency' 
     means--
       ``(A) an agency specified in subsection (b)(1); and
       ``(B) the National Institutes of Health.
       ``(g) Funding.--
       ``(1) Allocations.--Of the amounts appropriated for a 
     specified agency for a fiscal year, the Secretary may reserve 
     not more than 0.5 percent for the purpose of carrying out 
     activities under this section through the minority health 
     office of the agency. In reserving an amount under the 
     preceding sentence for a minority health office for a fiscal 
     year, the Secretary shall reduce, by substantially the same 
     percentage, the amount that otherwise would be available for 
     each of the programs of the designated agency involved.
       ``(2) Availability of funds for staffing.--The purposes for 
     which amounts made available under paragraph (1) may be 
     expended by a minority health office include the costs of 
     employing staff for such office.''.

     SEC. 363. ASSISTANT SECRETARY OF HEALTH AND HUMAN SERVICES 
                   FOR CIVIL RIGHTS.

       (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. 229. ASSISTANT SECRETARY FOR CIVIL RIGHTS.

       ``(a) Establishment of Position.--There shall be in the 
     Department of Health and Human Services an Assistant 
     Secretary for Civil Rights, who shall be appointed by the 
     President, by and with the advice and consent of the Senate.
       ``(b) Responsibilities.--The Assistant Secretary shall 
     perform such functions relating to civil rights as the 
     Secretary may assign.''.
       (b) Conforming Amendment.--Section 5315 of title 5, United 
     States Code, is amended, in the item relating to Assistant 
     Secretaries of Health and Human Services, by striking ``(6)'' 
     and inserting ``(7)''.

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