[Congressional Record Volume 150, Number 89 (Thursday, June 24, 2004)]
[Senate]
[Pages S7454-S7461]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. LIEBERMAN:
  S. 2594. A bill to reduce health care disparities and improve health 
care quality, to improve the collection of racial, ethnic, primary 
language, and socio-economic determination data for use by healthcare 
researchers and policymakers, to provide performance incentives for 
high performing hospitals and community health centers, and to expand 
current Federal programs seeking to eliminate health disparities; to 
the Committee on Finance.
  Mr. LIEBERMAN. Mr. President, our Nation wrestles with a medical 
mystery that affects the health and very lives of millions of Americans 
every year: Why do patients with similar ailments have such disparate 
outcomes?
  Albert Einstein once said: ``I cannot believe that God plays dice 
with the world.'' I would never quibble with Einstein. And besides, I 
strongly believe that myself.
  I also believe we should aspire to that ideal in the earthly 
institutions we create, like our health care system. Medical outcomes 
should not be a matter of luck. Treatment should be as predictable and 
equal as possible within the bounds of science and human fallibility.
  But that is not the system we have today. Study after study shows 
that we have created a health care casino where the quality of care 
seems to have as much to do with the luck of the dice as anything else.
  In America, good medical care for all should be a given--not a 
gamble.
  That is why today I am introducing legislation I call FairCare. 
FairCare will give us the tools we need to begin eliminating these 
across-the-board problems of medical disparities among patients with 
identical ailments.
  In the broadest sense, we know we have two problems--quality of care 
and disparity of care. While these problems are distinct and separate--
solving either will help solve both.
  Let me dramatize the kind of odds we are talking about when a patient 
enters the healthcare system. I would ask my colleagues to imagine for 
a moment that they are in a casino, rolling dice and need a five or a 
nine to win. The odds of you winning with either of those numbers is 
about 60 percent. Of course, that means you have a 40 percent chance of 
losing.
  Now, if you enjoy gambling--and are not betting a lot of money--maybe 
that's fun. But would you bet your house on those odds? Or your 
children's college fund? Or your health--or your life?
  Well, the odds in our imaginary dice game are the precise odds we 
send people into the health care system every day.
  A recent study reported in the New England Journal of Medicine said 
that about 40 percent of patients reported medical errors in the care 
of either themselves or a loved one. The cost of these mistakes is 
staggering. Between 44,000 and 100,000 people die each year because of 
those medical mistakes.
  To put those shocking numbers in perspective, imagine if you will 
that our nation experienced a day like September the 11th, at least 
twice a month, every month--for a year.
  Overall, the cost of not getting it right the first time represents a 
yearly loss to the national economy of $17 to $29 billion. This is due 
largely to the medical complications that must be treated down the line 
because of the initial medical errors, as well as lost wages and 
productivity.
  Now, while most Americans have problems finding high-quality health 
care at a reasonable cost, racial and ethnic minorities fare the worst.
  Medical studies also show that:
  When actors portrayed patients with identical complaints of chest 
pain, women and African Americans were 40 percent less likely to have 
their complaints taken seriously and be referred for further diagnostic 
tests.
  Hispanics with asthma are almost twice as likely as white patients to 
face largely-avoidable emergency rooms visits or have the illness limit 
their daily activities.
  Infants born to American Indians and Alaskan Natives are twenty-five 
percent more likely than the national average to die in the first year 
of life.
  Asian American women are 20 percent less likely to get life-saving 
screening exams for cervical cancer than white women.
  And many of these disparities persist, even when factors like income 
and access to health care are taken into account. Why is this? The 
answer is: We don't exactly know. But it is clear that we do not have a 
color blind healthcare system. And unequal treatment is Un-American. We 
cannot tolerate it. Rather, we must understand it, confront it, and fix 
it.
  Besides, solving this medical mystery for the most severely affected 
minority groups will improve healthcare for everyone else as well. In 
other words, if we can dramatically increase the quality of medical 
care, unfair disparities will decline and all will benefit.
  The clues to solving the problems of both medical quality and 
healthcare disparities are there. We just have to go find them. That 
will require gathering crucial information that will help us clearly 
identify the problems. Then we can help finance the solutions that will 
cure them.
  That's why we need FairCare.
  To begin, we need data--we need to see where we have quality problems 
and where we have disparities in care. FairCare will bring the medical 
and patient communities together to help us better measure healthcare 
quality in a scientific way that will give us our first comprehensive 
glimpse of where the problems lie.
  Once glimpsed, FairCare can begin to fund improvement efforts 
developed by local hospitals and community health centers that fit the 
needs of their local neighborhoods. FairCare will use the reach and 
resources of Medicare to reward hospitals that improve quality and 
reduce disparities.

[[Page S7455]]

  In recent testimony before the House Ways and Means Subcommittee on 
Health Care, Glenn Hackbarth, Chairman of Medicare Payment Advisory 
Commission, said he agreed with this approach. ``It is time for 
Medicare to take the next step in quality improvement and put financial 
incentives for quality directly into its payment systems,'' he said.
  Under FairCare, community health centers not part of the Medicare 
system will be eligible for grants and bonuses. In other words, 
FairCare is a carrots program, not a sticks program--it rewards 
hospitals and health centers that perform--that make progress in 
implementing quality healthcare and reducing healthcare disparities.
  We will also provide tax relief to help FairCare providers cover the 
cost of their malpractice insurance.
  Taken together, FairCare will give our most overburdened and 
financially strapped healthcare providers--that act to deliver quality 
medicine--the help they need to give their communities the help they 
need. And when they succeed, we will all win. When they succeed, good 
medical care for all will be a given--not a gamble.
  Just as God does not play dice with the world, we will no longer play 
dice with the lives of our most vulnerable--the sick and the ailing.
  Mr. President, I ask unanimous consent that the text of the bill and 
statements of support be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 2594

       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 ``Faircare 
     Act''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.

                  TITLE I--DEMOGRAPHIC DATA COLLECTION

Sec. 101. Data on race, ethnicity, highest education level attained, 
              and primary language.
Sec. 102. Revision of HIPAA claims standards.

             TITLE II--IMPROVED COLLECTION OF QUALITY DATA

Sec. 201. Authority of Agency for Healthcare Research and Quality.

             ``Part C--Improved Collection of Quality Data

``Sec. 921. General authority of the Agency to determine measures.
``Sec. 922. Use of hospital-specific measures.
``Sec. 923. Outpatient-specific measures.
``Sec. 924. Ranking of measures.
``Sec. 925. Advisory Committee on Quality.
``Sec. 926. Updates of conditions.
``Sec. 927. Reporting of measures.
``Sec. 928. Voluntary submission of data.
``Sec. 929. Authorization of appropriations.
Sec. 202. Office of national healthcare disparities and quality.

                  TITLE III--FAIRCARE HOSPITAL PROGRAM

Sec. 301. Faircare hospital program.
Sec. 302. Technical assistance grants.

                  TITLE IV--COMMUNITY HEALTH CENTERS.

Sec. 401. Authority of Bureau of Primary Health Care to develop new 
              reporting standards.
Sec. 402. Faircare designation for health centers.
Sec. 403. Grants for technical assistance.
Sec. 404. Health disparity collaboratives.

                          TITLE V--REACH 2010

Sec. 501. Expansion of REACH 2010

                 TITLE VI--MALPRACTICE INSURANCE RELIEF

Sec. 601. Refundable tax credit for the cost of malpractice insurance 
              for certain providers.
Sec. 602. Grants to non-profit hospitals.
Sec. 603. Grants for research into quality of care and medical errors.
Sec. 604. Authorization of appropriations.

     SEC. 2. FINDINGS.

       (a) Evidence of Healthcare Disparities.--With respect to 
     evidence of healthcare disparities, Congress makes the 
     following findings:
       (1) Healthcare disparities affect the lives, health, and 
     livelihood of Americans, and increase the overall cost of 
     health care in the United States.
       (2) Minority patients with chronic diseases have been found 
     less likely to receive the necessary services required to 
     manage effectively these illnesses, such as routine blood 
     pressure checks or eye examinations, and are less likely to 
     receive treatments to cure these conditions, such as heart 
     surgeries or kidney transplants.
       (3) Studies have shown that non-English speaking patients 
     report more satisfaction with health encounters and have 
     better health outcomes after encounters with healthcare 
     providers who speak their primary language.
       (4) The Institute of Medicine's report ``In the Nation's 
     Compelling Interest'', concluded that racial and ethnic 
     minority healthcare providers are significantly more likely 
     than their white peers to serve minority and medically 
     underserved communities, thereby helping to improve problems 
     of limited minority access to care.
       (5) Data from the National Center for Health Statistics 
     demonstrates that minorities are less likely to receive 
     routine cancer screenings even when they do have health 
     insurance and access to healthcare providers, and once 
     diagnosed with cancer, elderly minority patients are also 
     less likely to receive appropriate treatment for pain 
     associated with cancer.
       (b) Evidence of Inconsistencies in Healthcare Quality.--
     With respect to evidence of inconsistencies in healthcare 
     quality, Congress makes the following findings:
       (1) Inconsistent healthcare quality threatens the health of 
     all Americans regardless of race, ethnicity, or socio-
     economic status.
       (2) Studies by the RAND Corporation have shown that all 
     patients in the United States have only a 55 percent 
     possibility of receiving clinically appropriate care in the 
     healthcare setting, despite the fact that the United States 
     spends twice as much as other industrialized countries on 
     health care.
       (3) The control of hypertension is essential to reducing 
     mortality from heart disease, stroke, and diabetes 
     complications, yet, only 23 percent of Americans with 
     hypertension are adequately treated.
       (4) About 1 in 5 elderly Americans are prescribed 
     inappropriate medications.
       (5) Only 21 percent of Americans with diabetes get all 
     recommended checkups.
       (6) One of the safest, simplest, and most cost-effective 
     ways to reduce cancer morbidity and mortality is to increase 
     screening rates for selected cancers including colorectal 
     cancers, yet, less than half of men and women over the age of 
     50 report screening for colorectal cancers.
       (7) In the United States, over 1/4 of infants and toddlers 
     of all races and ethnicities do not receive all recommended 
     vaccines.
       (8) Breakthroughs in treatments have enabled more patients 
     to survive and live better, yet too many of these treatments 
     are not being administered to all those who can benefit from 
     them.

     SEC. 3. DEFINITIONS.

       In this Act:
       (1) Health disparity populations.--The term ``health 
     disparity populations'' has the meaning given that term in 
     section 485E(d) of the Public Health Service Act (42 U.S.C. 
     287c-31(d)).
       (2) Racial and ethnic minority.--The term ``racial and 
     ethnic minority'' has the meaning given the term ``racial and 
     ethnic minority group'' in section 1707(g)(1) of the Public 
     Health Service Act (42 U.S.C. 300u-6(g)(1)).

                  TITLE I--DEMOGRAPHIC DATA COLLECTION

     SEC. 101. DATA ON RACE, ETHNICITY, HIGHEST EDUCATION LEVEL 
                   ATTAINED, AND PRIMARY LANGUAGE.

       (a) Purpose.--It is the purpose of this section to promote 
     data collection and reporting by race, ethnicity, highest 
     education level attained, and primary language among 
     federally supported health programs.
       (b) Amendment.--Part B of title II of the Public Health 
     Service Act (42 U.S.C. 238 et seq.) is amended by adding at 
     the end the following:

     ``SEC. 249. DATA ON RACE, ETHNICITY, HIGHEST EDUCATION LEVEL 
                   ATTAINED, AND PRIMARY LANGUAGE.

       ``(a) Requirements.--
       ``(1) In general.--Each health-related program operated by 
     or that receives funding or reimbursement, in whole or in 
     part, either directly or indirectly from the Department of 
     Health and Human Services shall, in accordance with the 
     schedule described in subsection (e)--
       ``(A) require the collection, by the agency or program 
     involved, of data on the race, ethnicity, highest education 
     level attained, and primary language of each applicant for 
     and recipient of health-related assistance under such 
     program--
       ``(i) using, at a minimum, the categories for race and 
     ethnicity described in the 1997 Office of Management and 
     Budget Standards for Maintaining, Collecting, and Presenting 
     Federal Data on Race and Ethnicity;
       ``(ii) using the standards developed under subsection (d) 
     for the collection of language data;
       ``(iii) where practicable, collecting data for additional 
     population groups if such groups can be aggregated into the 
     minimum race and ethnicity categories as defined by the 
     Office of Management and Budget; and
       ``(iv) where practicable, through self-reporting;
       ``(B) with respect to the collection of the data described 
     in subparagraph (A) for applicants and recipients who are 
     minors or otherwise legally incapacitated, require that--
       ``(i) such data be collected from the parent or legal 
     guardian of such an applicant or recipient; and
       ``(ii) the preferred language of the parent or legal 
     guardian of such an applicant or recipient be collected; and

[[Page S7456]]

       ``(C) ensure that the provision of assistance to an 
     applicant or recipient of assistance is not denied or 
     otherwise adversely affected because of the failure of the 
     applicant or recipient to provide race, ethnicity, highest 
     education level attained, and primary language data.
       ``(2) Rule of construction.--Nothing in this subsection 
     shall be construed to permit the use of information collected 
     under this subsection in a manner that would adversely affect 
     any individual providing any such information.
       ``(b) Protection of Data.--The Secretary shall ensure 
     (through the promulgation of regulations or otherwise) that 
     all data collected pursuant to subsection (a) is protected--
       ``(1) under the same privacy protections as the Secretary 
     applies to other health data under the regulations 
     promulgated under section 264(c) of the Health Insurance 
     Portability and Accountability Act of 1996 (Public Law 104-
     191; 110 Stat. 2033) relating to the privacy of individually 
     identifiable health information and other protections; and
       ``(2) from all inappropriate internal use by any entity 
     that collects, stores, or receives the data, including use of 
     such data in determinations of eligibility (or continued 
     eligibility) in health plans, and from other inappropriate 
     uses, as defined by the Secretary.
       ``(c) Compliance with Standards.--Data collected under 
     subsection (a) shall be obtained, maintained, and presented 
     (including for reporting purposes) in accordance with, at a 
     minimum, the 1997 Office of Management and Budget Standards 
     for Maintaining, Collecting, and Presenting Federal Data on 
     Race and Ethnicity.
       ``(d) Language Collection Standards.--Not later than 1 year 
     after the date of enactment of this section, the Director of 
     the Office of Minority Health, in consultation with the 
     Office for Civil Rights of the Department of Health and Human 
     Services, shall develop and disseminate Standards for the 
     Classification of Federal Data on Preferred Written and 
     Spoken Language.
       ``(e) Schedule of Compliance.--Data collection under 
     subsection (a) shall be required within the following time 
     periods:
       ``(1) With respect to medicare-related data (under title 
     XVIII of the Social Security Act), such data shall be 
     collected not later than 2 years after the date of enactment 
     of this section, including data related to--
       ``(A) the Medicare Hospital Quality Initiative;
       ``(B) the Center for Medicare and Medicaid Services 
     Abstraction or Reporting Tools (referred to in this section 
     as `CART');
       ``(C) all CART equivalent private databases used to submit 
     data for the Medicare Hospital Quality Initiative or medicare 
     billing (including data for both medicare and non-medicare 
     patients); and
       ``(D) all medicare billing communications.
       ``(2) With respect to data that is not currently mandated 
     or collected and reported by the medicaid and State 
     Children's Health Insurance Program (under titles XIX and XXI 
     of the Social Security Act), such data shall be collected not 
     later than 4 years after the date of enactment of this 
     section.
       ``(3) With respect to data relating to biomedical and 
     health services research that is described in subsection (a), 
     such data shall be collected not later than 6 years after the 
     date of enactment of this section.
       ``(4) With respect to data relating to all other programs 
     described in subsection (a), such data shall be collected not 
     later than 6 years after the date of enactment of this 
     section.
       ``(f) Technical Assistance for the Collection and Reporting 
     of Data.--
       ``(1) In general.--The Secretary may, either directly or 
     through grant or contract, provide technical assistance to 
     enable a healthcare program or an entity operating under such 
     program to comply with the requirements of this section.
       ``(2) Types of assistance.--Assistance provided under this 
     subsection may include assistance to--
       ``(A) enhance or upgrade information technology that will 
     facilitate race, ethnicity, highest education level attained, 
     and primary language data collection and analysis;
       ``(B) improve methods for health data collection and 
     analysis including additional population groups beyond the 
     Office of Management and Budget categories if such groups can 
     be aggregated into the minimum race and ethnicity categories;
       ``(C) develop mechanisms for submitting collected data 
     subject to existing privacy and confidentiality regulations; 
     and
       ``(D) develop educational programs to inform health 
     insurance issuers, health plans, health providers, health-
     related agencies, and the general public that data collection 
     and reporting by race, ethnicity, and preferred language are 
     legal and essential for eliminating health and healthcare 
     disparities.
       ``(g) Grants for Data Collection by Community Health 
     Centers and Hospitals.--
       ``(1) In general.--The Secretary, in consultation with the 
     Administrator of the Centers for Medicare & Medicaid Services 
     and the Administrator of the Health Resources and Services 
     Administration, is authorized to award grants for the conduct 
     of 100 demonstration programs, 50 percent of which shall be 
     conducted by community health centers and 50 percent of which 
     shall be conducted by hospitals, to enhance the ability of 
     such centers and hospitals to collect, analyze, and report 
     the data required under subsection (a).
       ``(2) Eligibility.--To be eligible to receive a grant under 
     paragraph (1), a community health center or hospital shall--
       ``(A) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require; and
       ``(B) provide assurances that the community health center 
     or hospital will use, at a minimum, the racial and ethnic 
     categories and the standards for collection described in the 
     1997 Office of Management and Budget Standards for 
     Maintaining, Collecting, and Presenting Federal Data on Race 
     and Ethnicity and available standards for language.
       ``(3) Activities.--A grantee shall use amounts received 
     under a grant under paragraph (1) to--
       ``(A) collect, analyze, and report data by race, ethnicity, 
     highest education level attained, and primary language for 
     patients served by the hospital (including emergency room 
     patients and patients served on an outpatient basis) or 
     community health center;
       ``(B) enhance or upgrade computer technology that will 
     facilitate racial, ethnic, highest education level attained, 
     and primary language data collection and analysis;
       ``(C) provide analyses of disparities in health and 
     healthcare, including specific disease conditions, diagnostic 
     and therapeutic procedures, or outcomes;
       ``(D) 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;
       ``(E) develop mechanisms for sharing collected data subject 
     to privacy and confidentiality regulations;
       ``(F) 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 healthcare; and
       ``(G) develop quality assurance systems designed to track 
     disparities and quality improvement systems designed to 
     eliminate disparities.
       ``(4) Community Health Center; Hospital.--In this 
     subsection:
       ``(A) Community health center.--The term `community health 
     center' means a Federally qualified health center as defined 
     in section 1861(aa)(4) of the Social Security Act.
       ``(B) Hospital.--The term `hospital' means a hospital 
     participating in the prospective payment system under section 
     1886 of the Social Security Act and that is submitting 
     quality indicators data in accordance with section 
     1886(b)(3)(B)(vii)(II) of the Social Security Act.
       ``(h) Definition.--In this section, the term `health-
     related program' means a program--
       ``(1) under the Social Security Act (42 U.S.C. 301 et seq.) 
     that pays for healthcare and services; and
       ``(2) under this Act that provides Federal financial 
     assistance for healthcare, biomedical research, health 
     services research, and other programs designated by the 
     Secretary.
       ``(i) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $50,000,000 for 
     fiscal year 2005, and such sums as may be necessary for each 
     of fiscal years 2006 through 2015.''.

     SEC. 102. REVISION OF HIPAA CLAIMS STANDARDS.

       (a) In General.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services shall revise the regulations promulgated under part 
     C of title XI of the Social Security Act (42 U.S.C. 1320d et 
     seq.), as added by the Health Insurance Portability and 
     Accountability Act of 1996 (Public Law 104-191), relating to 
     the collection of data on race, ethnicity, highest education 
     level attained, and primary language in a health-related 
     transaction to require--
       (1) the use, at a minimum, of the categories for race and 
     ethnicity described in the 1997 Office of Management and 
     Budget Standards for Maintaining, Collecting, and Presenting 
     Federal Data on Race and Ethnicity;
       (2) the establishment of new data code sets for highest 
     education level attained and primary language; and
       (3) the designation of the racial, ethnic, highest 
     education level attained, and primary language code sets as 
     ``required'' for claims and enrollment data.
       (b) Dissemination.--The Secretary of Health and Human 
     Services shall disseminate the new standards developed under 
     subsection (a) to all health entities that are subject to the 
     regulations described in such subsection and provide 
     technical assistance with respect to the collection of the 
     data involved.
       (c) Compliance.--Not later than 1 year after the final 
     promulgation of the regulations developed under subsection 
     (a), the Secretary of Health and Human Services shall require 
     that health entities comply with such standards.
       (d) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary for each of fiscal years 2005 through 2015.

[[Page S7457]]

             TITLE II--IMPROVED COLLECTION OF QUALITY DATA

     SEC. 201. AUTHORITY OF AGENCY FOR HEALTHCARE RESEARCH AND 
                   QUALITY.

       Title IX of the Public Health Service Act (42 U.S.C. 299 et 
     seq.) is amended--
       (1) by redesignating part C as part D;
       (2) by redesignating sections 921 through 928, as sections 
     931 through 938, respectively;
       (3) in section 938(1) (as so redesignated), by striking 
     ``921'' and inserting ``931''; and
       (4) by inserting after part B the following:

             ``PART C--IMPROVED COLLECTION OF QUALITY DATA

     ``SEC. 921. GENERAL AUTHORITY OF THE AGENCY TO DETERMINE 
                   MEASURES.

       ``(a) In General.--The Agency, in consultation with the 
     Centers for Medicare & Medicaid Services, the Health 
     Resources and Services Administration, the Office for Civil 
     Rights of the Department of Health and Human Services, and 
     the Office of Minority Health, shall have the authority to 
     develop a new set of quality measures for each of the most 
     common treatment settings. Such settings shall include, but 
     not be limited to, hospitals, outpatient facilities, 
     community health centers, long term care facilities, and 
     other independent health care facilities.
       ``(b) Requirements.--The quality measures developed under 
     subsection (a) shall--
       ``(1) as closely as possible reflect the healthcare 
     priority areas determined by the Institute of Medicine, the 
     National Quality Forum, the Quality Initiative, and other 
     healthcare quality and health care disparity organizations as 
     determined by the Secretary;
       ``(2) reflect the Institute of Medicine's goal of 
     inclusiveness, improvability, and impact, addressing 
     pervasive health and healthcare problems that produce a high 
     level of morbidity and mortality, that disproportionally 
     affect health disparity populations, and that have the 
     potential for improvement with the consistent application of 
     proven medical interventions; and
       ``(3) where practical, employ process measures of care.

     ``SEC. 922. USE OF HOSPITAL-SPECIFIC MEASURES.

       ``(a) Development.--
       ``(1) In general.--The Agency, in conjunction with the 
     Centers for Medicare & Medicaid Services, shall develop a set 
     of hospital quality measures.
       ``(2) Use.--The Secretary shall ensure that the Hospital 
     Quality Initiative and the Robust Project Measures of the 
     Centers for Medicare & Medicaid Services, and other Centers 
     for Medicare & Medicaid Services directed quality initiatives 
     use the hospital quality measures developed under paragraph 
     (1).
       ``(b) Submission.--The information required under the 
     measures developed under subsection (a) shall be submitted in 
     accordance with section 1886(b)(3)(B)(vii) except that any 
     reference to `2007' shall be deemed to be a reference to 
     `2015'.

     ``SEC. 923. OUTPATIENT-SPECIFIC MEASURES.

       ``(a) In General.--The Agency, in conjunction with the 
     Bureau of Primary Health Care within the Health Resources and 
     Services Administration, shall develop a set of outpatient 
     quality measures. Such measures may be used as a supplement 
     to existing demographic or quality reporting instruments or 
     other quality reporting instruments utilized by the Health 
     Resources and Services Administration.
       ``(b) Voluntary Submission.--Submission of the 
     supplementary information required under the measures 
     developed under subsection (a) shall be voluntary.
       ``(c) Discretionary Use.--The measures developed under 
     subsection (a) may be used as appropriate by the Hospital 
     Quality Initiative and the Robust Project Measures and other 
     Centers for Medicare & Medicaid Services-directed quality 
     initiatives.

     ``SEC. 924. RANKING OF MEASURES.

       ``The Agency shall--
       ``(1) determine which of the quality measures developed 
     under this part have the greatest potential to remedy 
     healthcare disparities;
       ``(2) rank such quality measures according to such 
     potential; and
       ``(3) rank such quality measures separately as applicable 
     to hospitals and outpatients.

     ``SEC. 925. ADVISORY COMMITTEE ON QUALITY.

       ``(a) In General.--The Agency shall establish an Advisory 
     Committee on Quality (referred to in this section as the 
     `Advisory Committee') to recommend quality indicators for all 
     quality data sets developed under this section. The Agency 
     may designate a governmental or nongovernmental committee 
     existing on the date of enactment of this part to serve as 
     the Advisory Committee so long as the membership requirements 
     of subsection (b) are complied with.
       ``(b) Membership.--The Advisory Committee shall be composed 
     of not less than 10 members, including--
       ``(1) the Director;
       ``(2) the Administrator of the Centers for Medicare & 
     Medicaid Services;
       ``(3) the Director of the Centers for Disease Control and 
     Prevention;
       ``(4) the Administrator of the Health Resources and 
     Services Administration;
       ``(5) the Director of the Office of Minority Health of the 
     Department of Health and Human Services;
       ``(6) the Director of the Office for Civil Rights of the 
     Department of Health and Human Services;
       ``(7) the Director of the Indian Health Service;
       ``(8) the chairperson of the Institute of Medicine National 
     Roundtable on Healthcare Quality or other representatives of 
     the Institute of Medicine;
       ``(9) the chairperson of the National Quality Forum;
       ``(10) the Director of the Joint Commission on 
     Accreditation of Healthcare Organizations;
       ``(11) a representative of the Quality Initiative; and
       ``(12) other members to be appointed by the Secretary to 
     represent other private, public, and non-profit stakeholders 
     from medicine, healthcare, patient groups, and academia, who 
     shall serve for a term of 3 years, and shall include a mix of 
     different professions and broad geographic and culturally 
     diverse representation
       ``(c) Duties.--The Advisory Committee shall--
       ``(1) for each 3 year period beginning with fiscal year 
     2005, report to the Agency recommendations of quality 
     indicators for all quality data sets described in this part;
       ``(2) in making the recommendations described in paragraph 
     (1), focus on how best to integrate the findings of the 
     Institute of Medicine, the National Quality Forum, the 
     Quality Initiative, and other healthcare quality and 
     healthcare disparity organizations as determined by the 
     Secretary into quality measures that can be used in carrying 
     out sections 922 and 923; and
       ``(3) address issues of continuity of care between 
     ambulatory care and inpatient settings to the maximum extent 
     practicable.

     ``SEC. 926. UPDATES OF CONDITIONS.

       ``(a) In General.--At least once during every 3-year period 
     beginning in fiscal year 2006, the Secretary shall direct the 
     Agency to update the list of measures as described in 
     sections 922 and 923. Such updates shall be based on 
     recommendations of the Advisory Committee established under 
     section 925 and determined in consultation with the Centers 
     for Medicare & Medicaid Services and the Health Resources and 
     Services Administration.
       ``(b) Requirement.--For each period in which an update is 
     undertaken under subsection (a), the Agency shall ensure that 
     the recommendations referred to such subsection include 
     measures for at least 4 additional conditions identified by 
     the Institute of Medicine National Roundtable on Healthcare 
     Quality, or measures developed by other healthcare disparity 
     or healthcare quality organizations as determined by the 
     Secretary, and not addressed by the quality reporting 
     initiatives administered by the Secretary on the date of 
     enactment of this part. The requirement of this section shall 
     apply until there are measures for all Institute of Medicine 
     priority areas.

     ``SEC. 927. REPORTING OF MEASURES.

       ``(a) In General.--Not later than 5 years after the date of 
     enactment of the Faircare Act, the Secretary shall enter into 
     a contract with the Institute of Medicine to produce a report 
     on the effectiveness of the quality measures developed by the 
     Agency under this part in accurately assessing the quality of 
     healthcare and healthcare disparities present in hospitals, 
     community health centers, and other appropriate health care 
     settings. Such report shall evaluate the progress made in 
     improving the quality and consistency of healthcare and 
     reducing healthcare disparities.
       ``(b) Manner of Reporting.--All data reported under the 
     Faircare Act (including data reported under this part) shall, 
     to the maximum extent practicable, be reported by race, 
     ethnicity, primary language, and highest educational level 
     attained in accordance with section 249.

     ``SEC. 928. EFFECTIVENESS RESEARCH GRANTS.

       ``The Office of Minority Health shall have the authority to 
     award grants to study the effectiveness of all measures and 
     programs established under this part. The Office shall 
     recommend ways to improve such measure and programs and to 
     implement the findings of the study conducted under section 
     927.

     ``SEC. 929. PROTECTION OF DATA.

       ``(a) Rule of Construction.--Nothing in this part shall be 
     construed to permit the use of information collected under 
     this part in a manner that would adversely affect any 
     individual providing any such information.
       ``(b) Protection of Data.--The Secretary shall ensure 
     (through the promulgation of regulations or otherwise) that 
     all data collected pursuant to this part is protected--
       ``(1) under the same privacy protections as the Secretary 
     applies to other health data under the regulations 
     promulgated under section 264(c) of the Health Insurance 
     Portability and Accountability Act of 1996 (Public Law 104-
     191; 110 Stat. 2033) relating to the privacy of individually 
     identifiable health information and other protections; and
       ``(2) from all inappropriate internal use by any entity 
     that collects, stores, or receives the data, including use of 
     such data in determinations of eligibility (or continued 
     eligibility) in health plans, and from other inappropriate 
     uses, as defined by the Secretary.

     ``SEC. 929A. AUTHORIZATION OF APPROPRIATIONS.

       ``There is authorized to be appropriated to carry out this 
     section, $5,000,000 for each of fiscal years 2005 through 
     2007, and such sums as may be necessary for each of fiscal 
     years 2008 through 2015.''.

     SEC. 202. OFFICE OF NATIONAL HEALTHCARE DISPARITIES AND 
                   QUALITY.

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

[[Page S7458]]

     ``SEC. 904. OFFICE OF NATIONAL HEALTHCARE DISPARITIES AND 
                   QUALITY.

       ``(a) In General.--There is established within the Agency 
     an Office of National Healthcare Disparities and Quality 
     (referred to in this section as the `Office'). Such Office 
     shall administer the development and submission of the annual 
     National Healthcare Disparities Report (under section 
     903(a)(6)) and the National Healthcare Quality Report (under 
     section 913(b)(2)) and carry out any other activities 
     determined appropriate by the Secretary.
       ``(b) National Healthcare Disparities and Quality 
     Reports.--
       ``(1) Reporting requirements.--Not later than 1 year after 
     the date of enactment of this section, and annually 
     thereafter, the Office, in consultation with the Advisory 
     Committee under section 925, the Office of Minority Health, 
     and the Office for Civil Rights of the Department of Health 
     and Human Services, shall submit to the Secretary, the 
     appropriate committees of Congress, and the public--
       ``(A) a report on the disparities in healthcare which shall 
     include data using the quality measures developed by the 
     Agency under part C; and
       ``(B) a report on general healthcare quality.
       ``(2) Limitations.--The reports under paragraph (1) shall 
     not identify individual hospitals or healthcare providers but 
     shall include regional and State level data. To the maximum 
     extent practicable, such reports shall--
       ``(A) indicate variations in healthcare quality between 
     States and regions; and
       ``(B) to the maximum extent practicable, include data 
     reported by race, ethnicity, primary language, and highest 
     educational level attained in accordance with section 249.
       ``(3) Availability.--The Office shall make such reports 
     available to States, tribal organizations, and territorial 
     governments upon request.
       ``(4) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out this subsection, $10,000,000 
     for each of fiscal years 2005 through 2007, and such sums as 
     may be necessary for each of fiscal years 2008 through 2015.
       ``(c) Activities Relating to Best Practices.--
       ``(1) Report.--The Office of National Healthcare 
     Disparities and Quality shall annually publish a report that 
     describes the specific activities undertaken by Faircare 
     Level I institutions, as designated under section 330P of 
     this Act or section 1898(b) of the Social Security Act, that 
     have resulted in a decrease in healthcare disparities or 
     improved quality. Such reports shall include recommendations 
     for carrying out such activities at other healthcare 
     institutions.
       ``(2) Conference.--In conjunction with the publication of 
     each report under paragraph (1), Office of National 
     Healthcare Disparities and Quality shall hold an annual 
     conference at which personnel from the Faircare institutions 
     described in paragraph (1) can interact, advise, and consult 
     with other healthcare institutions.
       ``(3) Technical assistance.--The Office of National 
     Healthcare Disparities and Quality shall offer technical 
     assistance to healthcare institutions in reducing healthcare 
     disparities, including through the dissemination of 
     information through the Office Internet website, the 
     development of an electronic mail list of best practices, the 
     maintenance of a database and clearinghouse of best 
     practices, and through other activities determined 
     appropriate by the Office.
       ``(4) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out this subsection, $5,000,000 
     for each of fiscal years 2005 to 2007, and such sums as may 
     be necessary for each of fiscal years 2008 through 2015.''.

                  TITLE III--FAIRCARE HOSPITAL PROGRAM

     SEC. 301. FAIRCARE HOSPITAL PROGRAM.

       (a) Purposes.--The purposes of this section are to--
       (1) require the Administrator of the Center for Medicare & 
     Medicaid Services to--
       (A) determine which hospitals have successfully reduced 
     healthcare disparities between health disparity populations 
     and other patients and improved healthcare quality based on 
     the Hospital Quality Initiative measures established by the 
     Agency for Healthcare Research and Quality under part C of 
     title IX of the Public Health Service Act, as added by title 
     II;
       (B) verify the accuracy of the data submitted by such 
     hospitals for purposes of being designated as a Faircare 
     Hospital; and
       (C) designate such hospitals as Faircare hospitals; and
       (2) provide such hospitals with increased payments under 
     the medicare program.
       (b) Program.--Title XVIII of the Social Security Act, as 
     amended by section 1016 of the Medicare Prescription Drug, 
     Improvement, and Modernization Act of 2003 (Public Law 108-
     173; 117 Stat. 2447), is amended by adding at the end the 
     following new section:


                ``performance incentive payment program

       ``Sec. 1898. (a) Establishment.--
       ``(1) In general.--The Secretary shall establish a program 
     under which financial incentive payments are made in 
     accordance with subsection (c) to subsection (d) hospitals 
     (as defined in paragraph (2)) that have been designated under 
     subsection (b).
       ``(2) Subsection (d) hospital.--In this section, the term 
     `subsection (d) hospital' has the meaning given that term in 
     section 1886(d)(1)(B).
       ``(b) Designation of Faircare Hospitals.--
       ``(1) In general.--For each of fiscal years 2006 through 
     2014, the Secretary shall designate subsection (d) hospitals 
     as follows:
       ``(A) Level iii faircare hospital.--The Secretary shall 
     designate a subsection (d) hospital as a Level III Faircare 
     hospital if the following requirements are met:
       ``(i) The subsection (d) hospital submitted data described 
     in section 249 of the Public Health Service Act and part C of 
     title IX of such Act to the Secretary in such form and manner 
     and at such time specified by the Secretary under such 
     section and part and all such data submitted relating to 
     patient quality includes data on the race, ethnicity, highest 
     education level attained, and primary language of such 
     patients.
       ``(ii) The Secretary determines that the subsection (d) 
     hospital has improved the rate of delivery of high quality 
     care during the 24-month period preceding such determination. 
     A hospital shall be determined to meet the requirement in the 
     preceding sentence if the Secretary determines that the 
     hospital has increased the frequency of appropriate care for 
     the majority of the applicable measures during such 24-month 
     period by at least 5 percentage points within each such 
     measure.
       ``(B) Level ii faircare hospital.--The Secretary shall 
     designate a subsection (d) hospital as a Level II Faircare 
     hospital if the following requirements are met:
       ``(i) The requirements described in clauses (i) and (ii) of 
     subparagraph (A) are met.
       ``(ii) The Secretary determines that the subsection (d) 
     hospital, during the 24-month period preceding such 
     determination, has made a significant reduction in the 
     disparities in the treatment of health disparity populations 
     relative to other patients for--

       ``(I) the majority of the applicable measures; or
       ``(II) all of the 25 percent highest ranked applicable 
     measures, as ranked for their importance for healthcare 
     equity by the Agency for Healthcare Research and Quality 
     under section 925 of the Public Health Service Act.

       ``(C) Level i faircare hospital.--The Secretary shall 
     designate a subsection (d) hospital as a Level I Faircare 
     hospital if the following requirements are met:
       ``(i) The requirement described subparagraph (A)(i) is met.
       ``(ii) Either--

       ``(I) the requirement described in subparagraph (A)(ii) is 
     met; or
       ``(II) the Secretary determines that the frequency of 
     appropriate care provided by the subsection (d) hospital for 
     each applicable measure is at least 10 percentage points 
     greater than the national average for the frequency of 
     appropriate care for each applicable measure.

       ``(iii) The Secretary determines that the subsection (d) 
     hospital, during the 24-month period preceding such 
     determination, has had no significant disparity in the 
     treatment of health disparity populations relative to other 
     patients for all of the 75 percent highest ranked applicable 
     measures, as ranked for their importance for healthcare 
     equity by the Agency for Healthcare Research and Quality 
     under section 925 of the Public Health Service Act.
       ``(2) Applicable measures defined.--For purposes of this 
     subsection, the term `applicable measures' means the Hospital 
     Quality Initiative measures established by the Agency for 
     Healthcare Research and Quality under part C of title IX of 
     the Public Health Service Act.
       ``(3) Health disparity population defined.--For purposes of 
     this subsection, the term `health disparity population' has 
     the meaning given that term in section 485E(d) of the Public 
     Health Service Act.
       ``(b) Financial Incentive Payments.--
       ``(1) In general.--Subject to paragraph (2) and subsection 
     (d), for purposes of subclauses (XIX) and (XX) of section 
     1886(b)(3)(B)(i) for each of fiscal years 2007 through 2015, 
     in the case of a subsection (d) hospital that has been 
     designated under subsection (b) for a fiscal year, the 
     Secretary shall increase the applicable percentage increase 
     for the subsequent fiscal year for such hospital--
       ``(A) in the case of a Level I Faircare hospital, by 4 
     percentage points (or 8 percentage points in the case of such 
     a hospital who is also described in subparagraph (B) of 
     section 1923(b)(1)(B));
       ``(B) in the case of a Level II Faircare hospital, by 2 
     percentage points (or 4 percentage points in the case of such 
     a hospital who is also described in subparagraph (B) of 
     section 1923(b)(1)(B));; and
       ``(C) in the case of a Level III Faircare hospital, by 1 
     percentage point (or 2 percentage points in the case of such 
     a hospital who is also described in subparagraph (B) of 
     section 1923(b)(1)(B)).
       ``(2) Reduction in financial incentive payments if 
     insufficient funding available.--If the Secretary estimates 
     that the total amount of increased payments under paragraph 
     (1) for a fiscal year will exceed the funding available under 
     subsection (d) for such increased payments for the fiscal 
     year, the Secretary shall proportionately reduce the 
     percentage points described in subparagraphs (A), (B), and 
     (C) of paragraph (1) in order to eliminate such excess.
       ``(3) Increased payment not built into the base.--Any 
     increased payment under paragraph (1) shall only apply to the 
     fiscal year involved and the Secretary shall not

[[Page S7459]]

     take into account any such increased payment in computing the 
     applicable percentage increase under clause (i)(XIX) for a 
     subsequent fiscal year.
       ``(d) Authorization of Appropriations.--There are 
     authorized to be appropriated for making payments under 
     subsection (b) such sums as may be necessary for each of 
     fiscal years 2007 through 2015.''.

     SEC. 302. TECHNICAL ASSISTANCE GRANTS.

       (a) In General.--The Secretary of Health and Human Services 
     shall provide technical assistance to eligible entities for 
     the conduct of demonstration projects to improve the quality 
     of healthcare and to reduce healthcare disparities.
       (b) Eligibility.--To be eligible to receive technical 
     assistance under subsection (a), an entity shall--
       (1) be a hospital--
       (A) that, by legal mandate or explicitly adopted mission, 
     provides patients with access to services regardless of their 
     ability to pay;
       (B) that provides care or treatment for a substantial 
     number of patients who are uninsured, are receiving 
     assistance under a State program under title XIX of the 
     Social Security Act, or are members of health disparity 
     populations, as determined by the Secretary; and
       (C)(i) with respect to which, not less than 50 percent of 
     the entity's patient population is made up of racial and 
     ethnic minorities; or
       (ii) that serves a disproportionate percentage of local, 
     minority racial and ethnic patients, or that has a patient 
     population, at least 50 percent of which is limited English 
     proficient; and
       (2) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require.
       (c) Types of Assistance.--The type of technical assistance 
     that may be provided under this section shall be determined 
     by the Centers for Medicare & Medicaid Services. Such 
     assistance may include competitively awarded grants and other 
     forms of assistance.
       (d) Use of Assistance.--Assistance provided under this 
     section shall be used to improve healthcare quality or to 
     reduce healthcare disparities.
       (e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary for each of fiscal years 2005 through 2015.

                  TITLE IV--COMMUNITY HEALTH CENTERS.

     SEC. 401. AUTHORITY OF BUREAU OF PRIMARY HEALTH CARE TO 
                   DEVELOP NEW REPORTING STANDARDS.

       (a) In General.--The Secretary of Health and Human 
     Services, acting through the Bureau of Primary Health Care 
     within the Health Resources and Services Administration, 
     shall have the authority to--
       (1) incorporate the outpatient measures of the Agency for 
     Healthcare Research and Quality as developed under part C of 
     title IX of the Public Health Service Act (as added by title 
     II) into a supplement to existing demographic or quality 
     reporting instruments or other quality reporting instruments 
     utilized by the Health Resources and Services Administration;
       (2) verify the submission of data under this title (and the 
     amendments made by this title); and
       (3) award Faircare designations in accordance with section 
     339P of the Public Health Service Act (as added by section 
     402).
       (b) Distribution.--Not later than 1 year after the date of 
     enactment of this Act, the standards described in subsection 
     (a) shall be designed and distributed to health centers under 
     section 339P of the Public Health Service Act (as added by 
     section 402).

     SEC. 402. FAIRCARE DESIGNATION FOR HEALTH CENTERS.

       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. 399P. FAIRCARE DESIGNATION FOR HEALTH CENTERS.

       ``(a) Designation of Faircare Health Centers.--
       ``(1) In general.--For each of fiscal years 2006 through 
     2014, the Secretary shall designate health centers that 
     receive Federal assistance as follows:
       ``(A) Level iii faircare health center.--The Secretary 
     shall designate a health center as a Level III Faircare 
     health center if the following requirements are met:
       ``(i) The health center submitted data described in section 
     249 and part C of title IX to the Secretary in such form and 
     manner and at such time specified by the Secretary under such 
     section and part and all such data submitted relating to 
     patient quality includes data on the race, ethnicity, highest 
     education level attained, and primary language of such 
     patients.
       ``(ii) The Secretary determines that the health center has 
     improved the rate of delivery of high quality care during the 
     24-month period preceding such determination. A health center 
     shall be determined to meet the requirement in the preceding 
     sentence if the Secretary determines that the health center 
     has increased the frequency of appropriate care for the 
     majority of the applicable measures during such 24-month 
     period by at least 5 percentage points within each such 
     measure.
       ``(B) Level ii faircare health center.--The Secretary shall 
     designate a health center as a Level II Faircare health 
     center if the following requirements are met:
       ``(i) The requirements described in clauses (i) and (ii) of 
     subparagraph (A) are met.
       ``(ii) The Secretary determines that the health center, 
     during the 24-month period preceding such determination, has 
     made a significant reduction in the disparities in the 
     treatment of health disparity populations relative to other 
     patients for--

       ``(I) the majority of the applicable measures; or
       ``(II) all of the 25 percent highest ranked applicable 
     measures, as ranked for their importance for healthcare 
     equity by the Agency for Healthcare Research and Quality 
     under section 925.

       ``(C) Level i faircare health center.--The Secretary shall 
     designate a health center as a Level I Faircare health center 
     if the following requirements are met:
       ``(i) The requirement described subparagraph (A)(i) is met.
       ``(ii) Either--

       ``(I) the requirement described in subparagraph (A)(ii) is 
     met; or
       ``(II) the Secretary determines that the frequency of 
     appropriate care provided by the health center for each 
     applicable measure is at least 10 percentage points greater 
     than the national average for the frequency of appropriate 
     care for each applicable measure.

       ``(iii) The Secretary determines that the health center, 
     during the 24-month period preceding such determination, has 
     had no significant disparity in the treatment of health 
     disparity populations relative to other patients for all of 
     the 75 percent highest ranked applicable measures, as ranked 
     for their importance for healthcare equity by the Agency for 
     Healthcare Research and Quality under section 925.
       ``(2) Applicable measures defined.--For purposes of this 
     subsection, the term `applicable measures' means the measures 
     determined applicable under section 401(a) of the Faircare 
     Act.
       ``(3) Health disparity population defined.--For purposes of 
     this subsection, the term `health disparity population' has 
     the meaning given that term in section 485E(d).
       ``(b) Eligibility for Bonuses.--A health center that is 
     designated as a Faircare health center under subsection (a) 
     shall be eligible for the following annual bonuses in the 
     fiscal year following the year in which the health center is 
     designated as a Faircare health center under this section, 
     with respect to assistance received under Federal health care 
     programs:
       ``(1) With respect to a health center that is designated as 
     a Level III Faircare health center, the Secretary shall 
     determine the amount of such bonus which shall not be less 
     than $200,000.
       ``(2) With respect to a health center that is designated as 
     a Level II Faircare health center, the Secretary shall 
     determine the amount of such bonus which shall not be less 
     than $300,000.
       ``(3) With respect to a health center that is designated as 
     a Level I Faircare health center, the Secretary shall 
     determine the amount of such bonus which shall not be less 
     than $500,000.
       ``(c) Reduction in Financial Incentive Payments if 
     Insufficient Funding Available.--If the Secretary estimates 
     that the total amount of bonuses under subsection (b) for a 
     fiscal year will exceed the funding available under 
     subsection (e) for such bonuses for the fiscal year, the 
     Secretary shall proportionately reduce the amount of the 
     bonus payments described in paragraphs (1), (2), and (3) of 
     subsection (b) in order to eliminate such excess.
       ``(d) Definition.--For purposes of this section, the term 
     `health center' means a Federally qualified health center as 
     defined in section 1861(aa)(4) of the Social Security Act.
       ``(e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary for each of fiscal years 2007 through 
     2015.''.

     SEC. 403. GRANTS FOR TECHNICAL ASSISTANCE.

       Part P of title III of the Public Health Service Act (42 
     U.S.C. 280g et seq.), as amended by section 402, is further 
     amended by adding at the end the following:

     ``SEC. 399Q. GRANTS FOR TECHNICAL ASSISTANCE IN IMPROVING 
                   QUALITY.

       ``(a) In General.--If a health center reporting data 
     described in section 399P(a)(1)(A) for 3 or more years has 
     demonstrated no improvement or a decrease in healthcare 
     quality on at least 30 percent of all quality measures as 
     designated under section 401(a) of the Faircare Act, such 
     health center shall be given priority to receive technical 
     assistance from the Bureau of Primary Health Care within the 
     Health Resources and Services Administration.
       ``(b) Type of Assistance.--The type of technical assistance 
     that may be provided under subsection (a) shall be determined 
     by the Bureau of Primary Health Care and may include 
     competitively awarded grants and other forms of assistance.
       ``(c) Use of Assistance.--Assistance provided under this 
     section shall be used by the health center to improve 
     healthcare quality or reduce healthcare disparities.
       ``(d) Definition.--For purposes of this section, the term 
     `health center' means a Federally qualified health center as 
     defined in section 1861(aa)(4) of the Social Security Act.
       ``(e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this subsection, such sums as 
     may be necessary for each of fiscal years 2007 through 
     2015.''.

[[Page S7460]]

     SEC. 404. HEALTH DISPARITY COLLABORATIVES.

       (a) In General.--The Bureau of Primary Health Care within 
     the Health Resources and Services Administration shall--
       (1) provide technical assistance and funding to the Health 
     Disparity Collaboratives; and
       (2) expand the provision of technical assistance and 
     funding, at the discretion of the Bureau, to priority areas 
     designated by the Agency for Healthcare Research and Quality 
     in consultation with the Advisory Committee established under 
     section 925 of the Public Health Service Act.
       (b) Funding.--The Bureau of Primary Health Care within the 
     Health Resources and Services Administration shall continue 
     to fund collaboratives with a goal of adding at least 50 new 
     health centers each year.
       (c) Definition.--For purposes of this section, the term 
     `health center' means a Federally qualified health center as 
     defined in section 1861(aa)(4) of the Social Security Act.
       (d) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary for each of fiscal years 2005 through 2015.

                          TITLE V--REACH 2010

     SEC. 501. EXPANSION OF REACH 2010

       (a) In General.--The Secretary of Health and Human 
     Services, acting through the Director of the Centers for 
     Disease Control and Prevention, shall award grants and carry 
     out other activities to expand the Racial and Ethnic 
     Approaches to Community Health Program (REACH 2010) program 
     to support coalitions in all 50 States and territories.
       (b) Eligibility.--To be eligible to receive a grant under 
     this section an entity shall--
       (1) be a coalition that is comprised of , at a minimum, a 
     community-based organization and at least 3 other 
     organizations, one of which is either a State or local health 
     department or a university or research organization; and
       (2) prepare and submit to the Secretary of Health and Human 
     Services an application at such time, in such manner, and 
     containing such information as the Secretary may require.
       (c) Use of Grants.--Amounts provided under a grant under 
     this section shall be used to support community coalitions in 
     designing, implementing, and evaluating community-driven 
     strategies to eliminate health disparities, with an emphasis 
     on African Americans, American Indians, Alaska Natives, Asian 
     Americans, Hispanic Americans, and Pacific Islanders.
       (d) Priority Areas.--In carrying out the Racial and Ethnic 
     Approaches to Community Health Program (REACH 2010) program, 
     the Director of the Centers for Disease Control and 
     Prevention shall include the following priority areas:
       (1) Cardiovascular disease.
       (2) Immunizations.
       (3) Breast and cervical cancer screening and management.
       (4) Diabetes.
       (5) HIV/AIDS.
       (6) Infant mortality.
       (7) Asthma.
       (8) Obesity.
       (9) At the discretion of the Director of the Centers for 
     Disease Control and Prevention, any additional priority areas 
     determined appropriate by the Agency for Healthcare Research 
     and Quality in consultation with the Advisory Committee 
     established under section 925 of the Public Health Service 
     Act.
       (e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section and the Racial 
     and Ethnic Approaches to Community Health Program (REACH 
     2010) program, $200,000,000 for each of fiscal years 2005 to 
     2007, and such sums as may be necessary for each of fiscal 
     years 2008 through 2015.

                 TITLE VI--MALPRACTICE INSURANCE RELIEF

     SEC. 601. REFUNDABLE TAX CREDIT FOR THE COST OF MALPRACTICE 
                   INSURANCE FOR CERTAIN PROVIDERS.

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

     ``SEC. 36. CERTAIN MALPRACTICE INSURANCE COSTS.

       ``(a) In General.--In the case of an eligible health care 
     provider, there shall be allowed as a credit against the tax 
     imposed by this subtitle for the taxable year an amount equal 
     to the applicable percentage of qualified malpractice 
     insurance expenditures paid or incurred during the taxable 
     year.
       ``(b) Applicable percentage.--For purposes of this 
     section--
       ``(1) In general.--The applicable percentage shall be--
       ``(A) 10 percent for any taxable year for which the person 
     claiming the credit is an eligible health care provider, plus
       ``(B) 5 percent for each consecutive prior taxable year 
     ending after the date of enactment of this section for which 
     such person was an eligible health care provider.
       ``(2) Limitation.--The applicable percentage shall not 
     exceed 25 percent.
       ``(c) Eligible Health Care Provider.--For purposes of this 
     section, the term `eligible health care provider' means--
       ``(1) a public or private nonprofit hospital which is--
       ``(A) located in a medically underserved area (as defined 
     in section 1302(7) of the Public Health Service Act) or in a 
     health professional shortage area (as designated under 
     section 332 of the Public Health Service Act), and
       ``(B) designated as a Level I Faircare Hospital under 
     section 339P of the Public Health Service Act or section 1898 
     of the Social Security Act for the year in which such 
     hospital's taxable year ends, and
       ``(2) a physician for whom not less than 66 percent of the 
     practice for the taxable year is at a facility described in 
     paragraph (1).
       ``(d) Qualified Medical Malpractice Insurance 
     Expenditure.--The term `qualified medical malpractice 
     insurance expenditure' means so much of any professional 
     insurance premium, surcharge, payment or other cost or 
     expense required as a condition of State licensure which is 
     incurred by an eligible health care provider in a taxable 
     year for the sole purpose of providing or furnishing general 
     medical malpractice liability insurance for such eligible 
     health care provider.''.
       (b) Denial of Double Benefit.--Section 280C of the Internal 
     Revenue Code of 1986 (relating to certain expenses for which 
     credits are allowable) is amended by adding at the end the 
     following new subsection:
       ``(d) Credit for Medical Malpractice Liability Insurance 
     Premiums.--
       ``(1) In general.--No deduction shall be allowed for that 
     portion of the qualified medical malpractice insurance 
     expenditures otherwise allowable as a deduction for the 
     taxable year which is equal to the amount of the credit 
     allowable for the taxable year under section 36.
       ``(2) Controlled groups.--In the case of a corporation 
     which is a member of a controlled group of corporations 
     (within the meaning of section 41(f)(5)) or a trade or 
     business which is treated as being under common control with 
     other trades or business (within the meaning of section 
     41(f)(1)(B)), this subsection shall be applied under rules 
     prescribed by the Secretary similar to the rules applicable 
     under subparagraphs (A) and (B) of section 41(f)(1).''.
       (c) Conforming Amendment.--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''.
       (d) Clerical Amendment.--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 item related 
     to section 36 and inserting the following new items:

``Sec. 36. Certain malpractice insurance costs.
``Sec. 37. Overpayments of tax.''.

       (e) Effective Date.--The amendments made by this section 
     shall apply to expenditures incurred after December 31, 2005.
       (f) Availability of Credit for Tax Exempt Organizations.--
     The Secretary of the Treasury shall administer the credit 
     allowable under section 36 of the Internal Revenue Code of 
     1986 (as added by this section) in such a manner so as to 
     minimize to the largest extent possible the administrative 
     burden on tax exempt organizations claiming the credit.

     SEC. 602. GRANTS TO NON-PROFIT HOSPITALS.

       (a) In General.--The Secretary of Health and Human 
     Services, acting through the Administrator of the Health 
     Resources and Services Administration, shall award grants to 
     eligible entities to assist such entities in defraying 
     qualified medical malpractice insurance expenditures.
       (b) Eligibility.--To be eligible to receive a grant under 
     subsection (a), an entity shall--
       (1) be a Faircare Level I non-profit hospital (as 
     determined under section 1898(b) of the Social Security Act) 
     in the preceding fiscal year;
       (2) not be eligible to claim the tax credit under section 
     36 of the Internal Revenue Code of 1986;
       (3) prepare and submit to the Secretary of Health and Human 
     Services an application at such time, in such manner, and 
     containing such information as the Secretary may require.
       (c) Amount of Grant.--The amount of a grant awarded to an 
     eligible entity under this section shall be--
       (1) with respect to the first year of the grant, an amount 
     equal to 10 percent of the qualified medical malpractice 
     insurance expenditures of the entity for the year;
       (2) with respect to the second year of the grant, an amount 
     equal to 15 percent of the qualified medical malpractice 
     insurance expenditures of the entity for the year;
       (3) with respect to the third year of the grant, an amount 
     equal to 20 percent of the qualified medical malpractice 
     insurance expenditures of the entity for the year; and
       (4) with respect to the fourth and subsequent years of the 
     grant, an amount equal to 25 percent of the qualified medical 
     malpractice insurance expenditures of the entity for the 
     year.
       (d) Definition.--In this section, the term ``qualified 
     medical malpractice insurance expenditure'' has the meaning 
     given such term in section 36(d) of the Internal Revenue Code 
     of 1986.

     SEC. 603. GRANTS FOR RESEARCH INTO QUALITY OF CARE AND 
                   MEDICAL ERRORS.

       (a) In General.--The Secretary of Health and Human Services 
     shall award grants to eligible entities to study the 
     relationship between institutions that are designated as 
     Faircare hospitals under section 1898(b) of the Social 
     Security Act and medical errors or the rate of claims of 
     malpractice.
       (b) Eligibility.--To be eligible to receive a grant under 
     subsection (a), an entity shall

[[Page S7461]]

     prepare and submit to the Secretary of Health and Human 
     Services an application at such time, in such manner, and 
     containing such information as the Secretary may require.

     SEC. 604. AUTHORIZATION OF APPROPRIATIONS.

       There is authorized to be appropriated to carry out this 
     title, such sums as may be necessary for each of fiscal years 
     2005 through 2015.
                                  ____


         Statements of Support for the Lieberman FairCare Bill


                    The National Health Law Program

       ``The National Health Law Program (NHeLP) commends the 
     announcement of The Faircare Act. Recognizing that 
     comprehensive and accurate data is critical to identifying 
     and then eliminating health disparities, the Faircare Act 
     would require race, ethnicity and primary language data 
     collection throughout federally operated or funded health 
     programs and provide crucial technical and financial 
     assistance to healthcare providers to meet the challenges of 
     eliminating health disparities.''


     Joint Commission on Accreditation of Healthcare Organizations

       ``The legislation comprehensively reflects current national 
     research and programmatic initiatives such as those of the 
     Joint Commission, private foundations, professional 
     organizations, academic institutions, and state and national 
     government agencies. For example, the Joint Commission has 
     two externally funded research projects that are looking at 
     issues related to culture and language. One, funded by the 
     Commonwealth Fund, is looking at the impact of limited 
     English proficiency on adverse medical events. Another, 
     funded by The California Endowment, is looking at how 
     hospitals across the nation are responding to issues of 
     culture and language. In addition to research activities, the 
     Joint Commission is engaging in field review of a proposed 
     new standard to require the collection of information on 
     patients' race, ethnicity, and primary language, is 
     supporting the National Conference of Quality Health Care for 
     Culturally Diverse Populations, and staff from the Joint 
     Commission serve on a number of national advisory panels that 
     are addressing issues of health care disparities, cultural 
     and linguistic issues, and issues related to health 
     literacy.''
       ``Financial incentives, as proposed in this legislation, 
     are timely and appropriate. Based on focus group feedback, 
     and input from Joint Commission advisory groups, the lack of 
     incentive, competing priorities, and limited resources for 
     providing culturally and linguistically appropriate services 
     is the main barrier to implementation, secondary, only to the 
     lack of awareness of the issue.''


                    The Progressive Policy Institute

       ``Sen. Lieberman's FairCare Legislation would 
     simultaneously make health care fairer and less wasteful by 
     tackling one of the core problems with health care today: 
     payment by procedure instead of performance. Too often, 
     patients, especially minorities, do not receive basic high 
     care quality like aspirin or beta-blockers for heart attack 
     victims because providers can't charge for it. It's time for 
     the federal government to make pay-for-performance a core 
     feature of health care policy.''


                      Physicians for Human Rights

       ``Senator Lieberman's Faircare bill is an important step 
     toward eliminating racial and ethnic disparities in 
     healthcare by both assuring quality of care and reducing care 
     inequities. Quality care means making the same healthcare 
     available to all Americans regardless of race or ethnicity.''


                     The Out of Many, One Coalition

       ``We applaud Senator Lieberman's leadership in tying the 
     elimination of health disparities to the improvement of 
     healthcare quality in the Nation.''


             National Conference for Community and Justice

       ``By establishing quantifiable standards, and providing 
     incentives to meet those standards, Faircare: A Bill to 
     Decrease Disparities in Healthcare Through Improving 
     Healthcare Quality for All can help raise the quality and 
     consistency of healthcare for all of us, not just some of us. 
     The issue of disparities in healthcare is a national crisis, 
     and the National Conference for Community and Justice (NCCJ) 
     remains committed to working with decision-makers and 
     community leaders to address this crisis on a national and 
     regional level. It is a critical part of America's unfinished 
     business, and through education and advocacy, we will bridge 
     the divides of quality healthcare so that all people receive 
     the information and treatment needed to lead healthy lives.''
                                 ______