[Congressional Record Volume 150, Number 32 (Friday, March 12, 2004)]
[Senate]
[Pages S2794-S2802]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. FRIST:
  S. 2217. A bill to improve the health of health disparity 
populations; to the Committee on Finance.
  Mr. FRIST: Mr. President, today I am introducing additional 
legislation to address health disparities.
  On February 12th I joined with Senator Landrieu, Senator Cochran, 
Senator DeWine, Senator Bond and Senator Talent to introduce the 
``Closing the Health Care Gap Act of 2004.'' Today I am introducing 
similar legislation to that introduced several weeks ago with one 
significant addition. This additional provision directly addresses the 
problem of access to health insurance for low income Americans.
  We know that millions of Americans still experience disparities in 
health outcomes as a result of ethnicity, race, gender, or limited 
access to quality health care. For example, disparity populations 
exhibit poorer health outcomes and have higher rates of HIV/AIDS, 
diabetes, infant mortality, cancer, heart disease, and other illnesses. 
African Americans and Native Americans die younger than any other 
racial or ethnic group. African Americans and Native American babies 
die at significantly higher rates than the rest of the population. 
African Americans, Hispanic Americans and Native Americans are at least 
twice as likely to suffer from diabetes and experience serious 
complications from diabetes.
  These gaps are simply unacceptable. Every American deserves the best 
quality of health care possible, regardless of their race, ethnicity, 
gender, or where they live.
  There is a growing awareness on the national level of the existence 
and importance of the serious disparities in the quality of health care 
that many minority and underserved Americans receive. And this presents 
us with an important opportunity to move forward.
  The legislation we introduced on February 12th and the legislation I 
introduce today does this by focusing on these 5 key areas: expanding 
access to quality health care; strengthening national efforts and 
coordination; helping increase the diversity of health professionals; 
promoting more aggressive health professional education intended to 
reduce barriers to care; and enhancing research to identify sources of 
racial, ethnic, and geographic disparities and assess promising 
intervention strategies.
  However, the legislation I am introducing today goes farther. This 
legislation includes a provision based on President Bush's proposal to 
provide refundable health insurance tax credits to lower income 
Americans. I believe that the improved access to affordable medical 
care fostered by this tax credit will be yet one more critical 
component to the overall effort to reduce disparities in health care 
for America's vulnerable populations.
  My intention is to continue to build awareness of these health care 
disparities and thereby provide the basis for bipartisan efforts to 
fight and reduce them. I think today's bill introduction represents yet 
another key step in this process. It is my hope that, working together, 
members of this body can make substantial progress in reducing and 
eliminating disparities.
  Iask 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. 2217

       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 ``Closing 
     the Health Care Gap Act of 2004''.
       (b) Table of contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.

TITLE I--IMPROVED HEALTH CARE QUALITY AND EFFECTIVE DATA COLLECTION AND 
                                ANALYSIS

Sec. 101. Standardized measures of quality health care.
Sec. 102. Data collection.

            TITLE II--EXPANDED ACCESS TO QUALITY HEALTH CARE

              Subtitle A--Access, Awareness, and Outreach

Sec. 201. Access and awareness grants.
Sec. 202. Innovative outreach programs.

             Subtitle B--Refundable Health Insurance Credit

Sec. 211. Refundable health insurance costs credit.
Sec. 212. Advance payment of credit to issuers of qualified health 
              insurance.

  TITLE III--STRONG NATIONAL LEADERSHIP, COOPERATION, AND COORDINATION

Sec. 301. Office of Minority Health and Health Disparities.

       TITLE IV--PROFESSIONAL EDUCATION, AWARENESS, AND TRAINING

Sec. 401. Workforce diversity and training.
Sec. 402. Higher education technical amendments.
Sec. 403. Model cultural competency curriculum development.
Sec. 404. Internet cultural competency clearinghouse.

                       TITLE V--ENHANCED RESEARCH

Sec. 501. Agency for Healthcare Research and Quality.
Sec. 502. National Institutes of Health.

                   TITLE VI--MISCELLANEOUS PROVISIONS

Sec. 601. Definitions.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) The overall health of Americans has dramatically 
     improved over the last century, and Americans are justifiably 
     proud of the great strides that have been made in the health 
     and medical sciences.
       (2) As medical science and technology have advanced at a 
     rapid pace, however, the health care delivery system has not 
     been able to provide consistently high quality care to all 
     Americans.
       (3) In particular, people of lower socioeconomic status, 
     racial and ethnic minorities, and medically underserved 
     populations have experienced poor health and challenges in 
     accessing high quality health care.
       (4) Recent studies have raised significant questions 
     regarding differences in clinical care provided to racial and 
     ethnic minorities and other health disparity populations. 
     These differences are often grouped together under the broad 
     heading of ``health disparities''.
       (5) Studies indicate that a gap exists between ideal health 
     care and the actual health care that some Americans receive.
       (6) Data collection, analysis, and reporting by race, 
     ethnicity, and primary language across federally supported 
     health programs are essential for identifying, understanding 
     the causes of, monitoring, and eventually eliminating health 
     disparities.
       (7) Current health related data collection and reporting 
     activities largely reflect the efforts of the Department of 
     Health and Human Services. Despite considerable efforts by 
     the Department, data collection efforts governing racial, 
     ethnic, and health disparity populations remain inconsistent 
     and inadequate. They often quantify disparities but shed 
     little light on their causes.
       (8) Many Americans, and particularly racial and ethnic 
     minorities and other health disparity populations, miss 
     opportunities for preventive medical care. Similarly, 
     management of chronic illnesses in these populations presents 
     unique challenges to the nation's health care system.
       (9) The largest numbers of the medically underserved are 
     white individuals, and many of them have the same health care 
     access problems as do members of minority groups. Nearly 
     22,000,000 white individuals live below the poverty line with 
     many living in nonmetropolitan, rural areas such as 
     Appalachia, where the high percentage of countries designated 
     as health professional shortage areas (47 percent) and the 
     high rate of poverty contribute to disparity outcomes. 
     However, there is a higher proportion of racial and ethnic 
     minorities in the United States represented among the 
     medically underserved.
       (10) While much research examines the question of racial 
     and ethnic differences in health care, less is known about 
     the magnitude and extent of differences in the quality of 
     health care related to nonsocioeconomic factors. Only 
     recently have scientists and quality improvement experts 
     begun to address the issue of how best to measure, track, and 
     improve quality of health care in diverse populations. 
     Additional research in order to understand the

[[Page S2795]]

     causes of disparities and develop effective approaches to 
     eliminate these gaps in health care quality will be 
     necessary.
       (11) There is a need to ensure appropriate representation 
     of racial and ethnic minorities, and other health disparity 
     populations, in the health care professions and in the fields 
     of biomedical, clinical, behavioral, and health services 
     research.
       (12) Preventable disparities in access to and quality of 
     health care are unacceptable. Health care delivered in the 
     United States should be care that is as safe, effective, 
     patient-centered, timely, efficient and equitable as 
     possible.

TITLE I--IMPROVED HEALTH CARE QUALITY AND EFFECTIVE DATA COLLECTION AND 
                                ANALYSIS

     SEC. 101. STANDARDIZED MEASURES OF QUALITY HEALTH CARE.

       (a) In General.--
       (1) Collaboration.--The Secretary of Health and Human 
     Services, the Secretary of Defense, the Secretary of Veterans 
     Affairs, the Director of the Indian Health Service, and the 
     Director of the Office of Personnel Management (referred to 
     in this section as the ``Secretaries'') shall work 
     collaboratively to establish uniform, standardized health 
     care quality measures across all Federal Government health 
     programs. Such measures shall be designed to assess quality 
     improvement efforts with regard to the safety, timeliness, 
     effectiveness, patient-centeredness, and efficiency of health 
     care delivered across all federally supported health care 
     delivery programs including those in which health care 
     services are delivered to health disparity populations.
       (2) Development of measures.--Relying on earlier work by 
     the Secretary of Health and Human Services or others 
     (including work such as the Healthy People 2010 or the IOM 
     Quality Chasm reports) and with an emphasis on health 
     conditions disproportionately affecting health disparity 
     populations and taking into account health literacy and 
     primary language and cultural factors, the Secretaries shall 
     develop standardized sets of quality measures for--
       (A) 5 common health conditions by not later than January 1, 
     2006; and
       (B) an additional 10 common health conditions by not later 
     than January 1, 2007.
       (3) Pilot testing.--Each federally administered health care 
     program may conduct a pilot test of the quality measures 
     developed under paragraph (2) that shall include a collection 
     of patient-level data and a public release of comparative 
     performance reports.
       (b) Public Reporting Requirements.--The Secretaries shall 
     work collaboratively to establish standardized public 
     reporting requirements for clinicians, institutional 
     providers, and health plans in each of the health programs 
     described in subsection (a).
       (c) Full Implementation.--The Secretaries shall work 
     collaboratively to prepare for the full implementation of all 
     standardized sets of quality measures and reporting systems 
     developed under subsections (a) and (b) by not later than 
     January 1, 2009.
       (d) Progress Report.--The Secretary of Health and Human 
     Services shall prepare an annual progress report that details 
     the collaborative efforts carried out under subsection (a).
       (e) Comparative Quality Reports.--Beginning on January 1, 
     2008, in order to make comparative quality information 
     available to health care consumers, including members of 
     health disparity populations, health professionals, public 
     health officials, researchers, and other appropriate 
     individuals and entities, the Secretaries shall provide for 
     the pooling and analysis of quality measures collected under 
     this section. Nothing in this section shall be construed as 
     modifying the privacy standards under the Health Insurance 
     Portability and Accountability Act of 1996 (Public Law 104-
     191).
       (f) Ongoing Evaluation of Use.--The Secretary of Health and 
     Human Services shall ensure the ongoing evaluation of the use 
     of the health care quality measures established under this 
     section.
       (g) Existing Activities.--Notwithstanding any other 
     provision of law, the standardized measures and reporting 
     activities described in this section shall replace, to the 
     extent practicable and appropriate, any existing measurement 
     and reporting activities currently utilized by federally 
     supported health care delivery programs.
       (h) Evaluation.--
       (1) Institute of Medicine.--
       (A) In general.--The Secretary of Health and Human Services 
     shall request the Institute of Medicine to conduct an 
     evaluation of the collaborative efforts of the Secretaries to 
     establish uniform, standardized health care quality measures 
     and reporting requirements for federally supported health 
     care delivery programs as required under this section.
       (B) Report.--Not later than 2 years after the date of 
     enactment of this Act, the Institute of Medicine shall submit 
     a report concerning the results of the evaluation under 
     subparagraph (A) to the Secretary.
       (2) Regulations.--
       (A) Proposed.--Not later than 18 months after the date on 
     which the report is submitted under paragraph (1)(B), the 
     Secretary shall publish proposed regulations regarding the 
     uniform, standardized health care quality measures and 
     reporting requirements described in this section.
       (B) Final regulations.--Not later than 3 years after the 
     date on which the report is submitted under paragraph (1)(B), 
     the Secretary shall publish final regulations regarding the 
     uniform, standardized health care quality measures and 
     reporting requirements described in this section.

     SEC. 102. DATA COLLECTION.

       (a) In General.--The Secretary of Health and Human Services 
     (referred to in this section as the ``Secretary'') shall--
       (1) ensure that data collected under the medicare program 
     under title XVIII of the Social Security Act (42 U.S.C. 1395 
     et seq.) are accurate by race, ethnicity, and primary 
     language and available for inclusion in the National Health 
     Disparities Report;
       (2) enforce State data collection and reporting by race, 
     ethnicity, and primary language for enrollees in the medicaid 
     program under title XIX of the Social Security Act (42 U.S.C. 
     1396 et seq.) and the State Children's Health Insurance 
     Program under title XXI of such Act (42 U.S.C. 1397aa et 
     seq.) and ensure that such data are available for inclusion 
     in the National Health Disparities Report;
       (3) ensure that ongoing and any new program initiatives--
       (A) collect and report data by race, ethnicity, and primary 
     language and provide technical assistance to promote 
     compliance;
       (B) address technological difficulties;
       (C) ensure privacy and confidentiality of data collected; 
     and
       (D) implement effective educational strategies;
       (4) expand educational programs to inform insurers, 
     providers, agencies and the public of the importance of data 
     collection by race, ethnicity, and primary language to 
     improving health care access and quality;
       (5) raise awareness that these data are critical for 
     achieving Healthy People 2010 goals and essential to the 
     nondiscrimination requirements of title VI of the Civil 
     Rights Act (42 U.S.C. 2000d et seq.); and
       (6) support research on existing best practices for data 
     collection.
       (b) Grants for Data Collection by Health Plans, Health 
     Centers, and Hospitals.--
       (1) In general.--The Secretary, acting through the Director 
     of the Agency for Healthcare Research and Quality, may 
     support or conduct not to exceed 20 demonstration programs to 
     enhance the collection, analysis, and reporting of the data 
     required under this section.
       (2) Eligibility.--To be eligible to receive a grant under 
     this section an entity shall--
       (A) be a health plan, federally qualified health center or 
     health center network, or hospital; and
       (B) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such as information 
     as the Secretary may require.
       (3) Use of funds.--A grantee shall use amounts received 
     under a grant under this subsection to--
       (A) collect, analyze, and report data by race, ethnicity, 
     or other health disparity category for patients served by the 
     grantee, including--
       (i) in the case of a hospital, emergency room patients and 
     patients served on an inpatient or outpatient basis;
       (ii) in the case of a health plan, data for enrollees; and
       (iii) in the case of a federally qualified health center or 
     health center network, primary care, specialty care, and 
     referrals;
       (B) provide analyses of racial, ethnic and other 
     disparities in health and health care, including specific 
     disease conditions, diagnostic and therapeutic procedures, or 
     outcomes;
       (C) improve health data collection and analysis for 
     additional population groups beyond the Office of Management 
     and Budget categories if such groups can be aggregated into 
     the minimum race and ethnicity categories;
       (D) develop mechanisms for sharing collected data, subject 
     to applicable privacy and confidentiality regulations;
       (E) develop educational programs to inform health insurance 
     issuers, health plans, health providers, health-related 
     agencies, patients, enrollees, and the general public that 
     data collection, analysis, and reporting by race, ethnicity, 
     and preferred language are legal and essential for 
     eliminating disparities in health and health care; and
       (F) ensure the evaluation of activities conducted under 
     this section.

            TITLE II--EXPANDED ACCESS TO QUALITY HEALTH CARE

              Subtitle A--Access, Awareness, and Outreach

     SEC. 201. ACCESS AND AWARENESS GRANTS.

       (a) Demonstration Projects.--The Secretary of Health and 
     Human Services (in this section referred to as the 
     ``Secretary'') may award contracts or competitive grants to 
     eligible entities to support demonstration projects designed 
     to improve the health and health care of health disparity 
     populations through improved access to health care, health 
     care navigation assistance, and health literacy education.
       (b) Eligible Entity Defined.--In this section the term 
     ``eligible entity'' means--
       (1) a hospital;
       (2) an academic institution;
       (3) a State health agency;
       (4) an Indian Health Service hospital or clinic, Indian 
     tribal health facility, or urban Indian facility;
       (5) a nonprofit organization including a faith-based 
     organization or consortia, to the extent that a grant awarded 
     to such an entity is consistent with the requirements of 
     section 1955 of the Public Health Service Act

[[Page S2796]]

     (42 U.S.C. 300x-65) relating to grant award to 
     nongovernmental entities;
       (6) a primary care practice-based research network as 
     defined by the Director of the Agency for Healthcare Research 
     and Quality;
       (7) a Federally qualified health center (as defined in 
     section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 
     1396d(l)(2)(B))); or
       (9) any other entity determined to be appropriate by the 
     Secretary.
       (c) Application.--An eligible entity seeking a grant under 
     this section shall submit an application to the Secretary at 
     such time, in such manner, and containing such information as 
     the Secretary may require, including assurances that the 
     eligible entity will--
       (1) target patient populations that are members of racial 
     and ethnic minority groups or health disparity populations 
     through specific outreach activities;
       (2) coordinate with appropriate community organizations and 
     include appropriate community participation in planning and 
     implementation of activities;
       (3) coordinate culturally competent and appropriate care;
       (4) include a plan to ensure that the entity will become 
     self-sustaining when funding under the grant terminates; and
       (5) include quality and outcomes performance measures to 
     evaluate the effectiveness of activities funded under this 
     section to ensure that the activities are meeting their 
     goals, and disseminate findings from such evaluations.
       (d) Priorities.--In awarding contracts and grants under 
     this section, the Secretary shall give priority to applicants 
     that intend to use amounts received under this section to 
     carry out all programs specified under subsection (e).
       (e) Use of Funds.--An eligible entity shall use amounts 
     received under this section to carry out programs that 
     involve at least 2 of the following:
       (1) Providing resources and guidance to individuals 
     regarding sources of health insurance coverage, as well as 
     information on how to obtain health coverage in the private 
     insurance market, through Federal and State programs, and 
     through other available coverage options.
       (2) Providing patient navigator services to help 
     individuals better utilize their health coverage by working 
     through the health system to obtain appropriate quality care, 
     including programs in which--
       (A) trained individuals (such as representatives from the 
     community, nurses, social workers, physicians, or patient 
     advocates) are assigned to act as contacts--
       (i) within the community; or
       (ii) within the health care system, to facilitate access to 
     health care services;
       (B) partnerships are created with community organizations 
     (which may include hospitals, federally qualified health 
     centers or health center networks, faith-based organizations, 
     primary care providers, home care, nonprofit organizations, 
     health plans, or other health providers determined 
     appropriate by the Secretary) to help facilitate access or to 
     improve the quality of care;
       (C) activities are conducted to coordinate care and 
     preventive services and referrals;
       (D) services are provided for translation, interpretation, 
     and other such linguistic services for patients with limited 
     English proficiency; or
       (E) an entity receiving a grant under this section 
     negotiates on behalf of the patient with relevant entities, 
     or provides referrals and guides the patient through the 
     mediation or arbitration process, to resolve issues that 
     impede access to care.
       (3) Promoting broad health awareness and prevention 
     efforts, including patient education and health literacy 
     programs to help increase a patient's knowledge of how to 
     best participate in such patient's and such patient's 
     children's treatment decisions.
       (4) Enhancing preventive services and coordinated, 
     multidisciplinary disease management of chronic conditions, 
     such as diabetes mellitus, HIV/AIDS, asthma, cancer, 
     cardiovascular disease, and obesity.
       (f) Report.--Not later than 3 years after the date an 
     entity receives a grant under this section and annually 
     thereafter, the entity shall provide to the Secretary a 
     report containing the results of any evaluation conducted 
     pursuant to subsection (c)(5).
       (g) Authorization of Appropriations.--There are authorized 
     to be appropriated to carry out this section such sums as may 
     be necessary for each of fiscal years 2005 through 2009.

     SEC. 202. INNOVATIVE OUTREACH PROGRAMS.

       (a) Grants To Promote Innovative Outreach and Enrollment 
     Under Medicaid and SCHIP.--Section 2104(e) of the Social 
     Security Act (42 U.S.C. 1397dd(e)) is amended--
       (1) by striking ``Amounts allotted'' and inserting the 
     following:
       ``(1) In general.--Subject to paragraph (2), amounts 
     allotted''; and
       (2) by adding at the end the following:
       ``(2) Grants to promote innovative outreach and enrollment 
     efforts.--
       ``(A) In general.--Prior to September 30 of each fiscal 
     year, beginning with fiscal year 2004, the Secretary shall 
     reserve from any unexpended allotments made to States under 
     subsection (b) or (c) (including any portion of such 
     allotments that were redistributed under subsection (f) or 
     (g)) for a fiscal year that would revert to the Treasury on 
     October 1 of the succeeding fiscal year but for the 
     application of this paragraph, the lesser of $50,000,000 or 
     the total amount of such unexpended allotments for purposes 
     of awarding grants under this paragraph for such succeeding 
     fiscal year to States or national, local, and community-based 
     public or nonprofit private organizations to conduct 
     innovative outreach and enrollment efforts that are designed 
     to increase the enrollment and participation of eligible 
     children under this title and title XIX.
       ``(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 
     geographic areas--
       ``(i) with high rates of eligible but unenrolled children, 
     including such children who reside in rural areas;
       ``(ii) with high rates of families for whom English is not 
     their primary language; or
       ``(iii) with high rates of racial and ethnic minorities and 
     health disparity populations.
       ``(C) Application.--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. Such application 
     shall include quality and outcomes performance measures to 
     evaluate the effectiveness of activities funded by a grant 
     under this paragraph to ensure that the activities are 
     meeting their goals, and disseminate findings from such 
     evaluations.''.
       (b) Demonstrations To Reduce Health Disparities.--
       (1) In general.--The Secretary of Health and Human Services 
     shall, through contracts or grants to public and private 
     entities, support demonstration programs for the purpose of 
     conducting interventions among health disparity populations 
     to--
       (A) target, identify, and reduce or prevent behavioral risk 
     factors that contribute to health disparities;
       (B) promote translation, interpretation, and other such 
     linguistic services for patients with limited English 
     speaking proficiency;
       (C) promote preventive services; or
       (D) enhance coordinated, multidisciplinary disease 
     management of chronic conditions, such as diabetes mellitus, 
     HIV/AIDS, asthma, cancer, and obesity.
       (2) Application.--An entity desiring a contract or grant 
     under paragraph (1) shall submit an application to the 
     Secretary of Health and Human Services in such form and 
     manner, and containing such information, as the Secretary may 
     require.
       (3) Authorization of Appropriations.--There are authorized 
     to be appropriated to carry out this subsection such sums as 
     may be necessary for each of fiscal years 2005 through 2009.

             Subtitle B--Refundable Health Insurance Credit

     SEC. 211. REFUNDABLE HEALTH INSURANCE COSTS CREDIT.

       (a) Allowance of Credit.--
       (1) In general.--Subpart C of part IV of subchapter A of 
     chapter 1 of the Internal Revenue Code of 1986 (relating to 
     refundable personal credits) is amended by redesignating 
     section 36 as section 37 and by inserting after section 35 
     the following new section:

     ``SEC. 36. HEALTH INSURANCE COSTS FOR UNINSURED INDIVIDUALS.

       ``(a) Allowance of Credit.--In the case of an individual, 
     there shall be allowed as a credit against the tax imposed by 
     this subtitle for the taxable year an amount equal to the 
     amount paid by the taxpayer during such taxable year for 
     qualified health insurance for the taxpayer and the 
     taxpayer's spouse and dependents.
       ``(b) Limitations.--
       ``(1) In general.--The amount allowed as a credit under 
     subsection (a) to the taxpayer for the taxable year shall not 
     exceed the lesser of--
       ``(A) the sum of the monthly limitations for coverage 
     months during such taxable year for the individuals referred 
     to in subsection (a) for whom the taxpayer paid during the 
     taxable year any amount for coverage under qualified health 
     insurance, or
       ``(B) 90 percent of the sum of the amounts paid by the 
     taxpayer for qualified health insurance for each such 
     individual for coverage months of the individual during the 
     taxable year.
       ``(2) Monthly limitation.--
       ``(A) In general.--The monthly limitation for an individual 
     for each coverage month of such individual during the taxable 
     year is the amount equal to \1/12\ of--
       ``(i) $1,000 if such individual is the taxpayer,
       ``(ii) $1,000 if--

       ``(I) such individual is the spouse of the taxpayer,
       ``(II) the taxpayer and such spouse are married as of the 
     first day of such month, and

       ``(III) the taxpayer files a joint return for the taxable 
     year, and

       ``(iii) $500 if such individual is an individual for whom a 
     deduction under section 151(c) is allowable to the taxpayer 
     for such taxable year.
       ``(B) Limitation to 2 dependents.--Not more than 2 
     individuals may be taken into account by the taxpayer under 
     subparagraph (A)(iii).
       ``(C) Special rule for married individuals.--In the case of 
     a taxpayer--
       ``(i) who is married (within the meaning of section 7703) 
     as of the close of the taxable year but does not file a joint 
     return for such year, and
       ``(ii) who does not live apart from such taxpayer's spouse 
     at all times during the taxable year,


[[Page S2797]]


     the dollar limitation imposed under subparagraph (A)(iii) 
     shall be divided equally between the taxpayer and the 
     taxpayer's spouse unless they agree on a different division.
       ``(3) Income phaseout of credit percentage.--
       ``(A) Phaseout for single coverage.--If a taxpayer with 
     self-only coverage has modified adjusted gross income in 
     excess of $15,000 for a taxable year, the 90 percent under 
     paragraph (1)(B) shall be reduced (but not below zero) by--
       ``(i) 2 percentage points for each $250 of such income in 
     excess of $15,000 but not in excess of $20,000, and
       ``(ii) 1.25 percentage points for each $250 of such income 
     in excess of $20,000.
       ``(B) Amount of reduction for family coverage.--If a 
     taxpayer with family coverage has modified adjusted gross 
     income in excess of $25,000 for a taxable year, the 90 
     percent under paragraph (1)(B) shall be reduced (but not 
     below zero) by--
       ``(i) in the case of family coverage covering only 1 adult, 
     1.5 percentage points for each $250 of such excess, and
       ``(ii) in the case of family coverage covering more than 1 
     adult, 0.643 percentage points for each $250 of such excess.

     Any percentage resulting from a reduction under clause (ii) 
     shall be rounded to the nearest one-tenth of a percent.
       ``(C) Modified adjusted gross income.--The term `modified 
     adjusted gross income' means adjusted gross income 
     determined--
       ``(i) without regard to this section and sections 911, 931, 
     and 933, and
       ``(ii) after application of sections 86, 135, 137, 219, 
     221, and 469.
       ``(c) Coverage Month.--For purposes of this section--
       ``(1) In general.--The term `coverage month' means, with 
     respect to an individual, any month if--
       ``(A) as of the first day of such month such individual is 
     covered by qualified health insurance, and
       ``(B) the premium for coverage under such insurance for 
     such month is paid by the taxpayer.
       ``(2) Employer-subsidized coverage.--
       ``(A) In general.--The term `coverage month' shall not 
     include any month for which such individual is eligible to 
     participate in any subsidized health plan (within the meaning 
     of section 162(l)(2)) maintained by any employer of the 
     taxpayer or of the spouse of the taxpayer. A subsidized 
     health plan shall not include a plan substantially all of the 
     coverage of which is of excepted benefits described in 
     section 9832(c).
       ``(B) Premiums to nonsubsidized plans.--If an employer of 
     the taxpayer or the spouse of the taxpayer maintains a health 
     plan which is not a subsidized health plan (as so defined) 
     and which constitutes qualified health insurance, employee 
     contributions to the plan shall be treated as amounts paid 
     for qualified health insurance.
       ``(3) Cafeteria plan and flexible spending account 
     beneficiaries.--The term `coverage month' shall not include 
     any month during a taxable year if any amount is not 
     includible in the gross income of the taxpayer for such year 
     under section 106 with respect to--
       ``(A) a benefit chosen under a cafeteria plan (as defined 
     in section 125(d)), or
       ``(B) a benefit provided under a flexible spending or 
     similar arrangement.
       ``(4) Medicare, medicaid, and schip.--The term `coverage 
     month' shall not include any month with respect to an 
     individual if, as of the first day of such month, such 
     individual--
       ``(A) is entitled to any benefits under part A of title 
     XVIII of the Social Security Act or is enrolled under part B 
     of such title, or
       ``(B) is enrolled in the program under title XIX or XXI of 
     such Act (other than under section 1928 of such Act).
       ``(5) Certain other coverage.--The term `coverage month' 
     shall not include any month during a taxable year with 
     respect to an individual if, at any time during such year, 
     any benefit is provided to such individual under--
       ``(A) chapter 89 of title 5, United States Code,
       ``(B) chapter 55 of title 10, United States Code,
       ``(C) chapter 17 of title 38, United States Code, or
       ``(D) any medical care program under the Indian Health Care 
     Improvement Act.
       ``(6) Prisoners.--The term `coverage month' shall not 
     include any month with respect to an individual if, as of the 
     first day of such month, such individual is imprisoned under 
     Federal, State, or local authority.
       ``(7) Insufficient presence in united states.--The term 
     `coverage month' shall not include any month during a taxable 
     year with respect to an individual if such individual is 
     present in the United States on fewer than 183 days during 
     such year (determined in accordance with section 7701(b)(7)).
       ``(d) Qualified Health Insurance.--For purposes of this 
     section--
       ``(1) In general.--The term `qualified health insurance' 
     means health insurance coverage (as defined in section 
     9832(b)(1)) which--
       ``(A) is coverage described in paragraph (2), and
       ``(B) meets the requirements of paragraph (3).
       ``(2) Eligible coverage.--Coverage described in this 
     paragraph is the following:
       ``(A) Coverage under individual health insurance.
       ``(B) Coverage under a group health plan (as defined in 
     section 5000 without regard to subsection (d)).
       ``(C) Coverage through a private sector health care 
     coverage purchasing pool.
       ``(D) Coverage under a State high risk pool described in 
     subparagraph (C) of section 35(e)(1).
       ``(E) Continuation coverage described in subparagraph (A) 
     or (B) of section 35(a)(1).
       ``(F) Coverage under an eligible State buyin program.
       ``(3) Requirements.--The requirements of this paragraph are 
     as follows:
       ``(A) Cost limits.--Under the coverage, the sum of the 
     annual deductible and the other annual out-of-pocket expenses 
     required to be paid (other than premiums) for covered 
     benefits does not exceed--
       ``(i) $5,000 for self-only coverage, and
       ``(ii) twice the dollar amount in clause (i) for family 
     coverage, or
       ``(B) Maximum benefits.--Under the coverage, the annual and 
     lifetime maximum benefits are not less than $700,000.
       ``(4) Eligible state buyin program.--For purposes of 
     paragraph (2)(F)--
       ``(A) In general.--The term `eligible State buyin program' 
     means a State program under which an individual not otherwise 
     eligible for assistance under the State medicaid program 
     under title XIX of the Social Security Act or the State 
     children's health insurance program under title XXI of such 
     Act is able to buy health insurance coverage through a 
     purchasing arrangement entered into between the State and a 
     private sector health care purchasing group or health plan 
     for purposes of providing health insurance coverage to 
     recipients of assistance under such program or for purposes 
     of providing such coverage to State employees.
       ``(B) Requirements.--Subparagraph (A) shall only apply to a 
     State program if--
       ``(i) the program uses private sector health care 
     purchasing groups or health plans, and
       ``(ii) the State maintains separate risk pools for 
     participants under the State program.
       ``(e) Archer MSA Contributions; HSA Contributions.--If a 
     deduction would be allowed under section 220 to the taxpayer 
     for a payment for the taxable year to the Archer MSA of an 
     individual or under section 223 to the taxpayer for a payment 
     for the taxable year to the Health Savings Account of such 
     individual, subsection (a) shall not apply to the taxpayer 
     for any month during such taxable year for which the 
     taxpayer, spouse, or dependent is an eligible individual for 
     purposes of either such section.
       ``(f) Inflation Adjustment.--
       ``(1) In general.--In the case of any taxable year 
     beginning after 2004, each dollar amount referred to in 
     subsections (b)(2)(A) and (d)(3) shall be increased by an 
     amount equal to--
       ``(A) such dollar amount, multiplied by
       ``(B) the cost-of-living adjustment determined under 
     section 213(d)(10)(B)(ii) for the calendar year in which the 
     taxable year begins, except that `2003' shall be substituted 
     for `1996' in subclause (II) thereof.
       ``(2) Rounding.--If any amount as adjusted under paragraph 
     (1) is not a multiple of $10, such amount shall be rounded to 
     the next lowest multiple of $10.
       ``(g) Special Rules.--
       ``(1) Coordination with medical expense deduction.--The 
     amount which would (but for this paragraph) be taken into 
     account by the taxpayer under section 213 for the taxable 
     year shall be reduced by the credit (if any) allowed by this 
     section to the taxpayer for such year.
       ``(2) Coordination with deduction for health insurance 
     costs of self-employed individuals.--In the case of a 
     taxpayer who is eligible to deduct any amount under section 
     162(l) for the taxable year, this section shall apply only if 
     the taxpayer elects not to claim any amount as a deduction 
     under such section for such year.
       ``(3) Denial of credit to dependents.--No credit shall be 
     allowed under this section to any individual with respect to 
     whom a deduction under section 151 is allowable to another 
     taxpayer for a taxable year beginning in the calendar year in 
     which such individual's taxable year begins.
       ``(4) Coordination with advance payment.--Rules similar to 
     the rules of section 35(g)(1) shall apply to any credit to 
     which this section applies.
       ``(5) Coordination with section 35.--If a taxpayer is 
     eligible for the credit allowed under this section and 
     section 35 for any taxable year, the taxpayer shall elect 
     which credit is to be allowed.
       ``(h) Expenses Must Be Substantiated.--A payment for 
     insurance to which subsection (a) applies may be taken into 
     account under this section only if the taxpayer substantiates 
     such payment in such form as the Secretary may prescribe.
       ``(i) Regulations.--The Secretary shall prescribe such 
     regulations as may be necessary to carry out the purposes of 
     this section.''.
       (b) Information Reporting.--
       (1) In general.--Subpart B of part III of subchapter A of 
     chapter 61 of the Internal Revenue Code of 1986 (relating to 
     information concerning transactions with other persons) is 
     amended by inserting after section 6050T the following:

     ``SEC. 6050U. RETURNS RELATING TO PAYMENTS FOR QUALIFIED 
                   HEALTH INSURANCE.

       ``(a) In General.--Any person who, in connection with a 
     trade or business conducted

[[Page S2798]]

     by such person, receives payments during any calendar year 
     from any individual for coverage of such individual or any 
     other individual under creditable health insurance, shall 
     make the return described in subsection (b) (at such time as 
     the Secretary may by regulations prescribe) with respect to 
     each individual from whom such payments were received.
       ``(b) Form and Manner of Returns.--A return is described in 
     this subsection if such return--
       ``(1) is in such form as the Secretary may prescribe, and
       ``(2) contains--
       ``(A) the name, address, and TIN of the individual from 
     whom payments described in subsection (a) were received,
       ``(B) the name, address, and TIN of each individual who was 
     provided by such person with coverage under creditable health 
     insurance by reason of such payments and the period of such 
     coverage,
       ``(C) the aggregate amount of payments described in 
     subsection (a), and
       ``(D) such other information as the Secretary may 
     reasonably prescribe.
       ``(c) Creditable Health Insurance.--For purposes of this 
     section, the term `creditable health insurance' means 
     qualified health insurance (as defined in section 36(d)).
       ``(d) Statements To Be Furnished to Individuals With 
     Respect to Whom Information Is Required.--Every person 
     required to make a return under subsection (a) shall furnish 
     to each individual whose name is required under subsection 
     (b)(2)(A) to be set forth in such return a written statement 
     showing--
       ``(1) the name and address of the person required to make 
     such return and the phone number of the information contact 
     for such person,
       ``(2) the aggregate amount of payments described in 
     subsection (a) received by the person required to make such 
     return from the individual to whom the statement is required 
     to be furnished, and
       ``(3) the information required under subsection (b)(2)(B) 
     with respect to such payments.

     The written statement required under the preceding sentence 
     shall be furnished on or before January 31 of the year 
     following the calendar year for which the return under 
     subsection (a) is required to be made.
       ``(e) Returns Which Would Be Required To Be Made by 2 or 
     More Persons.--Except to the extent provided in regulations 
     prescribed by the Secretary, in the case of any amount 
     received by any person on behalf of another person, only the 
     person first receiving such amount shall be required to make 
     the return under subsection (a).''.
       (2) Assessable penalties.--
       (A) Subparagraph (B) of section 6724(d)(1) of such Code 
     (relating to definitions) is amended by redesignating clauses 
     (xii) through (xviii) as clauses (xiii) through (xix), 
     respectively, and by inserting after clause (xi) the 
     following:
       ``(xii) section 6050U (relating to returns relating to 
     payments for qualified health insurance),''.
       (B) Paragraph (2) of section 6724(d) of such Code is 
     amended by striking ``or'' at the end of subparagraph (AA), 
     by striking the period at the end of the subparagraph (BB) 
     and inserting ``, or'', and by adding at the end the 
     following:
       ``(CC) section 6050U(d) (relating to returns relating to 
     payments for qualified health insurance).''.
       (3) Clerical amendment.--The table of sections for subpart 
     B of part III of subchapter A of chapter 61 of such Code is 
     amended by inserting after the item relating to section 6050T 
     the following:

``Sec. 6050U. Returns relating to payments for qualified health 
              insurance.''.

       (c) Criminal Penalty for Fraud.--Subchapter B of chapter 75 
     of the Internal Revenue Code of 1986 (relating to other 
     offenses) is amended by adding at the end the following:

     ``SEC. 7276. PENALTIES FOR OFFENSES RELATING TO HEALTH 
                   INSURANCE TAX CREDIT.

       ``Any person who knowingly misuses Department of the 
     Treasury names, symbols, titles, or initials to convey the 
     false impression of association with, or approval or 
     endorsement by, the Department of the Treasury of any 
     insurance products or group health coverage in connection 
     with the credit for health insurance costs under section 36 
     shall on conviction thereof be fined not more than $10,000, 
     or imprisoned not more than 1 year, or both.''.
       (d) Conforming Amendments.--
       (1) Section 162(l) of the Internal Revenue Code of 1986 is 
     amended by adding at the end the following:
       ``(6) Election to have subsection apply.--No deduction 
     shall be allowed under paragraph (1) for a taxable year 
     unless the taxpayer elects to have this subsection apply for 
     such year.''.
       (2) Paragraph (2) of section 1324(b) of title 31, United 
     States Code, is amended by inserting before the period ``, or 
     from section 36 of such Code''.
       (3) The table of sections for subpart C of part IV of 
     subchapter A of chapter 1 of the Internal Revenue Code of 
     1986 is amended by striking the last item and inserting the 
     following:

``Sec. 36. Health insurance costs for uninsured individuals.
``Sec. 37. Overpayments of tax.''

       (4) The table of sections for subchapter B of chapter 75 of 
     such Code is amended by adding at the end the following:

``Sec. 7276. Penalties for offenses relating to health insurance tax 
              credit.''

       (e) Effective Dates.--
       (1) In general.--Except as provided in paragraph (2), the 
     amendments made by this section shall apply to taxable years 
     beginning after December 31, 2003, without regard to whether 
     final regulations to carry out such amendments have been 
     promulgated by such date.
       (2) Penalties.--The amendments made by subsections (c) and 
     (d)(4) shall take effect on the date of the enactment of this 
     Act.

     SEC. 212. ADVANCE PAYMENT OF CREDIT TO ISSUERS OF QUALIFIED 
                   HEALTH INSURANCE.

       (a) In General.--Chapter 77 of the Internal Revenue Code of 
     1986 (relating to miscellaneous provisions) is amended by 
     adding at the end the following:

     ``SEC. 7529. ADVANCE PAYMENT OF CREDIT FOR HEALTH INSURANCE 
                   COSTS OF ELIGIBLE INDIVIDUALS.

       ``(a) General Rule.--Not later than January 1, 2005, the 
     Secretary shall establish a program for making payments on 
     behalf of certified individuals to providers of qualified 
     health insurance (as defined in section 36(d)) for such 
     individuals.
       ``(b) Program Options.--The program under subsection (a) 
     may--
       ``(1) provide that payments may be made on the basis of 
     modified adjusted gross income of certified individuals for 
     the preceding taxable year, and
       ``(2) provide that, in lieu of payments to providers, the 
     following amounts may be offset:
       ``(A) Amounts required to be deposited by the provider as 
     estimated income tax under section 6654 or 6655.
       ``(B) Amounts required to be deducted and withheld under 
     section 3401 (relating to wage withholding).
       ``(C) Taxes imposed under section 3111(a) or 50 percent of 
     taxes imposed under section 1401(a) (relating to FICA 
     employer taxes).
       ``(D) Amounts required to be deducted under section 3102 
     with respect to taxes imposed under section 3101(a) or 50 
     percent of taxes imposed under section 1401(a) (relating to 
     FICA employee taxes).
       ``(c) Certified Individual.--For purposes of this section, 
     the term `certified individual' means any individual for whom 
     a qualified health insurance credit eligibility certificate 
     is in effect.
       ``(d) Qualified Health Insurance Credit Eligibility 
     Certificate.--For purposes of this section, a qualified 
     health insurance credit eligibility certificate is a 
     statement furnished by an individual to a provider of 
     qualified health insurance which--
       ``(1) certifies that the individual will be eligible to 
     receive the credit provided by section 36 for the taxable 
     year,
       ``(2) estimates the amount of such credit for such taxable 
     year, and
       ``(3) provides such other information as the Secretary may 
     require for purposes of this section.''
       (b) Clerical Amendment.--The table of sections for chapter 
     77 of the Internal Revenue Code of 1986 is amended by adding 
     at the end the following:

``Sec. 7529. Advance payment of health insurance credit for purchasers 
              of qualified health insurance.''

       (c) Effective Date.--The amendments made by this section 
     shall take effect on July 1, 2005, without regard to whether 
     final regulations to carry out such amendments have been 
     promulgated by such date.

  TITLE III--STRONG NATIONAL LEADERSHIP, COOPERATION, AND COORDINATION

     SEC. 301. OFFICE OF MINORITY HEALTH AND HEALTH DISPARITIES.

       (a) In General.--Section 1707 of the Public Health Service 
     Act (42 U.S.C. 300u-6) is amended--
       (1) by striking the section heading and inserting the 
     following:


       ``office of minority health and health disparities''; and

       (2) in subsection (a)--
       (A) by striking ``Office of Minority Health'' each place 
     that such appears and inserting ``Office of Minority Health 
     and Health Disparities''; and
       (B) by striking ``for Minority Health'' and inserting ``for 
     Minority Health and Health Disparities''.
       (b) Duties.--Section 1707(b) of the Public Health Service 
     Act (42 U.S.C. 300u-6(b)) is amended--
       (1) in the matter preceding paragraph (1)--
       (A) by inserting ``and health disparity populations'' after 
     ``groups'' and
       (B) by striking ``for Minority Health'' and inserting ``for 
     Minority Health and Health Disparities'';
       (2) in paragraph (1)--
       (A) by striking ``Establish'' and all that follows through 
     ``coordinate'' and inserting ``Coordinate''; and
       (B) by striking ``such individuals'' and inserting ``health 
     disparities'';
       (4) in paragraph (1)
       (3) in paragraph (5), by inserting ``or health disparity 
     populations'' after ``minority groups'';
       (4) in paragraph (6), by inserting ``or health disparity 
     population'' after ``minority group'';
       (5) by striking paragraphs (7) and (9);

[[Page S2799]]

       (6) by redesignating paragraphs (1), (2), (3), (4), (5), 
     (6), (8), and (10) as paragraphs (3), (4), (6), (7), (9), 
     (10), (11), and (12), respectively;
       (7) by inserting before paragraph (3) (as so redesignated) 
     the following:
       ``(1) Establish specific short- and long-term goals and 
     objectives for analyzing the causes of health disparities and 
     addressing them, with a particular focus on the areas of 
     health promotion, disease prevention, chronic care and 
     research.
       ``(2) Work with agencies within the Department of Health 
     and Human Services and with the Surgeon General to establish 
     a strategic plan to analyze and address the causes of health 
     disparities. The plan shall include recommendations to 
     improve the collection, analysis, and reporting of data at 
     the Federal, State, territorial, Tribal, and local levels, 
     including how to--
       ``(A) implement data collection while minimizing the cost 
     and administrative burdens of data collection and reporting;
       ``(B) expand awareness of the importance of such data 
     collection to improving health care quality; and
       ``(C) provide researchers with greater access to racial, 
     ethnic, and other health disparity data.'';
       (8) by inserting after paragraph (4) (as so redesignated), 
     the following:
       ``(5) Increase awareness of disparities in health care 
     among health care providers, health plans, and the public.'';
       (9) in paragraph (6) (as so redesignated)--
       (A) by striking ``Support'' and inserting ``In cooperation 
     with the appropriate agencies, support'';
       (B) by inserting before the period the following: ``for--
       ``(A) expanding health care access;
       ``(B) improving health care quality; and
       ``(C) increasing health care educational opportunity.'';
       (10) by inserting after paragraph (7) (as so redesignated), 
     the following:
       ``(8) Consistent with section 102 of the Closing the Health 
     Care Gap Act of 2004, coordinate the classification and 
     collection of health care data to allow for the ongoing 
     analysis of the causes of disparities and monitoring of 
     progress toward the elimination of disparities.''; and
       (11) by inserting after paragraph (12), as so redesignated, 
     the following:
       ``(13) Work with Federal agencies and departments outside 
     of the Department of Health and Human Services to maximize 
     program resources available to understand why disparities 
     exist, and effective ways to reduce and eliminate 
     disparities.
       ``(14) Support a center for linguistic and cultural 
     competence to carry out the following:
       ``(A) 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 such 
     individuals to such services by developing and carrying out 
     programs to provide bilingual or interpretive services.
       ``(B) Carry out programs to improve access to health care 
     services for individuals with limited proficiency in speaking 
     the English language. Activities under this subparagraph 
     shall include developing and evaluating model projects.''.
       (c) Advisory Committee.--Section 1707(c) of the Public 
     Health Service Act (42 U.S.C. 300u-6(c)) is amended--
       (1) in paragraph (1), by inserting ``and Health 
     Disparities'' after ``Minority Health'';
       (2) in paragraph (2), by inserting ``and health disparity 
     populations'' after ``minority group''; and
       (3) in paragraph (4)(B)--
       (A) by inserting ``and health disparities'' after 
     ``minority health''; and
       (B) by inserting ``and health disparity populations'' after 
     ``minority groups''.
       (d) Duty Requirements.--Section 1707(d) of the Public 
     Health Service Act (42 U.S.C. 300u-6(d)) is amended--
       (1) in paragraph (1)(A), by striking ``(b)(9)'' and 
     inserting ``(b)(14);
       (2) in paragraph (1)(B), by striking ``(b)(10)'' and 
     inserting ``(b)(13); and
       (3) in paragraph (3), insert ``take into account the unique 
     cultural or linguistic issues facing such populations and'' 
     after ``subsection (b)''.
       (e) Reports.--Section 1707(f) of the Public Health Service 
     Act (42 U.S.C. 300u-6(f)) is amended--
       (1) in paragraph (1)--
       (A) by striking the subsection heading and inserting 
     ``Report on activities.--'';
       (B) by striking ``1999'' and inserting ``2006'';
       (C) by striking ``Committee on Energy and Commerce of the 
     House of Representatives, and to the Committee on Labor and 
     Human Resources of the Senate'' and inserting ``appropriate 
     committees of Congress''; and
       (D) by inserting ``and health disparity populations'' after 
     ``racial and ethnic minority groups'';
       (2) in paragraph (2)--
       (A) by striking ``1999'' and inserting ``2005''; and
       (B) by inserting ``and health disparity'' after ``minority 
     health'';
       (3) by redesignating paragraph (1) and (2) as paragraphs 
     (2) and (3), respectively; and
       (4) by inserting after the subsection heading, the 
     following:
       ``(1) In general.--Not later than 1 year after the date of 
     enactment of the Closing the Health Care Gap Act of 2004, the 
     Secretary shall submit to the appropriate committees of 
     Congress, a report on the plan developed under subsection 
     (b)(2).''.
       (f) Authorization of Appropriations.--Section 1707(h) of 
     the Public Health Service Act (42 U.S.C. 300u-6(h)) is 
     amended--
       (1) by striking ``Funding.--'' and all that follows through 
     the paragraph designation in paragraph (1); and
       (2) by striking ``$30,000,000'' and all that follows 
     through the period and inserting ``$50,000,000 for fiscal 
     year 2005, such sums as may be necessary for each of fiscal 
     years 2006 through 2009.''.

       TITLE IV--PROFESSIONAL EDUCATION, AWARENESS, AND TRAINING

     SEC. 401. WORKFORCE DIVERSITY AND TRAINING.

       (a) Purpose.--Part B of title VII of the Public Health 
     Service Act (42 U.S.C. 293 et seq.) is amended by inserting 
     before section 736 the following:

     ``SEC. 736A. PURPOSE OF PROGRAM.

       ``It is the purpose of this part to improve health care 
     quality and access in medically underserved communities, to 
     improve the cultural competence of health care providers by 
     increasing minority representation in the health professions, 
     and to strengthen the research and education programs of 
     designated health professions schools that disproportionately 
     serve health disparity populations.''.
       (b) Centers of Excellence.--Section 736 of the Public 
     Health Service Act (42 U.S.C. 293) is amended--
       (1) by striking subsection (a) and inserting the following:
       ``(a) In General.--The Secretary shall make grants to, and 
     enter into contracts with, public and nonprofit private 
     health or educational entities, including designated health 
     professions schools described in subsection (c), for the 
     purpose of assisting the schools in supporting programs of 
     excellence in health professions education for racial or 
     ethnic minority or health disparity populations.'';
       (2) in subsection (b)--
       (A) in paragraph (2), by striking ``under-represented 
     minority'' and inserting ``racial or ethnic minority'';
       (B) in paragraph (3), by striking ``under-represented 
     minority'' and inserting ``racial or ethnic minority'';
       (C) in paragraph (4), by striking ``minority health'' and 
     inserting ``health disparity'';
       (D) in paragraph (5), by striking ``under-represented 
     minority groups'' and inserting ``racial or ethnic minorities 
     and health disparity populations'';
       (E) in paragraph (6)--
       (i) in the matter preceding subparagraph (A), by striking 
     ``under-represented minority'' and inserting ``individuals 
     from racial or ethnic minorities or health disparity 
     populations''; and
       (ii) by striking ``and'' at the end;
       (F) in paragraph (7), by striking the period and inserting 
     ``; and''; and
       (G) by adding at the end the following:
       ``(8) to conduct accountability and other reporting 
     activities, as required by the Secretary.'';
       (3) in subsection (c)--
       (A) in paragraph (1)(B)--
       (i) in clause (i), by striking ``under-represented 
     minority'' and inserting ``individuals from racial or ethnic 
     minorities or health disparity populations'';
       (ii) in clause (ii), by striking ``under-represented 
     minority'' and inserting ``such'';
       (iii) in clause (iii)--

       (I) by striking ``under-represented minority individuals'' 
     the first place that such appears and inserting ``such 
     students'';
       (II) by striking ``such individuals'' and inserting ``such 
     students'';and
       (III) by striking ``under-represented minority'' the second 
     place that such appears and inserting ``such''; and

       (iv) in clause (iv), by striking ``under-represented 
     minority individuals'' and inserting ``individuals from 
     racial or ethnic minorities or health disparity 
     populations''; and
       (B) in paragraph (2)(B)--
       (i) in clause (i), by striking ``under-represented'' and 
     inserting ``racial or''; and
       (C) in paragraph (5)(B)--
       (i) by striking ``under-represented'' and inserting 
     ``racial or''; and
       (ii) by inserting ``or a health disparity population'' 
     after ``minorities'';
       (4) in subsection (d)(1), by striking ``Under-Represented 
     Minority Health'' and inserting ``Minority Health and Health 
     Disparity'';
       (5) in subsection (h)--
       (A) in paragraph (1), by striking ``$26,000,000'' and all 
     that follows and inserting ``$50,000,000 for fiscal year 
     2005, and such sums as may be necessary for each of fiscal 
     years 2006 through 2009''; and
       (B) in paragraph (2)--
       (i) in subparagraph (C)--

       (I) in the matter preceding clause (i), by striking ``are 
     $30,000,000 or more'' and inserting ``exceed $30,000,000 but 
     are less than $40,000,000''; and
       (II) in clause (iv), by striking ``any remaining funds'' 
     and inserting ``any remaining excess amount''; and

       (ii) by adding at the end the following:
       ``(D) Funding in excess of $40,000,000.--If amounts 
     appropriated under paragraph (1) for a fiscal year are 
     $40,000,000 or more, the Secretary shall make available--
       ``(i) not less than $16,000,000 for grants under subsection 
     (a) to health professions schools that meet the conditions 
     described in subsection (c)(2)(A);
       ``(ii) not less than $16,000,000 for grants under 
     subsection (a) to health professions schools that meet the 
     conditions described in

[[Page S2800]]

     paragraph (3) or (4) of subsection (c) (including meeting 
     conditions pursuant to subsection (e));
       ``(iii) not less than $8,000,000 for grants under 
     subsection (a) to health professions schools that meet the 
     conditions described in subsection (c)(5); and
       ``(iv) after grants are made with funds under clauses (i) 
     through (iii), any remaining funds for grants under 
     subsection (a) to health professions schools that meet the 
     conditions described in paragraph (2)(A), (3), (4), or (5) of 
     subsection (c).''; and
       (6) by adding at the end the following:
       ``(i) Evaluation.--
       ``(1) In general.--Not later than 1 year after the date of 
     enactment of the Closing the Health Care Gap Act of 2004, the 
     Secretary shall request that the Institute of Medicine 
     evaluate the effectiveness of the programs under this section 
     in meeting the purpose of this part. The Institute of 
     Medicine shall submit a report on the evaluation to the 
     Secretary.
       ``(2) Working group.--Upon submission of the report under 
     paragraph (1), the Secretary shall convene a working group 
     composed of stakeholders, including designated health 
     professions schools described in subsection (c), to define 
     quality performance measures and reporting requirements of 
     grant recipients that shall be tied to the purpose of this 
     part.
       ``(3) Regulations.--Not later than 18 months after the date 
     the Institute of Medicine submits the report under paragraph 
     (1), the Secretary shall publish proposed regulations 
     regarding the quality performance measures and reporting 
     requirements described in paragraph (2). Not later than 3 
     years after the date the Institute of Medicine submits the 
     report under paragraph (1), the Secretary shall publish final 
     regulations regarding the quality performance measures and 
     reporting requirements described in paragraph (2).''.
       (c) Scholarships for Disadvantaged Students.--Section 737 
     of the Public Health Service Act (42 U.S.C. 293a) is 
     amended--
       (1) in subsection (c), by striking ``under-represented 
     minority'' and inserting ``minority and health disparity''; 
     and
       (2) in subsection (d)(1)(B), by inserting ``or health 
     disparity'' after ``minority''.
       (d) Loan Repayments and Fellowships Regarding Faculty 
     Positions.--Section 738(b) of the Public Health Service Act 
     (42 U.S.C. 293b(b)) is amended--
       (1) in paragraph (1), by striking ``underrepresented'';
       (2) in paragraph (3)(A), by striking ``underrepresented 
     minority individuals'' and inserting ``individuals from 
     racial or ethnic minorities or health disparity 
     populations''; and
       (3) by striking paragraph (5).
       (e) National Health Service Corps.--
       (1) Assignment.--Section 333(a)(3) of the Public Health 
     Service Act (42 U.S.C. 254f(a)(3)) is amended--
       (A) in the second sentence--
       (i) by striking ``shall give preference'' and inserting the 
     following: ``shall--
       ``(A) give preference''; and
       (ii) by striking the period and inserting ``; and''; and
       (B) by adding at the end the following:
       ``(B) give preference to applications from entities 
     described in subparagraph (A) that serve individuals a 
     majority of whom are members of a racial or ethnic minority 
     or other health disparity population with annual incomes at 
     or below twice those set forth in the most recent poverty 
     guidelines issued by the Secretary pursuant to section 402(2) 
     of the Community Services Block Grant Act.''.
       (2) Priorities.--Section 333A(a) of the Public Health 
     Service Act (42 U.S.C. 254f-1(a)) is amended--
       (A) by redesignating paragraphs (1) through (3) as 
     paragraphs (2) through (4), respectively; and
       (B) by inserting before paragraph (2) (as so redesignated), 
     the following:
       ``(1) give preference to applications as described in 
     section 333(a)(3);''.
       (e) Authorization of Appropriations.--Section 740 of the 
     Public Health Service Act (42 U.S.C. 293d) is amended--
       (1) in subsection (a), by striking ``2002'' and inserting 
     ``2009'';
       (2) in subsection (b), by striking ``2002'' and inserting 
     ``2009'';
       (3) in subsection (c), by striking ``2002'' and inserting 
     ``2009''; and
       (4) by striking subsection (d).
       (f) Grants for Health Professions Education.--Section 741 
     of the Public Health Service Act (42 U.S.C. 293e) is 
     amended--
       (1) in subsection (a)(2), in the first sentence by striking 
     ``Unless'' and all that follows through ``the Secretary'' and 
     inserting ``The Secretary''; and
       (2) in subsection (b), by striking ``$3,500,000'' and all 
     that follows through the period and inserting ``such sums as 
     may be necessary for each of fiscal years 2005 through 
     2009.''.
       (g) Health Careers Opportunity Program.--Subpart 2 of part 
     E of title VII of the Public Health Service Act (42 U.S.C. 
     295 et seq.) is amended--
       (1) in section 770 by inserting ``(other than section 
     771)'' after ``this subpart'';
       (2) by redesignating section 770 as section 771;
       (3) by inserting after section 769 the following:

     ``SEC. 770. HEALTH CAREERS OPPORTUNITY PROGRAM.

       ``(a) In General.--The Secretary may make grants and enter 
     into cooperative agreements and contracts with eligible 
     entities for any of the following purposes:
       ``(1) Identifying and recruiting students who--
       ``(A) are from disadvantaged backgrounds or health 
     disparity populations; and
       ``(B) are interested in a career in the health professions.
       ``(2) Providing counseling or other services designed to 
     assist such individuals in entering a health professions 
     school and successfully completing their education at such a 
     school.
       ``(3) 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.
       ``(b) Receipt of Award.--
       ``(1) Eligible entities; requirement of consortium.--The 
     Secretary may make an award under subsection (a) only if an 
     eligible entity meets the following conditions:
       ``(A) The eligible entity is a public or private entity, 
     and such entity has established a consortium consisting of 
     private community-based organizations and health professions 
     schools.
       ``(B) The health professions schools in the consortium are 
     schools of medicine or osteopathic medicine, public health, 
     nursing, dentistry, optometry, pharmacy, allied health, or 
     podiatric medicine, or graduate programs in mental health 
     practice (including programs in clinical psychology).
       ``(C)(i) Except as provided in clause (ii), the membership 
     of the consortium includes not less than 1 nonprofit private 
     community-based organization and not less than 3 health 
     professions schools.
       ``(ii) In the case of an eligible entity whose exclusive 
     activity under the award will be carrying out 1 or more 
     programs described in subsection (a)(5), the membership of 
     the consortium includes not less than 1 nonprofit private 
     community-based organization and not less than 1 health 
     professions school.
       ``(D) 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 on a competitive basis.
       ``(c) Requirements.--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--
       ``(1) 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
       ``(2) the members of the consortium demonstrate to the 
     satisfaction of the Secretary a commitment to continue such 
     activities, regardless of whether such assistance continues 
     to be available.
       ``(d) Objectives Under Awards.--Before making a first award 
     to an eligible entity 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.
       ``(e) 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 
     fiscal years 2005 through 2009.''.

     SEC. 402. HIGHER EDUCATION TECHNICAL AMENDMENTS.

       Section 326(c) of the Higher Education Act of 1965 (20 
     U.S.C. 1063b(c)) is amended--
       (1) in paragraph (2), by inserting before the semicolon, 
     the following: ``, and for the acquisition and development of 
     real property that is adjacent to the campus to improve the 
     academic environment'';
       (2) in paragraph (6), by striking ``and'' at the end;
       (3) in paragraph (7), by striking the period and inserting 
     a semicolon; and
       (4) by adding at the end the following:
       ``(8) Support of faculty exchanges, development, and 
     fellowship to enable attainment of advanced degrees in their 
     field of instruction; and
       ``(9) Tutoring, counseling, and student service programs 
     designed to improve academic success.''.

     SEC. 403. MODEL CULTURAL COMPETENCY CURRICULUM DEVELOPMENT.

       (a) Curricula Development and Model Curricula.--The 
     Secretary of Health and Human Services (in this section 
     referred to as the ``Secretary'') may award grants to 
     eligible entities for curricula development for the training 
     of health care providers and health professions students 
     regarding cultural competency, and for demonstration projects 
     to test new innovations for cultural competence education 
     model curricula for and identify additional barriers to 
     culturally appropriate care.
       (b) Application.--Each eligible entity desiring a grant 
     under subsection (a) shall submit an application to the 
     Secretary at such

[[Page S2801]]

     time, in such manner, and containing such information as the 
     Secretary may require.
       (c) Authorization of Appropriations.--There are authorized 
     to be appropriated to carry out this section such sums as may 
     be necessary for each of fiscal years 2005 through 2009.

     SEC. 404. INTERNET CULTURAL COMPETENCY CLEARINGHOUSE.

       (a) Development.--The Director of the Office of Minority 
     Health and Health Disparities, with assistance from the 
     Administrator of the Agency for Healthcare Research and 
     Quality, shall develop and maintain an Internet clearinghouse 
     to improve health care quality for individuals with specific 
     cultural needs or with limited English proficiency or low 
     functional health literacy and to reduce or eliminate the 
     duplication of effort to translate materials.
       (b) Templates.--In developing the clearinghouse under 
     subsection (a), the Director of the Office of Minority Health 
     and Health Disparities shall develop, test, and make 
     available templates for standard documents that are necessary 
     for patients and consumers to access and make educated 
     decisions about their health care, including--
       (1) administrative and legal documents;
       (2) clinical information such as how to take medications, 
     how to prevent transmission of a contagious disease, and 
     other prevention and treatment instructions; and
       (3) patient education and outreach materials such as 
     immunization notices, health warnings, or screening notices.
       (c) Online Library or Database.--The Director of the Office 
     of Minority Health and Health Disparities shall develop a 
     readily accessible online library or database with searchable 
     clinically relevant cultural information that is important 
     for health care providers to have on hand in the direct 
     provision of medical care to individuals from specific 
     minority, ethnic, or other health disparity groups.

                       TITLE V--ENHANCED RESEARCH

     SEC. 501. AGENCY FOR HEALTHCARE RESEARCH AND QUALITY.

       Part B of title IX of the Public Health Service Act (42 
     U.S.C. 299b) is amended by adding at the end the following:

     ``SEC. 918. ENHANCED RESEARCH WITH RESPECT TO HEALTH 
                   DISPARITIES.

       ``(a) Accelerating the Elimination of Disparities.--
       ``(1) In general.--The Secretary, acting through the 
     Director, may award grants or contracts to eligible entities 
     (as defined in paragraph (4)) for short-term research to 
     analyze the causes of disparities and identify or develop and 
     evaluate effective strategies in closing the health care gap 
     between minority and health disparity populations and 
     nonminority populations or non-health disparity populations.
       ``(2) Prompt use of research.--To ensure that research 
     described in paragraph (1) is effective and is disseminated 
     and applied promptly, the Director shall--
       ``(A) expand practice-based research networks (primary care 
     and larger delivery systems) to include networks of delivery 
     sites serving large numbers of minority and health disparity 
     populations including--
       ``(i) public hospitals;
       ``(ii) health centers; and
       ``(iii) other sites as determined appropriate by the 
     Director;
       ``(B) work with health care providers to identify and 
     develop those interventions for minority and health disparity 
     populations for which effective implementation strategies are 
     not clear; and
       ``(C) develop a broad virtual network of continuous 
     learning among health care providers (including institutions 
     that did not receive a grant or contract under paragraph (1)) 
     so that those participating in research can share findings 
     and experience throughout the duration of such research and 
     to facilitate interest in and prompt adoption of such 
     findings and experience.
       ``(3) Technical assistance.--The Director of the Agency for 
     Healthcare Research and Quality shall provide technical 
     assistance to assist in the implementation of strategies of 
     evidence-based practices that will reduce health care 
     disparities.
       ``(4) Eligible entities.--In paragraph (1), the term 
     `eligible entities' means institutions with researchers who 
     have experience in conducting research relating to minority 
     health and health disparity populations.
       ``(5) Public hospitals.--In this subsection, the term 
     `public hospitals' means a hospital (as defined in section 
     1886(d)(1)(B) of the Social Security Act) that--
       ``(A) is owned or operated by a unit of State or local 
     government, is a public or private non-profit corporation 
     which is formally granted governmental powers by a unit of 
     State or local government, or is a private non-profit 
     hospital that has a contract with a State or local government 
     to provide health care services to low income individuals who 
     are not entitled to benefits under title XVIII of the Social 
     Security Act or eligible for assistance under the State plan 
     under title XIX of the Social Security Act; and
       ``(B) for the most recent cost reporting period that ended 
     before the calendar quarter involved, had a disproportionate 
     share adjustment percentage (as determined under section 
     1886(d)(5)(F) of the Social Security Act) greater than 11.75 
     percent or was described in section 1886(d)(5)F)(i)(II) of 
     such Act.
       ``(b) Realizing the Potential of Disease Management.--
       ``(1) Public-private sector partnership to assess 
     effectiveness of existing data management strategies.--The 
     Director shall establish a public-private partnership to 
     assess the effectiveness of disease management strategies and 
     identify effective interventions and support strategies with 
     respect to minority and health disparity populations.
       ``(2) Effective management of patients with multiple 
     chronic diseases.--
       ``(A) Initiative for disease management strategies.--The 
     Director shall coordinate an initiative to identify those 
     chronic conditions for which disease-specific disease 
     management strategies pose conflicts in preferred clinical 
     interventions.
       ``(B) Research.--The Director, with support from other 
     agencies within the Department of Health and Human Services 
     shall conduct a program of research based in community and 
     primary-care settings to test and evaluate the implications 
     for patient outcomes of alternative approaches for 
     reconciling conflicts from disease-specific disease 
     management initiatives.
       ``(c) Development of Effective Measurement of 
     Disparities.--
       ``(1) In general.--The Director shall conduct a 
     demonstration project to--
       ``(A) assess alternative strategies for identifying 
     population subgroups at highest risk of poor quality and poor 
     health;
       ``(B) improve data collection for health care priority 
     populations (as described in section 901(c)(1)(B));
       ``(C) improve the ability to identify the causes of 
     disparities; and
       ``(D) track progress in reducing health care disparities 
     with a focus on--
       ``(i) the minimum data set necessary to track such 
     progress; and
       ``(ii) the identification of measures for which data 
     currently being collected are insufficient.
       ``(2) Report.--Not later than 3 years after the date the 
     demonstration project described in paragraph (1) receives 
     funding, the Director shall submit to the appropriate 
     committees of Congress a report containing the findings of 
     the demonstration project together with any policy 
     recommendations.
       ``(d) Analysis of Racial, Ethnic, and Other Health 
     Disparity Data.--The Secretary, acting through the Director 
     of the Agency for Healthcare Research and Quality, and in 
     coordination with the Administrator of the Centers for 
     Medicare & Medicaid Services and the Director of the Centers 
     for Disease Control and Prevention, shall provide technical 
     assistance to agencies of the Department of Health and Human 
     Services in meeting Federal standards for race, ethnicity, 
     and other health disparity data collection and analysis of 
     racial, ethnic, and other disparities in health and health 
     care in Federally-administered programs by--
       ``(1) identifying appropriate quality assurance mechanisms 
     to monitor for health disparities;
       ``(2) specifying the clinical, diagnostic, or therapeutic 
     measures which should be monitored;
       ``(3) developing new quality measures relating to racial, 
     ethnic, or other health disparities;
       ``(4) identifying the level at which data analysis should 
     be conducted; and
       ``(5) sharing data with external organizations for research 
     and quality improvement purposes.''.

     SEC. 502. NATIONAL INSTITUTES OF HEALTH.

       The Director of the National Institutes of Health, in 
     consultation with the Director of the National Center on 
     Minority Health and Health Disparities, shall expand and 
     intensify research at the National Institutes of Health 
     relating to the sources of health and health care 
     disparities, and increase efforts to recruit minority 
     scientists and research professionals into the field of 
     health disparity research.

                   TITLE VI--MISCELLANEOUS PROVISIONS

     SEC. 601. DEFINITIONS.

       (a) In General.--In this Act, including the amendments made 
     by this Act:
       (1) Culturally competent.--
       (A) In general.--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 
     subparagraph (A) may be modified as needed at the discretion 
     of the Secretary after providing a 30-day notice to Congress.
       (2) Minority health conditions.--The term ``minority health 
     conditions'', with respect to individuals who are members of 
     minority groups, means all diseases, disorders, and 
     conditions (including with respect to mental health and 
     substance abuse)--
       (A) unique to, more serious, or more prevalent in such 
     groups;
       (B) for which the factors of medical risk or types of 
     medical intervention may be different for such groups, or for 
     which it is unknown whether such factors or types are 
     different for such individuals; or
       (C) with respect to which there has been insufficient 
     research involving such individual members of such groups as 
     subjects or insufficient data on such individuals.

[[Page S2802]]

       (3) Minority health disparities research.--The term 
     ``minority health disparities research'' means basic, 
     clinical, behavioral and health services research on minority 
     health conditions (as defined in paragraph (2)), including 
     research to prevent, diagnose, and treat such conditions.
       (4) Minority.--The terms ``minority'' and ``minorities'' 
     refer to individuals from a minority group.
       (5) Minority group.--The term ``minority group'' has the 
     meaning given the term ``racial and ethnic minority group'' 
     in section 1707 of the Public Health Service Act (42 U.S.C. 
     300u-6).
       (b) Health Disparity Populations.--In this Act, including 
     the amendments made by this Act:
       (1) Health disparity population.--The term ``health 
     disparity population'' has the meaning given such term in 
     section 903(d)(1) of the Public Health Service Act (42 U.S.C. 
     299a-1(d)(1)).
       (2) Health disparities research.--The term ``health 
     disparities research'' shall include basic, clinical, 
     behavioral, and health services research on health disparity 
     populations (including individual members and communities of 
     such populations) that relates to health disparities as 
     defined under paragraph (1), including the causes of such 
     disparities and methods to prevent, diagnose, and treat such 
     disparities.

                          ____________________