[House Report 106-986]
[From the U.S. Government Publishing Office]
106th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 106-986
======================================================================
HEALTH CARE FAIRNESS ACT OF 2000
_______
October 18, 2000.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Bliley, from the Committee on Commerce, submitted the following
R E P O R T
[To accompany H.R. 3250]
[Including cost estimate of the Congressional Budget Office]
The Committee on Commerce, to whom was referred the bill
(H.R. 3250) to amend the Public Health Service Act to improve
the health of minority individuals, having considered the same,
report favorably thereon with an amendment and recommend that
the bill as amended do pass.
CONTENTS
Page
Amendment........................................................ 1
Purpose and Summary.............................................. 15
Background and Need for Legislation.............................. 16
Hearings......................................................... 16
Committee Consideration.......................................... 17
Committee Votes.................................................. 17
Committee Oversight Findings..................................... 17
Committee on Government Reform Oversight Findings................ 17
New Budget Authority, Entitlement Authority, and Tax Expenditures 18
Committee Cost Estimate.......................................... 18
Congressional Budget Office Estimate............................. 18
Federal Mandates Statement....................................... 20
Advisory Committee Statement..................................... 20
Constitutional Authority Statement............................... 20
Applicability to Legislative Branch.............................. 20
Section-by-Section Analysis of the Legislation................... 21
Changes in Existing Law Made by the Bill, as Reported............ 30
Amendment
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Health Care Fairness
Act of 2000''.
(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--IMPROVING MINORITY HEALTH THROUGH THE NATIONAL INSTITUTES OF
HEALTH; ESTABLISHMENT OF NATIONAL CENTER
Sec. 101. Establishment of National Center for Research on Minority
Health and Health Disparities.
Sec. 102. Centers of excellence for research education and training.
Sec. 103. Extramural loan repayment program for minority health
research.
Sec. 104. General provisions regarding the Center.
Sec. 105. Report regarding resources of National Institutes of Health
dedicated to research on minority health.
TITLE II--HEALTH DISPARITIES RESEARCH BY AGENCY FOR HEALTHCARE RESEARCH
AND QUALITY
Sec. 201. Health disparities research by Agency for Healthcare Research
and Quality.
TITLE III--DATA COLLECTION RELATING TO RACE OR ETHNICITY
Sec. 301. Study and report by National Academy of Sciences.
TITLE IV--MEDICAL EDUCATION AND OTHER HEALTH PROFESSIONS EDUCATION
Sec. 401. Grants for health care education curriculum development.
Sec. 402. National conference on continuing health professional
education and disparities in health outcomes.
Sec. 403. Continuing medical education incentive program.
Sec. 404. Advisory committee.
Sec. 405. Cultural competency clearinghouse.
TITLE V--MISCELLANEOUS PROVISIONS
Sec. 501. Office for Civil Rights.
Sec. 502. Development of outcome measures; study to measure patient
outcomes under the medicare and medicaid programs by race and
ethnicity.
Sec. 503. Departmental definition regarding minority individuals.
Sec. 504. Conforming provision regarding definitions.
TITLE VI--EFFECTIVE DATE
Sec. 601. Effective date.
SEC. 2. FINDINGS.
The Congress finds as follows:
(1) Despite notable progress in the overall health of the
Nation, there are continuing disparities in the burden of
illness and death experienced by African Americans, Indians,
Alaska Natives, and Asian Pacific Islanders, compared to the
United States population as a whole.
(2) Minority Americans lag behind on nearly every health
indicator, including health care coverage, access to care, life
expectancy, and disease rates. More detailed data on health
disparities is needed to evaluate the impact that race,
ethnicity, and socioeconomic status have on health status,
access to care, and the quality of care. More data is also
needed to enforce existing protections for equal access to
care.
(3) Despite substantial overall improvements in Americans'
health, racial and ethnic disparities persist across age, sex,
and income categories. Some striking examples are as follows:
(A) The black infant mortality rate, which is twice that of all
U.S. infants. (B) A higher breast cancer mortality rate for
black women than white women (even though black women have a
lower incidence rate). (C) Nearly twice as many Hispanics
adults report they do not have a regular doctor compared to
white adults.
(4) Minority adults are more likely to lack health insurance
than are white adults, a consistent trend over the past decade.
Nearly two of five (38 percent) Hispanic adults, one of four
(24 percent) black adults, and one of four (24 percent) Asian
American adults are uninsured, compared with one of seven (14
percent) white adults.
(5) Differences in the socioeconomic status among U.S. ethnic
groups exist. When examined collectively, African Americans and
Hispanics are three times as likely as whites to be poor. Low
socioeconomic and ethnic minority status are not synonymous,
but many members of ethnic minority who also have low income
comprise an important proportion of underserved populations in
the United States.
(6) The largest numbers of the medically underserved are
white, and many of them have the same health care access
problems as do members of minority groups. Nearly 20,000,000
white Americans live below the poverty line with many living in
non-metropolitan, rural areas. However, there is a higher
proportion of racial and ethnic minorities in the United States
represented among the medically underserved.
(7) Despite suffering disproportionate rates of illness,
death and disability, minorities have not been proportionately
represented in many clinical trials, except in studies of
behavioral risk factors associated with negative stereotypes.
(8) Many minority groups suffer disproportionately from
cancer. Mortality rates remain the most important measure of
the overall progress against cancer. Decreasing rates of death
from cancer reflect improvements in both prevention and
treatment. Among all ethnic groups in the United States,
African American males have the highest overall rate of
mortality from cancer. Some specific forms of cancer affect
other ethnic minority communities at rates up to several times
higher than the national averages (such as stomach and liver
cancers among Asian American populations, colon and rectal
cancer among Alaska natives, and cervical cancer among Hispanic
and Vietnamese-American women).
(9) In Appalachian Kentucky, a region characterized by high
rates of poverty, the incidence of lung cancer among white
males was 127 per 100,000 in 1992, a rate higher than that for
any ethnic minority groups in the United States during the same
period.
(10) Major disparities exist among population groups, with a
disproportionate burden of death and disability from
cardiovascular disease in minority and low-income populations.
Compared with rates for whites, coronary heart disease
mortality was 40 percent lower for Asian Americans but 40
percent higher for African-Americans.
(11) While racial and ethnic groups account only for about 25
percent of the U.S. population, they account for more than 50
percent of all AIDS cases. While overall AIDS deaths are down
dramatically, AIDS remains the leading killer of African-
Americans age 25-44. The death rate from HIV/AIDS for African
Americans is more than seven times that of whites.
(12) The prevalence of diabetes in African-Americans is
approximately 70 percent higher than whites and the prevalence
in Hispanics is nearly double that of whites.
(13) American Indians and Alaska Natives have an infant
mortality rate almost double that of whites. The rate of
diabetes for this population group is more than twice that for
whites. The Pima of Arizona have one of the highest rates of
diabetes in the world. American Indians living in North and
South Dakota have an average life expectancy that is 11 years
less than that for the rest of the U.S. population. Overall,
the life expectancy for American Indians and Alaska Native is
71 years of age-nearly five years less than the U.S. Races
populations.
(14) Asian and Pacific Islanders, on average, have indicators
of being one of the healthiest population groups in the United
States. However, there is great diversity within this
population group, and health disparities for some specific
groups are quite marked. Vietnamese women suffer from cervical
cancer at nearly five times the rate of white women. New cases
of hepatitis and tuberculosis are also higher in Asian and
Pacific Islanders living in the United States than in whites.
(15) Minority populations have a disproportionately higher
infection rate of hepatitis C virus than the general United
States Population. The prevalence rate of hepatitis C virus
among African Americans is more than twice that of the general
population (3.5 to 5 percent and 1.8 percent, respectively).
(16) There is a national need for minority scientists in the
fields of biomedical, clinical, behavioral, and health services
research. Ninety percent of minority physicians produced by
Historically Black Medical Colleges live and serve in minority
communities.
(17) The proportion of minorities in high academic ranks,
such as professors and associate professors, decreased from
1980 to 1990. Only 1 percent of full professors were minority
persons in 1990.
(18) Demographic trends inspire concern about the Nation's
ability to meet its future scientific, technological and
engineering workforce needs. Historically, non-Hispanic white
males have made up the majority of the United States
scientific, technological, and engineering workers.
(19) The Hispanic and Black population will increase
significantly in the next 50 years. The scientific,
technological, and engineering workforce may decrease if
participation by underepresented minorities remains the same.
(20) Increasing rates of Black and Hispanic workers must
occur in order to ensure strong scientific, technological, and
engineering workforce.
(21) Individuals such as underepresented minorities and women
in the scientific, technological, and engineering workforce
enable society to address its diverse needs.
(22) If there had not been a substantial increase in the
number of science and engineering degrees awarded to women and
underepresented minorities over the past few decades, the
United States would be facing even greater shortages in
scientific, technological, and engineering workers.
(23) In order to effectively promote a diverse and strong
21st Century scientific, technological, and engineering
workforce: agencies should expand or add programs that
effectively overcome barriers such as educational transition
from one level to the next and student requirements for
financial resources.
(24) Federal agencies should work in concert with the private
sector to emphasize the recruitment and retention of qualified
individuals from ethnic and gender groups that are currently
underrepresented in the scientific, technological, and
engineering workforce.
(25) Cultural competency training in medical schools and
residency training programs has the potential to reduce
disparities in health care and health outcomes.
(26) Culturally sensitive approaches to research are needed
to encourage participation of minorities and the
socioeconomically disadvantages in research studies.
(27) African Americans with identical complaints of chest
pain are less likely than white Americans to be referred by
physicians for sophisticated cardiac tests.
(28) Behavioral and social sciences research has increased
awareness and understanding of factors associated with health
care utilization and access, patient attitudes toward health
services, and risk and protective behaviors that affect health
and illness. These factors have the potential to then be
modified to help close the health disparities gap among ethnic
minority populations. In addition, there is a shortage of
minority behavioral science researchers and behavioral health
care professionals. According to the National Science
Foundation, only 15.5 percent of behavioral research-oriented
psychology doctorate degrees were awarded to minority students
in 1997. In addition, only 17.9 percent of practice-oriented
psychology doctorate degrees were awarded to ethnic minorities.
TITLE I--IMPROVING MINORITY HEALTH THROUGH NATIONAL INSTITUTES OF
HEALTH; ESTABLISHMENT OF NATIONAL CENTER
SEC. 101. ESTABLISHMENT OF NATIONAL CENTER FOR RESEARCH ON MINORITY
HEALTH AND HEALTH DISPARITIES.
(a) In General.--Part E of title IV of the Public Health Service Act
(42 U.S.C. 287 et seq.) is amended by adding at the end the following
subpart:
``Subpart 6--National Center for Research on Minority Health and Health
Disparities
``SEC. 485E. PURPOSE OF CENTER.
``(a) In General.--The general purpose of the National Center for
Research on Minority Health and Health Disparities (in this subpart
referred to as the `Center') is the conduct and support of basic and
clinical research, training, the dissemination of health information,
and other programs with respect to the health of racial and ethnic
minority groups and other health disparity populations.
``(b) Priorities.--The Director of the Center shall in expending
amounts appropriated under this section give priority to conducting and
supporting minority health research.
``(c) Minority Health Research.--For purposes of this subpart:
``(1) The term `minority health research' means research on
minority health conditions (as defined in paragraph (2)),
including research on preventing such conditions; research on
access, outreach, treatment, and the quality of health care;
and research on cultural and linguistic services for decreasing
the extent of health problems associated with such conditions.
``(2) The term `minority health conditions', with respect to
individuals who are members of racial and ethnic 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 individuals;
``(B) for which the factors of medical risk or types
of medical intervention are different for such
individuals, 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 individuals as
subjects or insufficient data on such individuals.
``(3) The term `racial and ethnic minority group' has the
meaning given such term in section 1707.
``(4) The term `minorities' means individuals from a racial
or ethnic minority group.
``(d) Health Disparity Populations.--
``(1) In general.--For purposes of this subpart:
``(A) A population is a health disparity population
if, as determined by the Director of the Center after
consultation with the Director of the Agency for
Healthcare Research and Quality, there is a significant
disparity in the overall rate of disease incidence,
morbidity, mortality, or survival rates in the
population as compared to the health status of the
general population.
``(B) The term `health disparity populations'
includes racial and ethnic minority groups.
``(C) The term `health disparities research' means
research on health disparity populations (and
individual members and communities of such populations)
that relates to the health disparities involved,
including basic and applied biomedical and behavioral
research on the nature of health disparities, the
causes of such disparities, and remedies for such
disparities. Such term includes minority health
research.
``(2) Priority.--With amounts available under this section
for a fiscal year after providing for minority health research
in accordance with subsection (b), the Secretary shall conduct
and support health disparities research on other health
disparity populations, with priority given to such research on
health disparity populations for which socioeconomic status is
one of the principal causal factors with respect to being a
health disparity population.
``(e) Coordination of Activities.--The Director of the Center shall
act as the primary Federal official with responsibility for overseeing
all minority health and other health disparities research conducted or
supported by the National Institutes of Health, and--
``(1) shall represent the health disparities research program
of the National Institutes of Health, including the minority
health research program, at all relevant Executive branch task
forces, committees and planning activities; and
``(2) shall maintain communications with all relevant Public
Health Service agencies and with various other departments of
the Federal Government, to ensure the timely transmission of
information concerning advances in minority health and other
health disparities research between these various agencies for
dissemination to affected communities and health care
providers.
``(f) Collaborative Comprehensive Plan and Budget.--
``(1) In general.--Subject to the provisions of this section
and other applicable law, the Director of NIH, the Director of
the Center, and the directors of the national research
institutes in collaboration (and in consultation with the
advisory council for the Center) shall--
``(A) establish a comprehensive plan and budget for
the conduct and support of all minority health and
other health disparities research activities of the
agencies of the National Institutes of Health (which
plan and budget shall be first established under this
subsection not later than 12 months after the date of
the enactment of this subpart);
``(B) ensure that the plan and budget demonstrate how
health disparities research activities address the
health needs of specific health disparity populations,
taking into account socioeconomic status; the areas in
which the population involved resides; attitudes toward
health; the language spoken, the extent of formal
education; and such other factors as the Director of
the Center determines to be appropriate;
``(C) ensure that the plan and budget establish
priorities among the health disparities research
activities that such agencies are authorized to carry
out;
``(D) ensure that the plan and budget establish
objectives regarding such activities, describes the
means for achieving the objectives, and designates the
date by which the objectives are expected to be
achieved;
``(E) ensure that, with respect to amounts
appropriated for activities of the Center, the plan and
budget give priority in the expenditure of funds to
conducting and supporting minority health research;
``(F) ensure that all amounts appropriated for such
activities are expended in accordance with the plan and
budget;
``(G) review the plan and budget not less than
annually, and revise the plan and budget as
appropriate; and
``(H) ensure that the plan and budget serve as a
broad, binding statement of policies regarding minority
health and other health disparities research activities
of the agencies, but do not remove the responsibility
of the heads of the agencies for the approval of
specific programs or projects, or for other details of
the daily administration of such activities, in
accordance with the plan and budget.
``(2) Certain components of plan and budget.--With respect to
health disparities research activities of the agencies of the
National Institutes of Health, the Director of the Center shall
ensure that the plan and budget under paragraph (1) provide
for--
``(A) basic research and applied research, including
research and development with respect to products;
``(B) research that is conducted by the agencies;
``(C) research that is supported by the agencies;
``(D) proposals developed pursuant to solicitations
by the agencies and for proposals developed
independently of such solicitations; and
``(E) behavioral research and social sciences
research, which may include cultural and linguistic
research in each of the agencies.
``(3) Minority health research.--The plan and budget under
paragraph (1) shall include a separate statement of the plan
and budget for minority health research.
``(g) Clinical Research Equity.--The Director of the Center shall
assist in the administration of section 492B with respect to the
inclusion of members of minority groups as subjects in clinical
research.
``(h) Research Endowments.--The Director of the Center may carry out
a program to facilitate minority health research by providing for
research endowments at centers of excellence under section 736.
``(i) Certain Activities.--In carrying out subsection (a), the
Director of the Center--
``(1) shall assist the Director of the National Center for
Research Resources in carrying out section 481(c)(3) and in
committing resources for construction at Institutions of
Emerging Excellence;
``(2) shall establish projects to promote cooperation among
Federal agencies, State, local, and regional public health
agencies, and private entities in health disparities research;
``(3) may conduct or support research on the use of service
delivery models (such as health centers under section 330) to
reduce health disparities; and
``(4) may utilize information from previous health
initiatives concerning minorities and other health disparity
populations.
``(j) Advisory Council.--
``(1) In general.--The Secretary shall, in accordance with
section 406, establish an advisory council to advise, assist,
consult with, and make recommendations to the Director of the
Center on matters relating to the activities described in
subsection (a), and with respect to such activities to carry
out any other functions described in section 406 for advisory
councils under such section. Functions under the preceding
sentence shall include making recommendations on budgetary
allocations made in the plan under subsection (f), and shall
include reviewing reports under subjection (k) before the
reports are submitted under such subsection.
``(2) Membership.--With respect to the membership of the
advisory council under paragraph (1), a majority of the members
shall be representatives of the various racial and ethnic
minority groups; representatives of other health disparity
populations shall be included; and a diversity of health
professionals shall be represented. The membership shall in
addition include a representative of the Office of Behavioral
and Social Sciences Research under section 404A.
``(k) Annual Report.--The Director of the Center shall prepare an
annual report on the activities carried out or to be carried out by the
Center, and shall submit each such report to the Congress, the
Secretary, and the Director of NIH. With respect to the fiscal year
involved, the report shall--
``(1) describe and evaluate the progress made in health
disparities research conducted or supported by the national
research institutes;
``(2) summarize and analyze expenditures made for activities
with respect to health disparities research conducted or
supported by the National Institutes of Health;
``(3) include a separate statement applying the requirements
of paragraphs (1) and (2) specifically to minority health
research; and
``(4) contain such recommendations as the Director considers
appropriate.
``(l) Authorization of Appropriations.--For the purpose of carrying
out this subpart, there are authorized to be appropriated $100,000,000
for fiscal year 2001, and such sums as may be necessary for each of the
fiscal years 2002 through 2005. Such authorization of appropriations is
in addition to other authorizations of appropriations that are
available for the conduct and support of minority health or other
health disparities research by the national research institutes and
other agencies of the National Institutes of Health.''.
(b) Conforming Amendment.--Part A of title IV of the Public Health
Service Act (42 U.S.C. 281 et seq.) is amended--
(1) in section 401(b)(2)--
(A) in subparagraph (F), by moving the subparagraph
two ems to the left; and
(B) by adding at the end the following subparagraph:
``(G) The National Center for Research on Minority Health and
Health Disparities.''; and
(2) by striking section 404.
SEC. 102. CENTERS OF EXCELLENCE FOR RESEARCH EDUCATION AND TRAINING.
Subpart 6 of part E of title IV of the Public Health Service Act, as
added by section 101 of this Act, is amended by adding at the end the
following section:
``SEC. 485F. CENTERS OF EXCELLENCE FOR RESEARCH EDUCATION AND TRAINING.
``(a) In General.--The Director of the Center shall make awards of
grants or contracts to designated biomedical and behavioral research
institutions under paragraph (1) of subsection (c), or to consortia
under paragraph (2) of such subsection, for the purpose of assisting
the institutions in supporting programs of excellence in biomedical and
behavioral research education for individuals who are members of health
disparity populations, including minorities.
``(b) Required Use of Funds.--An award may be made under subsection
(a) only if the applicant involved agrees that the grant will be
expended--
``(1) to conduct minority health research, including research
on the use of service delivery models (such as health centers
under section 330) with respect to minority health conditions;
``(2) to train minorities and other members of health
disparities populations as professionals in the area of
biomedical or behavioral research or both; or
``(3) to expand, remodel, renovate, or alter existing
research facilities or construct new research facilities for
the purpose of conducting minority health research.
``(c) Centers of Excellence.--
``(1) In general.--For purposes of this section, a designated
biomedical and behavioral research institution is a biomedical
and behavioral research institution that--
``(A) has a significant number of health disparity
students, including minorities, enrolled in the
institution (including individuals accepted for
enrollment in the institution);
``(B) has been effective in assisting such students
of the institution to complete the program of education
and receive the degree involved;
``(C) has been effective in recruiting members of
health disparity populations, including minorities, to
enroll in and graduate from the institution, including
providing scholarships and other financial assistance
to such individuals and encouraging health disparity
students from all levels of the educational pipeline to
pursue biomedical research careers; and
``(D) has made significant recruitment efforts to
increase the number of members of health disparities
populations, including minorities, serving in faculty
or administrative positions at the institution.
``(2) Consortium.--Any designated biomedical and behavioral
research institution involved may, with other biomedical and
behavioral institutions (designated or otherwise), form a
consortium to receive an award under subsection (a).
``(3) Application of criteria to other programs.--In the case
of any criteria established by the Director of the Center for
purposes of determining whether institutions meet the
conditions described in paragraph (1), this section may not,
with respect to minorities, be construed to authorize, require,
or prohibit the use of such criteria in any program other than
the program established in this section.
``(d) Duration of Grant.--The period during which payments are made
under a grant under subsection (a) may not exceed 5 years. Such
payments shall be subject to annual approval by the Director of the
Center and to the availability of appropriations for the fiscal year
involved to make the payments.
``(e) Maintenance of Effort.--
``(1) In general.--With respect to activities for which an
award under subsection (a) is authorized to be expended, the
Director of the Center may not make such an award to a
designated research institution or consortium for any fiscal
year unless the institution, or institutions in the consortium,
as the case may be, agree to maintain expenditures of non-
Federal amounts for such activities at a level that is not less
than the level of such expenditures maintained by the
institutions involved for the fiscal year preceding the fiscal
year for which such institutions receive such an award.
``(2) Use of federal funds.--With respect to any Federal
amounts received by a designated research institution or
consortium and available for carrying out activities for which
an award under subsection (a) is authorized to be expended, the
Director of the Center may make such an award only if the
institutions involved agree that the institutions will, before
expending the award, expend the Federal amounts obtained from
sources other than the award.
``(f) Certain Expenditures.--The Director of the Center may authorize
a designated biomedical and behavioral research institution to expend a
portion of an award under subsection (a) for research endowments.
``(g) Definitions.--For purposes of this section:
``(1) The term `designated biomedical and behavioral research
institution' has the meaning indicated for such term in
subsection (c)(1). Such term includes any health professions
school receiving an award of a grant or contract under section
736.
``(2) The term `program of excellence' means any program
carried out by a designated biomedical and behavioral research
institution with an award under subsection (a), if the program
is for purposes for which the institution involved is
authorized in subsection (b) to expend the grant.
``(h) Authorization of Appropriations.--For the purpose of making
grants under subsection (a), there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001 through
2005.''.
SEC. 103. EXTRAMURAL LOAN REPAYMENT PROGRAM FOR MINORITY HEALTH
RESEARCH.
Subpart 6 of part E of title IV of the Public Health Service Act, as
amended by section 102 of this Act, is amended by adding at the end the
following section:
``SEC. 485G. LOAN REPAYMENT PROGRAM FOR MINORITY HEALTH RESEARCH.
``(a) In General.--The Director of the Center shall establish a
program of entering into contracts with qualified health professionals
under which such health professionals agree to engage in minority
health research in consideration of the Federal Government agreeing to
repay, for each year of engaging in such research, not more than
$35,000 of the principal and interest of the educational loans of such
health professionals.
``(b) Service Provisions.--The provisions of sections 338B, 338C, and
338E shall, except as inconsistent with subsection (a), apply to the
program established in such subsection to the same extent and in the
same manner as such provisions apply to the National Health Service
Corps Loan Repayment Program established in subpart III of part D of
title III.
``(c) Requirement Regarding Health Disparity Populations.--The
Director of the Center shall ensure that not fewer than 50 percent of
the contracts entered into under subsection (a) are for appropriately
qualified health professionals who are members of a health disparity
population.
``(d) Priority.--With respect to minority health research under
subsection (a), the Secretary shall ensure that priority is given to
conducting projects of biomedical research.
``(e) Funding.--
``(1) Authorization of appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 2001 through 2005.
``(2) Availability of appropriations.--Amounts available for
carrying out this section shall remain available until the
expiration of the second fiscal year beginning after the fiscal
year for which the amounts were made available.''.
SEC. 104. GENERAL PROVISIONS REGARDING THE CENTER.
Subpart 6 of part E of title IV of the Public Health Service Act, as
amended by section 103 of this Act, is amended by adding at the end the
following section:
``SEC. 485H. GENERAL PROVISIONS REGARDING THE CENTER.
``(a) Administrative Support for Center.--The Secretary, acting
through the Director of the National Institutes of Health, shall
provide administrative support and support services to the Director of
the Center and shall ensure that such support takes maximum advantage
of existing administrative structures at the agencies of the National
Institutes of Health.
``(b) Evaluation and Report.--
``(1) Evaluation.--Not later than 5 years after the date of
the enactment of this part, the Secretary shall conduct an
evaluation to--
``(A) determine the effect of this section on the
planning and coordination of the health disparities
research programs at the institutes, centers and
divisions of the National Institutes of Health;
``(B) evaluate the extent to which this part has
eliminated the duplication of administrative resources
among such Institutes, centers and divisions; and
``(C) provide recommendations concerning future
legislative and administrative modifications with
respect to this part, for both minority health research
and research on other health disparity populations.
``(2) Minority health research.--The evaluation under
paragraph (1) shall include a separate statement that applies
subparagraphs (A) and (B) of such paragraph to minority health
research.
``(3) Report.--Not later than 1 year after the date on which
the evaluation is commenced under paragraph (1), the Secretary
shall prepare and submit to the Committee on Health, Education,
Labor, and Pensions of the Senate, and the Committee on
Commerce of the House of Representatives, a report concerning
the results of such evaluation.''.
SEC. 105. REPORT REGARDING RESOURCES OF NATIONAL INSTITUTES OF HEALTH
DEDICATED TO RESEARCH ON MINORITY HEALTH.
Not later than December 1, 2003, the Director of the National Center
for Research on Minority Health and Health Disparities (established by
the amendment made by section 101(a)), after consultation with the
advisory council for such Center, shall submit to the Congress, the
Secretary of Health and Human Services, and the Director of the
National Institutes of Health a report that provides the following:
(1) Recommendations for the methodology that should be used
to determine the extent of the resources of the National
Institutes of Health that are dedicated to research on minority
health, including determining the amount of funds that are used
to conduct and support such research. With respect to such
methodology, the report shall address the discrepancies between
the methodology used by such Institutes as of the date of the
enactment of this Act and the methodology used by the Institute
of Medicine as of such date.
(2) A determination of whether and to what extent, relative
to fiscal year 1999, there has been an increase in the level of
resources of the National Institutes of Health that are
dedicated to research on minority health, including the amount
of funds used to conduct and support such research. The report
shall include provisions describing whether and to what extent
there have been increases in the number and amount of awards to
minority serving institutions.
TITLE II--HEALTH DISPARITIES RESEARCH BY AGENCY FOR HEALTHCARE RESEARCH
AND QUALITY
SEC. 201. HEALTH DISPARITIES RESEARCH BY AGENCY FOR HEALTHCARE RESEARCH
AND QUALITY.
(a) General.--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:
``SEC. 903. RESEARCH ON HEALTH DISPARITIES.
``(a) In General.--The Director shall--
``(1) conduct and support research to identify how to improve
the quality and outcomes of health care services for health
disparity populations and the causes of the health disparities
involved, including identifying barriers to health care access
and environmental factors leading to health problems;
``(2) conduct and support research and support demonstration
projects to identify, test, and evaluate strategies for
eliminating health disparities and promoting effective
interventions;
``(3) develop measures for the assessment and improvement of
the quality and appropriateness of health care services
provided to health disparity populations; and
``(4) in carrying out 902(c), provide support to increase the
number of researchers who are members of health disparity
populations, and the health services research capacity of
institutions that train such researchers.
``(b) Research and Demonstration Projects.--
``(1) In general.--In carrying out subsection (a), the
Director shall conduct and support research to--
``(A) identify the clinical, cultural, socioeconomic,
and organizational factors that contribute to health
disparities, including for minority populations, which
factors include examination of patterns of clinical
decisionmaking and of the availability of support
services;
``(B) identify and evaluate clinical and
organizational strategies to improve the quality,
outcomes, and access to care for health disparity
populations, including minority populations;
``(C) support demonstrations to test such strategies;
and
``(D) widely disseminate strategies for which there
is scientific evidence of effectiveness.
``(2) Use of certain strategies.--In carrying out this
section, the Director shall implement research strategies and
mechanisms that will enhance the involvement of individuals who
are members of health disparity populations (including minority
populations), health services researchers who are such
individuals, institutions that train such individuals as
researchers, members of health disparity populations (including
minority populations) for whom the Agency is attempting to
improve the quality and outcomes of care, and representatives
of appropriate community-based organizations with respect to
health disparity populations. Such research strategies and
mechanisms may include the use of--
``(A) centers of excellence that can demonstrate,
either individually or through consortia, a combination
of multi-disciplinary expertise in outcomes or quality
improvement research and a demonstrated capacity to
engage members and communities of health disparity
populations, including minority populations, in the
planning, conduct and translation of research, with
linkages to relevant sites of care;
``(B) provider-based research networks, including
health plans, facilities, or delivery system sites of
care (especially primary care), that make extensive use
of health care providers who are members of health
disparity populations or who serve patients in such
populations and have the capacity to evaluate and
promote quality improvement;
``(C) service delivery models (such as health centers
under section 330) to reduce health disparities; and
``(D) other innovative mechanisms or strategies that
will facilitate the translation of past research
investments into clinical practices that can reasonably
be expected to benefit these populations.
``(c) Quality Measurement Development.--
``(1) In general.--To ensure that health disparity
populations, including minority populations, benefit from the
progress made in the ability of individuals to measure the
quality of health care delivery, the Director shall support the
development of quality of health care measures that assess the
experience of such populations with health care systems, such
as measures that assess the access of such populations to
health care, the cultural competence of the care provided, the
quality of the care provided, the outcomes of care, or other
aspects of health care practice that the Director determines to
be important. In carrying out the preceding sentence, the
Director shall in consultation with the Administrator of the
Health Resources and Services Administration examine the
practices of providers (such as health centers under section
330) that have a record of reducing health disparities or have
experience in providing culturally competent health services to
minority or other health disparity populations.
``(2) Report.--Not later than 24 months after the date of the
enactment of this section, the Secretary, acting through the
Director, shall prepare and submit to the appropriate
committees of Congress a report describing the state-of-the-art
of quality measurement for minority and other health disparity
populations that will identify critical unmet needs, the
current activities of the Department to address those needs,
and a description of related activities in the private sector.
``(d) Definition.--For purposes of this section:
``(1) The term `health disparity population' has the meaning
given such term in section 485E.
``(2) The term `minority', with respect to populations,
refers to racial and ethnic minority groups as defined in
section 1707.''.
(b) Funding.--Section 927 of the Public Health Service Act (42 U.S.C.
299c-6) is amended by adding at the end the following:
``(d) Health Disparities Research.--For the purpose of carrying out
the activities under section 903, there are authorized to be
appropriated such sums as may be necessary for each of the fiscal years
2001 through 2005.''.
TITLE III--DATA COLLECTION RELATING TO RACE OR ETHNICITY
SEC. 301. STUDY AND REPORT BY NATIONAL ACADEMY OF SCIENCES.
(a) Study.--The National Academy of Sciences shall conduct a
comprehensive study of the Department of Health and Human Services'
data collection systems and practices, and any data collection or
reporting systems required under any of the programs or activities of
the Department, relating to the collection of data on race or
ethnicity, including other Federal data collection systems (such as the
Social Security Administration) with which the Department interacts to
collect relevant data on race and ethnicity.
(b) Report.--Not later than 1 year after the date of enactment of
this Act, the National Academy of Sciences shall prepare and submit to
the Committee on Health, Education, Labor, and Pensions of the Senate
and the Committee on Commerce of the House of Representatives, a report
that--
(1) identifies the data needed to support efforts to evaluate
the effects of race and ethnicity on access to health care and
other services and on disparity in health and other social
outcomes and the data needed to enforce existing protections
for equal access to health care;
(2) examines the effectiveness of the systems and practices
of the Department of Health and Human Services described in
subsection (a), including pilot and demonstration projects of
the Department, and the effectiveness of selected systems and
practices of other Federal and State agencies and the private
sector, in collecting and analyzing such data;
(3) contains recommendations for ensuring that the Department
of Health and Human Services, in administering its entire array
of programs and activities, collects, or causes to be
collected, reliable and complete information relating to race
and ethnicity; and
(4) includes projections about the costs associated with the
implementation of the recommendations described in paragraph
(3), and the possible effects of the costs on program
operations.
(c) Authorization of Appropriations.--For the purpose of carrying out
this section, there are authorized to be appropriated such sums as may
be necessary for fiscal year 2001.
TITLE IV--MEDICAL EDUCATION AND OTHER HEALTH PROFESSIONS EDUCATION
SEC. 401. GRANTS FOR HEALTH CARE EDUCATION CURRICULUM DEVELOPMENT.
Part F of title VII of the Public Health Service Act (42 U.S.C. 295j
et seq.) is amended by inserting after section 791 the following:
``SEC. 791A. GRANTS FOR HEALTH PROFESSIONAL EDUCATION CURRICULUM
DEVELOPMENT.
``(a) Grants for Graduate Education Curriculum Development.--
``(1) In general.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration and in collaboration with the Director of the
Agency for Healthcare Research and Quality and the Deputy
Assistant Secretary for Minority Health, may make awards of
grants, contracts, or cooperative agreements to public and
nonprofit private entities for the purpose of carrying out
research projects and demonstration projects to develop
curricula to reduce disparities in health care outcomes,
including curricula for cultural competency in graduate health
professions education.
``(2) Eligibility.--To be eligible to receive an award under
paragraph (1), an entity shall--
``(A) be a school of medicine, school of osteopathic
medicine, school or dentistry, school of public health,
school of nursing, graduate program in behavioral
health and mental health practice, or other recognized
health profession school; and
``(B) prepare and submit to the Secretary an
application at such time, in such manner, and
containing such information as the Secretary may
require.
``(3) Use of funds.--An entity shall use amounts received
under an award under paragraph (1) to carry out research
projects and demonstration projects to develop curricula to
reduce disparity in health care outcomes, including curricula
for cultural competency in graduate health professions
education.
``(4) Number of grants and grant term.--The Secretary shall
award grants, contracts or cooperative agreements (or
combination thereof) under paragraph (1) in each of the first
and second fiscal years for which funds are available under
subsection (f). The term of each such grant, contract or
cooperative agreement shall be 3 years.
``(b) Grants for Continuing Health Professional Education Curriculum
Development.--
``(1) In general.--The Secretary, acting through the Health
Resources and Services Administration and the Agency for
Healthcare Research Quality and in collaboration with the
Office of Minority Health, shall award grants to eligible
entities for the establishment of demonstration and pilot
projects to develop curricula to reduce disparity in health
care and health outcomes, including curricula for cultural
competency, in continuing health professions education.
``(2) Eligibility.--To be eligible to receive a grant under
paragraph (1) an entity shall--
``(A) be a school of medicine, osteopathic medicine,
public health, dentistry, optometry, pharmacy, allied
health, chiropractic, podiatric medicine, nursing, and
public health and health administration, public or
nonprofit private school that offers a graduate program
in clinical social work or other graduate programs in
behavioral health and mental health practice, program
for the training of physician assistants, health
professional association, or other public or nonprofit
health educational entity, or any consortium of
entities described in this subparagraph; and
``(B) prepare and submit to the Secretary an
application at such time, in such manner, and
containing such information as the Secretary may
require.
``(3) Use of funds.--An entity shall use amounts received
under a grant under paragraph (1) to develop and evaluate the
effect of curricula for continuing health professions education
courses or programs to provide education concerning issues
relating to disparity in health care and health outcomes,
including cultural competency of health professionals. Such
curricula shall focus on the need to remove bias from health
care at a personal level as well as at a systemic level.
``(4) Number of grants and grant term.--The Secretary shall
award grants under paragraph (1) in each of the first and
second fiscal years for which funds are available under
subsection (f). The term of each such grant shall be 3 years.
``(c) Distribution of Projects.--The Secretary shall ensure that, to
the extent practicable, projects under subsections (a) and (b) are
carried out in each of the principal geographic regions of the United
States and involve different health disparity populations (as defined
in section 485E) and health professions.
``(d) Monitoring.--An entity that receives a grant, contract or
cooperative agreement under subsection (a) or (b) shall ensure that
procedures are in place to monitor activities undertaken using grant,
contract or cooperative agreement funds. Such entity shall annually
prepare and submit to the Secretary a report concerning the
effectiveness of curricula developed under the grant contract or
cooperative agreement.
``(e) Report to Congress.--Not later than January 1, 2002, the
Secretary shall prepare and submit to the appropriate committees of
Congress, a report concerning the effectiveness of programs funded
under this section and a plan to encourage the implementation and
utilization of curricula to reduce disparities in health care and
health outcomes. A final report shall be submitted by the Secretary not
later than January 1, 2004.
``(f) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $3,500,000 for fiscal year
2001, $7,000,000 for fiscal year 2002, $7,000,000 for fiscal year 2003,
and $3,500,000 for fiscal year 2004.''.
SEC. 402. NATIONAL CONFERENCE ON CONTINUING HEALTH PROFESSIONAL
EDUCATION AND DISPARITIES IN HEALTH OUTCOMES.
(a) In General.--Not later than 1 year after the date of enactment of
this Act, the Secretary of Health and Human Services shall convene a
national conference on continuing medical education as a method for
reducing disparities in health care and health outcomes, including
continuing medical education on cultural competency. The conference
shall include sessions to address measurements of outcomes to assess
the effectiveness of curricula in reducing disparities.
(b) Participants.--The Secretary of Health and Human Services shall
invite minority and other health disparity populations advocacy groups,
health education entities described in section 791A(b)(2)(A) of the
Public Health Service Act (as added by section 401), health centers
under section 330 of such Act, and other interested parties to attend
the conference under subsection (a).
(c) Issues.--The national conference convened under subsection (a)
shall address issues relating to the role of continuing medical
education in the effort to reduce disparities in health care and health
outcomes, including the role of continuing medical education in
improving the cultural competency of health professionals. The
conference shall focus on methods to achieve reductions in the
disparities in health care and health outcomes through continuing
medical education courses or programs and on strategies for measuring
the effectiveness of curricula to reduce disparities.
(d) Publication of Findings.--Not later than 6 months after the
convening of the national conference under subsection (a), the
Secretary of Health and Human Services shall publish in the Federal
Register a summary of the proceedings and the findings of the
conference.
(e) Authorization of Appropriations.--There is authorized to be
appropriated such sums as may be necessary to carry out this section.
SEC. 403. CONTINUING MEDICAL EDUCATION INCENTIVE PROGRAM.
(a) In General.--The Secretary of Health and Human Services shall
develop and implement a program to provide incentives to health
maintenance organizations, community health centers, rural health
centers, and other entities providing services under title XVIII or XIX
of the Social Security Act (42 U.S.C. 1395 et seq. or 1396 et seq.) to
encourage health care professionals employed by, or under contract
with, such entities to participate in continuing medical education
programs designed to reduce health disparities.
(b) Effective Programs.--In developing the program under subsection
(a), the Secretary of Health and Human Services shall ensure that
incentives are targeted at programs that address each of the following
issues:
(1) Implementing new curricula or strategies for continuing
medical education programs designed to reduce health
disparities, or continuing medical education curricula or
strategies that have been proven effective in reducing such
disparities.
(2) Encouraging health professionals to participate in such
curricula.
(3) Monitoring health care and health outcomes as a way to
evaluate the effectiveness of continuing medical education
programs in reducing health disparities.
(c) Definition.--For purposes of this section, the term ``health
disparities'' has the meaning given such term in section 485E of the
Public Health Service Act.
(d) Authorization of Appropriations.--There is authorized to be
appropriated such sums as may be necessary to carry out this section.
SEC. 404. ADVISORY COMMITTEE.
(a) Establishment.--The Secretary of Health and Human Services shall
establish an advisory committee to provide advice to the Secretary on
matters related to the development, implementation, and evaluation of
graduate and continuing education curricula for health care
professionals to decrease disparities in health care and health
outcomes, including curricula on cultural competency as a method of
eliminating health disparities.
(b) Membership.--Not later than 3 months after the date on which
amounts are appropriated to carry out this section, the Secretary of
Health and Human Services shall appoint the members of the advisory
committee. Such members shall be appointed from among individuals who--
(1) are not officers or employees of the Federal Government;
(2) are experienced in issues relating to health disparities;
(3) are minorities or representatives of racial and ethnic
minority groups or other health disparity populations; and
(4) meet such other requirements as the Secretary determines
appropriate;
Such committee shall include individuals who are experienced in
providing health services to racial and ethnic minority groups or other
health disparity populations, including representatives of health
centers under section 330 of the Public Health Service Act. The
committee shall in addition include a representative of the Office of
Minority Health under section 1707 of such Act, a representative of the
Health Resources and Services Administration, and such other
representatives of offices and agencies of the Public Health Service as
the Secretary determines to be appropriate. Such representatives shall
include one or more individuals who serve on the advisory committee
under section 1707(c) of such Act.
(c) Collaboration.--The advisory committee shall carry out its duties
under this section in collaboration with the Office of Minority Health
of the Department of Health and Human Services, and other offices,
centers, and institutes of the Department of Health and Human Services,
and other Federal agencies.
(d) Termination.--The advisory committee shall terminate on the date
that is 4 years after the date on which the first member of the
committee is appointed.
(e) Existing Committee.--The Secretary may designate an existing
advisory committee operating under the authority of the Office of
Minority Health of the Department of Health and Human Services to serve
as the advisory committee under this section.
SEC. 405. CULTURAL COMPETENCY CLEARINGHOUSE.
(a) Establishment.--The Director of the Office of Minority Health of
the Department of Health and Human Services shall establish within the
Resource Center of the Office of Minority Health, or through the
awarding of a grant provide for the establishment of, an information
clearinghouse for curricula to reduce disparities in health care and
health outcomes. The clearinghouse shall facilitate and enhance,
through the effective dissemination of information, knowledge and
understanding of practices that lead to reductions in health
disparities (as defined in section 485E of the Public Health Service
Act), including curricula for continuing medical education to develop
cultural competency in health care professionals.
(b) Availability of Information.--Information contained in the
clearinghouse shall be made available to minority health advocacy
groups and other organizations representing health disparity
populations, health education entities described in section
791A(b)(2)(A) of the Public Health Service Act (as added by section
401), health maintenance organizations, and other interested parties.
(c) Authorization of Appropriations.--There is authorized to be
appropriated such sums as may be necessary to carry out this section.
TITLE V--MISCELLANEOUS PROVISIONS
SEC. 501. OFFICE FOR CIVIL RIGHTS.
(a) Public Awareness Campaign.--
(1) In general.--The Secretary of Health and Human Services
shall conduct a national media campaign for the purpose of
informing the public of the programs and activities of the
Office for Civil Rights, Department of Health and Human
Services. The campaign shall--
(A) have a specific focus on racial and ethnic
minority communities, as well as the general public;
and
(B) involve racial and ethnic minority media as
participants in the design and conduct of the campaign.
(2) Authorization of appropriations.--For the purpose of
carrying out paragraph (1), there are authorized to be
appropriated such sums as may be necessary for fiscal year
2001.
(b) Ombudsman Demonstration Program.--
(1) In general.--The Secretary of Health and Human Services
(in this subsection referred to as the ``Secretary'') shall
carry out a demonstration program under which the Secretary
makes grants to States for the purpose of establishing and
operating State offices to identify, investigate, and
facilitate the resolution of complaints relating to civil
rights, and to carry out functions authorized pursuant to
paragraph (3) (which office is referred to in this subsection
as the ``State Ombudsman Office'').
(2) Ombudsman.--The Secretary shall require that each State
Ombudsman Office under paragraph (1) be headed by an individual
with expertise and experience in the field of civil rights and
advocacy.
(3) Certain requirements and authorities.--In carrying out
paragraph (1), the Secretary shall consider the requirements
and authorities that apply to the operation of State offices
under chapter 2 of subtitle A of title VII of the Older
Americans Act of 1965 (relating to State Long-Term Care
Ombudsman Programs). In providing for State Ombudsman Offices
under paragraph (1), the Secretary may establish requirements
and authorities with respect to civil rights that are the same
as or similar to the requirements and authorities that apply
under such chapter 2 with respect to residents of long-term
care facilities.
(c) Funding.--There are authorized to be appropriated for the Office
for Civil Rights, Department of Health and Human Services, $36,000,000
for fiscal year 2001 and each subsequent fiscal year.
SEC. 502. DEVELOPMENT OF OUTCOME MEASURES; STUDY TO MEASURE PATIENT
OUTCOMES UNDER THE MEDICARE AND MEDICAID PROGRAMS
BY RACE AND ETHNICITY.
(a) Development of Outcome Measures.--Not later than 1 year after the
date of the enactment of this Act, the Secretary of Health and Human
Services, acting through the Administrator of the Health Care Financing
Administration, shall develop outcome measures to evaluate, by race and
ethnicity, and on an age-specific and sex-specific basis, the
performance of health care programs and projects that provide health
care to individuals under the medicare and medicaid programs (under
titles XVIII and XIX, respectively, of the Social Security Act (42
U.S.C. 1395 et seq. and 1396 et seq.).
(b) Study.--After the Secretary develops the outcome measures under
subsection (a), the Secretary shall conduct a study that evaluates, by
race and ethnicity, and on an age-specific and sex-specific basis, the
performance of health care programs and projects referred to in
subsection (a) in relation to such outcome measures.
(c) Report to Congress.--Not later that 2 years after the date of the
enactment of this Act, the Secretary of Health and Human Services shall
submit to Congress a report describing the outcome measures developed
under subsection (a), and the results of the study conducted pursuant
to subsection (b).
SEC. 503. DEPARTMENTAL DEFINITION REGARDING MINORITY INDIVIDUALS.
Section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u-
6) is amended--
(1) by striking ``Asian Americans and'' and inserting ``Asian
Americans;''; and
(2) by inserting ``Native Hawaiians and other'' before
``Pacific Islanders;''.
SEC. 504. CONFORMING PROVISION REGARDING DEFINITIONS.
For purposes of this Act, the term ``racial and ethnic minority
group'' has the meaning given such term in section 1707 of the Public
Health Service Act.
TITLE VI--EFFECTIVE DATE
SEC. 601. EFFECTIVE DATE.
This Act and the amendments made by this Act take effect October 1,
2000, or upon the date of the enactment of this Act, whichever occurs
later.
Purpose and Summary
The purpose of this legislation is to address disparities
that exist in biomedical and behavioral research, health
education, and the study and collection of date regarding
health disparity populations. Health disparity populations are
defined as populations for which there is a significant
disparity in the overall rate of disease, morbidity, mortality
or survival rates as compared to the health status of the
general population.
Among the activities authorized by the legislation is the
establishment of a National Center for Research on Minority
Health and Health Disparities at the National Institute of
Health (NIH) to help coordinate research related to health
disparities and develop a comprehensive research agenda that
seeks to address differences in morbidity and mortality in
minority and underserved populations. Further, the bill will
authorize the Agency for Healthcare Research and Quality (AHRQ)
to conduct and support research related to quality and outcomes
in health care for health disparity populations. It will also
require the National Academy of Sciences to study and report to
Congress on the Department of Health and Human Services (HHS)
data collection systems and practices relating to collection of
data on race and ethnicity and create new grants for health
education curricula development on health disparities. The
legislation also requires the Secretary to conduct a national
media campaign to inform the public of programs and activities
of the Office of Civil Rights in the Department of HHS.
Finally, the legislation requires the Secretary to develop
outcomes measures for the Medicare and Medicaid programs to
address the needs of health disparity populations.
Background and Need for Legislation
Studies indicate that, despite overall improvement in the
Nation's health over the past two decades, disparities exist in
incidence of disease, disability, and death due to health
status for African Americans, Hispanics, American Indians,
Alaskan Natives and Asian Pacific Islanders, and other
underserved Americans compared to the U.S. population as a
whole.
For example, the infant mortality rate for African
Americans is almost twice that of white Americans. Deaths due
to heart disease are more than 40 percent higher for blacks
than for whites. The death rate for all cancers is almost 30
percent higher for blacks as it is for whites. The death rate
due to HIV/AIDs is more than seven times greater for African
Americans as it is for white Americans.
Hispanics are almost twice as likely to die from
complications related to diabetes than whites. American Indians
and Alaskan Natives have an infant mortality rate almost twice
that of whites. Vietnamese women suffer from cervical cancer at
nearly 5 times the rate of white women.
H.R. 3250 will address the need for research, education,
and data collection regarding these and other health
disparities. Important changes were made to H.R. 3250 to
address concerns raised by some Committee Members. Chief among
these concerns related to the legislation's sole focus on
racial and ethnic minorities as opposed to medically
underserved populations. The definition of ``health disparity
population'' was added to ensure that all Americans who suffer
disproportionate levels of disease incidence, morbidity, and
mortality would be included in research, education, and data
collection programs under H.R. 3250.
Another significant change was made to the bill by removing
the provision that allowed for the new Center for Research on
Minority Health and Health Disparities to receive direct
funding from the appropriation for the Department of Health and
Human Services. This so-called ``bypass budget'' would have
allowed funding for the Center to bypass the Secretary of HHS
and the Director of NIH, removing any discretion they would
have over budget issues for the Center. The Committee amendment
removed the bypass budget authority for the Center.
Hearings
The Subcommittee on Health and Environment held a hearing
on H.R. 3250, the Health Care Fairness Act of 1999 on May 11,
2000. The Subcommittee received testimony from: The Honorable
Jesse Jackson, Jr., M.C., the Honorable J. C. Watts, M.C., the
Honorable John Lewis, M.C., the Honorable J. D. Hayworth, M.C.,
the Honorable Robert Underwood, M.C., and the Honorable Ciro
Rodriguez, M.C.
The Subcommittee also received testimony from: The
Honorable David Satcher, M.D., Surgeon General, accompanied by
Kermit Smith, M.D., Chief Medical Officer of the Indian Health
Service and John Ruffin, PhD., Associate Director, Office of
Research on Minority Health, National Institutes of Health;
Louis Sullivan, M.D., President, Morehouse School of Medicine;
Gilbert Friedell, M.D., Director for Cancer Control, Markey
Cancer Center, University of Kentucky on behalf of the
Institute of Medicine; Jordan Cohen, M.D., President,
Association of American Medical Colleges; Kevin Schulman, M.D.,
Associate Professor of Medicine and Director, Center for
Clinical and Genetic Economics, Duke University Medical Center;
E. Anne Peterson, MD, MPH, Health Commissioner, Commonwealth of
Virginia; John Harley, M.D., Member of Arthritis Immunology,
Oklahoma Medical Research Foundation; Elena Rios, M.D.,
President, National Hispanic Medical Association; and Mr.
Ignatius Bau, Director of Health Policy, Asian Pacific-Islander
American Health Forum.
Committee Consideration
On July 26, 2000, the Subcommittee on Health and
Environment was discharged from the further consideration of
H.R. 3250. On July 26, 2000, the Committee on Commerce met in
open markup session and ordered H.R. 3250 reported, with an
amendment, by a voice vote.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report legislation and amendments thereto.
There were no record votes taken in connection with ordering
H.R. 3250 reported. A motion by Mr. Bliley to order H.R. 3250
reported to the House, with an amendment, was agreed to by a
voice vote.
The following amendments were agreed to by a voice vote--
An amendment in the nature of a substitute by Mr.
Bilbray, No. 1, addressing disparities in health care
research, education and data collection for health
disparity populations.
An amendment to the amendment in the nature of a
substitute by Ms. DeGette, No. 1a, including age-based
and sex-based criteria in developing health care
outcomes measures for health disparity populations in
the Medicare and Medicaid programs, (as modified by a
unanimous consent request).
An amendment to the amendment in the nature of a
substitute by Mr. Engel, No. 1b, including
consideration of environmental factors when researching
causes of health disparities.
Committee Oversight Findings
Pursuant to clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the Committee held a legislative
hearing and made findings that are reflected in this report.
Committee on Government Reform Oversight Findings
Pursuant to clause 3(c)(4) of rule XIII of the Rules of the
House of Representatives, no oversight findings have been
submitted to the Committee by the Committee on Government
Reform.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee finds that H.R.
3250, the Health Care Fairness Act of 2000, would result in no
new or increased budget authority, entitlement authority, or
tax expenditures or revenues.
Committee Cost Estimate
The Committee adopts as its own the cost estimate prepared
by the Director of the Congressional Budget Office pursuant to
section 402 of the Congressional Budget Act of 1974.
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
provided by the Congressional Budget Office pursuant to section
402 of the Congressional Budget Act of 1974:
U.S. Congress
Congressional Budget Office,
Washington, DC, September 21, 2000.
Hon. Tom Bliley,
Chairman, Committee on Commerce,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 3250, the Health
Care Fairness Act of 2000.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Christopher
J. Topoleski.
Sincerely,
Barry B. Anderson
(For Dan L. Crippin, Director).
Enclosure.
H.R. 3250--Health Care Fairness Act of 2000
Summary: H.R. 3250 would expand the role of the federal
government in supporting research on the health needs of racial
and ethnic minorities as well as health disparity
populations.\1\
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\1\ Health disparity populations are defined as populations with a
significant disparity in the overall rate of disease incidence,
morbidity, mortality, and survival rates in the population as compared
to the health of the general population. Specific determinations of
health disparity populations would be made by the Director of the
National Center for Research on Minority Health and Health Disparities
in consultation with the Director of the Agency for Healthcare Research
and Quality (AHRQ).
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The Health Care Fairness Act of 2000 would affect the
National Institutes of Health (NIH), the Agency for Healthcare
Research and Quality (AHRQ), the Health Resources and Services
Administration (HRSA), the Office of Civil Rights, and the
Health Care Financing Administration (HCFA). The bill would
replace the Office of Research on Minority Health (ORMH) within
the Office of the Director of NIH with a new center focusing on
the health needs of racial and ethnic minorities and health
disparity populations. The center is designed to promote
cooperation among federal, state and local health agencies, and
private entities in health disparity research.
AHRQ would be responsible for developing quality
measurement mechanisms to examine the extent to which the
health needs of minority and health disparity populations are
met, including examination and support of demonstration
projects. HRSA, the Office of Civil Rights, and HCFA, would be
responsible for various initiatives, programs, incentives, and
reports to better understand the needs of minority and health
disparity populations.
Assuming the appropriation of the necessary amounts, CBO
estimates that implementing H.R. 3250 would cost $43 million in
2001 and $402 million over the 2001-2005 period, assuming
annual adjustments for inflation for those activities without
specified authorization levels. The five-year total would be
$397 million if such inflation adjustments are not made. The
legislation would not affect direct spending or receipts;
therefore, pay-as-you-go procedures would not apply.
H.R. 3250 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
It would authorize a number of grant and assistance programs
for which state and other public entities, especially colleges
and universities, could qualify.
Estimated cost to the Federal Government: The estimated
budgetary impact of H.R. 3250 is shown in the following table.
The costs of this legislation fall within budget function 550
(health).
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By fiscal year, in millions of dollars--
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2000 2001 2002 2003 2004 2005
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SPENDING SUBJECT TO APPROPRIATION
Spending Under Current Law:
Estimated Authorization Level \1\..................... 1,548 1,580 1,612 1,643 1,676 1,709
Estimated Outlays..................................... 1,341 1,468 1,531 1,588 1,614 1,646
Proposed Changes \2\
Estimated Authorization Level......................... 0 99 104 103 100 98
Estimated Outlays..................................... 0 43 72 91 98 98
Spending Under H.R. 3250:
Estimated Authorization Level......................... 1,548 1,679 1,716 1,746 1,776 1,807
Estimated Outlays..................................... 1,341 1,511 1,603 1,679 1,712 1,744
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\1\ The 2000 level is the amount appropriated for that year for the agencies that would be affected by H.R.
3250. The 2001-2005 levels are CBO baseline projections, including adjustments for anticipated inflation.
\2\ The amounts shown reflect adjustments for anticipated inflation for those activities for which the bill
would authorize such sums as necessary. Without such inflation adjustments, the five-year changes in
authorization levels would total $493 million (instead of $504 million) and the changes in outlays would total
$397 million (instead of $402 million).
Basis of estimate: For this estimate, CBO assumes that the
bill would have an effective date of October 1, 2000, and that
outlays would follow historical spending rates for the relevant
agencies for the authorized activities. Where specified in H.R.
3250, CBO assumes the authorized amounts would be appropriated.
Where appropriations of such sums as necessary are authorized,
CBO based its estimates on amounts spent in the past for
similar types of activities.
Many of the proposed activities under H.R. 3250 are
currently handled by the ORMH and are reflected in the
estimated changes to both budget authority and outlays. The
estimates of changes in budget authority and outlays of the
proposal reflect the incremental cost of additional
responsibilities of the NIH and other offices and agencies.
Pay-as-you-go considerations: None.
Estimated impact on state, local, and tribal governments:
H.R. 3250 contains no intergovernmental mandates as defined in
UMRA. It would authorize a number of grant and assistance
programs for which state and other public entities, especially
colleges and universities, could qualify. Among those programs
are grants and contracts for biomedical and behavioral
education and research targeting minorities and other
populations that face high levels of disease and mortality. The
bill would also authorize grants for developing curricula in
medical schools and continuing education programs that aim to
reduce disparities in health care among racial and ethnic
groups. Finally, the bill would authorize grants to states for
establishing and operating ombudsman programs designed to
identify, investigate, and facilitate the resolution of civil
rights complaints.
Estimated impact on the private sector: The bill contains
no private-sector mandates as defined in UMRA.
Estimate prepared by: Federal Costs: Christopher J.
Topoleski. Impact on State, Local, and Tribal Governments: Leo
Lex. Impact on the Private Sector: Rekha Ramesh.
Estimate approved by: Peter H. Fontaine, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
Advisory Committee Statement
Section 404 of H.R. 3250 creates an advisory committee to
advise the Secretary on matters related to the development,
implementation, and evaluation of curricula for graduate and
continuing medical education for health care professionals to
decrease disparities in health care and health outcomes.
Pursuant to the requirements of subsection 5(b) of the Federal
Advisory Committee Act, the Committee finds that the functions
of the proposed advisory committee are not and cannot be
performed by an existing Federal agency or advisory commission
or by enlarging the mandate of an existing advisory committee.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for this legislation is provided in
Article I, section 8, clause 3, which grants Congress the power
to regulate commerce with foreign nations, among the several
States, and with Indian tribes.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
Section 1. Short title; table of contents
This section provides the short title of the bill, the
``Health Care Fairness Act of 2000,'' and includes a table of
contents.
Section 2. Findings
This section provides certain Congressional findings.
TITLE I: IMPROVING MINORITY HEALTH THROUGH THE NATIONAL INSTITUTES OF
HEALTH; ESTABLISHMENT OF NATIONAL CENTER
Section 101. Establishment of National Center for Research on Minority
Health and Health Disparities
Subsection (a) amends part E of the title IV of the Public
Health Service Act (PHSA) by creating a new subpart 6 creating
a National Center for Research on Minority Health and Health
Disparities.
New section 485E(a) establishes the purpose of the National
Center for Research on Minority Health and Health Disparities,
which is the conduct and support of basic and clinical
research, training, the dissemination of health information,
and other programs with respect to the health of racial and
ethnic minority groups and other health disparity populations.
New subsection (b) establishes priorities for the Center.
With appropriated funds, the Director of the Center must give
priority to conducting and supporting minority health research.
New subsection (c) defines ``Minority health research'' as
research on minority health conditions, research on access,
outreach, treatment, quality of health care, and research on
cultural and linguistic services to decrease health problems of
minorities. The term ``Minority health conditions'' is defined
as all diseases, disorders, and conditions (including mental
health and substance abuse) (1) that are unique to, more
serious or prevalent in ethnic or minority groups, (2) or for
which factors of medical risk or medical interventions are
different, or (3) for which insufficient research or data
exists. The term ``Racial and ethnic minority group'' is
defined as American Indians (including Alaska Natives, Eskimos,
and Aleuts); Asian Americans, Native Hawaiians and other
Pacific Islanders; Blacks; and Hispanics. The term
``Minorities'' is defined as being individuals from a racial or
ethnic group.
New subsection (d) defines a ``health disparity
population'' as one determined by the Director of the Center,
after consultation with the Director of the Agency for
Healthcare Research and Quality (AHRQ), to have a significant
disparity in the overall rate of disease incidences, morbidity,
mortality, and survival rates within that population as
compared to the health status of the general population. Health
disparity populations include racial and ethnic minority
groups. The term ``Health disparities research'' is defined as
research on health disparity populations that relates to the
health disparities involved, including basic and applied
biomedical and behavioral research on the nature and causes of
health disparities, and remedies for such disparities. Minority
health research is included in health disparities research.
After providing for minority health research with appropriated
funds, the Secretary must conduct and support health
disparities research on other health disparity populations,
giving priority to health disparity populations for which
socioeconomic status is one of the principal causal factors of
health disparity.
New subsection (e) requires that the Director of the Center
coordinate all minority health and other health disparities
research conducted or supported by the National Institutes of
Health (NIH). Also, the Director of the Center represents the
health disparities research program of NIH at all relevant
Executive branch task forces, committees and planning
activities, and maintains communications with all relevant
Public Health Service agencies and other departments of the
Federal government.
New subsection (f) provides that the Director of NIH, the
Director of the Center, and the directors of the national
research institutes must establish a comprehensive plan and
budget for the conduct and support of all minority health and
other health disparities research activities of the agencies of
the National Institutes of Health. The first plan and budget
must be established no later than 12 months after the date of
the enactment. The Directors must: ensure that the plan and
budget demonstrate how activities in health disparities
research will address the health needs of specific health
disparity populations; establish priorities among the
activities in health disparities research that such agencies
are authorized to carry out; and establish objectives and
action plans, including target dates, for carrying out health
disparities research. Also, the Directors must: ensure that the
plan and budget give priority to conducting and supporting
minority health research;ensure that all amounts appropriated
for such activities are expended in accordance with the plan and
budget; review the plan and budget not less than annually; and revise
the plan and budget as appropriate. The plan and budget must serve as a
statement of policies regarding minority health and other health
disparities research activities of the agencies, but heads of the
agencies are responsible for the approval of specific programs or
projects in accordance with the plan and budget. The Director of the
Center is required to include budget provisions for (1) basic and
applied research; (2) research that is conducted by the agencies; (3)
research that is supported by the agencies; (4) solicited and
unsolicited proposals; and (5) behavioral research and social sciences
research. The collaborative comprehensive plan and budget must include
a separate statement of the plan and budget for minority health
research.
New subsection (g) requires that the Director of the Center
to assist in the administration of requirements to include
women and minorities in clinical research.
New subsection (h) authorizes the Director of the Center to
provide for research endowments at centers of excellence
(health professions schools with significant minority
enrollment) to facilitate minority health research.
New subsection (i) requires the Director of the Center to
assist the Director of the National Center for Research
Resources in carrying out requirements and committing resources
for institutions of emerging excellence. Also, the Director of
the Center must establish projects to promote cooperation in
minority health disparities research among governmental,
regional and private entities. The Director of the Center may
conduct or support research on service delivery models to
reduce health disparities and may use information from earlier
initiatives on minorities and other health disparity
populations.
New subsection (j) directs the Secretary to establish an
advisory council to make recommendations to the Director of the
Center on matters related to the Center's research mission,
budgetary allocations, and report reviews. A majority of
members of the advisory council must be representatives of
various racial and ethnic minority groups, other health
disparity populations must be included, and a diversity of
health professions must be represented. A representative of the
Office of Behavioral and Social Sciences Research must also be
a member of the advisory council.
New subsection (k) requires that the Director of the Center
must submit an annual report to Congress, the Secretary, and
the Director of NIH describing and evaluating NIH health
disparities research, and such research supported by the
national research institutes, as well as a separate analysis of
minority health research. As part of that report, the Director
may include recommendations.
New subsection (l) authorizes appropriations of $100
million for FY 2001, and such sums as necessary for each for
the fiscal years 2002 through 2005. Authorization of
appropriations made by this subsection is in addition to other
monies or funds available for the conduct and support of
minority health or other health disparities research by the
national research institutes and other agencies of the NIH.
Section 101(b) makes a conforming amendment by repealing
section 404 of the PHSA.
Section 102. Centers of excellence for research education and training
This section further amends subpart 6 of part E of title IV
of the PHSA (as added by section 101 of this bill) by adding at
the end a new section 485F, establishing a Center for
Excellence for Research Education and Training.
New subsection (a) authorizes the Director of the Center to
award grants or contracts to biomedical and behavioral research
institutions designated as centers of excellence, or to
designated consortia, in support of programs of excellence in
biomedical and behavioral research education for individuals
who are members of health disparity populations, including
minorities.
New subsection (b) permits the Director to make an award to
an applicant only if the applicant agrees that the grant will
be expended to: (1) conduct minority health research, including
research on the use of service delivery models (such as health
centers under section 330 of the PHSA) with respect to minority
health conditions; (2) train minorities and other members of
health disparities populations as professionals in the area of
biomedical or behavioral research; or (3) alter existing
research facilities or construct new research facilities for
the purpose of conducting minority health research.
New subsection (c) establishes that an institution is a
designated biomedical and behavioral research institution if it
has a significantnumber of health disparity students, including
minorities, enrolled in the institution, has a record of effectiveness
in recruiting, assisting, supporting and graduating such students from
its educational programs. One or more designated biomedical and
behavioral research institutions may form a consortium to receive a
``center of excellence'' grant or contract. Criteria established under
this section regarding minorities may not be applied to other programs.
New subsection (d) establishes the duration of the grant.
The grant period may not exceed 5 years. Grant payments are
subject to the availability of appropriations and to annual
approval by the Director.
New subsection (e) provides that, in order to receive an
award, the institution must agree to maintain expenditures of
non-Federal amounts for its activities at a level that is not
less than what the institution expended for the fiscal year
preceding the year the award is made. The Director may make
awards to designated research institutions or consortia only if
the institutions involved agree that they will first expend
federal amounts obtained from sources other than the award.
New subsection (f) authorizes the Director to permit
designated research institutions or consortia to expend a
portion of an award for research endowments.
New subsection (g) defines certain terms. While
``Designated biomedical and behavioral research institution,''
is defined in new subsection (c), a ``program of excellence''
is defined as a program carried out by a designated biomedical
research institution under new subsection (b).
Finally, new subsection (h) authorizes such sums as
necessary for each of the fiscal years 2001 through 2005 for
grants and contracts to centers of excellence.
Section 103. Loan Repayment Program for minority health research
Section 103 adds another section to subpart 6 of part E of
title IV of the PHSA by adding a new section 485G, establishing
a Loan Repayment Program for Minority Health Research.
New subsection (a) directs the Director of the Center to
establish a program of offering contracts to qualified health
professionals to conduct minority health research in exchange
for repayment of up to $35,000 for educational loans.
New subsection (b) ensures that provisions in current law
for the National Health Service Corps (338B), Obligated Service
(338C), and Breaches of Scholarship Contract or Loan Repayment
Contract (338E) apply to the proposed ``Loan Repayment Program
for Minority Health Research.''
New subsection (c) requires the Director of the Center to
ensure that at least 50% of all contracts are for appropriately
qualified health professionals who are members of a health
disparity population.
New subsection (d) requires the Secretary to ensure that
priority is given to biomedical research projects.
New subsection (e) authorizes to be appropriated such sums
as may be necessary for each of the fiscal years 2001 through
2005 for this loan repayment program. Amounts available must
remain available for 2 fiscal years beyond the fiscal year when
amounts were made available.
Section 104. General provisions regarding the center
Section 104 amends subpart 6 of part E of title IV of the
PHSA, as amended by section 103 of this bill by adding a new
section 485 H describing general provisions regarding the
Center.
New subsection (a) requires that the Secretary, acting
through the Director of the NIH, provide administrative support
and support services to the Director of the Center, and ensure
that such support takes maximum advantage of existing
administrative structures at NIH.
New subsection (b) directs the Secretary within 5 years to
evaluate the effect of the Center for Research on Minority
Health and Health Disparities on the planning and coordination
of health disparities research programs at the institutes,
centers and divisions of NIH. The report should include
recommendations concerning future legislation and
administrative modifications to the Center. Within 1 year of
completing the evaluation, the Secretary must submit a report
on the evaluation to the Senate Committee on Health, Education,
Labor, and Pensions and the House Committee on Commerce.
Section 105. Report regarding resources of National Institutes of
Health dedicated to research on minority health
By December 1, 2003, the Director of the National Center
for Research on Minority Health and Health Disparities must
submit to Congress, the Secretary of HHS, and the Director of
NIH a report on recommendations for the method that should be
used to determine the level of resources that the NIH dedicates
to research on minority health. The report must determine the
extent to which there has been an increase in NIH resources
dedicated to minority health research since FY 1999, and in the
number and amount of awards to minority-serving institutions.
TITLE II: HEALTH DISPARITIES RESEARCH BY THE AGENCY FOR HEALTHCARE
RESEARCH AND QUALITY
Section 201. Health disparities research by Agency for Healthcare
Research and Quality
Subsection (a) amends Part A of Title IX of the PHSA by
creating a new section 903 for Research on Health Disparities.
New subsection (a) directs the Director of the Agency for
Healthcare Research and Quality (AHRO) to conduct and support
research for various purposes, including how to improve the
quality and outcomes of health care services for health
disparity populations, developing measures for assessing and
improving the quality and appropriateness of health care
services provided to health disparity populations, and
providing support to increase the number of researchers who are
members of health disparity populations.
New subsection (b) requires the Director to conduct and
support research to identify the clinical, cultural,
socioeconomic, and organizational factors that contribute to
health disparities; identify and evaluate clinical and
organizational strategies to improve quality, outcomes, and
access to care for health disparity populations; support
demonstrations to test strategies for quality improvement; and
disseminate strategies for which there is evidence of
effectiveness. The Director must implement research strategies
and mechanisms that will enhance the involvement of members of
health disparity populations, health services researchers who
are such individuals, institutions that train such individuals
as researchers, and others. Such research strategies and
mechanisms may include the use of centers of excellence,
provider-based research networks, service delivery models and
other innovative mechanisms that will facilitate the
translation of past research investments into clinical
practices that can benefit these populations.
New subsection (c) requires the Director of AHRQ to support
the development of quality of health care measures that assess
the experience of health disparity populations with health care
systems. The Administrator must, in consultation with the
Administrator of the Health Resources and Services
Administration (HRSA) examine the practices of providers that
have a record of reducing health disparities or have experience
in providing culturally competent health services to minority
or other health disparity populations. Within two years of
enactment, the Secretary must prepare and submit to Congress a
report describing the state-of-the-art of quality measurement
for minority and other health disparity populations that will
identify critical needs and the activities of the Department to
meet those needs, together with a description of related
activities in the private sector.
New subsection (d) references the definition given to
``health disparity population'' in section 485E.
Section 201(b) authorizes such sums as may be necessary for
each of the fiscal years 2001 through 2005 for research
conducted by AHRQ.
TITLE III: DATA COLLECTION RELATING TO RACE OR ETHNICITY
Section 301. Study and report by National Academy of Sciences
Subsection (a) authorizes the National Academy of Sciences
(NAS) to conduct a comprehensive study of data collection
systems and practices on characteristics of race or ethnicity
within the Department of HHS. The study must include other
federal data collection systems with which the Department
interacts to collect relevant data on race and ethnicity.
Subsection (b) requires the NAS to submit a report within
one year of enactment to the Senate Committee on Health,
Education, Labor, and Pensions and the House Committee on
Commerce. The report must identify data needed to evaluate the
effects of race and ethnicity on access to health care and
disparities in health care; examine the effectiveness of the
systems and practices of HHS and other federal and state
agencies in collecting and analyzing data on race or ethnicity;
recommend how the HHS may collect reliable and complete
information relating to race and ethnicity; and include
projections about the costs associated with the implementation
of the recommendations, and possible effects on the costs on
program operations.
Subsection (c) authorizes such sums as necessary for FY2001
for the NAS study.
TITLE IV: MEDICAL EDUCATION AND OTHER HEALTH PROFESSIONS EDUCATION
Section 401. Grants for health care education curriculum development
Section 401 amends part F of title VII of the PHSA by
including a new subsection for Grants for Health Professional
Education Curriculum Development.
New subsection (a) authorizes the Secretary, acting through
the Administrator of the Health Resources and Services
Administration, and in collaboration with the Director of AHRQ
and the Deputy Assistant Secretary for Minority Health to award
grants, contracts, or cooperative agreements to public and
nonprofit private entities for carrying out research and
demonstration projects to develop curricula to reduce
disparities in health care outcomes. Schools of medicine,
osteopathic medicine, dentistry, public health, nursing, and
others are eligible to apply for an award. Award periods for
each grant, contract, or cooperative grant are limited to three
years. The Secretary must make awards in each of the first and
second fiscal years for which funds are available through
authorized appropriations.
New subsection (b) allows the Secretary, acting through the
Administrator of the Health Resources and Service
Administration, and in collaboration with the Director of the
AHRQ and the Deputy Assistant Secretary for Minority Health, to
award grants for developing curricula in continuing education
for health professions to reduce disparities in health care and
health outcomes. The curricula must focus on the need to remove
bias from health care at personal and systemic levels. Schools
of medicine, osteopathic medicine, dentistry, public health,
nursing, and others are eligible to apply for those grants. The
Secretary must make awards available the first two years for
which funds are available through authorized appropriations.
Award periods for each grant are limited to three years.
New subsection (c) requires that projects initiated as part
of this grant program be carried out in each of the principal
geographic regions of the United States and must involve
different health disparity populations and health professions.
New subsection (d) requires grant recipients to ensure that
procedures are in place to monitor the activities supported by
the grant, contract, or cooperative agreements. The award
recipient must submit to the Secretary an annual report on the
effectiveness of the curriculum that was developed under the
agreement.
New subsection (e) directs the Secretary to submit a report
to Congress no later than January 1, 2002, detailing the
effectiveness of the grant's program for curricula development
to reduce disparities in health care and health care outcomes.
The Secretary must submit a final report no later than January
1, 2004.
New subsection (f) authorizes appropriations for curriculum
development at the following levels: $3.5 million for FY2001;
$7 million for FY2002; $7 million for FY2003; and, $3.5 million
for FY2004.
Section 402. National conference on continuing health professional
education and disparities in health outcomes
Subsection (a) requires the Secretary to convene within one
year of enactment a national conference on continuing medical
education as a method for reducing disparities in health
outcomes. The conference must include sessions that address
measurements of outcomes to assess the effectiveness of
curricula in reducing disparities.
Subsection (b) directs the Secretary to invite to the
conference members of minority and other health disparity
populations, advocacy groups, health education entities, health
centers grantees, and other interested parties.
Subsection (c) requires that the conference address various
issues, including the role of continuing medical education in
reducing disparities in health care and health outcomes. A
focus of the conference will be methods and strategies to
achieve reduction in disparities in health and health care
through continuing medical education courses or programs.
Subsection (d) requires the Secretary to publish in the
Federal Register a summary of the proceedings and findings
within 6 months of the national conference.
Subsection (e) authorizes to be appropriated such sums as
may be necessary for the conference.
Section 403. Continuing Medical Education Incentive Program
Subsection (a) requires the Secretary to develop and
implement a program to provide incentives to health maintenance
organizations, community health centers, rural health centers
and other entities that provide services under the Medicare or
Medicaid program to encourage health professionals to
participate in continuing medical education programs designed
to reduce health disparities.
Subsection (b) targets the Continuing Medical Education
Incentive program incentives to programs that (1) implement new
curricula or strategies for continuing medical education
designed to reduce health disparities; (2) encourage health
professionals to participate in such curricula, and (3) monitor
health care and health outcome to evaluatethe effectiveness of
continuing medical education programs in reducing health care
disparities.
Subsection (c) references the definition given to ``health
disparity population'' in section 485E.
Subsection (d) authorizes to be appropriated such sums as
necessary for the incentive program.
Section 404. Advisory Committee
Subsection (a) requires the Secretary to establish an
Advisory Committee to advise the Secretary on matters related
to the development, implementation and evaluation of curricula
for graduate and continuing education for health care
professionals to decrease disparities in health care and health
outcomes.
Subsection (b) directs the Secretary to approve members of
the Advisory Committee within three months of the date when
appropriations are provided for the program. Advisory Committee
members must (1) not be officers or employees of the Federal
government; (2) be experienced in issues related to health
disparities; and, (3) be members and representatives of racial
and ethnic minority groups or health disparity populations.
Also, the Advisory Committee must include persons experienced
in providing health services to racial and ethnic minority
groups or other health disparity populations including
representatives of health centers, the Office of Minority
Health, the Health Resources and Services Administration, and
other agencies of the PHS.
Subsection (c) requires the Advisory Committee to
collaborate with the Office of Minority Health of HHS and other
offices, centers, and institutes of HHS and Federal agencies.
Subsection (d) terminates the Advisory Committee four years
from the date when the first member of the committee is
appointed.
Subsection (e) allows the Secretary to appoint the existing
advisory committee in the Office of Minority Health of HHS to
serve as the advisory committee established by this section.
Section 405. Cultural competency clearinghouse
Subsection (a) requires the Director of the Office of
Minority Health of HHS to establish an information
clearinghouse for curricula to reduce disparities in health
care and health outcomes. The clearinghouse must facilitate and
enhance knowledge and understanding of practices that lead to
reductions in health disparities.
Subsection (b) establishes that information contained in
the clearinghouse be made available to minority health advocacy
groups and other organizations representing health disparity
populations, health education entities, health maintenance
organizations and other interested parties.
Subsection (c) authorizes to be appropriated such sums as
may be necessary for the clearinghouse.
TITLE V: MISCELLANEOUS PROVISIONS
Section 501. Office for Civil Rights
Subsection (a) requires the Secretary to conduct a national
media campaign to inform the public of programs and activities
of the Office for Civil Rights in HHS. The campaign must focus
on racial and ethnic minority communities, and involve racial
and ethnic minority media in the design and as participants.
Such sums as may be necessary for FY2001 are authorized to be
appropriated.
Subsection (b) directs the Secretary to carry out a
demonstration program in which grants are made to states to
establish and operate ``State Ombudsman Offices,'' which are
modeled after State Long-Term Care Ombudsman programs
established in title VII of the Older Americans Act of 1965.
The offices are to identify, investigate, and facilitate the
resolution of civil rights complaints.
Subsection (c) authorizes $36 million to be appropriated
for the Office for Civil Rights for fiscal year 2001 and each
subsequent fiscal year.
Section 502. Development of outcome measures; study to measure patient
outcomes under the Medicare and Medicaid programs by race and
ethnicity
Subsection (a) requires the Secretary to develop, within
one year of enactment, outcome measures to evaluate, by race
and ethnicity, and on an age-specific and sex-specific basis,
the performance of health care programs and projects that
provide health care to individuals under the Medicare and
Medicaid programs.
Subsection (b) directs the Secretary to evaluate the
performance of health care programs and projects under the
Medicare and Medicaid programs, using the specific outcome
measures developed under this section.
Subsection (c) requires the Secretary, within two years of
enactment, to submit a report to Congress on the development of
outcome measures and the results of the study evaluating the
measures in the context of the Medicare and Medicaid programs.
Section 503. Departmental definition regarding minority individuals
This section amends section 1707(g)(1) of the Public Health
Service Act to add ``Native Hawaiian'' to the current
definition of ``racial and ethnic minority groups.''
Section 504. Conforming provision regarding definitions
This section provides that the definition of ``racial and
ethnic minority groups,'' as amended, conforms with provisions
in the bill.
TITLE VI: EFFECTIVE DATE
Section 601. Effective date
This section provides that provisions of this bill take
effect on October 1, 2000, or upon date of enactment, whichever
occurs later.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules
of the House of Representatives, changes in existing law made
by the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE IV--NATIONAL RESEARCH INSTITUTES
Part A--National Institutes of Health
organization of the national institutes of health
Sec. 401. (a) * * *
(b)(1) * * *
* * * * * * *
(2) The following entities are agencies of the National
Institutes of Health:
(A) * * *
* * * * * * *
(F) The National Center for Complementary and
Alternative Medicine.
(G) The National Center for Research on Minority
Health and Health Disparities.
* * * * * * *
[office of research on minority health
[Sec. 404. (a) Establishment.--There is established within
the Office of the Director of NIH an office to be known as the
Office of Research on Minority Health (in this section referred
to as the ``Office''). The Office shall be headed by a
director, who shall be appointed by the Director of NIH.
[(b) Purpose.--The Director of the Office shall--
[(1) identify projects of research on minority health
that should be conducted or supported by the national
research institutes;
[(2) identify multidisciplinary research relating to
research on minority health that should be so conducted
or supported;
[(3) promote coordination and collaboration among
entities conducting research identified under paragraph
(1) or (2);
[(4) encourage the conduct of such research by
entities receiving funds from the national research
institutes;
[(5) recommend an agenda for conducting and
supporting such research;
[(6) promote the sufficient allocation of the
resources of the national research institutes for
conducting and supporting such research; and
[(7) assist in the administration of section 492B
with respect to the inclusion of members of minority
groups as subjects in clinical research.]
* * * * * * *
Part E--Other Agencies of NIH
* * * * * * *
Subpart 6--National Center for Research on Minority Health and Health
Disparities
SEC. 485E. PURPOSE OF CENTER.
(a) In General.--The general purpose of the National Center
for Research on Minority Health and Health Disparities (in this
subpart referred to as the ``Center'') is the conduct and
support of basic and clinical research, training, the
dissemination of health information, and other programs with
respect to the health of racial and ethnic minority groups and
other health disparity populations.
(b) Priorities.--The Director of the Center shall in
expending amounts appropriated under this section give priority
to conducting and supporting minority health research.
(c) Minority Health Research.--For purposes of this subpart:
(1) The term ``minority health research'' means
research on minority health conditions (as defined in
paragraph (2)), including research on preventing such
conditions; research on access, outreach, treatment,
and the quality of health care; and research on
cultural and linguistic services for decreasing the
extent of health problems associated with such
conditions.
(2) The term ``minority health conditions'', with
respect to individuals who are members of racial and
ethnic 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 individuals;
(B) for which the factors of medical risk or
types of medical intervention are different for
such individuals, 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
individuals as subjects or insufficient data on
such individuals.
(3) The term ``racial and ethnic minority group'' has
the meaning given such term in section 1707.
(4) The term ``minorities'' means individuals from a
racial or ethnic minority group.
(d) Health Disparity Populations.--
(1) In general.--For purposes of this subpart:
(A) A population is a health disparity
population if, as determined by the Director of
the Center after consultation with the Director
of the Agency for Healthcare Research and
Quality, there is a significant disparity in
the overall rate of disease incidence,
morbidity, mortality, or survivalrates in the
population as compared to the health status of the general population.
(B) The term ``health disparity populations''
includes racial and ethnic minority groups.
(C) The term ``health disparities research''
means research on health disparity populations
(and individual members and communities of such
populations) that relates to the health
disparities involved, including basic and
applied biomedical and behavioral research on
the nature of health disparities, the causes of
such disparities, and remedies for such
disparities. Such term includes minority health
research.
(2) Priority.--With amounts available under this
section for a fiscal year after providing for minority
health research in accordance with subsection (b), the
Secretary shall conduct and support health disparities
research on other health disparity populations, with
priority given to such research on health disparity
populations for which socioeconomic status is one of
the principal causal factors with respect to being a
health disparity population.
(e) Coordination of Activities.--The Director of the Center
shall act as the primary Federal official with responsibility
for overseeing all minority health and other health disparities
research conducted or supported by the National Institutes of
Health, and--
(1) shall represent the health disparities research
program of the National Institutes of Health, including
the minority health research program, at all relevant
Executive branch task forces, committees and planning
activities; and
(2) shall maintain communications with all relevant
Public Health Service agencies and with various other
departments of the Federal Government, to ensure the
timely transmission of information concerning advances
in minority health and other health disparities
research between these various agencies for
dissemination to affected communities and health care
providers.
(f) Collaborative Comprehensive Plan and Budget.--
(1) In general.--Subject to the provisions of this
section and other applicable law, the Director of NIH,
the Director of the Center, and the directors of the
national research institutes in collaboration (and in
consultation with the advisory council for the Center)
shall--
(A) establish a comprehensive plan and budget
for the conduct and support of all minority
health and other health disparities research
activities of the agencies of the National
Institutes of Health (which plan and budget
shall be first established under this
subsection not later than 12 months after the
date of the enactment of this subpart);
(B) ensure that the plan and budget
demonstrate how health disparities research
activities address the health needs of specific
health disparity populations, taking into
account socioeconomic status; the areas in
which the population involved resides;
attitudes toward health; the language spoken,
the extent of formal education; and such other
factors as the Director of the Center
determines to be appropriate;
(C) ensure that the plan and budget establish
priorities among the health disparities
research activities that such agencies are
authorized to carry out;
(D) ensure that the plan and budget establish
objectives regarding such activities, describes
the means for achieving the objectives, and
designates the date by which the objectives are
expected to be achieved;
(E) ensure that, with respect to amounts
appropriated for activities of the Center, the
plan and budget give priority in the
expenditure of funds to conducting and
supporting minority health research;
(F) ensure that all amounts appropriated for
such activities are expended in accordance with
the plan and budget;
(G) review the plan and budget not less than
annually, and revise the plan and budget as
appropriate; and
(H) ensure that the plan and budget serve as
a broad, binding statement of policies
regarding minority health and other health
disparities research activities of the
agencies, but do not remove the responsibility
of the heads of the agencies for the approval
of specific programs or projects, or for other
details of the daily administration of such
activities, in accordance with the plan and
budget.
(2) Certain components of plan and budget.--With
respect to health disparities research activities of
the agencies of the National Institutes of Health, the
Director of the Center shall ensure that the plan and
budget under paragraph (1) provide for--
(A) basic research and applied research,
including research and development with respect
to products;
(B) research that is conducted by the
agencies;
(C) research that is supported by the
agencies;
(D) proposals developed pursuant to
solicitations by the agencies and for proposals
developed independently of such solicitations;
and
(E) behavioral research and social sciences
research, which may include cultural and
linguistic research in each of the agencies.
(3) Minority health research.--The plan and budget
under paragraph (1) shall include a separate statement
of the plan and budget for minority health research.
(g) Clinical Research Equity.--The Director of the Center
shall assist in the administration of section 492B with respect
to the inclusion of members of minority groups as subjects in
clinical research.
(h) Research Endowments.--The Director of the Center may
carry out a program to facilitate minority health research by
providing for research endowments at centers of excellence
under section 736.
(i) Certain Activities.--In carrying out subsection (a), the
Director of the Center--
(1) shall assist the Director of the National Center
for Research Resources in carrying out section
481(c)(3) and in committing resources for construction
at Institutions of Emerging Excellence;
(2) shall establish projects to promote cooperation
among Federal agencies, State, local, and regional
public health agencies, and private entities in health
disparities research;
(3) may conduct or support research on the use of
service delivery models (such as health centers under
section 330) to reduce health disparities; and
(4) may utilize information from previous health
initiatives concerning minorities and other health
disparity populations.
(j) Advisory Council.--
(1) In general.--The Secretary shall, in accordance
with section 406, establish an advisory council to
advise, assist, consult with, and make recommendations
to the Director of the Center on matters relating to
the activities described in subsection (a), and with
respect to such activities to carry out any other
functions described in section 406 for advisory
councils under such section. Functions under the
preceding sentence shall include making recommendations
on budgetary allocations made in the plan under
subsection (f), and shall include reviewing reports
under subjection (k) before the reports are submitted
under such subsection.
(2) Membership.--With respect to the membership of
the advisory council under paragraph (1), a majority of
the members shall be representatives of the various
racial and ethnic minority groups; representatives of
other health disparity populations shall be included;
and a diversity of health professionals shall be
represented. The membership shall in addition include a
representative of the Office of Behavioral and Social
Sciences Research under section 404A.
(k) Annual Report.--The Director of the Center shall prepare
an annual report on the activities carried out or to be carried
out by the Center, and shall submit each such report to the
Congress, the Secretary, and the Director of NIH. With respect
to the fiscal year involved, the report shall--
(1) describe and evaluate the progress made in health
disparities research conducted or supported by the
national research institutes;
(2) summarize and analyze expenditures made for
activities with respect to health disparities research
conducted or supported by the National Institutes of
Health;
(3) include a separate statement applying the
requirements of paragraphs (1) and (2) specifically to
minority health research; and
(4) contain such recommendations as the Director
considers appropriate.
(l) Authorization of Appropriations.--For the purpose of
carrying out this subpart, there are authorized to be
appropriated $100,000,000 for fiscal year 2001, and such sums
as may be necessary for each of the fiscal years 2002 through
2005. Such authorization of appropriations is in addition to
other authorizations of appropriations that are available for
the conduct and support of minority health or other health
disparities research by the national research institutes and
other agencies of the National Institutes of Health.
SEC. 485F. CENTERS OF EXCELLENCE FOR RESEARCH EDUCATION AND TRAINING.
(a) In General.--The Director of the Center shall make awards
of grants or contracts to designated biomedical and behavioral
research institutions under paragraph (1) of subsection (c), or
to consortia under paragraph (2) of such subsection, for the
purpose of assisting the institutions in supporting programs of
excellence in biomedical and behavioral research education for
individuals who are members of health disparity populations,
including minorities.
(b) Required Use of Funds.--An award may be made under
subsection (a) only if the applicant involved agrees that the
grant will be expended--
(1) to conduct minority health research, including
research on the use of service delivery models (such as
health centers under section 330) with respect to
minority health conditions;
(2) to train minorities and other members of health
disparities populations as professionals in the area of
biomedical or behavioral research or both; or
(3) to expand, remodel, renovate, or alter existing
research facilities or construct new research
facilities for the purpose of conducting minority
health research.
(c) Centers of Excellence.--
(1) In general.--For purposes of this section, a
designated biomedical and behavioral research
institution is a biomedical and behavioral research
institution that--
(A) has a significant number of health
disparity students, including minorities,
enrolled in the institution (including
individuals accepted for enrollment in the
institution);
(B) has been effective in assisting such
students of the institution to complete the
program of education and receive the degree
involved;
(C) has been effective in recruiting members
of health disparity populations, including
minorities, to enroll in and graduate from the
institution, including providing scholarships
and other financial assistance to such
individuals and encouraging health disparity
students from all levels of the educational
pipeline to pursue biomedical research careers;
and
(D) has made significant recruitment efforts
to increase the number of members of health
disparities populations, including minorities,
serving in faculty or administrative positions
at the institution.
(2) Consortium.--Any designated biomedical and
behavioral research institution involved may, with
other biomedical and behavioral institutions
(designated or otherwise), form a consortium to receive
an award under subsection (a).
(3) Application of criteria to other programs.--In
the case of any criteria established by the Director of
the Center for purposes of determining whether
institutions meet the conditions described in paragraph
(1), this section may not, with respect to minorities,
be construed to authorize, require, or prohibit the use
of such criteria in any program other than the program
established in this section.
(d) Duration of Grant.--The period during which payments are
made under a grant under subsection (a) may not exceed 5 years.
Such payments shall be subject to annual approval by the
Director of the Center and to the availability of
appropriations for the fiscal year involved to make the
payments.
(e) Maintenance of Effort.--
(1) In general.--With respect to activities for which
an award under subsection (a) is authorized to be
expended, the Director of the Center may not make such
an award to a designated research institution or
consortium for any fiscal year unless the institution,
or institutions in the consortium, as the case may be,
agree to maintain expenditures of non-Federal amounts
for such activities at a level that is not less than
the level of such expenditures maintained by the
institutions involved for the fiscal year preceding the
fiscal year for which such institutions receive such an
award.
(2) Use of federal funds.--With respect to any
Federal amounts received by a designated research
institution or consortium and available for carrying
out activities for which an award under subsection (a)
is authorized to be expended, the Director of the
Center may make such an award only if the institutions
involved agree that the institutions will, before
expending the award, expend the Federal amounts
obtained from sources other than the award.
(f) Certain Expenditures.--The Director of the Center may
authorize a designated biomedical and behavioral research
institution to expend a portion of an award under subsection
(a) for research endowments.
(g) Definitions.--For purposes of this section:
(1) The term ``designated biomedical and behavioral
research institution'' has the meaning indicated for
such term in subsection (c)(1). Such term includes any
health professions school receiving an award of a grant
or contract under section 736.
(2) The term ``program of excellence'' means any
program carried out by a designated biomedical and
behavioral research institution with an award under
subsection (a), if the program is for purposes for
which the institution involved is authorized in
subsection (b) to expend the grant.
(h) Authorization of Appropriations.--For the purpose of
making grants under subsection (a), there are authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 2001 through 2005.
SEC. 485G. LOAN REPAYMENT PROGRAM FOR MINORITY HEALTH RESEARCH.
(a) In General.--The Director of the Center shall establish a
program of entering into contracts with qualified health
professionals under which such health professionals agree to
engage in minority health research in consideration of the
Federal Government agreeing to repay, for each year of engaging
in such research,not more than $35,000 of the principal and
interest of the educational loans of such health professionals.
(b) Service Provisions.--The provisions of sections 338B,
338C, and 338E shall, except as inconsistent with subsection
(a), apply to the program established in such subsection to the
same extent and in the same manner as such provisions apply to
the National Health Service Corps Loan Repayment Program
established in subpart III of part D of title III.
(c) Requirement Regarding Health Disparity Populations.--The
Director of the Center shall ensure that not fewer than 50
percent of the contracts entered into under subsection (a) are
for appropriately qualified health professionals who are
members of a health disparity population.
(d) Priority.--With respect to minority health research under
subsection (a), the Secretary shall ensure that priority is
given to conducting projects of biomedical research.
(e) Funding.--
(1) Authorization of appropriations.--For the purpose
of carrying out this section, there are authorized to
be appropriated such sums as may be necessary for each
of the fiscal years 2001 through 2005.
(2) Availability of appropriations.--Amounts
available for carrying out this section shall remain
available until the expiration of the second fiscal
year beginning after the fiscal year for which the
amounts were made available.
SEC. 485H. GENERAL PROVISIONS REGARDING THE CENTER.
(a) Administrative Support for Center.--The Secretary, acting
through the Director of the National Institutes of Health,
shall provide administrative support and support services to
the Director of the Center and shall ensure that such support
takes maximum advantage of existing administrative structures
at the agencies of the National Institutes of Health.
(b) Evaluation and Report.--
(1) Evaluation.--Not later than 5 years after the
date of the enactment of this part, the Secretary shall
conduct an evaluation to--
(A) determine the effect of this section on
the planning and coordination of the health
disparities research programs at the
institutes, centers and divisions of the
National Institutes of Health;
(B) evaluate the extent to which this part
has eliminated the duplication of
administrative resources among such Institutes,
centers and divisions; and
(C) provide recommendations concerning future
legislative and administrative modifications
with respect to this part, for both minority
health research and research on other health
disparity populations.
(2) Minority health research.--The evaluation under
paragraph (1) shall include a separate statement that
applies subparagraphs (A) and (B) of such paragraph to
minority health research.
(3) Report.--Not later than 1 year after the date on
which the evaluation is commenced under paragraph (1),
the Secretary shall prepare and submit to the Committee
on Health, Education, Labor, and Pensions of the
Senate, and the Committee on Commerce of the House of
Representatives, a report concerning the results of
such evaluation.
* * * * * * *
TITLE VII--HEALTH PROFESSIONS EDUCATION
* * * * * * *
PART F--GENERAL PROVISIONS
* * * * * * *
SEC. 791A. GRANTS FOR HEALTH PROFESSIONAL EDUCATION CURRICULUM
DEVELOPMENT.
(a) Grants for Graduate Education Curriculum Development.--
(1) In general.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration and in collaboration with the Director
of the Agency for Healthcare Research and Quality and
the Deputy Assistant Secretary for Minority Health, may
make awards of grants, contracts, or cooperative
agreements to public and nonprofit private entities for
the purpose of carrying out research projects and
demonstration projects to develop curricula to reduce
disparities in health care outcomes, including
curricula for cultural competency in graduate health
professions education.
(2) Eligibility.--To be eligible to receive an award
under paragraph (1), an entity shall--
(A) be a school of medicine, school of
osteopathic medicine, school or dentistry,
school of public health, school of nursing,
graduate program in behavioral health and
mental health practice, or other recognized
health profession school; and
(B) prepare and submit to the Secretary an
application at such time, in such manner, and
containing such information as the Secretary
may require.
(3) Use of funds.--An entity shall use amounts
received under an award under paragraph (1) to carry
out research projects and demonstration projects to
develop curricula to reduce disparity in health care
outcomes, including curricula for cultural competency
in graduate health professions education.
(4) Number of grants and grant term.--The Secretary
shall award grants, contracts or cooperative agreements
(or combination thereof) under paragraph (1) in each of
the first and second fiscal years for which funds are
available under subsection (f). The term of each such
grant, contract or cooperative agreement shall be 3
years.
(b) Grants for Continuing Health Professional Education
Curriculum Development.--
(1) In general.--The Secretary, acting through the
Health Resources and Services Administration and the
Agency forHealthcare Research Quality and in
collaboration with the Office of Minority Health, shall award grants to
eligible entities for the establishment of demonstration and pilot
projects to develop curricula to reduce disparity in health care and
health outcomes, including curricula for cultural competency, in
continuing health professions education.
(2) Eligibility.--To be eligible to receive a grant
under paragraph (1) an entity shall--
(A) be a school of medicine, osteopathic
medicine, public health, dentistry, optometry,
pharmacy, allied health, chiropractic,
podiatric medicine, nursing, and public health
and health administration, public or nonprofit
private school that offers a graduate program
in clinical social work or other graduate
programs in behavioral health and mental health
practice, program for the training of physician
assistants, health professional association, or
other public or nonprofit health educational
entity, or any consortium of entities described
in this subparagraph; and
(B) prepare and submit to the Secretary an
application at such time, in such manner, and
containing such information as the Secretary
may require.
(3) Use of funds.--An entity shall use amounts
received under a grant under paragraph (1) to develop
and evaluate the effect of curricula for continuing
health professions education courses or programs to
provide education concerning issues relating to
disparity in health care and health outcomes, including
cultural competency of health professionals. Such
curricula shall focus on the need to remove bias from
health care at a personal level as well as at a
systemic level.
(4) Number of grants and grant term.--The Secretary
shall award grants under paragraph (1) in each of the
first and second fiscal years for which funds are
available under subsection (f). The term of each such
grant shall be 3 years.
(c) Distribution of Projects.--The Secretary shall ensure
that, to the extent practicable, projects under subsections (a)
and (b) are carried out in each of the principal geographic
regions of the United States and involve different health
disparity populations (as defined in section 485E) and health
professions.
(d) Monitoring.--An entity that receives a grant, contract or
cooperative agreement under subsection (a) or (b) shall ensure
that procedures are in place to monitor activities undertaken
using grant, contract or cooperative agreement funds. Such
entity shall annually prepare and submit to the Secretary a
report concerning the effectiveness of curricula developed
under the grant contract or cooperative agreement.
(e) Report to Congress.--Not later than January 1, 2002, the
Secretary shall prepare and submit to the appropriate
committees of Congress, a report concerning the effectiveness
of programs funded under this section and a plan to encourage
the implementation and utilization of curricula to reduce
disparities in health care and health outcomes. A final report
shall be submitted by the Secretary not later than January 1,
2004.
(f) Authorization of Appropriations.--There is authorized to
be appropriated to carry out this section, $3,500,000 for
fiscal year 2001, $7,000,000 for fiscal year 2002, $7,000,000
for fiscal year 2003, and $3,500,000 for fiscal year 2004.
* * * * * * *
TITLE IX--AGENCY FOR HEALTHCARE RESEARCH AND QUALITY
PART A--ESTABLISHMENT AND GENERAL DUTIES
* * * * * * *
SEC. 903. RESEARCH ON HEALTH DISPARITIES.
(a) In General.--The Director shall--
(1) conduct and support research to identify how to
improve the quality and outcomes of health care
services for health disparity populations and the
causes of the health disparities involved, including
identifying barriers to health care access and
environmental factors leading to health problems;
(2) conduct and support research and support
demonstration projects to identify, test, and evaluate
strategies for eliminating health disparities and
promoting effective interventions;
(3) develop measures for the assessment and
improvement of the quality and appropriateness of
health care services provided to health disparity
populations; and
(4) in carrying out 902(c), provide support to
increase the number of researchers who are members of
health disparity populations, and the health services
research capacity of institutions that train such
researchers.
(b) Research and Demonstration Projects.--
(1) In general.--In carrying out subsection (a), the
Director shall conduct and support research to--
(A) identify the clinical, cultural,
socioeconomic, and organizational factors that
contribute to health disparities, including for
minority populations, which factors include
examination of patterns of clinical
decisionmaking and of the availability of
support services;
(B) identify and evaluate clinical and
organizational strategies to improve the
quality, outcomes, and access to care for
health disparity populations, including
minority populations;
(C) support demonstrations to test such
strategies; and
(D) widely disseminate strategies for which
there is scientific evidence of effectiveness.
(2) Use of certain strategies.--In carrying out this
section, the Director shall implement research
strategies and mechanisms that will enhance the
involvement of individuals who are members of health
disparity populations (including minority populations),
health services researchers who are such individuals,
institutions that train such individuals as
researchers, members of health disparity populations
(including minority populations) for whom the Agency is
attempting to improve the quality and outcomes of care,
and representatives of appropriatecommunity-based
organizations with respect to health disparity populations. Such
research strategies and mechanisms may include the use of--
(A) centers of excellence that can
demonstrate, either individually or through
consortia, a combination of multi-disciplinary
expertise in outcomes or quality improvement
research and a demonstrated capacity to engage
members and communities of health disparity
populations, including minority populations, in
the planning, conduct and translation of
research, with linkages to relevant sites of
care;
(B) provider-based research networks,
including health plans, facilities, or delivery
system sites of care (especially primary care),
that make extensive use of health care
providers who are members of health disparity
populations or who serve patients in such
populations and have the capacity to evaluate
and promote quality improvement;
(C) service delivery models (such as health
centers under section 330) to reduce health
disparities; and
(D) other innovative mechanisms or strategies
that will facilitate the translation of past
research investments into clinical practices
that can reasonably be expected to benefit
these populations.
(c) Quality Measurement Development.--
(1) In general.--To ensure that health disparity
populations, including minority populations, benefit
from the progress made in the ability of individuals to
measure the quality of health care delivery, the
Director shall support the development of quality of
health care measures that assess the experience of such
populations with health care systems, such as measures
that assess the access of such populations to health
care, the cultural competence of the care provided, the
quality of the care provided, the outcomes of care, or
other aspects of health care practice that the Director
determines to be important. In carrying out the
preceding sentence, the Director shall in consultation
with the Administrator of the Health Resources and
Services Administration examine the practices of
providers (such as health centers under section 330)
that have a record of reducing health disparities or
have experience in providing culturally competent
health services to minority or other health disparity
populations.
(2) Report.--Not later than 24 months after the date
of the enactment of this section, the Secretary, acting
through the Director, shall prepare and submit to the
appropriate committees of Congress a report describing
the state-of-the-art of quality measurement for
minority and other health disparity populations that
will identify critical unmet needs, the current
activities of the Department to address those needs,
and a description of related activities in the private
sector.
(d) Definition.--For purposes of this section:
(1) The term ``health disparity population'' has the
meaning given such term in section 485E.
(2) The term ``minority'', with respect to
populations, refers to racial and ethnic minority
groups as defined in section 1707.
* * * * * * *
PART C--GENERAL PROVISIONS
* * * * * * *
SEC. 927. FUNDING.
(a) * * *
* * * * * * *
(d) Health Disparities Research.--For the purpose of carrying
out the activities under section 903, there are authorized to
be appropriated such sums as may be necessary for each of the
fiscal years 2001 through 2005.
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TITLE XVII--HEALTH INFORMATION AND HEALTH PROMOTION
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office of minority health
Sec. 1707. (a) * * *
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(g) Definition.--For purposes of this section:
(1) The term ``racial and ethnic minority group''
means American Indians (including Alaska Natives,
Eskimos, and Aleuts); [Asian Americans and] Asian
Americans; Native Hawaiians and other Pacific
Islanders; Blacks; and Hispanics.
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