[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\
---------------------------------------------------------------------------
    \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).
---------------------------------------------------------------------------
    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).

----------------------------------------------------------------------------------------------------------------
                                                                  By fiscal year, in millions of dollars--
                                                           -----------------------------------------------------
                                                              2000     2001     2002     2003     2004     2005
----------------------------------------------------------------------------------------------------------------
                                        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
----------------------------------------------------------------------------------------------------------------
\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.

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          TITLE IX--AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

PART A--ESTABLISHMENT AND GENERAL DUTIES

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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.

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PART C--GENERAL PROVISIONS

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SEC. 927. FUNDING.

  (a)  * * *

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  (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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