,i #aacth ,,congress #b;d ,session ,h4 ,r4 #ebid ,,in ,,the ,,house ,,of ,,representatives ,july #cj1 #bjad ,ms4 ,roybal-,allard 7for herself1 ,ms4 ,lee of ,california1 ,mrs4 ,christensen1 ,ms4 ,bordallo1 ,ms4 ,brown of ,florida1 ,mr4 ,butterfield1 ,ms4 ,chu1 ,ms4 ,clarke of ,new ,york1 ,mr4 ,crdenas1 ,mr4 ,carson of ,indiana1 ,ms4 ,castor of ,florida1 ,mr4 ,conyers1 ,mr4 ,crowley1 ,mr4 ,cummings1 ,mr4 ,danny ,k4 ,davis of ,illinois1 ,ms4 ,de,gette1 ,ms4 ,de,lauro1 ,ms4 ,edwards1 ,mr4 ,ellison1 ,mr4 ,faleomavaega1 ,mr4 ,farr1 ,mr4 ,fattah1 ,ms4 ,fudge1 ,mr4 ,garcia1 ,mr4 ,grijalva1 ,ms4 ,michelle ,lujan ,grisham of ,new ,mexico1 ,mr4 ,gutirrez1 ,ms4 ,hahn1 ,mr4 ,hinojosa1 ,mr4 ,honda1 ,ms4 ,jackson ,lee1 ,ms4 ,eddie ,bernice ,johnson of ,texas1 ,mr4 ,johnson of ,georgia1 ,mr4 ,lewis1 ,ms4 ,lofgren1 ,mrs4 ,lowey1 ,mr4 ,ben ,ray ,lujn of ,new ,mexico1 ,ms4 ,matsui1 ,ms4 ,mc,collum1 ,mr4 ,mc,govern1 ,mrs4 ,negrete ,mc,leod1 ,mr4 ,meeks1 ,ms4 ,meng1 ,mrs4 ,napolitano1 ,ms4 ,norton1 ,mr4 ,pastor of ,arizona1 ,mr4 ,pierluisi1 ,mr4 ,rangel1 ,mr4 ,richmond1 ,mr4 ,rush1 ,mr4 ,sablan1 ,ms4 ,linda ,t4 ,snchez of ,california1 ,ms4 ,loretta ,sanchez of ,california1 ,ms4 ,schakowsky1 ,mr4 ,schiff1 ,mr4 ,david ,scott of ,georgia1 ,mr4 ,scott of ,virginia1 ,mr4 ,serrano1 ,mr4 ,sires1 ,ms4 ,slaughter1 ,mr4 ,takano1 ,mr4 ,tonko1 ,mr4 ,vargas1 ,mr4 ,vela1 ,ms4 ,velzquez1 and ,ms4 ,waters7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means1 ,agriculture1 ,education and the ,workforce1 the ,budget1 ,veterans' ,affairs1 ,armed ,services1 the ,judiciary1 and ,natural ,resources1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to improve the health of minority individuals1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,health ,equity and ,accountability ,act of #bjad4 #b4 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title4 ,sec4 #b4 ,table of contents4 ,sec4 #c4 ,findings4 ,title ,i--,data collection and reporting ,sec4 #aja4 ,amendment to the ,public ,health ,service ,act4 ,sec4 #ajb4 ,elimination of prerequisite of direct appropriations for data collection and analysis4 ,sec4 #ajc4 ,collection of race and ethnicity data by the ,social ,security ,administration4 ,sec4 #ajd4 ,revision of ,,hipaa claims standards4 ,sec4 #aje4 ,national ,center for ,health ,statistics4 ,sec4 #ajf4 ,oversampling of ,asian-,americans1 ,native ,hawaiians1 or ,pacific ,islanders and other underrepresented groups in ,federal health surveys4 ,sec4 #ajg4 ,geo-access study4 ,sec4 #ajh4 ,racial1 ethnic1 and primary language data collected by the ,federal ,government4 ,sec4 #aji4 ,data collection and analysis grants to minority-serving institutions4 ,sec4 #aaj4 ,standards for measuring sexual orientation and gender identity in collection of health data4 ,sec4 #aaa4 ,standards for measuring socioeconomic status in collection of health data4 ,sec4 #aab4 ,safety and effectiveness of drugs with respect to racial and ethnic background4 ,sec4 #aac4 ,improving health data regarding ,native ,hawaiians and other ,pacific ,islanders4 ,sec4 #aad4 ,clarification of simplified administrative reporting requirement4 ,title ,,ii--,culturally and linguistically appropriate health care ,sec4 #bja4 ,definitions4 ,sec4 #bjb4 ,amendment to the ,public ,health ,service ,act4 ,sec4 #bjc4 ,pilot program for improvement and development of ,state medical interpreting services4 ,sec4 #bjd4 ,training tomorrow's doctors for culturally and linguistically appropriate care3 graduate medical education4 ,sec4 #bje4 ,federal reimbursement for culturally and linguistically appropriate services under the ,medicare1 ,medicaid1 and ,state ,children's ,health ,insurance ,programs4 ,sec4 #bjf4 ,increasing understanding of and improving health literacy4 ,sec4 #bjg4 ,assurances for receiving ,federal funds4 ,sec4 #bjh4 ,report on ,federal efforts to provide culturally and linguistically appropriate health care services4 ,sec4 #bji4 ,english for speakers of other languages4 ,sec4 #baj4 ,implementation4 ,sec4 #baa4 ,language access services4 ,title ,,iii--,health workforce ,diversity ,sec4 #cja4 ,amendment to the ,public ,health ,service ,act4 ,sec4 #cjb4 ,hispanic-serving health professions schools4 ,sec4 #cjc4 ,loan repayment program of ,centers for ,disease ,control and ,prevention4 ,sec4 #cjd4 ,cooperative agreements for online degree programs at schools of public health and schools of allied health4 ,sec4 #cje4 ,sense of ,congress on the mission of the ,national ,health ,care ,workforce ,commission4 ,sec4 #cjf4 ,scholarship and fellowship programs4 ,sec4 #cjg4 ,mc,nair ,postbaccalaureate ,achievement ,program4 ,sec4 #cjh4 ,rules for determination of full-time equivalent residents for cost-reporting periods4 ,sec4 #cji4 ,developing and implementing strategies for local health equity4 ,sec4 #caj4 ,loan forgiveness for mental and behavioral health social workers4 ,sec4 #caa4 ,health ,professions ,workforce ,fund4 ,sec4 #cab4 ,findings2 sense of ,congress relating to graduate medical education4 ,sec4 #cac4 ,career support for skilled internationally educated health professionals4 ,title ,,iv--,improvement of ,health ,care ,services ,subtitle ,a--,health ,empowerment ,zones ,sec4 #dja4 ,short title4 ,sec4 #djb4 ,findings4 ,sec4 #djc4 ,designation of health empowerment zones4 ,sec4 #djd4 ,assistance to those seeking designation4 ,sec4 #dje4 ,benefits of designation4 ,sec4 #djf4 ,definition4 ,sec4 #djg4 ,authorization of appropriations4 ,subtitle ,b--,other ,improvements of ,health ,care ,services ,chapter #a--;,expansion of ,coverage ,sec4 #daa4 ,amendment to the ,public ,health ,service ,act4 ,sec4 #dab4 ,removing citizenship and immigration barriers to access to affordable health care under the ,,aca4 ,sec4 #dac4 ,study on the uninsured4 ,sec4 #dad4 ,medicaid payment parity for the territories4 ,sec4 #dae4 ,extension of ,medicare secondary payer4 ,sec4 #daf4 ,border health grants4 ,sec4 #dag4 ,removing ,medicare barrier to health care4 ,sec4 #dah4 #ajj percent ,,fmap for medical assistance provided by urban ,indian health centers4 ,sec4 #dai4 #ajj percent ,,fmap for medical assistance provided to a ,native ,hawaiian through a federally qualified health center or a ,native ,hawaiian health care system under the ,medicaid program4 ,chapter #b--;,expansion of ,access ,sec4 #dba4 ,grants for racial and ethnic approaches to community health4 ,sec4 #dbb4 ,critical access hospital improvements4 ,sec4 #dbc4 ,establishment of ,rural ,community ,hospital 7,,rch7 ,program4 ,sec4 #dbd4 ,medicare remote monitoring pilot projects4 ,sec4 #dbe4 ,rural health quality advisory commission and demonstration projects4 ,sec4 #dbf4 ,rural health care services4 ,sec4 #dbg4 ,community health center collaborative access expansion4 ,sec4 #dbh4 ,facilitating the provision of telehealth services across ,state lines4 ,sec4 #dbi4 ,scoring of preventive health savings4 ,sec4 #dcj4 ,sense of ,congress4 ,sec4 #dca4 ,repeal of requirement for documentation evidencing citizenship or nationality under the ,medicaid program4 ,sec4 #dcb4 ,office of ,minority ,health in ,veterans ,health ,administration of ,department of ,veterans ,affairs4 ,sec4 #dcc4 ,indian defined in ,,ppaca4 ,sec4 #dcd4 ,study of ,,dsh payments to ensure hospital access for low-income patients4 ,sec4 #dce4 ,assistant ,secretary of the ,indian ,health ,service4 ,sec4 #dcf4 ,reauthorization of the ,native ,hawaiian ,health ,care ,improvement ,act4 ,title ,v--,,improving ,,health ,,outcomes ,,for ,,women1 ,,children1 ,,and ,,families ,sec4 #eja4 ,grants to promote positive health behaviors in women and children4 ,sec4 #ejb4 ,removing barriers to health care and nutrition assistance for children1 pregnant women1 and lawfully present individuals4 ,sec4 #ejc4 ,repeal of denial of benefits4 ,sec4 #ejd4 ,birth defects prevention1 risk reduction1 and awareness4 ,sec4 #eje4 ,uniform ,state maternal mortality review committees on pregnancy-related deaths4 ,sec4 #ejf4 ,eliminating disparities in maternity health outcomes4 ,sec4 #ejg4 ,decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood4 ,sec4 #ejh4 ,reducing unintended teenage pregnancies4 ,sec4 #eji4 ,gestational diabetes4 ,sec4 #eaj4 ,emergency contraception education and information programs4 ,sec4 #eaa4 ,supporting healthy adolescent development4 ,sec4 #eab4 ,compassionate assistance for rape emergencies4 ,sec4 #eac4 ,access to birth control duties of pharmacies to ensure provision of ,,fda-approved contraception4 ,sec4 #ead4 ,additional focus area for the ,office on ,women's ,health4 ,sec4 #eae4 ,interagency coordinating committee on the promotion of optimal maternity outcomes4 ,sec4 #eaf4 ,consumer education campaign4 ,sec4 #eag4 ,bibliographic database of systematic reviews for care of childbearing women and newborns4 ,sec4 #eah4 ,maternity care health professional shortage areas4 ,sec4 #eai4 ,expansion of ,,cdc prevention research centers program to include centers on optimal maternity outcomes4 ,sec4 #ebj4 ,expanding models allowed to be tested by ,center for ,medicare and ,medicaid ,innovation to include maternity care models4 ,sec4 #eba4 ,development of interprofessional maternity care educational models and tools4 ,sec4 #ebb4 ,including within inpatient hospital services under ,medicare services furnished by certain students1 interns1 and residents supervised by certified nurse midwives4 ,sec4 #ebc4 ,grants to professional organizations to increase diversity in maternity care professionals4 ,title ,,vi--,,mental ,,health ,sec4 #fja4 ,coverage of marriage and family therapist services1 mental health counselor services1 and substance abuse counselor services under part ,b of the ,medicare program4 ,sec4 #fjb4 ,minority ,fellowship ,program4 ,sec4 #fjc4 ,integrated ,health ,care ,demonstration ,program4 ,sec4 #fjd4 ,addressing racial and ethnic minority mental health disparities research gaps4 ,sec4 #fje4 ,health professions competencies to address racial and ethnic minority mental health disparities4 ,title ,,vii--,,addressing ,,high ,,impact ,,minority ,,diseases ,subtitle ,a--,cancer ,sec4 #gja4 ,lung cancer mortality reduction4 ,sec4 #gjb4 ,expanding prostate cancer research1 outreach1 screening1 testing1 access1 and treatment effectiveness4 ,sec4 #gjc4 ,improved ,medicaid coverage for certain breast and cervical cancer patients in the territories4 ,sec4 #gjd4 ,cancer prevention and treatment demonstration for ethnic and racial minorities4 ,sec4 #gje4 ,reducing cancer disparities within ,medicare4 ,subtitle ,b--,viral ,hepatitis and ,liver ,cancer ,control and ,prevention ,sec4 #gaa4 ,viral hepatitis and liver cancer control and prevention4 ,subtitle ,c--,acquired ,bone ,marrow ,failure ,diseases ,sec4 #gba4 ,acquired bone marrow failure diseases4 ,subtitle ,d--,cardiovascular ,disease1 ,chronic ,disease1 and ,other ,disease ,issues ,sec4 #gca4 ,guidelines for disease screening for minority patients4 ,sec4 #gcb4 ,,cdc ,wisewoman ,screening ,program4 ,sec4 #gcc4 ,report on cardiovascular care for women and minorities4 ,sec4 #gcd4 ,coverage of comprehensive tobacco cessation services in ,medicaid4 ,sec4 #gce4 ,clinical research funding for oral health4 ,sec4 #gcf4 ,participation by ,medicaid beneficiaries in approved clinical trials4 ,subtitle ,e--,,hiv_/,,aids ,sec4 #gda4 ,statement of policy4 ,sec4 #gdb4 ,findings4 ,sec4 #gdc4 ,additional funding for ,,aids drug assistance program treatments4 ,sec4 #gdd4 ,enhancing the national ,,hiv surveillance system4 ,sec4 #gde4 ,evidence-based strategies for improving linkage to and retention in appropriate care4 ,sec4 #gdf4 ,improving entry into and retention in care and antiretroviral adherence for persons with ,,hiv4 ,sec4 #gdg4 ,services to reduce ,,hiv_/,,aids in racial and ethnic minority communities4 ,sec4 #gdh4 ,minority ,,aids initiative4 ,sec4 #gdi4 ,health care professionals treating individuals with ,,hiv_/,,aids4 ,sec4 #gej4 ,,hiv_/,,aids provider loan repayment program4 ,sec4 #gea4 ,dental education loan repayment program4 ,sec4 #geb4 ,reducing new ,,hiv infections among injecting drug users4 ,sec4 #gec4 ,support for expansion of comprehensive sexual health and education programs4 ,sec4 #ged4 ,elimination of abstinence-only education program4 ,sec4 #gee4 ,report on impact of ,,hiv_/,,aids in vulnerable populations4 ,sec4 #gef4 ,national ,,hiv_/,,aids observance days4 ,sec4 #geg4 ,review of all ,federal and ,state laws1 policies1 and regulations regarding the criminal prosecution of individuals for ,,hiv-related offenses4 ,sec4 #geh4 ,repeal of limitation against use of funds for education or information designed to promote or encourage1 directly1 homosexual or heterosexual activity or intravenous substance abuse4 ,sec4 #gei4 ,expanding support for condoms in prisons4 ,sec4 #gfj4 ,automatic reinstatement or enrollment in ,medicaid for people who test positive for ,,hiv before reentering communities4 ,sec4 #gfa4 ,stop ,,aids in prison4 ,sec4 #gfb4 ,support data system review and indicators for monitoring ,,hiv care4 ,sec4 #gfc4 ,transfer of funds for implementation of national ,,hiv_/,,aids strategy4 ,sec4 #gfd4 ,,hiv integrated services delivery model demonstration4 ,sec4 #gfe4 ,report on the implementation of goal #d 7improved coordination7 of the national ,,hiv_/,,aids strategy4 ,subtitle ,f--,diabetes ,sec4 #gga4 ,research1 treatment1 and education4 ,sec4 #ggb4 ,research1 education1 and other activities4 ,sec4 #ggc4 ,research1 education1 and other activities4 ,sec4 #ggd4 ,research1 education1 and other activities4 ,sec4 #gge4 ,updated report on health disparities4 ,subtitle ,g--,lung ,disease ,sec4 #ggf4 ,expansion of the ,national ,asthma ,education and ,prevention ,program4 ,sec4 #ggg4 ,asthma-related activities of the ,centers for ,disease ,control and ,prevention4 ,sec4 #ggh4 ,influenza and pneumonia vaccination campaign4 ,sec4 #ggi4 ,chronic obstructive pulmonary disease action plan4 ,subtitle ,h--,osteoarthritis and ,musculoskeletal ,diseases ,sec4 #gha4 ,findings4 ,sec4 #ghb4 ,osteoarthritis and other musculoskeletal health-related activities of the ,centers for ,disease ,control and ,prevention4 ,subtitle ,i--,sleep and ,circadian ,rhythm ,disorders ,sec4 #gia4 ,short title2 findings4 ,sec4 #gib4 ,sleep and circadian rhythm disorders research activities of the ,national ,institutes of ,health4 ,sec4 #gic4 ,sleep and circadian rhythm health disparities-related activities of the ,centers for ,disease ,control and ,prevention4 ,title ,,viii--,health ,information ,technology ,sec4 #hjj4 ,definitions4 ,subtitle ,a--,reducing ,health ,disparities ,through ,health ,,it ,sec4 #hja4 ,,hrsa assistance to health centers for promotion of ,health ,,it4 ,sec4 #hjb4 ,assessment of impact of ,health ,,it on racial and ethnic minority communities2 outreach and adoption of ,health ,,it in such communities4 ,subtitle ,b--,modifications ,to ,achieve ,parity in ,existing ,programs ,sec4 #haa4 ,extending funding to strengthen the ,health ,,it infrastructure in racial and ethnic minority communities4 ,sec4 #hab4 ,prioritizing regional extension center assistance to racial and ethnic minority groups4 ,sec4 #hac4 ,extending competitive grants for the development of loan programs to facilitate adoption of certified ,,ehr technology by providers serving racial and ethnic minority groups4 ,sec4 #had4 ,authorization of appropriations4 ,subtitle ,c--,additional ,research and ,studies ,sec4 #hca4 ,data collection and assessments conducted in coordination with minority-serving institutions4 ,sec4 #hcb4 ,study of health information technology in medically underserved communities4 ,subtitle ,d--,closing ,gaps in ,funding ,to ,adopt ,certified ,e,h,rs ,sec4 #hda4 ,application of ,medicare ,,hitech payments to hospitals in ,puerto ,rico4 ,sec4 #hdb4 ,extending ,medicaid ,,ehr incentive payments to rehabilitation facilities1 long-term care facilities1 and home health agencies4 ,sec4 #hdc4 ,extending physician assistant eligibility for ,medicaid electronic health record incentive payments4 ,title ,,ix--,accountability and ,evaluation ,sec4 #ija4 ,prohibition on discrimination in ,federal assisted health care services and research programs on the basis of sex1 race1 color1 national origin1 marital status1 familial status1 sexual orientation1 gender identity1 or disability status4 ,sec4 #ijb4 ,treatment of ,medicare payments under title ,,vi of the ,civil ,rights ,act of #aifd4 ,sec4 #ijc4 ,accountability and transparency within the ,department of ,health and ,human ,services4 ,sec4 #ijd4 ,united ,states ,commission on ,civil ,rights4 ,sec4 #ije4 ,sense of ,congress concerning full funding of activities to eliminate racial and ethnic health disparities4 ,sec4 #ijf4 ,,gao and ,,nih reports4 ,title ,x--,addressing ,social ,determinants and ,improving ,environmental ,justice ,sec4 #ajja4 ,definitions4 ,sec4 #ajjb4 ,findings4 ,sec4 #ajjc4 ,health impact assessments4 ,sec4 #ajjd4 ,implementation of recommendations by ,environmental ,protection ,agency4 ,sec4 #ajje4 ,grant program to conduct environmental health improvement activities and to improve social determinants of health4 ,sec4 #ajjf4 ,additional research on the relationship between the built environment and the health of community residents4 ,sec4 #ajjg4 ,environment and public health restoration4 ,sec4 #ajjh4 ,,gao report on health effects of ,deepwater ,horizon oil rig explosion in the ,gulf ,coast4 #c4 ,findings ,the ,congress finds as follows3 7#a7 ,the population of racial and ethnic minorities is expected to increase over the next few decades1 yet racial and ethnic minorities have the poorest health status and face substantial cultural1 social1 and economic barriers to obtaining quality health care4 7#b7 ,health disparities are a function of not only access to health care1 but also the social determinants of health--including the environment1 the physical structure of communities1 nutrition and food options1 educational attainment1 employment1 race1 ethnicity1 sex1 geography1 language preference1 immigrant or citizenship status1 sexual orientation1 gender identity1 socioeconomic status1 or disability status--that directly and indirectly affect the health1 health care1 and wellness of individuals and communities4 7#c7 ,by #bjbj1 the ,nation will face a shortage of health care providers and allied health workers and this shortage disproportionately affects health professional shortage areas where many racial and ethnic minority populations reside4 7#d7 ,all efforts to reduce health disparities and barriers to quality health services require better and more consistent data4 7#e7 ,a full range of culturally and linguistically appropriate health care and public health services must be available and accessible in every community4 7#f7 ,racial and ethnic minorities and underserved populations must be included early and equitably in health reform innovations4 7#g7 ,efforts to improve minority health have been limited by inadequate resources in funding1 staffing1 stewardship1 and accountability4 ,targeted investments that are focused on disparities elimination must be made in providing care and services that are community-based1 including prevention and policies addressing social determinants of health4 7#h7 ,in #bjaa1 the ,department of ,health and ,human ,services developed the ,,hhs ,action ,plan to ,reduce ,racial and ,ethnic ,health ,disparities and the ,national ,stakeholder ,strategy for ,achieving ,health ,equity1 two strategic plans that represent the country's first coordinated roadmap to reducing health disparities4 ,along with the ,national ,prevention ,strategy1 ,healthy ,people #bjbj1 and the ,national ,health ,care ,quality ,strategy1 as well as critical resources such as the #bjab ,national ,healthcare ,quality and ,disparities ,reports1 these comprehensive plans will work to increase the number of ,americans who are healthy at every stage of life4 7#i7 ,the ,department of ,health and ,human ,services also developed other strategic planning documents to combat disease disparities with a high impact on minority populations including the ,national ,,hiv_/,,aids ,strategy1 and the ,action ,plan for the ,prevention1 ,care and ,treatment of ,viral ,hepatitis4 7#aj7 ,the ,patient ,protection and ,affordable ,care ,act1 as amended by the ,health ,care and ,education ,reconciliation ,act1 represents the biggest advancement for minority health in the last #dj years4 ,i ,data collection and reporting #aja4 ,amendment to the ,public ,health ,service ,act 7a7 ,purpose ,it is the purpose of this section to promote data collection1 analysis1 and reporting by race1 ethnicity1 sex1 primary language1 sexual orientation1 disability status1 gender identity1 and socioeconomic status among federally supported health programs4 7b7 ,amendment ,title ,,xxxiv of the ,public ,health ,service ,act1 as amended by titles ,,ii and ,,iii of this ,act1 is further amended by inserting after subtitle ,a the following3 ,b ,strengthening data collection1 improving data analysis1 and expanding data reporting #cdca4 ,health disparity data 7a7 ,requirements 7#a7 ,in general ,each health-related program operated by or that receives funding or reimbursement1 in whole or in part1 either directly or indirectly from the ,department of ,health and ,human ,services shall-- 7,a7 require the collection1 by the agency or program involved1 of data on the race1 ethnicity1 sex1 primary language1 sexual orientation1 disability status1 gender identity1 and socioeconomic status of each applicant for and recipient of health-related assistance under such program-- 7i7 using1 at a minimum1 the standards for data collection on race1 ethnicity1 sex1 primary language1 sexual orientation1 disability status1 gender identity1 and socioeconomic status developed under section #caja2 7ii7 collecting data for additional population groups if such groups can be aggregated into the race and ethnicity categories outlined by the standards developed under section #caja2 7iii7 additionally referring1 where practicable1 to the standards developed by the ,institute of ,medicine in ,race1 ,ethnicity1 and ,language ,data3 ,standardization for ,health ,care ,quality ,improvement2 and 7iv7 where practicable1 through self-reporting2 7,b7 with respect to the collection of the data described in subparagraph 7,a71 for applicants and recipients who are minors1 require communication assistance in speech or writing1 and for applicants and recipients who are otherwise legally incapacitated1 require that-- 7i7 such data be collected from the parent or legal guardian of such an applicant or recipient2 and 7ii7 the primary language of the parent or legal guardian of such an applicant or recipient be collected2 7,c7 systematically analyze such data using the smallest appropriate units of analysis feasible to detect racial and ethnic disparities1 as well as disparities along the lines of primary language1 sex1 disability status1 sexual orientation1 gender identity1 and socioeconomic status in health and health care1 and report the results of such analysis to the ,secretary1 the ,director of the ,office for ,civil ,rights1 each agency listed in section #caja7;c77#a71 the ,committee on ,health1 ,education1 ,labor1 and ,pensions and the ,committee on ,finance of the ,senate1 and the ,committee on ,energy and ,commerce and the ,committee on ,ways and ,means of the ,house of ,representatives2 7,d7 provide such data to the ,secretary on at least an annual basis2 and 7,e7 ensure that the provision of assistance to an applicant or recipient of assistance is not denied or otherwise adversely affected because of the failure of the applicant or recipient to provide race1 ethnicity1 primary language1 sex1 sexual orientation1 disability status1 gender identity1 and socioeconomic status data4 7#b7 ,rules of construction ,nothing in this subsection shall be construed to-- 7,a7 permit the use of information collected under this subsection in a manner that would adversely affect any individual providing any such information2 or 7,b7 diminish existing or future requirements on health care providers to collect data4 7#c7 ,no compelled disclosure of data ,this title does not authorize any health care provider1 ,federal official1 or other entity to compel the disclosure of any data collected under this title4 ,the disclosure of any such data by an individual pursuant to this title shall be strictly voluntary4 7b7 ,protection of data ,the ,secretary shall ensure 7through the promulgation of regulations or otherwise7 that all data collected pursuant to subsection 7a7 are protected-- 7#a7 under the same privacy protections as the ,secretary applies to other health data under the regulations promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7,public ,law #ajd-aia2 #aaj ,stat4 #bjcc7 relating to the privacy of individually identifiable health information and other protections2 and 7#b7 from all inappropriate internal use by any entity that collects1 stores1 or receives the data1 including use of such data in determinations of eligibility 7or continued eligibility7 in health plans1 and from other inappropriate uses1 as defined by the ,secretary4 7c7 ,national plan of the data ,council ,the ,secretary shall develop and implement a national plan to ensure the collection of data in a culturally appropriate and competent manner1 to improve the collection1 analysis1 and reporting of racial1 ethnic1 sex1 primary language1 sexual orientation1 disability status1 gender identity1 and socioeconomic status data at the ,federal1 ,state1 territorial1 tribal1 and local levels1 including data to be collected under subsection 7a71 and to ensure that data collection activities carried out under this section are in compliance with the standards developed under section #caja4 ,the ,data ,council of the ,department of ,health and ,human ,services1 in consultation with the ,national ,committee on ,vital ,health ,statistics1 the ,office of ,minority ,health1 ,office on ,women's ,health1 and other appropriate public and private entities1 shall make recommendations to the ,secretary concerning the development1 implementation1 and revision of the national plan4 ,such plan shall include recommendations on how to-- 7#a7 implement subsection 7a7 while minimizing the cost and administrative burdens of data collection and reporting2 7#b7 expand awareness among ,federal agencies1 ,states1 territories1 ,indian tribes1 health providers1 health plans1 health insurance issuers1 and the general public that data collection1 analysis1 and reporting by race1 ethnicity1 primary language1 sexual orientation1 disability status1 gender identity1 and socioeconomic status is legal and necessary to assure equity and nondiscrimination in the quality of health care services2 7#c7 ensure that future patient record systems have data code sets for racial1 ethnic1 primary language1 sexual orientation1 disability status1 gender identity1 and socioeconomic status identifiers and that such identifiers can be retrieved from clinical records1 including records transmitted electronically2 7#d7 improve health and health care data collection and analysis for more population groups if such groups can be aggregated into the minimum race and ethnicity categories1 including exploring the feasibility of enhancing collection efforts in ,states for racial and ethnic groups that comprise a significant proportion of the population of the ,state2 7#e7 provide researchers with greater access to racial1 ethnic1 primary language1 sexual orientation1 disability status1 gender identity1 and socioeconomic status data1 subject to privacy and confidentiality regulations2 and 7#f7 safeguard and prevent the misuse of data collected under subsection 7a74 7d7 ,compliance with ,standards ,data collected under subsection 7a7 shall be obtained1 maintained1 and presented 7including for reporting purposes7 in accordance with the standards developed under section #caja4 7e7 ,technical assistance for the collection and reporting of data 7#a7 ,in general ,the ,secretary may1 either directly or through grant or contract1 provide technical assistance to enable a health care program or an entity operating under such program to comply with the requirements of this section4 7#b7 ,types of assistance ,assistance provided under this subsection may include assistance to-- 7,a7 enhance or upgrade computer technology that will facilitate racial1 ethnic1 primary language1 sexual orientation1 disability status1 gender identity1 and socioeconomic status data collection and analysis2 7,b7 improve methods for health data collection and analysis1 including additional population groups if such groups can be aggregated into the race and ethnicity categories outlined by the standards developed under section #caja2 7,c7 develop mechanisms for submitting collected data subject to existing privacy and confidentiality regulations2 and 7,d7 develop educational programs to inform health insurance issuers1 health plans1 health providers1 health-related agencies1 and the general public that data collection and reporting by race1 ethnicity1 primary language1 sexual orientation1 disability status1 gender identity1 and socioeconomic status are legal and essential for eliminating health and health care disparities4 7f7 ,analysis of health disparity data ,the ,secretary1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality and in coordination with the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall provide technical assistance to agencies of the ,department of ,health and ,human ,services in meeting ,federal standards for health disparity data collection and for analysis of racial and ethnic disparities in health and health care in public programs by-- 7#a7 identifying appropriate quality assurance mechanisms to monitor for health disparities2 7#b7 specifying the clinical1 diagnostic1 or therapeutic measures which should be monitored2 7#c7 developing new quality measures relating to racial and ethnic disparities and their overlap with other disparity factors in health and health care2 7#d7 identifying the level at which data analysis should be conducted2 and 7#e7 sharing data with external organizations for research and quality improvement purposes4 7g7 ,primary language ,references in this section-- 7#a7 to primary language data1 include spoken and written primary language data2 and 7#b7 to primary language data collection activities1 include identifying1 collecting1 storing1 tracking1 and analyzing primary language data and information on the methods used to meet the language access needs of limited-,english-proficient individuals4 7h7 ,definition ,in this section1 the term health-related program mean a program-- 7#a7 under the ,social ,security ,act 7#db ,u4,s4,c4 #cja et seq47 that pays for health care and services2 and 7#b7 under this ,act that provides ,federal financial assistance for health care1 biomedical research1 or health services research and or is designed to improve the public's health4 7i7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjbj4 #cdcb4 ,provisions relating to ,native ,americans 7a7 ,establishment of epidemiology centers ,the ,secretary shall establish an epidemiology center in each service area to carry out the functions described in subsection 7b74 ,any new center established after the date of the enactment of the ,health ,equity and ,accountability ,act of #bjad may be operated under a grant authorized by subsection 7d71 but funding under such a grant shall not be divisible4 7b7 ,functions of centers ,in consultation with and upon the request of ,indian tribes1 tribal organizations1 and urban ,indian organizations1 each service area epidemiology center established under this subsection shall1 with respect to such service area-- 7#a7 collect data relating to1 and monitor progress made toward meeting1 each of the health status objectives of the service1 the ,indian tribes1 tribal organizations1 and urban ,indian organizations in the service area2 7#b7 evaluate existing delivery systems1 data systems1 and other systems that impact the improvement of ,indian health2 7#c7 assist ,indian tribes1 tribal organizations1 and urban ,indian organizations in identifying their highest priority health status objectives and the services needed to achieve such objectives1 based on epidemiological data2 7#d7 make recommendations for the targeting of services needed by the populations served2 7#e7 make recommendations to improve health care delivery systems for ,indians and urban ,indians2 7#f7 provide requested technical assistance to ,indian tribes1 tribal organizations1 and urban ,indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community2 and 7#g7 provide disease surveillance and assist ,indian tribes1 tribal organizations1 and urban ,indian organizations to promote public health4 7c7 ,technical assistance ,the ,director of the ,centers for ,disease ,control and ,prevention shall provide technical assistance to the centers in carrying out the requirements of this subsection4 7d7 ,grants for studies 7#a7 ,in general ,the ,secretary may make grants to ,indian tribes1 tribal organizations1 urban ,indian organizations1 and eligible intertribal consortia to conduct epidemiological studies of ,indian communities4 7#b7 ,eligible intertribal consortia ,an intertribal consortium is eligible to receive a grant under this subsection if-- 7,a7 the intertribal consortium is incorporated for the primary purpose of improving ,indian health2 and 7,b7 the intertribal consortium is representative of the ,indian tribes or urban ,indian communities in which the intertribal consortium is located4 7#c7 ,applications ,an application for a grant under this subsection shall be submitted in such manner and at such time as the ,secretary shall prescribe4 7#d7 ,requirements ,an applicant for a grant under this subsection shall-- 7,a7 demonstrate the technical1 administrative1 and financial expertise necessary to carry out the functions described in paragraph 7#e72 7,b7 consult and cooperate with providers of related health and social services in order to avoid duplication of existing services2 and 7,c7 demonstrate cooperation from ,indian tribes or urban ,indian organizations in the area to be served4 7#e7 ,use of funds ,a grant awarded under paragraph 7#a7 may be used-- 7,a7 to carry out the functions described in subsection 7b72 7,b7 to provide information to and consult with tribal leaders1 urban ,indian community leaders1 and related health staff on health care and health service management issues2 and 7,c7 in collaboration with ,indian tribes1 tribal organizations1 and urban ,indian communities1 to provide the service with information regarding ways to improve the health status of ,indians4 7e7 ,access to information ,an epidemiology center operated by a grantee pursuant to a grant awarded under subsection 7d7 shall be treated as a public health authority for purposes of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7,public ,law #ajd-aia2 #aaj ,stat4 #bjcc71 as such entities are defined in part #afd4eja of title #de1 ,code of ,federal ,regulations 7or a successor regulation74 ,the ,secretary shall grant such grantees access to and use of data1 data sets1 monitoring systems1 delivery systems1 and other protected health information in the possession of the ,secretary4 4 #ajb4 ,elimination of prerequisite of direct appropriations for data collection and analysis ,section #caja of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjkk7 is amended-- 7#a7 by striking subsection 7h72 and 7#b7 by redesignating subsection 7i7 as subsection 7h74 #ajc4 ,collection of race and ethnicity data by the ,social ,security ,administration ,part ,a of title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq47 is amended by adding at the end the following3 #aaej;,c4 ,collection of race and ethnicity data by the ,social ,security ,administration 7a7 ,requirement ,the ,commissioner of ,social ,security1 in consultation with the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall-- 7#a7 require the collection of data on the race1 ethnicity1 primary language1 and disability status of all applicants for ,social ,security account numbers or benefits under title ,,ii or part ,a of title ,,xviii and all individuals with respect to whom the ,commissioner maintains records of wages and self-employment income in accordance with reports received by the ,commissioner or the ,secretary of the ,treasury-- 7,a7 using1 at a minimum1 the standards for data collection on race1 ethnicity1 primary language1 and disability status developed under section #caja of the ,public ,health ,service ,act2 7,b7 where practicable1 collecting data for additional population groups if such groups can be aggregated into the race and ethnicity categories outlined by the standards developed under section #caja of the ,public ,health ,service ,act2 and 7,c7 additionally referring1 where practicable1 to the standards developed by the ,institute of ,medicine in ,race1 ,ethnicity1 and ,language ,data3 ,standardization for ,health ,care ,quality ,improvement 7released ,august #ca1 #bjji72 7#b7 with respect to the collection of the data described in paragraph 7#a7 for applicants who are under #ah years of age or otherwise legally incapacitated1 require that-- 7,a7 such data be collected from the parent or legal guardian of such an applicant2 and 7,b7 the primary language of the parent or legal guardian of such an applicant or recipient be used2 7#c7 require that such data be uniformly analyzed and reported at least annually to the ,commissioner of ,social ,security2 7#d7 be responsible for storing the data reported under paragraph 7#c72 7#e7 ensure transmission to the ,centers for ,medicare ,medicaid ,services and other ,federal health agencies2 7#f7 provide such data to the ,secretary on at least an annual basis2 and 7#g7 ensure that the provision of assistance to an applicant is not denied or otherwise adversely affected because of the failure of the applicant to provide race1 ethnicity1 primary language1 and disability status data4 7b7 ,protection of data ,the ,commissioner of ,social ,security shall ensure 7through the promulgation of regulations or otherwise7 that all data collected pursuant to subsection 7a7 are protected-- 7#a7 under the same privacy protections as the ,secretary applies to health data under the regulations promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7,public ,law #ajd-aia2 #aaj ,stat4 #bjcc7 relating to the privacy of individually identifiable health information and other protections2 and 7#b7 from all inappropriate internal use by any entity that collects1 stores1 or receives the data1 including use of such data in determinations of eligibility 7or continued eligibility7 in health plans1 and from other inappropriate uses1 as defined by the ,secretary4 7c7 ,rule of construction ,nothing in this section shall be construed to permit the use of information collected under this section in a manner that would adversely affect any individual providing any such information4 7d7 ,technical assistance ,the ,secretary may1 either directly or by grant or contract1 provide technical assistance to enable any health entity to comply with the requirements of this section4 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjbj4 4 #ajd4 ,revision of ,,hipaa claims standards 7a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall revise the regulations promulgated under part ,c of title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;d et seq471 relating to the collection of data on race1 ethnicity1 and primary language in a health-related transaction1 to require-- 7#a7 the use1 at a minimum1 of the standards for data collection on race1 ethnicity1 primary language1 disability1 and sex developed under section #caja of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjkk72 and 7#b7 the designation of the racial1 ethnic1 primary language1 disability1 and sex code sets as required for claims and enrollment data4 7b7 ,dissemination ,the ,secretary of ,health and ,human ,services shall disseminate the new standards developed under subsection 7a7 to all health entities that are subject to the regulations described in such subsection and provide technical assistance with respect to the collection of the data involved4 7c7 ,compliance ,the ,secretary of ,health and ,human ,services shall require that health entities comply with the new standards developed under subsection 7a7 not later than #b years after the final promulgation of such standards4 #aje4 ,national ,center for ,health ,statistics ,section #cjf7n7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdbk7n77 is amended-- 7#a7 in paragraph 7#a71 by striking #bjjc and inserting #bjbj2 7#b7 in paragraph 7#b71 in the first sentence1 by striking #bjjc and inserting #bjbj2 and 7#c7 in paragraph 7#c71 by striking #bjjb and inserting #bjbj4 #ajf4 ,oversampling of ,asian-,americans1 ,native ,hawaiians1 or ,pacific ,islanders and other underrepresented groups in ,federal health surveys ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq47 is amended by inserting after section #cag,t the following3 #cag,u4 ,oversampling of ,asian-,americans1 ,native ,hawaiians1 or ,pacific ,islanders and other underrepresented groups in ,federal health surveys 7a7 ,national strategy 7#a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,national ,center for ,health ,statistics 7referred to in this section as ,,nchs7 of the ,centers for ,disease ,control and ,prevention1 and other agencies within the ,department of ,health and ,human ,services as the ,secretary determines appropriate1 shall develop and implement an ongoing and sustainable national strategy for oversampling ,asian-,americans1 ,native ,hawaiians1 or ,pacific ,islanders1 and other underrepresented populations as determined appropriate by the ,secretary in ,federal health surveys4 7#b7 ,consultation ,in developing and implementing a national strategy1 as described in paragraph 7#a71 not later than #ahj days after the date of the enactment of the this section1 the ,secretary-- 7,a7 shall consult with representatives of community groups1 nonprofit organizations1 nongovernmental organizations1 and government agencies working with ,asian-,americans1 ,native ,hawaiians1 or ,pacific ,islanders1 and other underrepresented populations2 and 7,b7 may solicit the participation of representatives from other ,federal departments and agencies4 7b7 ,progress report ,not later than #b years after the date of the enactment of this section1 the ,secretary shall submit to the ,congress a progress report1 which shall include the national strategy described in subsection 7a77#a74 7c7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjae through #bjbj4 4 #ajg4 ,geo-access study ,the ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration shall-- 7#a7 conduct a study to-- 7,a7 determine which geographic areas of the ,united ,states have shortages of specialty mental health providers2 and 7,b7 assess the preparedness of speciality mental health providers to deliver culturally and linguistically appropriate1 affordable1 and accessible services2 and 7#b7 submit a report to the ,congress on the results of such study4 #ajh4 ,racial1 ethnic1 and primary language data collected by the ,federal ,government 7a7 ,collection2 submission ,not later than #ij days after the date of the enactment of this ,act1 and ,january #ca of each year thereafter1 each department1 agency1 and office of the ,federal ,government that has collected racial1 ethnic1 or primary language data during the preceding calendar year shall submit such data to the ,secretary of ,health and ,human ,services4 7b7 ,analysis2 public availability2 reporting ,not later than ,april #cj1 #bjae1 and each ,april #cj thereafter1 the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities and the ,deputy ,assistant ,secretary for ,minority ,health1 shall-- 7#a7 collect and analyze the racial1 ethnic1 and primary language data submitted under subsection 7a7 for the preceding calendar year2 7#b7 make publicly available such data and the results of such analysis2 and 7#c7 submit a report to the ,congress on such data and analysis4 #aji4 ,data collection and analysis grants to minority-serving institutions 7a7 ,authority ,the ,secretary of ,health and ,human ,services1 acting through the ,national ,institute on ,minority ,health and ,health ,disparities and the ,office of ,minority ,health1 may award grants to access and analyze racial and ethnic1 and where possible other health disparity data1 to monitor and report on progress to reduce and eliminate disparities in health and health care4 7b7 ,eligible entity ,in this section1 the term eligible entity means a historically ,black college or university1 an ,hispanic-serving institution1 a tribal college or university1 or an ,asian-,american1 ,native ,american1 or ,pacific ,islander-serving institution with an accredited public health1 health policy1 or health services research program4 #aaj4 ,standards for measuring sexual orientation and gender identity in collection of health data ,section #caja7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjkk7a77 is amended-- 7#a7 in paragraph 7#a77;,a71 by inserting sexual orientation1 gender identity1 before and disability status2 7#b7 in paragraph 7#a77;,c71 by inserting sexual orientation1 gender identity1 before and disability status2 and 7#c7 in paragraph 7#b77;,b71 by inserting sexual orientation1 gender identity1 before and disability status4 #aaa4 ,standards for measuring socioeconomic status in collection of health data ,section #caja7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjkk7a771 as amended1 is amended-- 7#a7 in paragraph 7#a77;,a71 by inserting socioeconomic status1 before and disability status2 7#b7 in paragraph 7#a77;,c71 by inserting socioeconomic status1 before and disability status2 and 7#c7 in paragraph 7#b77;,b71 by inserting socioeconomic status1 before and disability status4 #aab4 ,safety and effectiveness of drugs with respect to racial and ethnic background 7a7 ,in general ,chapter ,v of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cea et seq47 is amended by adding after section #eje;,e the following3 #eje;,f4 ,safety and effectiveness of drugs with respect to racial and ethnic background 7a7 ,preapproval studies ,if there is evidence that there may be a disparity on the basis of racial or ethnic background as to the safety or effectiveness of a drug1 then-- 7#a7 7,a7 the investigations required under section #eje7;b77#a77;,a7 shall include adequate and well-controlled investigations of the disparity2 or 7,b7 the evidence required under section #cea7;a7 of the ,public ,health ,service ,act for approval of a biologics license application for the drug shall include adequate and well-controlled investigations of the disparity2 and 7#b7 if the investigations confirm that there is a disparity1 the labeling of the drug shall include appropriate information about the disparity4 7b7 ,postmarket studies 7#a7 ,in general ,if there is evidence that there may be a disparity on the basis of racial or ethnic background as to the safety or effectiveness of a drug for which there is an approved application under section #eje or a license under section #cea of the ,public ,health ,service ,act1 the ,secretary may by order require the holder of the approved application or license to conduct1 by a date specified by the ,secretary1 postmarketing studies to investigate the disparity4 7#b7 ,labeling ,if the ,secretary determines that the postmarket studies confirm that there is a disparity described in paragraph 7#a71 the labeling of the drug shall include appropriate information about the disparity4 7#c7 ,study design ,the ,secretary may specify all aspects of study design1 including the number of studies and study participants1 and the other demographic characteristics of study participants included1 in the order requiring postmarket studies of the drug4 7#d7 ,modifications of study design ,the ,secretary may by order modify any aspect of the study design as necessary after issuing an order under paragraph 7#a74 7#e7 ,study results ,the results from studies required under paragraph 7#a7 shall be submitted to the ,secretary as supplements to the drug application or biological license application4 7c7 ,disparity ,the term evidence that there may be a disparity on the basis of racial or ethnic background for adult and pediatric populations as to the safety or effectiveness of a drug includes-- 7#a7 evidence that there is a disparity on the basis of racial or ethnic background as to safety or effectiveness of a drug in the same chemical class as the drug2 7#b7 evidence that there is a disparity on the basis of racial or ethnic background in the way the drug is metabolized2 and 7#c7 other evidence as the ,secretary may determine4 7d7 ,applications under sections #eje7;b77#b7 and #eje7;j7 7#a7 ,in general ,a drug for which an application has been submitted or approved under section #eje7;j7 shall not be considered ineligible for approval under that section or misbranded under section #ejb on the basis that the labeling of the drug omits information relating to a disparity on the basis of racial or ethnic background as to the safety or effectiveness of the drug1 whether derived from investigations or studies required under this section or derived from other sources1 when the omitted information is protected by patent or by exclusivity under clause 7iii7 or 7iv7 of section #eje7;j77#e77;,b74 7#b7 ,labeling ,notwithstanding clauses 7iii7 and 7iv7 of section #eje7;j77#e77;,b71 the ,secretary may require that the labeling of a drug approved under section #eje7;j7 that omits information relating to a disparity on the basis of racial or ethnic background as to the safety or effectiveness of the drug include a statement of any appropriate contraindications1 warnings1 or precautions related to the disparity that the ,secretary considers necessary4 4 7b7 ,enforcement ,section #ejb of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #ceb7 is amended by adding at the end the following3 7cc7 ,if it is a drug and the holder of the approved application under section #eje or license under section #cea of the ,public ,health ,service ,act for the drug has failed to complete the investigations or studies1 or comply with any other requirement1 of section #eje;,f4 4 7c7 ,drug fees ,section #gcf7;a77#a77;,a77ii7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cgi;h7 is amended by adding after are required the following3 1 including supplements required under section #eje;,f4 #aac4 ,improving health data regarding ,native ,hawaiians and other ,pacific ,islanders ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq47 is amended by inserting after section #cag,u1 as added1 the following3 #cag,v4 ,native ,hawaiian and other ,pacific ,islander health data 7a7 ,definitions ,in this section3 7#a7 ,community group ,the term community group means a group of ,,nhopi who are organized at the community level1 and may include a church group1 social service group1 national advocacy organization1 or cultural group4 7#b7 ,nonprofit1 nongovernmental organization ,the term nonprofit1 nongovernmental organization means a group of ,,nhopi with a demonstrated history of addressing ,,nhopi issues1 including a ,,nhopi coalition4 7#c7 ,designated organization ,the term designated organization means an entity established to represent ,,nhopi populations and which has statutory responsibilities to provide1 or has community support for providing1 health care4 7#d7 ,government representatives ,the term government representatives means representatives from ,hawaii1 ,american ,samoa1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,federated ,states of ,micronesia1 ,guam1 the ,republic of ,palau1 and the ,republic of the ,marshall ,islands4 7#e7 ,native ,hawaiians and other ,pacific ,islanders 7,,nhopi7 ,the term ,native ,hawaiians and ,other ,pacific ,islanders or ,,nhopi means people having origins in any of the original peoples of ,american ,samoa1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,federated ,states of ,micronesia1 ,guam1 ,hawaii1 the ,republic of the ,marshall ,islands1 the ,republic of ,palau1 or any other ,pacific island4 7#f7 ,insular area ,the term insular area means ,guam1 the ,commonwealth of ,northern ,mariana ,islands1 ,american ,samoa1 the ,united ,states ,virgin ,islands1 the ,federated ,states of ,micronesia1 the ,republic of ,palau1 or the ,republic of the ,marshall ,islands4 7b7 ,national strategy 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,national ,center for ,health ,statistics 7referred to in this section as ,,nchs7 of the ,centers for ,disease ,control and ,prevention1 and other agencies within the ,department of ,health and ,human ,services as the ,secretary determines appropriate1 shall develop and implement an ongoing and sustainable national strategy for identifying and evaluating the health status and health care needs of ,,nhopi populations living in the continental ,united ,states1 ,hawaii1 ,american ,samoa1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,federated ,states of ,micronesia1 ,guam1 the ,republic of ,palau1 and the ,republic of the ,marshall ,islands4 7#b7 ,consultation ,in developing and implementing a national strategy1 as described in paragraph 7#a71 not later than #ahj days after the date of enactment of the ,health ,equity and ,accountability ,act of #bjad1 the ,secretary-- 7,a7 shall consult with representatives of community groups1 designated organizations1 and nonprofit1 nongovernmental organizations and with government representatives of ,,nhopi populations2 and 7,b7 may solicit the participation of representatives from other ,federal departments4 7c7 ,preliminary health survey 7#a7 ,in general ,the ,secretary1 acting through the ,director of ,,nchs1 shall conduct a preliminary health survey in order to identify the major areas and regions in the continental ,united ,states1 ,hawaii1 ,american ,samoa1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,federated ,states of ,micronesia1 ,guam1 the ,republic of ,palau1 and the ,republic of the ,marshall ,islands in which ,,nhopi people reside4 7#b7 ,contents ,the health survey described in paragraph 7#a7 shall include health data and any other data the ,secretary determines to be-- 7,a7 useful in determining health status and health care needs2 or 7,b7 required for developing or implementing a national strategy4 7#c7 ,methodology ,methodology for the health survey described in paragraph 7#a71 including plans for designing questions1 implementation1 sampling1 and analysis1 shall be developed in consultation with community groups1 designated organizations1 nonprofit1 nongovernmental organizations1 and government representatives of ,,nhopi populations1 as determined by the ,secretary4 7#d7 ,timeframe ,the survey required under this subsection shall be completed not later than #ah months after the date of enactment of the ,health ,equity and ,accountability ,act of #bjad4 7d7 ,progress report ,not later than #b years after the date of enactment of the ,health ,equity and ,accountability ,act of #bjad1 the ,secretary shall submit to ,congress a progress report1 which shall include the national strategy described in subsection 7b77#a74 7e7 ,study and report by the ,,iom 7#a7 ,in general ,the ,secretary shall enter into an agreement with the ,institute of ,medicine to conduct a study1 with input from stakeholders in insular areas1 on the following3 7,a7 ,the standards and definitions of health care applied to health care systems in insular areas and the appropriateness of such standards and definitions4 7,b7 ,the status and performance of health care systems in insular areas1 evaluated based upon standards and definitions1 as the ,secretary determines4 7,c7 ,the effectiveness of donor aid in addressing health care needs and priorities in insular areas4 7,d7 ,the progress toward implementation of recommendations of the ,committee on ,health ,care ,services in the ,united ,states--,associated ,pacific ,basin of the ,institute of ,medicine that are set forth in the #aiih report1 ,pacific ,partnerships for ,health3 ,charting a ,new ,course for the #bast ,century4 7#b7 ,report ,an agreement described in paragraph 7#a7 shall require the ,institute of ,medicine to submit to the ,secretary and to ,congress1 not later than #b years after the date of the enactment of the ,health ,equity and ,accountability ,act of #bjad1 a report containing a description of the results of the study conducted under paragraph 7#a71 including the conclusions and recommendations of the ,institute of ,medicine for each of the items described in subparagraphs 7,a7 through 7,d7 of such paragraph4 7f7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjae through #bjbj4 4 #aad4 ,clarification of simplified administrative reporting requirement ,section #aa7;a7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjbj7;a77 is amended by adding at the end the following3 7#e7 ,simplified administrative reporting requirement ,the administrative notification requirement under section #dba7;e77#b7 of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afca7;e77#b77 shall be satisfied by the submission by an agency of a report on the aggregate number of exceptions granted under such section by such agency in each year4 4 ,,ii ,culturally and linguistically appropriate health care #bja4 ,definitions ,in this title1 the definitions contained in section #cdjj of the ,public ,health ,service ,act1 as added by section #bjb1 shall apply4 #bjb4 ,amendment to the ,public ,health ,service ,act 7a7 ,findings ,congress finds the following3 7#a7 ,effective communication is essential to meaningful access to quality physical and mental health care4 7#b7 ,research indicates that the lack of appropriate language services creates language barriers that result in increased risk of misdiagnosis1 ineffective treatment plans and poor health outcomes for limited-,english-proficient individuals and individuals with communication disabilities such as hearing1 vision1 or print impairments4 7#c7 ,the number of limited-,english-speaking residents in the ,united ,states who speak ,english less than very well and1 therefore1 cannot effectively communicate with health and social service providers continues to increase significantly4 7#d7 ,the responsibility to fund language services in the provision of health care and health-care-related services to limited-,english-proficient individuals and individuals with communication disabilities such as hearing1 vision1 or print impairments is a societal one that cannot fairly be visited solely upon the health care1 public health1 or social services community4 7#e7 ,title ,,vi of the ,civil ,rights ,act of #aifd prohibits discrimination based on the grounds of race1 color1 or national origin by any entity receiving ,federal financial assistance4 ,in order to avoid discrimination on the grounds of national origin1 all programs or activities administered by the ,department must take adequate steps to ensure that their policies and procedures do not deny or have the effect of denying limited-,english-proficient individuals with equal access to benefits and services for which such persons qualify4 7#f7 ,linguistic diversity in the health care and health-care-related-services workforce is important for providing all patients the environment most conducive to positive health outcomes4 7#g7 ,all members of the health care and health-care-related-services community should continue to educate their staff and constituents about limited-,english-proficient and disability communication issues and help them identify resources to improve access to quality care for limited-,english-proficient individuals and individuals with communication disabilities such as hearing1 vision1 or print impairments4 7#h7 ,access to ,english as a second language and sign language instructions is an important mechanism for ensuring effective communication and eliminating the language barriers that impede access to health care4 7#i7 ,competent language services in health care settings should be available as a matter of course4 7b7 ,amendment ,the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bja et seq47 is amended by adding at the end the following3 ,,xxxiv ,,culturally ,,and ,,linguistically ,,appropriate ,,health ,,care #cdjj4 ,definitions ,in this title3 7#a7 ,bilingual ,the term bilingual with respect to an individual means a person who has sufficient degree of proficiency in two languages4 7#b7 ,community health worker ,the term community health worker includes a community health advocate1 a lay health educator1 a community health representative1 a peer health promoter1 a community health outreach worker1 and in ,spanish1 promotores de salud4 7#c7 ,competent interpreter services ,the term competent interpreter services means a translanguage rendition of a spoken or signed message in which the interpreter-- 7,a7 comprehends the source language and can communicate comprehensively in the target language to convey the meaning intended in the source language2 and 7,b7 knows health and health-related terminology and provides accurate interpretations by choosing equivalent expressions that convey the best matching and meaning to the source language and capture1 to the greatest possible extent1 all nuances intended in the source message4 7#d7 ,competent translation services ,the term competent translation services means a translanguage rendition of a written document in which the translator-- 7,a7 comprehends the source language and can write or sign comprehensively in the target language to convey the meaning intended in the source language2 and 7,b7 knows health and health-related terminology and provides accurate translations by choosing equivalent expressions that convey the best matching and meaning to the source language and capture1 to the greatest possible extent1 all nuances intended in the source document4 7#e7 ,cultural competence ,the term cultural competence means a set of congruent behaviors1 attitudes1 and policies that come together in a system1 agency1 or among professionals that enables effective work in cross-cultural situations4 ,in the preceding sentence-- 7,a7 the term cultural refers to integrated patterns of human behavior that include the language1 thoughts1 communications1 actions1 customs1 beliefs1 values1 and institutions of racial1 ethnic1 religious1 or social groups1 including lesbian1 gay1 bisexual1 transgender1 and intersex individuals1 and individuals with physical and mental disabilities2 and 7,b7 the term competence implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs1 behaviors1 and needs presented by consumers and their communities4 7#f7 ,effective communication ,the term effective communication means an exchange of information between the provider of health care or health-care-related services and the recipient of such services who is limited in ,english proficiency1 or has a communication impairment such as a hearing1 vision1 or learning impairment1 that enables access1 understanding1 and benefit from health care or health-care-related services1 and full participation in the development of their treatment plan4 7#g7 ,grievance resolution process ,the term grievance resolution process means all aspects of dispute resolution including filing complaints1 grievance and appeal procedures1 and court action4 7#h7 ,health care group ,the term health care group means a group of physicians organized1 at least in part1 for the purposes of providing physicians' services under the ,medicaid1 ,,schip1 or ,medicare programs and may include a hospital and any other individual or entity furnishing services covered under the ,medicaid1 ,,schip1 or ,medicare programs that is affiliated with the health care group4 7#i7 ,healthcare services ,the term health care services means services that address physical as well as mental health conditions in all care settings4 7#aj7 ,health-care-related services ,the term health-care-related services means human or social services programs or activities that provide access1 referrals or links to health care4 7#aa7 ,indian tribe ,the term ,indian tribe means any ,indian tribe1 band1 nation1 or other organized group or community1 including any ,alaska ,native village or group or regional or village corporation as defined in or established pursuant to the ,alaska ,native ,claims ,settlement ,act 7#he ,stat4 #fhh7 7#dc ,u4,s4,c4 #afja et seq471 which is recognized as eligible for the special programs and services provided by the ,united ,states to ,indians because of their status as ,indians4 7#ab7 ,integrated health care delivery system ,the term integrated health care delivery system means an interdisciplinary system that brings together providers from the primary health1 mental health1 substance use and related disciplines to improve the health outcomes of an individual4 ,providers may include but are not limited to hospitals1 health1 mental health or substance use clinics and providers1 home health agencies1 ambulatory surgery centers1 skilled nursing facilities1 rehabilitation centers1 and employed1 independent1 or contracted physicians4 7#ac7 ,interpreting_/interpretation ,the terms interpreting and interpretation mean the transmission of a spoken1 written1 or signed message from one language or format into another1 faithfully1 accurately1 and objectively4 7#ad7 ,language access ,the term language access means the provision of language services to an ,,lep individual or individual with communication disabilities designed to enhance that individual's access to1 understanding of1 or benefit from health care or health-care-related services4 7#ae7 ,language or language access services ,the term language or language access services means provision of health care services directly in a non-,english language1 interpretation1 translation1 signage1 video recording1 and ,english or non-,english alternative formats4 7#af7 ,,lep ,the term ,,lep means limited-,english-proficient4 7#ag7 ,medicare1 ,medicaid1 and ,,schip ,the terms ,medicare1 ,medicaid1 and ,,schip mean the respective programs under titles ,,xviii1 ,,xix1 and ,,xxi of the ,social ,security ,act4 7#ah7 ,minority 7,a7 ,in general ,the terms minority and minorities refer to individuals from a minority group4 7,b7 ,populations ,the term minority1 with respect to populations1 refers to racial and ethnic minority groups4 7#ai7 ,minority group ,the term minority group has the meaning given the term racial and ethnic minority group4 7#bj7 ,racial and ethnic minority group ,the term racial and ethnic minority group means ,american ,indians and ,alaska ,natives1 ,african-,americans 7including ,caribbean ,blacks1 ,africans1 and other ,blacks71 ,asian-,americans1 ,hispanics 7including ,latinos71 and ,native ,hawaiians and other ,pacific ,islanders4 7#ba7 ,onsite interpretation ,the term onsite interpretation means a method of interpreting or interpretation for which the interpreter is in the physical presence of the provider of health care or health-care-related services and the recipient of such services who is limited in ,english proficiency or has a communication impairment such as hearing1 vision1 or learning4 7#bb7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#bc7 ,sight translation ,the term sight translation means the transmission of a written message in one language into a spoken or signed message in another language1 or an alternative format in ,english or another language4 7#bd7 ,state ,the term ,state means each of the several ,states1 the ,district of ,columbia1 the ,commonwealth of ,puerto ,rico1 the ,indian tribes1 the ,united ,states ,virgin ,islands1 ,guam1 ,american ,samoa1 and the ,commonwealth of the ,northern ,mariana ,islands4 7#be7 ,telephonic interpretation ,the term telephonic interpretation 7also known as over the phone interpretation or ,,opi7 means a method of interpreting_/interpretation for which the interpreter is not in the physical presence of the provider of health care or related services and the limited-,english-proficient recipient of such services but is connected via telephone4 7#bf7 ,translation ,the term translation means the transmission of a written message in one language into a written or signed message in another language1 and includes translation into another language or alternative format1 such as large print font1 ,braille1 audio recording1 or ,,cd4 7#bg7 ,video interpretation ,the term video interpretation means a method of interpreting_/interpretation for which the interpreter is not in the physical presence of the provider of health care or related services and the limited-,english-proficient recipient of such services but is connected via a video hook-up that includes both audio and video transmission4 7#bh7 ,vital document ,the term vital document includes but is not limited to applications for government programs that provide health care services1 medical or financial consent forms1 financial assistance documents1 letters containing important information regarding patient instructions 7such as prescriptions1 referrals to other providers1 and discharge plans7 and participation in a program 7such as a ,medicaid managed care program71 notices pertaining to the reduction1 denial1 or termination of services or benefits1 notices of the right to appeal such actions1 and notices advising limited-,english-proficient individuals and individuals with communication disabilities of the availability of free language services1 alternative formats1 and other outreach materials4 #cdja4 ,improving access to services for individuals with limited ,english proficiency 7a7 ,purpose ,as provided in ,executive ,order #acaff1 it is the purpose of this section-- 7#a7 to improve ,federal agency performance regarding access to federally conducted and federally assisted programs and activities for individuals who are limited in their ,english proficiency2 7#b7 to require each ,federal agency to examine the services it provides and develop and implement a system by which limited-,english-proficient individuals can obtain cultural competence and meaningful access to those services consistent with1 and without substantially burdening1 the fundamental mission of the agency2 7#c7 to require each ,federal agency to ensure that recipients of ,federal financial assistance provide cultural competence and meaningful access to their limited-,english-proficient applicants and beneficiaries2 7#d7 to ensure that recipients of ,federal financial assistance take reasonable steps1 consistent with the guidelines set forth in the ,limited ,english ,proficient ,guidance of the ,department of ,justice 7as issued on ,june #ab1 #bjjb71 to ensure cultural competence and meaningful access to their programs and activities by limited-,english-proficient individuals2 and 7#e7 to ensure compliance with title ,,vi of the ,civil ,rights ,act of #aifd and that health care providers and organizations do not discriminate in the provision of services4 7b7 ,federally conducted programs and activities 7#a7 ,in general ,not later than #abj days after the date of enactment of this title1 each ,federal agency that carries out health-care-related activities shall prepare a plan to improve access cultural competence to the federally conducted1 health-care-related programs and activities of the agency by limited-,english-proficient individuals4 ,not later than one year after the date of enactment of this title1 each such ,federal agency shall ensure that such plan is fully implemented4 7#b7 ,plan requirement ,each plan under paragraph 7#a7 shall include-- 7,a7 the steps the agency will take to ensure that limited-,english-proficient individuals have access to the agency's federally conducted health care and health-care-related programs and activities2 7,b7 the policies and procedures for identifying1 assessing1 and meeting the language needs and cultural competence needs of its limited-,english-proficient beneficiaries served by federally conducted programs and activities2 7,c7 the steps the agency will take for its federally conducted programs and activities to improve cultural competence to provide a range of language assistance options1 notice to limited-,english-proficient individuals of the right to competent language services1 periodic training of staff1 monitoring and quality assessment of the language services and1 in appropriate circumstances1 the translation of written materials2 7,d7 the steps the agency will take to ensure that applications1 forms1 and other relevant documents for its federally conducted programs and activities are competently translated into the primary language of a limited-,english-proficient client where such materials are needed to improve access to federally conducted and federally assisted programs and activities for such a limited-,english-proficient individual2 7,e7 the resources the agency will provide to improve cultural competence to assist recipients of ,federal funds to improve access to health care or health-care-related programs and activities for limited-,english-proficient individuals2 7,f7 the resources the agency will provide to ensure that competent language assistance is provided to limited-,english-proficient patients by interpreters or trained bilingual staff2 and 7,g7 the resources the agency will provide to ensure that family1 particularly minor children1 and friends are not used to provide interpretation services1 except-- 7i7 in the case of a medical emergency where delay directly associated with obtaining a competent interpreter would jeopardize the health of the patient2 or 7ii7 on request of the patient1 who has been informed in his or her preferred language of the availability of free interpretation services1 if the health care services provider has determined that the family or friend can provide competent interpreter services as defined in section #cdjj4 7#c7 ,submission of plan to ,,doj ,each agency that is required to prepare a plan under paragraph 7#a7 shall send a copy of such plan to the ,department of ,justice1 which shall serve as the central repository of such plans4 7#d7 ,rule of construction ,paragraph 7#b77;,g77i7 shall not be construed to mean that emergency rooms or similar entities that regularly provide health care services in medical emergencies are exempt from legal or regulatory requirements related to competent interpreter services4 7c7 ,federally assisted programs and activities 7#a7 ,in general ,not later than #abj days after the date of enactment of this title1 each ,federal agency providing health-care-related ,federal financial assistance shall ensure that the guidance for recipients of ,federal financial assistance developed by the agency to ensure compliance with title ,,vi of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;d et seq47 is specifically tailored to the recipients of such assistance4 ,each agency shall send a copy of such guidance to the ,department of ,justice which shall serve as the central repository of the agency's plans4 ,after approval by the ,department of ,justice1 each agency shall publish its guidance document in the ,federal ,register for public comment4 7#b7 ,requirements ,the agency-specific guidance developed under paragraph 7#a7 shall take into account the types of health care services provided by the recipients1 the individuals served by the recipients1 and other factors set out in such standards4 7#c7 ,existing guidances ,a ,federal agency that has developed a guidance for purposes of title ,,vi of the ,civil ,rights ,act of #aifd shall examine such existing guidance1 as well as the programs and activities to which such guidance applies1 to determine if modification of such guidance is necessary to comply with this subsection4 7#d7 ,consultation ,each ,federal agency shall consult with the ,department of ,justice in establishing the guidances under this subsection4 7d7 ,consultations 7#a7 ,in general ,in carrying out this section1 each ,federal agency that carriers out health care and health-care-related activities shall ensure that stakeholders1 such as limited-,english-proficient individuals and their representative organizations1 recipients of ,federal assistance1 and other appropriate individuals or entities1 have an adequate opportunity to provide input with respect to the actions of the agency4 7#b7 ,evaluation ,each ,federal agency described in paragraph 7#a7 shall evaluate the-- 7,a7 particular needs of the limited-,english-proficient individuals served by the agency2 7,b7 particular needs of the limited-,english-proficient individuals served by the agency's recipients of ,federal financial assistance2 and 7,c7 burdens of compliance with the agency guidance and this section for the agency and its recipients4 #cdjb4 ,national standards for culturally and linguistically appropriate services in health care 7a7 ,applicability ,this section applies to any health program or activity1 any part of which is receiving ,federal financial assistance1 including credits1 subsidies1 or contracts of insurance1 or any program or activity that is administered by an executive agency or any entity established under title ,i of the ,patient ,protection and ,affordable ,care ,act 7or amendments made thereby71 as such programs1 activities1 agencies1 and entities are described in section #aeeg7;a7 of the ,patient ,protection and ,affordable ,care ,act4 7b7 ,standards ,the programs1 activities1 agencies1 and entities described in subsection 7a7 shall-- 7#a7 implement strategies to recruit1 retain1 and promote individuals at all levels to maintain a diverse staff and leadership that can provide culturally and linguistically appropriate health care to patient populations of the service area of the programs1 activities1 agencies1 and entities2 7#b7 educate and train governance1 leadership1 and workforce at all levels and across all disciplines of the programs1 activities1 agencies1 and entities in culturally and linguistically appropriate policies and practices on an ongoing basis2 7#c7 offer and provide language assistance1 including trained bilingual staff and interpreter services1 to individuals who have limited-,english proficiency or other communication needs1 at no cost to them at all points of contact1 and during all hours of operation1 to facilitate timely access to all health care and services2 7#d7 notify patients1 in a culturally appropriate manner1 of their right to receive language assistance services in their primary language1 verbally and in writing2 7#e7 ensure the competence of language assistance provided to limited-,english-proficient patients by interpreters and bilingual staff1 and ensure that family1 particularly minor children1 and friends are not used to provide interpretation services-- 7,a7 except in case of emergency2 or 7,b7 except on request of the patient1 who has been informed in his or her preferred language of the availability of free interpretation services if the health care services provider has determined that the family or friend can provide competent interpreter services as defined in section #cdjj2 7#f7 for each eligible ,,lep language group that constitutes #e percent or #ejj individuals1 whichever is less1 of the population of persons eligible to be served or likely to be affected or encountered in the service area of the organization1 make available-- 7,a7 easily understood patient-related materials1 including print and multimedia materials2 7,b7 information or notices about termination of benefits2 and 7,c7 signage2 7#g7 develop and implement clear goals1 policies1 operational plans1 and management1 accountability1 and oversight mechanisms to provide culturally and linguistically appropriate services and infuse them throughout the organization's planning and operations2 7#h7 conduct initial and ongoing organizational assessments of culturally and linguistically appropriate services-related activities and integrate valid linguistic1 competence-related ,national ,standards for ,culturally and ,linguistically ,appropriate ,services 7,,clas7 measures into the internal audits1 performance improvement programs1 patient satisfaction assessments1 continuous quality improvement activities1 and outcomes-based evaluations of the organization and develop ways to standardize the assessments2 7#i7 ensure that1 consistent with the privacy protections provided for under the regulations promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif1 data on an individual required to be collected pursuant to section #caja1 including the individual's alternative format preferences and policy modification needs1 are-- 7,a7 collected in health records2 7,b7 integrated into the organization's management information systems2 and 7,c7 periodically updated2 7#aj7 maintain a current demographic1 cultural1 and epidemiological profile of the community1 conduct regular assessments of community health assets and needs1 and use the results to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area of the organization2 7#aa7 develop participatory1 collaborative partnerships with communities and utilize a variety of formal and informal mechanisms to facilitate community and patient involvement in designing1 implementing1 and evaluating policies and practices to ensure culturally and linguistically appropriate service-related activities2 7#ab7 ensure that conflict and grievance resolution processes are culturally and linguistically sensitive and capable of identifying1 preventing1 and resolving cross-cultural conflicts or complaints by patients2 7#ac7 regularly make available to the public information about their progress and successful innovations in implementing the standards under this section and provide public notice in their communities about the availability of this information2 and 7#ad7 if requested1 regularly make available to the head of each ,federal entity from which ,federal funds are received1 information about their progress and successful innovations in implementing the standards under this section as required by the head of such entity4 #cdjc4 ,robert ,t4 ,matsui ,center for ,cultural and ,linguistic ,competence in ,health ,care 7a7 ,establishment ,the ,secretary1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality1 shall establish and support a center to be known as the ,robert ,t4 ,matsui ,center for ,cultural and ,linguistic ,competence in ,health ,care 7referred to in this section as the ,center7 to carry out the following activities3 7#a7 ,interpretation services ,the ,center shall provide resources via the ,internet to identify and link health care providers to competent interpreter and translation services4 7#b7 ,translation of written material 7,a7 ,the ,center shall provide1 directly or through contract1 vital documents from competent translation services for providers of health care and health-care-related services at no cost to such providers4 ,materials may be submitted for translation into non-,english languages4 ,translation services shall be provided in a timely and reasonable manner4 ,the quality of such translation services shall be monitored and reported publicly4 7,b7 ,for each form developed or revised by the ,secretary that will be used by ,,lep individuals in health care or health-care-related settings1 the ,center shall translate the form1 at a minimum1 into the top #ae non-,english languages in the ,united ,states according to the most recent data from the ,american ,community ,survey or its replacement4 ,the translation must be completed within #de days of the ,secretary receiving final approval of the form from the ,office of ,management and ,budget4 7#c7 ,toll-free customer service telephone number ,the ,center shall provide1 through a toll-free number1 a customer service line for ,,lep individuals-- 7,a7 to obtain information about federally conducted or funded health programs1 including ,medicare1 ,medicaid1 and ,,schip2 7,b7 to obtain assistance with applying for or accessing these programs and understanding ,federal notices written in ,english2 and 7,c7 to learn how to access language services4 7#d7 ,health information clearinghouse 7,a7 ,in general ,the ,center shall develop and maintain an information clearinghouse to facilitate the provision of language services by providers of health care and health-care-related services to reduce medical errors1 improve medical outcomes1 to improve cultural competence1 reduce health care costs caused by miscommunication with individuals with limited-,english proficiency1 and reduce or eliminate the duplication of effort to translate materials4 ,the clearinghouse shall make such information available on the ,internet and in print4 ,such information shall include the information described in the succeeding provisions of this paragraph4 7,b7 ,document templates ,the ,center shall collect and evaluate for accuracy1 develop1 and make available templates for standard documents that are necessary for patients and consumers to access and make educated decisions about their health care1 including the following3 7i7 ,administrative and legal documents1 including-- 7,i7 intake forms2 7,,ii7 ,medicare1 ,medicaid1 and ,,schip forms1 including eligibility information2 7,,iii7 forms informing patient of ,,hipaa compliance and consent2 and 7,,iv7 documents concerning informed consent1 advanced directives1 and waivers of rights4 7ii7 ,clinical information1 such as how to take medications1 how to prevent transmission of a contagious disease1 and other prevention and treatment instructions4 7iii7 ,public health1 patient education1 and outreach materials1 such as immunization notices1 health warnings1 or screening notices4 7iv7 ,additional health or health-care-related materials as determined appropriate by the ,director of the ,center4 7,c7 ,structure of forms ,in operating the clearinghouse1 the ,center shall-- 7i7 ensure that the documents posted in ,english and non-,english languages are culturally appropriate2 7ii7 allow public review of the documents before dissemination in order to ensure that the documents are understandable and culturally appropriate for the target populations2 7iii7 allow health care providers to customize the documents for their use2 7iv7 facilitate access to these documents2 7v7 provide technical assistance with respect to the access and use of such information2 and 7vi7 carry out any other activities the ,secretary determines to be useful to fulfill the purposes of the clearinghouse4 7,d7 ,language assistance programs ,the ,center shall provide for the collection and dissemination of information on current examples of language assistance programs and strategies to improve language services for ,,lep individuals1 including case studies using de-identified patient information1 program summaries1 and program evaluations4 7,e7 ,cultural and linguistic competence materials ,the ,center shall provide information relating to culturally and linguistically competent health care for minority populations residing in the ,united ,states to all health care providers and health-care-related services at no cost4 ,such information shall include-- 7i7 tenets of culturally and linguistically competent care2 7ii7 cultural and linguistic competence self-assessment tools2 7iii7 cultural and linguistic competence training tools2 7iv7 strategic plans to increase cultural and linguistic competence in different types of providers of health care and health-care-related services1 including regional collaborations among health care organizations2 and 7v7 cultural and linguistic competence information for educators1 practitioners1 and researchers4 7,f7 ,information about progress ,the ,center shall regularly collect and make publicly available information about the progress of entities receiving grants under section #cdjd regarding successful innovations in implementing the obligations under this subsection and provide public notice in the entities' communities about the availability of this information4 7b7 ,director ,the ,center shall be headed by a ,director who shall be appointed by1 and who shall report to1 the ,director of the ,agency for ,healthcare ,research and ,quality4 7c7 ,availability of language access ,the ,director shall collaborate with the ,deputy ,assistant ,secretary for ,minority ,health1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 and the ,administrator of the ,health ,resources and ,services ,administration to notify health care providers and health care organizations about the availability of language access services by the ,center4 7d7 ,education ,the ,secretary1 directly or through contract1 shall undertake a national education campaign to inform providers1 ,,lep individuals1 health professionals1 graduate schools1 and community health centers about-- 7#a7 ,federal and ,state laws and guidelines governing access to language services2 7#b7 the value of using trained interpreters and the risks associated with using family members1 friends1 minors1 and untrained bilingual staff2 7#c7 funding sources for developing and implementing language services2 and 7#d7 promising practices to effectively provide language services4 7e7 ,authorization of appropriations ,in addition to the amounts authorized under subsection 7e77#h77;,f71 there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjai4 #cdjd4 ,innovations in cultural and linguistic competence grants 7a7 ,in general ,the ,secretary1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality1 shall award grants to eligible entities to enable such entities to design1 implement1 and evaluate innovative1 cost-effective programs to improve cultural competence and language access in health care for individuals with limited-,english proficiency4 ,the ,director of the ,agency for ,healthcare ,research and ,quality shall coordinate with1 and ensure the participation of1 other agencies including the ,health ,resources and ,services ,administration1 the ,center on ,minority ,health and ,health ,disparities at the ,national ,institutes of ,health1 and the ,office of ,minority ,health1 regarding the design and evaluation of the grants program4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a7 an entity shall-- 7#a7 be-- 7,a7 a city1 county1 ,indian tribe1 ,state1 territory1 or subdivision thereof2 7,b7 an organization described in section #eja7;c77#c7 of the ,internal ,revenue ,code of #aihf and exempt from tax under section #eja7;a7 of such ,code2 7,c7 a community health1 mental health1 or substance use center or clinic2 7,d7 a solo or group physician practice2 7,e7 an integrated health care delivery system2 7,f7 a public hospital2 7,g7 a health care group1 university1 or college2 or 7,h7 other entity designated by the ,secretary2 and 7#b7 prepare and submit to the ,secretary an application1 at such time1 in such manner1 and accompanied by such additional information as the ,secretary may require4 7c7 ,use of funds ,an entity shall use funds received under a grant under this section to-- 7#a7 develop1 implement1 and evaluate models of providing competent interpretation services through onsite interpretation1 telephonic interpretation1 or video interpretation2 7#b7 implement strategies to recruit1 retain1 and promote individuals at all levels of the organization to maintain a diverse staff and leadership that can promote and provide language services to patient populations of the service area of the organization2 7#c7 develop and maintain a needs assessment that identifies the current demographic1 cultural1 and epidemiological profile of the community to accurately plan for and implement language services needed in service area of the organization2 7#d7 develop a strategic plan to implement language services2 7#e7 develop participatory1 collaborative partnerships with communities encompassing the ,,lep patient populations being served to gain input in designing and implementing language services2 7#f7 develop and implement grievance resolution processes that are culturally and linguistically sensitive and capable of identifying1 preventing1 and resolving complaints by ,,lep individuals2 or 7#g7 develop short-term medical mental health interpretation training courses and incentives for bilingual health care staff who are asked to interpret in the workplace2 7#h7 develop formal training programs1 including continued professional development and education programs as well as supervision1 for individuals interested in becoming dedicated health care interpreters and culturally competent providers2 7#i7 provide staff language training instruction1 which shall include information on the practical limitations of such instruction for non-native speakers2 7#aj7 develop policies that address compensation in salary for staff who receive training to become either a staff interpreter or bilingual provider2 7#aa7 develop other language assistance services as determined appropriate by the ,secretary2 7#ab7 develop1 implement1 and evaluate models of improving cultural competence2 and 7#ac7 ensure that1 consistent with the privacy protections provided for under the regulations promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7#db ,u4,s4,c4 #acbj;d-#b note7 and any applicable ,state privacy laws1 data on the individual patient or recipient's race1 ethnicity1 and primary language are collected 7and periodically updated7 in health records and integrated into the organization's information management systems or any similar system used to store and retrieve data4 7d7 ,priority ,in awarding grants under this section1 the ,secretary shall give priority to entities that primarily engage in providing direct care and that have developed partnerships with community organizations or with agencies with experience in improving language access4 7e7 ,evaluation 7#a7 ,by grantees ,an entity that receives a grant under this section shall submit to the ,secretary an evaluation that describes1 in the manner and to the extent required by the ,secretary1 the activities carried out with funds received under the grant1 and how such activities improved access to health and health-care-related services and the quality of health care for individuals with limited-,english proficiency4 ,such evaluation shall be collected and disseminated through the ,robert ,t4 ,matsui ,center for ,cultural and ,linguistic ,competence in ,health ,care established under section #cdjc4 ,the ,director of the ,agency for ,healthcare ,research and ,quality shall notify grantees of the availability of technical assistance for the evaluation and provide such assistance upon request4 7#b7 ,by ,secretary ,the ,director of the ,agency for ,healthcare ,research and ,quality shall evaluate or arrange with other individuals or organizations to evaluate projects funded under this section4 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section1 #e1jjj1jjj for each of fiscal years #bjae through #bjai4 #cdje4 ,research on cultural and language competence 7a7 ,in general ,the ,secretary1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality1 shall expand research concerning language access in the provision of health care4 7b7 ,eligibility ,the ,director of the ,agency for ,healthcare ,research and ,quality may conduct the research described in subsection 7a7 or enter into contracts with other individuals or organizations to do so4 7c7 ,use of funds ,research under this section shall be designed to do one or more of the following3 7#a7 ,to identify the barriers to mental and behavioral services that are faced by ,,lep individuals4 7#b7 ,to identify health care providers' and health administrators' attitudes1 knowledge1 and awareness of the barriers to quality health care services that are faced by ,,lep individuals4 7#c7 ,to identify optimal approaches for delivering language access4 7#d7 ,to identify best practices for data collection1 including-- 7,a7 the collection by providers of health care and health-care-related services of data on the race1 ethnicity1 and primary language of recipients of such services1 taking into account existing research conducted by the ,government or private sector2 7,b7 the development and implementation of data collection and reporting systems2 and 7,c7 effective privacy safeguards for collected data4 7#e7 ,to develop a minimum data collection set for primary language4 7#f7 ,to evaluate the most effective ways in which the ,department can create or coordinate1 and then subsidize or otherwise fund telephonic interpretation providers for health care providers1 taking into consideration1 among other factors1 the flexibility necessary for such a system to accommodate variations in-- 7,a7 provider type2 7,b7 languages needed and their frequency of use2 7,c7 type of encounter2 7,d7 time of encounter1 including regular business hours and after hours2 and 7,e7 location of encounter4 7d7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjai4 4 #bjc4 ,pilot program for improvement and development of ,state medical interpreting services 7a7 ,grants authorized ,the ,secretary shall award one grant in accordance with this section to each of three ,states to assist each such ,state in designing1 implementing1 and evaluating a statewide program to provide onsite interpreter services under ,medicaid4 7b7 ,grant period ,a grant awarded under this section is authorized for a period of three fiscal years beginning on ,october #a1 #bjad4 7c7 ,preference ,in awarding a grant under this section1 the ,secretary shall give preference to a ,state-- 7#a7 that has a high proportion of qualified ,,lep enrollees1 as determined by the ,secretary2 7#b7 that has a large number of qualified ,,lep enrollees1 as determined by the ,secretary2 7#c7 that has a high growth rate of the population of ,,lep individuals1 as determined by the ,secretary2 and 7#d7 that has a population of qualified ,,lep enrollees that is linguistically diverse1 requiring interpreter services in at least #bjj non-,english languages4 7d7 ,use of funds ,a ,state receiving a grant under this section shall use the grant funds to-- 7#a7 ensure that all health care providers in the ,state participating in the ,state plan under ,medicaid have access to onsite interpreter services1 for the purpose of enabling effective communication between such providers and qualified ,,lep enrollees during the furnishing of items and services and administrative interactions2 7#b7 establish1 expand1 procure1 or contract for-- 7,a7 a statewide health care information technology system that is designed to achieve efficiencies and economies of scale with respect to onsite interpreter services provided to health care providers in the ,state participating in the ,state plan under ,medicaid2 and 7,b7 an entity to administer such system1 the duties of which shall include-- 7i7 procuring and scheduling interpreter services for qualified ,,lep enrollees2 7ii7 procuring and scheduling interpreter services for ,,lep individuals seeking to enroll in the ,state plan under ,medicaid2 7iii7 ensuring that interpreters receive payment for interpreter services rendered under the system2 and 7iv7 consulting regularly with organizations representing consumers1 interpreters1 and health care providers2 and 7#c7 develop mechanisms to establish1 improve1 and strengthen the competency of the medical interpretation workforce that serves qualified ,,lep enrollees in the ,state1 including a national certification process that is valid1 credible1 and vendor-neutral4 7e7 ,application ,to receive a grant under this section1 a ,state shall submit an application at such time and containing such information as the ,secretary may require1 which shall include the following3 7#a7 ,a description of the language access needs of individuals in the ,state enrolled in the ,state plan under ,medicaid4 7#b7 ,a description of the extent to which the program will-- 7,a7 use the grant funds for the purposes described in subsection 7d72 7,b7 meet the health care needs of rural populations of the ,state2 and 7,c7 collect information that accurately tracks the language services requested by consumers as compared to the language services provided by health care providers in the ,state participating in the ,state plan under ,medicaid4 7#c7 ,a description of how the program will be evaluated1 including a proposal for collaboration with organizations representing interpreters1 consumers1 and ,,lep individuals4 7f7 ,definitions ,in this section3 7#a7 ,qualified ,,lep enrollee ,the term qualified ,,lep enrollee means an individual-- 7,a7 who is limited-,english-proficient2 and 7,b7 who is enrolled in a ,state plan under ,medicaid4 7#b7 ,state ,the term ,state has the meaning given the term in section #aaja7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acja7;a77#a771 for purposes of title ,,xix of such ,act4 7#c7 ,united ,states ,the term ,united ,states has the meaning given the term in section #aaja7;a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acja7;a77#b771 for purposes of title ,,xix of such ,act4 7g7 ,funding 7#a7 ,authorization of appropriations ,there is authorized to be appropriated #e1jjj1jjj to carry out this section4 7#b7 ,availability of funds ,the funds authorized by paragraph 7#a7 shall be available without fiscal year limitation4 7#c7 ,increased ,federal financial participation ,section #aijc7;a77#b77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#b77;,e771 as amended by section #bje7;d77#a7 of this ,act1 is further amended by inserting 7or1 in the case of a ,state receiving a grant under section #bjc of the ,health ,equity and ,accountability ,act of #bjad1 #ajj percent for each quarter occurring during the grant period7 after #ij percent4 7h7 ,limitation ,no ,federal funds under this section may be used to provide interpreter services from a location outside the ,united ,states4 #bjd4 ,training tomorrow's doctors for culturally and linguistically appropriate care3 graduate medical education 7a7 ,direct graduate medical education ,section #ahhf7;h77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77#d77 is amended by adding at the end the following new subparagraph3 7,l7 ,treatment of culturally competency training ,in determining a hospital's number of full-time equivalent residents for purposes of this subsection1 all the time that is spent by an intern or resident in an approved medical residency training program for education and training in cultural competency and linguistically appropriate service delivery shall be counted toward the determination of full-time equivalency4 4 7b7 ,indirect medical education ,section #ahhf7;d77#e77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77 is amended by adding at the end the following new clause3 7xii7 ,the provisions of subparagraph 7,l7 of subsection 7h77#d7 shall apply under this subparagraph in the same manner as they apply under such subsection4 4 7c7 ,effective date ,the amendments made by subsections 7a7 and 7b7 shall apply with respect to payments made to hospitals on or after the date that is one year after the date of the enactment of this ,act4 #bje4 ,federal reimbursement for culturally and linguistically appropriate services under the ,medicare1 ,medicaid1 and ,state ,children's ,health ,insurance ,programs 7a7 ,language ,access grants for ,medicare ,providers 7#a7 ,establishment 7,a7 ,in general ,not later than #f months after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 acting through the ,centers for ,medicare ,medicaid ,services and in consultation with the ,center for ,medicare and ,medicaid ,innovation1 shall establish a demonstration program under which the ,secretary shall award grants to eligible ,medicare service providers to improve communication between such providers and limited-,english-proficient ,medicare beneficiaries1 including beneficiaries who live in diverse and underserved communities4 7,b7 ,application of innovation rules ,the demonstration project under subparagraph 7,a7 shall be conducted in a manner that is consistent with the applicable provisions of subsections 7b71 7c71 and 7d7 of section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a74 7,c7 ,number of grants ,to the extent practicable1 the ,secretary shall award not less than #bd grants under this subsection4 7,d7 ,grant period ,except as provided under paragraph 7#b77;,d71 each grant awarded under this subsection shall be for a #c-year period4 7#b7 ,eligibility requirements ,to be eligible for a grant under this subsection1 an entity must meet the following requirements3 7,a7 ,medicare provider ,the entity must be-- 7i7 a provider of services under part ,a of title ,,xviii of the ,social ,security ,act2 7ii7 a provider of services under part ,b of such title2 7iii7 a ,medicare ,advantage organization offering a ,medicare ,advantage plan under part ,c of such title2 or 7iv7 a ,,pdp sponsor offering a prescription drug plan under part ,d of such title4 7,b7 ,underserved communities ,the entity must serve a community that1 with respect to necessary language services for improving access and utilization of health care among limited-,english-proficient individuals1 is disproportionally underserved4 7,c7 ,application ,the entity must prepare and submit to the ,secretary an application1 at such time1 in such manner1 and accompanied by such additional information as the ,secretary may require4 7,d7 ,reporting ,in the case of a grantee that received a grant under this subsection in a previous year1 such grantee is only eligible for continued payments under a grant under this subsection if the grantee met the reporting requirements under paragraph 7#i7 for such year4 ,if a grantee fails to meet the requirement of such paragraph for the first year of a grant1 the ,secretary may terminate the grant and solicit applications from new grantees to participate in the demonstration program4 7#c7 ,distribution ,to the extent feasible1 the ,secretary shall award-- 7,a7 at least #f grants to providers of services described in paragraph 7#b77;,a77i72 7,b7 at least #f grants to service providers described in paragraph 7#b77;,a77ii72 7,c7 at least #f grants to organizations described in paragraph 7#b77;,a77iii72 and 7,d7 at least #f grants to sponsors described in paragraph 7#b77;,a77iv74 7#d7 ,considerations in awarding grants 7,a7 ,variation in grantees ,in awarding grants under this subsection1 the ,secretary shall select grantees to ensure the following3 7i7 ,the grantees provide many different types of language services4 7ii7 ,the grantees serve ,medicare beneficiaries who speak different languages1 and who1 as a population1 have differing needs for language services4 7iii7 ,the grantees serve ,medicare beneficiaries in both urban and rural settings4 7iv7 ,the grantees serve ,medicare beneficiaries in at least two geographic regions1 as defined by the ,secretary4 7v7 ,the grantees serve ,medicare beneficiaries in at least two large metropolitan statistical areas with racial1 ethnic1 and economically diverse populations4 7,b7 ,priority for partnerships with community organizations and agencies ,in awarding grants under this subsection1 the ,secretary shall give priority to eligible entities that have a partnership with-- 7i7 a community organization2 or 7ii7 a consortia of community organizations1 ,state agencies1 and local agencies1 that has experience in providing language services4 7#e7 ,use of funds for competent language services 7,a7 ,in general ,subject to subparagraph 7,e71 a grantee may only use grant funds received under this subsection to pay for the provision of competent language services to ,medicare beneficiaries who are limited-,english-proficient4 7,b7 ,competent language services defined ,for purposes of this subsection1 the term competent language services means-- 7i7 interpreter and translation services that-- 7,i7 subject to the exceptions under subparagraph 7,c7-- 7aa7 if the grantee operates in a ,state that has statewide health care interpreter standards1 meet the ,state standards currently in effect2 or 7bb7 if the grantee operates in a ,state that does not have statewide health care interpreter standards1 utilizes competent interpreters who follow the ,national ,council on ,interpreting in ,health ,care's ,code of ,ethics and ,standards of ,practice2 and 7,,ii7 that1 in the case of interpreter services1 are provided through-- 7aa7 onsite interpretation2 7bb7 telephonic interpretation2 or 7cc7 video interpretation2 and 7ii7 the direct provision of health care or health-care-related services by a competent bilingual health care provider4 7,c7 ,exceptions ,the requirements of subparagraph 7,b77i77,i7 do not apply1 with respect to interpreter and translation services and a grantee-- 7i7 in the case of a ,medicare beneficiary who is limited-,english-proficient if-- 7,i7 such beneficiary has been informed1 in the beneficiary's primary language1 of the availability of free interpreter and translation services and the beneficiary instead requests that a family member1 friend1 or other person provide such services2 and 7,,ii7 the grantee documents such request in the beneficiary's medical record2 or 7ii7 in the case of a medical emergency where the delay directly associated with obtaining a competent interpreter or translation services would jeopardize the health of the patient4 ,subparagraph 7,c77ii7 shall not be construed to exempt emergency rooms or similar entities that regularly provide health care services in medical emergencies to limited-,english-proficient patients from any applicable legal or regulatory requirements related to providing competent interpreter and translation services without undue delay4 7,d7 ,medicare advantage organizations and ,,pdp sponsors ,if a grantee is a ,medicare ,advantage organization offering a ,medicare ,advantage plan under part ,c of title ,,xviii of the ,social ,security ,act or a ,,pdp sponsor offering a prescription drug plan under part ,d of such title1 such entity must provide at least #ej percent of the grant funds that the entity receives under this subsection directly to the entity's network providers 7including all health providers and pharmacists7 for the purpose of providing support for such providers to provide competent language services to ,medicare beneficiaries who are limited-,english-proficient4 7,e7 ,administrative and reporting costs ,a grantee may use up to #aj percent of the grant funds to pay for administrative costs associated with the provision of competent language services and for reporting required under paragraph 7#i74 7#f7 ,determination of amount of grant payments 7,a7 ,in general ,payments to grantees under this subsection shall be calculated based on the estimated numbers of limited-,english-proficient ,medicare beneficiaries in a grantee's service area utilizing-- 7i7 data on the numbers of limited-,english-proficient individuals who speak ,english less than very well from the most recently available data from the ,bureau of the ,census or other ,state-based study the ,secretary determines likely to yield accurate data regarding the number of such individuals in such service area2 or 7ii7 data provided by the grantee1 if the grantee routinely collects data on the primary language of the ,medicare beneficiaries that the grantee serves and the ,secretary determines that the data is accurate and shows a greater number of limited-,english-proficient individuals than would be estimated using the data under clause 7i74 7,b7 ,discretion of ,secretary ,subject to subparagraph 7,c71 the amount of payment made to a grantee under this subsection may be modified annually at the discretion of the ,secretary1 based on changes in the data under subparagraph 7,a7 with respect to the service area of a grantee for the year4 7,c7 ,limitation on amount ,the amount of a grant made under this subsection to a grantee may not exceed #ejj1jjj for the period under paragraph 7#a77;,d74 7#g7 ,assurances ,grantees under this subsection shall1 as a condition of receiving a grant under this subsection-- 7,a7 ensure that clinical and support staff receive appropriate ongoing education and training in linguistically appropriate service delivery2 7,b7 ensure the linguistic competence of bilingual providers2 7,c7 offer and provide appropriate language services at no additional charge to each patient with limited-,english proficiency for all points of contact between the patient and the grantee1 in a timely manner during all hours of operation2 7,d7 notify ,medicare beneficiaries of their right to receive language services in their primary language2 7,e7 post signage in the primary languages commonly used by the patient population in the service area of the organization2 and 7,f7 ensure that-- 7i7 primary language data are collected for recipients of language services and such data are consistent with standards developed under title ,,xxxiv of the ,public ,health ,service ,act1 as added by section #bjb of this ,act1 to the extent such standards are available upon the initiation of the demonstration program2 and 7ii7 consistent with the privacy protections provided under the regulations promulgated pursuant to section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7#db ,u4,s4,c4 #acbj;d-#b note71 if the recipient of language services is a minor or is incapacitated1 primary language data are collected on the parent or legal guardian of such recipient4 7#h7 ,no ,cost-,sharing ,limited-,english-proficient ,medicare beneficiaries shall not have to pay cost-sharing or co-payments for competent language services provided under this demonstration program4 7#i7 ,reporting ,requirements for grantees ,not later than the end of each calendar year1 a grantee that receives funds under this subsection in such year shall submit to the ,secretary a report that includes the following information3 7,a7 ,the number of ,medicare beneficiaries to whom competent language services are provided4 7,b7 ,the primary languages of those ,medicare beneficiaries4 7,c7 ,the types of language services provided to such beneficiaries4 7,d7 ,whether such language services were provided by employees of the grantee or through a contract with external contractors or agencies4 7,e7 ,the types of interpretation services provided to such beneficiaries1 and the approximate length of time such service is provided to such beneficiaries4 7,f7 ,the costs of providing competent language services4 7,g7 ,an account of the training or accreditation of bilingual staff1 interpreters1 and translators providing services funded by the grant under this subsection4 7#aj7 ,evaluation and report to ,congress ,not later than #a year after the completion of a #c-year grant under this subsection1 the ,secretary shall conduct an evaluation of the demonstration program under this subsection and shall submit to the ,congress a report that includes the following3 7,a7 ,an analysis of the patient outcomes and the costs of furnishing care to the limited-,english-proficient ,medicare beneficiaries participating in the project as compared to such outcomes and costs for limited-,english-proficient ,medicare beneficiaries not participating1 based on the data provided under paragraph 7#i7 and any other information available to the ,secretary4 7,b7 ,the effect of delivering language services on-- 7i7 ,medicare beneficiary access to care and utilization of services2 7ii7 the efficiency and cost effectiveness of health care delivery2 7iii7 patient satisfaction2 7iv7 health outcomes2 and 7v7 the provision of culturally appropriate services provided to such beneficiaries4 7,c7 ,the extent to which bilingual staff1 interpreters1 and translators providing services under such demonstration were trained or accredited and the nature of accreditation or training needed by type of provider1 service1 or other category as determined by the ,secretary to ensure the provision of high-quality interpretation1 translation1 or other language services to ,medicare beneficiaries if such services are expanded pursuant to subsection 7c7 of section #aijg of this ,act4 7,d7 ,recommendations1 if any1 regarding the extension of such project to the entire ,medicare program1 subject to the provisions of section #aaae;,a7c7 of the ,social ,security ,act4 7#aa7 ,appropriations ,there is appropriated to carry out this subsection1 in equal parts from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i7 and the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda of such ,act 7#db ,u4,s4,c4 #aciet71 #af1jjj1jjj for each fiscal year of the demonstration program4 7b7 ,language services under the ,medicare program 7#a7 ,inclusion as rural health clinic services ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended-- 7,a7 in subsection 7aa77#a7-- 7i7 in subparagraph 7,b71 by striking the and at the end2 7ii7 in subparagraph 7,c71 by inserting and after the comma at the end2 and 7iii7 by inserting after subparagraph 7,c7 the following3 7,d7 language services as defined in subsection 7iii77#a71 2 and 7,b7 by adding at the end the following new subsection3 7iii7 ,language services and related terms 7#a7 ,language services defined ,the term language services has the same meaning given language or language access services in section #cdjj of the ,public ,health ,service ,act4 7#b7 ,interpreter services defined ,for the purposes of this subsection1 the term interpreter services has the meaning given competent interpreter services under section #cdjj7c7 of the ,public ,health ,service ,act4 7#c7 ,interpreter defined ,the term interpreter-- 7,a7 means an individual-- 7i7 who faithfully1 accurately1 and objectively transmits a spoken message from one language into another language2 and 7ii7 who knows health and health-related terminology in both languages2 and 7,b7 includes individuals who provide in-person1 telephonic1 and video interpretation4 7#d7 ,translation defined ,the term translation means the transmission of a written message in one language into a written message in another language that retains the intended meaning of the original message4 7#e7 ,limited-,english-,proficient and ,,lep defined ,the terms limited-,english-proficient and ,,lep have the meaning given the term limited english proficient under section #iaja7be7 of the ,elementary and ,secondary ,education ,act of #aife1 except that subparagraphs 7,a71 7,b71 and 7,d7 of such section not apply4 4 7#b7 ,coverage ,section #ahcb7;a77#b7 of such ,act 7#db ,u4,s4,c4 #aciek7a77#b77 is amended-- 7,a7 by striking and at the end of subparagraph 7,i72 7,b7 by striking the period at the end of subparagraph 7,j7 and inserting 2 and2 and 7,c7 by adding at the end of subparagraph 7,j7 the following3 7,k7 language services 7as defined in paragraph 7#a7 of section #ahfa7;iii77 furnished by an interpreter 7as defined in paragraph 7#c7 of such section7 or translator4 4 7#c7 ,payment ,section #ahcc7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77 is amended-- 7,a7 by striking and at the end of paragraph 7#h72 7,b7 by redesignating paragraph 7#i7 as paragraph 7#aj72 and 7,c7 by inserting after paragraph 7#h7 the following new paragraph3 7#i7 in the case of language services described in section #ahfa7;iii77#a71 #ajj percent of the reasonable charges for such services1 as determined in consultation with the ,medicare ,payment ,advisory ,commission2 and 4 7#d7 ,waiver of budget neutrality ,for the #c-year period beginning on the date of enactment of this section1 the budget neutrality provision of section #ahdh7;c77#b77;,b77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77;,b77ii77 shall not apply with respect to language services 7as such term is defined in section #ahfa7;iii77#a7 of such ,act74 7c7 ,medicare parts ,c and ,d 7#a7 ,in general ,medicare ,advantage plans under part ,c of the ,social ,security ,act and prescription drug plans under part ,d of such ,act shall comply with title ,,vi of the ,civil ,rights ,act of #aifd and section #aeeg of the ,patient ,protection and ,affordable ,care ,act to provide effective language services to enrollees of such plans4 7#b7 ,medicare ,advantage plans and prescription drug plans reporting requirement ,section #aheg7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7;e77 is amended by adding at the end the following new paragraph3 7#e7 ,reporting requirements relating to effective language services ,a contract under this part shall require a ,medicare ,advantage organization 7and1 through application of section #ahfj;,d-#ab7;b77#c77;,d71 a contract under section #ahfj;,d-#ab shall require a ,,pdp sponsor7 to annually submit 7for each year of the contract7 a report that contains information on the plan's internal policies and procedures related to recruitment and retention efforts directed to workforce diversity and linguistically and culturally appropriate provision of services in each of the following contexts3 7,a7 ,the collection of data in a manner that meets the requirements of title ,i of the ,health ,equity and ,accountability ,act of #bjad1 regarding the enrollee population4 7,b7 ,education of staff and contractors who have routine contact with enrollees regarding the various needs of the diverse enrollee population4 7,c7 ,evaluation of the health plan's language services programs and services with respect to the plan's enrollee population1 such as through analysis of complaints or satisfaction survey results4 7,d7 ,methods by which the plan provides to the ,secretary information regarding the ethnic diversity of the plan's enrollee population4 7,e7 ,the periodic provision of educational information to plan enrollees on the plan's language services and programs4 4 7d7 ,improving language services in ,medicaid and ,,chip 7#a7 ,payments to ,states ,section #aijc7;a77#b77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#b77;,e77 is amended by-- 7,a7 striking #ge and inserting #ij2 7,b7 striking translation or interpretation services and inserting language services2 and 7,c7 striking children of families and inserting individuals4 7#b7 ,state plan requirements ,section #aijb7;a77#aj77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77 is amended by striking and 7#bh7 and inserting 7#bh71 and 7#bi74 7#c7 ,definition of medical assistance ,section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is amended by-- 7,a7 in paragraph 7#bh71 by striking and at the end2 7,b7 by redesignating paragraph 7#bi7 as paragraph 7#cj72 and 7,c7 by inserting after paragraph 7#bh7 the following new paragraph3 7#bi7 language services1 as such term is defined in section #ahfa7;iii77#a71 provided in a timely manner to limited-,english-proficient individuals who need such services2 and 4 7#d7 ,use of deductions and cost sharing ,section #aiaf7;a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo7#b77 is amended by-- 7,a7 by striking or at the end of subparagraph 7,d72 7,b7 by striking 2 and at the end of subparagraph 7,e7 and inserting 1 or2 and 7,c7 by adding at the end the following new subparagraph3 7,f7 language services described in section #aije7;a77#bi72 and 4 7#e7 ,,chip coverage requirements ,section #bajc of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7 is amended-- 7,a7 in subsection 7a71 in the matter before paragraph 7#a71 by striking and 7#g7 and inserting 7#g71 and 7#i72 and 7,b7 in subsection 7c71 by adding at the end the following new paragraph3 7#i7 ,language services ,the child health assistance provided to a targeted low-income child shall include coverage of language services1 as such term is defined in section #ahfa7;iii77#a71 provided in a timely manner to limited-,english-proficient individuals who need such services4 2 and 7,c7 in subsection 7e77#b7-- 7i7 in the heading1 by striking ,preventive and inserting ,certain2 and 7ii7 by inserting 1 subsection 7c77#i71 after subsection 7c77#a77;,c74 7#f7 ,definition of child health assistance ,section #baaj7;a77#bg7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;jj7 is amended by striking translation and inserting language services as described in section #bajc7;c77#i74 7#g7 ,state data collection ,pursuant to the reporting requirement described in section #bajg7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7b77#a771 the ,secretary of ,health and ,human ,services shall require that ,states collect data on-- 7,a7 the primary language of individuals receiving child health assistance under title ,,xxi of the ,social ,security ,act2 and 7,b7 in the case of such individuals who are minors or incapacitated1 the primary language of the individual's parent or guardian4 7#h7 ,,chip payments to ,states ,section #baje of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7c77 is amended-- 7,a7 in subsection 7a77#a7 by striking #ge and inserting #ij2 and 7,b7 in subsection 7c77#b77;,a71 by inserting before the period 1 except that expenditures pursuant to clause 7iv7 of subparagraph 7,d7 of such paragraph shall not count towards this total4 7e7 ,funding language services furnished by providers of health care and health-,care-,related services that serve high rates of uninsured ,,lep individuals 7#a7 ,payment of costs 7,a7 ,in general ,subject to subparagraph 7,b71 the ,secretary of ,health and ,human ,services shall make payments 7on a quarterly basis7 directly to eligible entities to support the provision of language services to limited-,english-proficient individuals in an amount equal to an eligible entity's eligible costs for such services for the quarter4 7,b7 ,funding ,out of any funds in the ,treasury not otherwise appropriated1 there are appropriated to the ,secretary of ,health and ,human ,services such sums as may be necessary for each of fiscal years #bjab through #bjaf4 7,c7 ,relation to ,medicaid ,,dsh ,payments under this subsection shall not offset or reduce payments under section #aibc of the ,social ,security ,act1 nor shall payments under such section be considered when determining uncompensated costs associated with the provision of language services4 7#b7 ,methodology for payment of claims 7,a7 ,in general ,the ,secretary shall establish a methodology to determine the average per person cost of language services4 7,b7 ,different entities ,in establishing such methodology1 the ,secretary may establish different methodologies for different types of eligible entities4 7,c7 ,no individual claims ,the ,secretary may not require eligible entities to submit individual claims for language services for individual patients as a requirement for payment under this subsection4 7#c7 ,data collection instrument ,for purposes of this subsection1 the ,secretary shall create a standard data collection instrument that is consistent with any existing reporting requirements by the ,secretary or relevant accrediting organizations regarding the number of individuals to whom language access are provided4 7#d7 ,guidelines ,not later than #f months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall establish and distribute guidelines concerning the implementation of this subsection4 7#e7 ,reporting requirements 7,a7 ,report to ,secretary ,entities receiving payment under this subsection shall provide the ,secretary with a quarterly report on how the entity used such funds4 ,such report shall contain aggregate 7and may not contain individualized7 data collected using the instrument under paragraph 7#c7 and shall otherwise be in a form and manner determined by the ,secretary4 7,b7 ,report to ,congress ,not later than #b years after the date of enactment of this ,act1 and every #b years thereafter1 the ,secretary shall submit a report to ,congress concerning the implementation of this subsection4 7#f7 ,definitions ,in this subsection3 7,a7 ,eligible costs ,the term eligible costs means1 with respect to an eligible entity that provides language services to limited-,english-proficient individuals1 the product of-- 7i7 the average per person cost of language services1 determined according to the methodology devised under paragraph 7#b72 and 7ii7 the number of limited-,english-proficient individuals who are provided language services by the entity and for whom no reimbursement is available for such services under the amendments made by subsections 7a71 7b71 7c71 or 7d7 or by private health insurance4 7,b7 ,eligible entity ,the term eligible entity means an entity that-- 7i7 is a ,medicaid provider that is-- 7,i7 a physician2 7,,ii7 a hospital with a low-income utilization rate 7as defined in section #aibc7;b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;b77#c777 of greater than #be percent2 or 7,,iii7 a federally qualified health center 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7772 7ii7 provide language services to at least #h percent of the entity's total number of patients1 not later than #f months after the date of the enactment of the ,act2 and 7iii7 prepare and submit an application to the ,secretary1 at such time1 in such manner1 and accompanied by such information as the ,secretary may require to ascertain the entity's eligibility for funding under this subsection4 7,c7 ,language services ,the term language services has the meaning given such term in section #ahfa7;iii77#a7 of the ,social ,security ,act4 7f7 ,application of ,civil ,rights ,act of #aifd and other laws ,nothing in this section shall be construed to limit otherwise existing obligations of recipients of ,federal financial assistance under title ,,vi of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj7;d7 et seq47 or other laws that protect the civil rights of individuals4 7g7 ,effective date 7#a7 ,in general ,except as otherwise provided and subject to paragraph 7#b71 the amendments made by this section shall take effect on ,january #a1 #bjac4 7#b7 ,exception if ,state legislation required ,in the case of a ,state plan for medical assistance under title ,,xix of the ,social ,security ,act which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirement imposed by the amendments made by this section1 the ,state plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of the enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of such session shall be deemed to be a separate regular session of the ,state legislature4 #bjf4 ,increasing understanding of and improving health literacy 7a7 ,in general ,the ,secretary1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality and the ,administrator of the ,health ,resources and ,services ,administration1 in consultation with the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities and the ,office of ,minority ,health1 shall award grants to eligible entities to improve health care for patient populations that have low functional health literacy4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an entity shall-- 7#a7 be a hospital1 health center or clinic1 health plan1 or other health entity 7including a nonprofit minority health organization or association72 and 7#b7 prepare and submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds 7#a7 ,agency for healthcare research and quality ,grants awarded under subsection 7a7 through the ,agency for ,healthcare ,research and ,quality shall be used-- 7,a7 to define and increase the understanding of health literacy2 7,b7 to investigate the correlation between low health literacy and health and health care2 7,c7 to clarify which aspects of health literacy have an effect on health outcomes2 and 7,d7 for any other activity determined appropriate by the ,director of the ,agency4 7#b7 ,health resources and services administration ,grants awarded under subsection 7a7 through the ,health ,resources and ,services ,administration shall be used to conduct demonstration projects for interventions for patients with low health literacy that may include-- 7,a7 the development of new disease management programs for patients with low health literacy2 7,b7 the tailoring of existing disease management programs addressing mental1 physical1 oral1 and behavioral health conditions for patients with low health literacy2 7,c7 the translation of written health materials for patients with low health literacy2 7,d7 the identification1 implementation1 and testing of low health literacy screening tools2 7,e7 the conduct of educational campaigns for patients and providers about low health literacy2 and 7,f7 other activities determined appropriate by the ,administrator of the ,health ,resources and ,services ,administration4 7d7 ,definitions ,in this section1 the term low health literacy means the inability of an individual to obtain1 process1 and understand basic health information and services needed to make appropriate health decisions4 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section1 such sums as may be necessary for each of fiscal years #bjae through #bjai4 #bjg4 ,assurances for receiving ,federal funds 7a7 ,in general ,any health program or activity1 any part of which is receiving ,federal financial assistance1 including credits1 subsidies1 or contracts of insurance1 and any program or activity that is administered by an executive agency or any entity established under title ,i of the ,patient ,protection and ,affordable ,care ,act 7or amendments made thereby71 as such programs1 activities1 agencies1 and entities are described in section #aeeg7;a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahaaf71 in order to ensure the right of ,,lep individuals to receive access to quality health care1 shall-- 7#a7 ensure that appropriate clinical and support staff receive ongoing education and training in linguistically appropriate service delivery2 7#b7 offer and provide appropriate language services at no additional charge to each patient with limited-,english-proficiency at all points of contact1 in a timely manner during all hours of operation2 7#c7 notify patients of their right to receive language services in their primary language2 and 7#d7 utilize only competent interpreter or translation services1 as defined in section #cdjj of the ,public ,health ,service ,act4 7b7 ,exemptions ,the requirements of subsection 7a77#d7 shall not apply as follows3 7#a7 ,when a patient 7who has been informed in his or her primary language of the availability of free interpreter and translation services7 requests the use of family1 friends1 or other persons untrained in interpretation or translation if the following conditions are met3 7,a7 ,the interpreter requested by the patient is over the age of #ah4 7,b7 ,the recipient informs the patient that he or she has the option of having the recipient provide an interpreter for him or her without charge1 or of using his or her own interpreter4 7,c7 ,the recipient informs the patient that the recipient may not require an ,,lep person to use a family member or friend as an interpreter4 7,d7 ,the recipient evaluates whether the person the patient wishes to use as an interpreter is competent4 ,if the recipient has reason to believe that the interpreter is not competent1 the recipient provides the recipient's own interpreter to protect the recipient from liability if the patient's interpreter is later found not competent4 7,e7 ,if the recipient has reason to believe that there is a conflict of interest between the interpreter and patient1 the recipient may not use the patient's interpreter4 7,f7 ,the recipient has the patient sign a waiver1 witnessed by at least #a individual not related to the patient1 that includes the information stated in subparagraphs 7,a7 through 7,e7 and is translated into the patient's language4 7#b7 ,when a medical emergency exists and the delay directly associated with obtaining competent interpreter or translation services would jeopardize the health of the patient1 but only until a competent interpreter or translation service is available4 7c7 ,rule of construction ,subsection 7b77#b7 shall not be construed to mean that emergency rooms or similar entities that regularly provide health care services in medical emergencies are exempt from legal or regulatory requirements related to competent interpreter services4 #bjh4 ,report on ,federal efforts to provide culturally and linguistically appropriate health care services 7a7 ,report ,not later than #a year after the date of enactment of this ,act and annually thereafter1 the ,secretary of ,health and ,human ,services shall enter into a contract with the ,institute of ,medicine for the preparation and publication of a report that describes ,federal efforts to ensure that all individuals with limited-,english proficiency have meaningful access culturally competent to health care and health-care-related services4 ,such report shall include-- 7#a7 a description and evaluation of the activities carried out under this ,act2 7#b7 a description and analysis of best practices1 model programs1 guidelines1 and other effective strategies for providing access to culturally and linguistically appropriate health care services2 7#c7 recommendations on the development and implementation of policies and practices by providers of health care and health-care-related services for limited-,english-proficient individuals2 7#d7 a description of the effect of providing language services on quality of health care and access to care2 and 7#e7 a description of the costs associated with or savings related to the provision of language services4 7b7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjai4 #bji4 ,english for speakers of other languages 7a7 ,grants authorized ,the ,secretary of ,education is authorized to provide grants to eligible entities for the provision of ,english as a second language 7hereafter referred to as ,,esl7 instruction and shall determine1 after consultation with appropriate stakeholders1 the mechanism for administering and distributing such grants4 7b7 ,eligible entity defined ,for purposes of this section1 the term eligible entity means a ,state or community-based organization that employs1 and serves1 minority populations4 7c7 ,application ,an eligible entity may apply for a grant under this section by submitting such information as the ,secretary may require and in such form and manner as the ,secretary may require4 7d7 ,use of grant ,as a condition of receiving a grant under this section1 an eligible entity shall-- 7#a7 develop and implement a plan for assuring the availability of ,,esl instruction that effectively integrates information about the nature of the ,united ,states health care system1 how to access care1 and any special language skills that may be required for them to access and regularly negotiate the system effectively2 7#b7 develop a plan1 including1 where appropriate1 public-private partnerships1 for making ,,esl instruction progressively available to all individuals seeking instruction2 and 7#c7 maintain current ,,esl instruction efforts by using the additional funds to supplement rather than supplant any funds expended for ,,esl instruction in the ,state as of ,january #a1 #bjae4 7e7 ,additional duties of the secretary ,the ,secretary of ,education shall-- 7#a7 collect and publicize annual data on how much ,federal1 ,state1 and local governments spend on ,,esl instruction2 7#b7 collect data from ,state and local governments to identify the unmet needs of ,english language learners for appropriate ,,esl instruction1 including-- 7,a7 the preferred written and spoken language of such ,english language learners2 7,b7 the extent of waiting lists including how many programs maintain waiting lists and1 for programs that do not have waiting lists1 the reasons why not2 7,c7 the availability of programs to geographically isolated communities2 7,d7 the impact of course enrollment policies1 including open enrollment1 on the availability of ,,esl instruction2 7,e7 the number individuals in the ,state and each participating locality2 7,f7 the effectiveness of the instruction in meeting the needs of individuals receiving instruction and those needing instruction2 7,g7 as assessment of the need for programs that integrate job training and ,,esl instruction1 to assist individuals to obtain better jobs2 and 7,h7 the availability of ,,esl slots by ,state and locality2 7#c7 determine the cost and most appropriate methods of making ,,esl instruction available to all ,english language learners seeking instruction2 and 7#d7 within #a year of the date of enactment of this ,act1 issue a report to ,congress that assesses the information collected in paragraphs 7#a71 7#b71 and 7#c7 and makes recommendations on steps that should be taken to progressively realize the goal of making ,,esl instruction available to all ,english language learners seeking instruction4 7f7 ,authorization of ,appropriations ,there are authorized to be appropriated to the ,secretary of ,education for each of fiscal years #bjae through #bjah #bej1jjj1jjj to carry out this section4 #baj4 ,implementation 7a7 ,general provisions 7#a7 ,a ,state shall not be immune under the ,eleventh ,amendment of the ,constitution of the ,united ,states from suit in ,federal court for failing to provide the language access funded pursuant to this title4 7#b7 ,in a suit against a ,state for a violation of this title1 remedies 7including remedies at both at law and in equity7 are available for such a violation to the same extent as such remedies are available for such a violation in the suit against any public or private entity other than a ,state4 7b7 ,rule of construction ,nothing in this title shall be construed to limit otherwise existing obligations of recipients of ,federal financial assistance under title ,,vi of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj7;d7 et seq47 or any other statute4 #baa4 ,language access services 7a7 ,essential benefits ,section #acjb7;b77#a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;b77#a77 is amended by adding at the end the following3 7,k7 ,language access services1 including oral interpretation and written translations4 4 7b7 ,employer-,sponsored minimum essential coverage ,section #cf;,b7c77#b77;,c7 of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following3 7v7 ,coverage must include language access and services ,except as provided in clause 7iii71 an employee shall not be treated as eligible for minimum essential coverage if such coverage consists of an eligible employer-sponsored plan 7as defined in section #ejjj;,a7f77#b77 and the plan does not provide coverage for language access services1 including oral interpretation and written translations4 4 7c7 ,quality ,reporting ,section #bgag7;a77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ag7;a77#a77 is amended-- 7#a7 by striking and at the end of subparagraph 7,c72 7#b7 by striking the period at the end of subparagraph 7,d7 and inserting 2 and2 and 7#c7 by adding at the end the following new subparagraph3 7,e7 reduce health disparities through the provision of language access services1 including oral interpretation and written translations4 4 7d7 ,regulations regarding internal claims and appeals and external review processes for health plans and health insurance issuers ,the ,secretary of the ,treasury1 the ,secretary of ,labor1 and the ,secretary of ,health and ,human ,services shall amend the regulations in section #ed4ihae-bgai,t7e7 of title #bf1 ,code of ,federal ,regulations1 section #beij4gae- #bgai7;e7 of title #bi1 ,code of ,federal ,regulations1 and section #adg4acf7;e7 of title #de1 ,code of ,federal ,regulations1 respectively1 to require group health plans and health insurance issuers offering group or individual health insurance coverage to which such sections apply-- 7#a7 to provide oral interpretation services without any threshold requirements2 7#b7 to provide in the ,english versions of all notices a statement prominently displayed in not less than #ae non-,english languages clearly indicating how to access the language services provided by the plan or issuer2 and 7#c7 with respect to written translations of notices1 to apply a threshold that #e percent of the population or at least #ejj individuals per service area are literate only in the same non-,english language in lieu of #aj percent or more residing in a county4 7e7 ,data collection and reporting ,the ,secretary of ,health and ,human ,services shall-- 7#a7 amend the single streamlined application form developed pursuant to section #adac of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjhc7 to collect the preferred spoken and written language for each household member applying for coverage under a qualified health plan through an ,exchange under title ,i of the ,patient ,protection and ,affordable ,care ,act2 7#b7 require navigators1 certified application counselors1 and other enrollment assisters to collect and report requests for language assistance2 and 7#c7 require the ,federal and ,state call centers established pursuant to section #acaa7;d77#d77;b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;d77#d77;b77 to submit an annual report documenting the number of language assistance requests1 the types of languages requested1 the range and average wait time for a consumer to speak with an interpreter1 and any steps the call center and language line have taken to actively address some of the consumer complaints4 7f7 ,effective date ,the amendments made by this section shall apply to plan years beginning after the date of the enactment of this ,act4 ,,iii ,health workforce ,diversity #cja4 ,amendment to the ,public ,health ,service ,act ,title ,,xxxiv of the ,public ,health ,service ,act1 as added by section #bjb1 is amended by adding at the end the following3 ,a ,diversifying the ,health ,care ,workplace #cdaa4 ,national ,working ,group on ,workforce ,diversity 7a7 ,in general ,the ,secretary1 acting through the ,bureau of ,health ,workforce within the ,health ,resources and ,services ,administration1 shall award a grant to an entity determined appropriate by the ,secretary for the establishment of a national working group on workforce diversity4 7b7 ,representation ,in establishing the national working group under subsection 7a73 7#a7 ,the grantee shall ensure that the group has representatives of the following3 7,a7 ,the ,health ,resources and ,services ,administration4 7,b7 ,the ,department of ,health and ,human ,services ,data ,council4 7,c7 ,the ,office of ,minority ,health of the ,department of ,health and ,human ,services4 7,d7 ,the ,substance ,abuse and ,mental ,health ,services ,administration4 7,e7 ,the ,bureau of ,labor ,statistics of the ,department of ,labor4 7,f7 ,the ,public ,health ,practice ,program ,office--,office of ,workforce ,policy and ,planning4 7,g7 ,the ,national ,institute on ,minority ,health and ,health ,disparities4 7,h7 ,the ,agency for ,healthcare ,research and ,quality4 7,i7 ,the ,institute of ,medicine ,study ,committee for the #bjjd workforce diversity report4 7,j7 ,the ,indian ,health ,service4 7,k7 ,minority-serving academic institutions4 7,l7 ,consumer organizations4 7,m7 ,health professional associations1 including those that represent underrepresented minority populations4 7,n7 ,researchers in the area of health workforce4 7,o7 ,health workforce accreditation entities4 7,p7 ,private foundations that have sponsored workforce diversity initiatives4 7,q7 ,local and ,state health departments4 7,r7 ,representatives of community members to be included on admissions committees for health profession schools pursuant to subsection 7c77#h74 7,s7 ,other entities determined appropriate by the ,secretary4 7#b7 ,the grantee shall ensure that1 in addition to the representatives under paragraph 7#a71 the group has not less than #e health professions students representing various health profession fields and levels of training4 7c7 ,activities ,the working group established under subsection 7a7 shall convene at least twice each year to complete the following activities3 7#a7 ,review current public and private health workforce diversity initiatives4 7#b7 ,identify successful health workforce diversity programs and practices4 7#c7 ,examine challenges relating to the development and implementation of health workforce diversity initiatives4 7#d7 ,draft a national strategic work plan for health workforce diversity1 including recommendations for public and private sector initiatives4 7#e7 ,develop a framework and methods for the evaluation of current and future health workforce diversity initiatives4 7#f7 ,develop recommended standards for workforce diversity that could be applicable to all health professions programs and programs funded under this ,act4 7#g7 ,develop guidelines to train health professionals to care for a diverse population4 7#h7 ,develop a strategy for the inclusion of community members on admissions committees for health profession schools4 7#i7 ,other activities determined appropriate by the ,secretary4 7d7 ,annual report ,not later than #a year after the establishment of the working group under subsection 7a71 and annually thereafter1 the working group shall prepare and make available to the general public for comment1 an annual report on the activities of the working group4 ,such report shall include the recommendations of the working group for improving health workforce diversity4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjbj4 #cdab4 ,technical ,clearinghouse for ,health workforce ,diversity 7a7 ,in general ,the ,secretary1 acting through the ,deputy ,assistant ,secretary for ,minority ,health1 and in collaboration with the ,bureau of ,health ,workforce within the ,health ,resources and ,services ,administration1 the ,national ,institute on ,minority ,health and ,health ,disparities1 shall establish a technical clearinghouse on health workforce diversity within the ,office of ,minority ,health and coordinate current and future clearinghouses4 7b7 ,information and services ,the clearinghouse established under subsection 7a7 shall offer the following information and services3 7#a7 ,information on the importance of health workforce diversity4 7#b7 ,statistical information relating to underrepresented minority representation in health and allied health professions and occupations4 7#c7 ,model health workforce diversity practices and programs1 including integrated models of care4 7#d7 ,admissions policies that promote health workforce diversity and are in compliance with ,federal and ,state laws4 7#e7 ,retainment policies that promote completion of health profession degrees for underserved populations4 7#f7 ,lists of scholarship1 loan repayment1 and loan cancellation grants as well as fellowship information for underserved populations for health professions schools4 7#g7 ,foundation and other large organizational initiatives relating to health workforce diversity4 7c7 ,consultation ,in carrying out this section1 the ,secretary shall consult with non-,federal entities which may include minority health professional associations and minority sections of major health professional associations to ensure the adequacy and accuracy of information4 7d7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjbj4 #cdac4 ,support for ,institutions committed to workforce ,diversity 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration and the ,centers for ,disease ,control and ,prevention1 shall award grants to eligible entities that demonstrate a commitment to health workforce diversity4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an entity shall-- 7#a7 be an educational institution or entity that historically produces or trains meaningful numbers of underrepresented minority health professionals1 including-- 7,a7 historically ,black colleges and universities2 7,b7 ,hispanic-serving health professions schools2 7,c7 ,hispanic-serving institutions2 7,d7 tribal colleges and universities2 7,e7 ,asian-,american1 ,native ,american1 and ,pacific ,islander-serving institutions2 7,f7 institutions that have programs to recruit and retain underrepresented minority health professionals1 in which a significant number of the enrolled participants are underrepresented minorities2 7,g7 health professional associations1 which may include underrepresented minority health professional associations2 and 7,h7 institutions-- 7i7 located in communities with predominantly underrepresented minority populations2 7ii7 with whom partnerships have been formed for the purpose of increasing workforce diversity2 and 7iii7 in which at least #bj percent of the enrolled participants are underrepresented minorities2 and 7#b7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,amounts received under a grant under subsection 7a7 shall be used to expand existing workforce diversity programs1 implement new workforce diversity programs1 or evaluate existing or new workforce diversity programs1 including with respect to mental health care professions4 ,such programs shall enhance diversity by considering minority status as part of an individualized consideration of qualifications4 ,possible activities may include-- 7#a7 educational outreach programs relating to opportunities in the health professions2 7#b7 scholarship1 fellowship1 grant1 loan repayment1 and loan cancellation programs2 7#c7 postbaccalaureate programs2 7#d7 academic enrichment programs1 particularly targeting those who would not be competitive for health professions schools2 7#e7 kindergarten through #abth grade and other health pipeline programs2 7#f7 mentoring programs2 7#g7 internship or rotation programs involving hospitals1 health systems1 health plans1 and other health entities2 7#h7 community partnership development for purposes relating to workforce diversity2 or 7#i7 leadership training4 7d7 ,reports ,not later than #a year after receiving a grant under this section1 and annually for the term of the grant1 a grantee shall submit to the ,secretary a report that summarizes and evaluates all activities conducted under the grant4 7e7 ,definition ,in this section1 the term ,asian-,american1 ,native ,american1 and ,pacific ,islander-serving institutions has the same meaning as the term ,asian ,american and ,native ,american ,pacific ,islander-serving institution as defined in section #cga7;c7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajfgq7c774 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section1 such sums as may be necessary for each of fiscal years #bjae through #bjbj4 #cdad4 ,career development for scientists and researchers 7a7 ,in general ,the ,secretary1 acting through the ,director of the ,national ,institutes of ,health1 the ,director of the ,centers for ,disease ,control and ,prevention1 the ,commissioner of ,food and ,drugs1 the ,director of the ,agency for ,healthcare ,research and ,quality1 and the ,administrator of the ,health ,resources and ,services ,administration1 shall award grants that expand existing opportunities for scientists and researchers and promote the inclusion of underrepresented minorities in the health professions4 7b7 ,research funding ,the head of each entity within the ,department of ,health and ,human ,services shall establish or expand existing programs to provide research funding to scientists and researchers in training4 ,under such programs1 the head of each such entity shall give priority in allocating research funding to support health research in traditionally underserved communities1 including underrepresented minority communities1 and research classified as community or participatory4 7c7 ,data collection ,the head of each entity within the ,department of ,health and ,human ,services shall collect data on the number 7expressed as an absolute number and a percentage7 of underrepresented minority and nonminority applicants who receive and are denied agency funding at every stage of review4 ,such data shall be reported annually to the ,secretary and the appropriate committees of ,congress4 7d7 ,student loan reimbursement ,the ,secretary shall establish a student loan reimbursement program to provide student loan reimbursement assistance to researchers who focus on racial and ethnic disparities in health4 ,the ,secretary shall promulgate regulations to define the scope and procedures for the program under this subsection4 7e7 ,student loan cancellation ,the ,secretary shall establish a student loan cancellation program to provide student loan cancellation assistance to researchers who focus on racial and ethnic disparities in health4 ,students participating in the program shall make a minimum #e-year commitment to work at an accredited health profession school4 ,the ,secretary shall promulgate additional regulations to define the scope and procedures for the program under this subsection4 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section1 such sums as may be necessary for each of fiscal years #bjae through #bjbj4 #cdae4 ,career support for nonresearch ,health professionals 7a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 the ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration1 the ,administrator of the ,health ,resources and ,services ,administration1 and the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall establish a program to award grants to eligible individuals for career support in nonresearch-related health and wellness professions4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an individual shall-- 7#a7 be a student in a health professions school1 a graduate of such a school who is working in a health profession1 an individual working in a health or wellness profession 7including mental and behavioral health71 or a faculty member of such a school2 and 7#b7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,an individual shall use amounts received under a grant under this section to-- 7#a7 support the individual's health activities or projects that involve underserved communities1 including racial and ethnic minority communities2 7#b7 support health-related career advancement activities2 7#c7 to pay1 or as reimbursement for payments of1 student loans or training or credentialing costs for individuals who are health professionals and are focused on health issues affecting underserved communities1 including racial and ethnic minority communities2 and 7#d7 to establish and promote leadership training programs to decrease health disparities and to increase cultural competence with the goal of increasing diversity in leadership positions4 7d7 ,definition ,in this section1 the term career in nonresearch-related health and wellness professions means employment or intended employment in the field of public health1 health policy1 health management1 health administration1 medicine1 nursing1 pharmacy1 psychology1 social work1 psychiatry1 other mental and behavioral health1 allied health1 community health1 social work1 or other fields determined appropriate by the ,secretary1 other than in a position that involves research4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjbj4 #cdaf4 ,research on the effect of workforce ,diversity on quality 7a7 ,in general ,the ,director of the ,agency for ,healthcare ,research and ,quality1 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health and the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities1 shall award grants to eligible entities to expand research on the link between health workforce diversity and quality health care4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an entity shall-- 7#a7 be a clinical1 public health1 or health services research entity or other entity determined appropriate by the ,director2 and 7#b7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,amounts received under a grant awarded under subsection 7a7 shall be used to support research that investigates the effect of health workforce diversity on-- 7#a7 language access2 7#b7 cultural competence2 7#c7 patient satisfaction2 7#d7 timeliness of care2 7#e7 safety of care2 7#f7 effectiveness of care2 7#g7 efficiency of care2 7#h7 patient outcomes2 7#i7 community engagement2 7#aj7 resource allocation2 7#aa7 organizational structure2 7#ab7 compliance of care2 or 7#ac7 other topics determined appropriate by the ,director4 7d7 ,priority ,in awarding grants under subsection 7a71 the ,director shall give individualized consideration to all relevant aspects of the applicant's background4 ,consideration of prior research experience involving the health of underserved communities shall be such a factor4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjbj4 #cdag4 ,health disparities education program 7a7 ,establishment ,the ,secretary1 acting through the ,national ,institute on ,minority ,health and ,health ,disparities and in collaboration with the ,office of ,minority ,health1 the ,office for ,civil ,rights1 the ,centers for ,disease ,control and ,prevention1 the ,centers for ,medicare ,medicaid ,services1 the ,health ,resources and ,services ,administration1 and other appropriate public and private entities1 shall establish and coordinate a health and health care disparities education program to support1 develop1 and implement educational initiatives and outreach strategies that inform health care professionals and the public about the existence of and methods to reduce racial and ethnic disparities in health and health care4 7b7 ,activities ,the ,secretary1 through the education program established under subsection 7a71 shall1 through the use of public awareness and outreach campaigns targeting the general public and the medical community at large-- 7#a7 disseminate scientific evidence for the existence and extent of racial and ethnic disparities in health care1 including disparities that are not otherwise attributable to known factors such as access to care1 patient preferences1 or appropriateness of intervention1 as described in the #bjjb ,institute of ,medicine ,report entitled ,unequal ,treatment3 ,confronting ,racial and ,ethnic ,disparities in ,health ,care1 as well as the impact of disparities related to age1 disability status1 socioeconomic status1 sex1 gender identity1 and sexual orientation on racial and ethnic minorities2 7#b7 disseminate new research findings to health care providers and patients to assist them in understanding1 reducing1 and eliminating health and health care disparities2 7#c7 disseminate information about the impact of linguistic and cultural barriers on health care quality and the obligation of health providers who receive ,federal financial assistance to ensure that people with limited-,english proficiency have access to language access services2 7#d7 disseminate information about the importance and legality of racial1 ethnic1 disability status1 socioeconomic status1 sex1 gender identity1 and sexual orientation1 and primary language data collection1 analysis1 and reporting2 7#e7 design and implement specific educational initiatives to health care providers relating to health and health care disparities2 and 7#f7 assess the impact of the programs established under this section in raising awareness of health and health care disparities and providing information on available resources4 7c7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjbj4 4 #cjb4 ,hispanic-serving health professions schools ,part ,b of title ,,vii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bic et seq47 is amended by adding at the end the following3 #gdb4 ,hispanic-serving health professions schools 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall award grants to ,hispanic-serving health professions schools for the purpose of carrying out programs to recruit ,hispanic individuals to enroll in and graduate from such schools1 which may include providing scholarships and other financial assistance as appropriate4 7b7 ,eligibility ,in subsection 7a71 the term ,hispanic-serving health professions school means an entity that-- 7#a7 is a school or program under section #gii;,b2 7#b7 has an enrollment of full-time equivalent students that is made up of at least #i percent ,hispanic students2 7#c7 has been effective in carrying out programs to recruit ,hispanic individuals to enroll in and graduate from the school2 7#d7 has been effective in recruiting and retaining ,hispanic faculty members2 7#e7 has a significant number of graduates who are providing health services to medically underserved populations or to individuals in health professional shortage areas2 and 7#f7 is a ,regional ,hispanic ,center of ,excellence4 4 #cjc4 ,loan repayment program of ,centers for ,disease ,control and ,prevention ,section #cag;,f7c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#g7;c77 is amended-- 7#a7 by striking and after #aiid12 and 7#b7 by inserting before the period at the end the following3 #gej1jjj for fiscal year #bjae1 and such sums as may be necessary for each of the fiscal years #bjaf through #bjbj4 #cjd4 ,cooperative agreements for online degree programs at schools of public health and schools of allied health ,part ,b of title ,,vii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bic et seq471 as amended by section #cjb1 is further amended by adding at the end the following3 #gdc4 ,cooperative agreements for online degree programs 7a7 ,cooperative agreements ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 in consultation with the ,director of the ,centers for ,disease ,control and ,prevention1 the ,director of the ,agency for ,healthcare ,research and ,quality1 and the ,deputy ,assistant ,secretary for ,minority ,health1 shall award cooperative agreements to schools of public health and schools of allied health to design and implement online degree programs4 7b7 ,priority ,in awarding cooperative agreements under this section1 the ,secretary shall give priority to any school of public health or school of allied health that has an established track record of serving medically underserved communities4 7c7 ,requirements ,recipients of cooperative agreements under this section shall design and implement an online degree program that meets the following restrictions3 7#a7 ,enrollment of individuals who have obtained a secondary school diploma or its recognized equivalent4 7#b7 ,maintaining a significant enrollment of underrepresented minority or disadvantaged students4 7#c7 ,achieving a high completion rate of enrolled underrepresented minority or disadvantaged students4 7d7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjbj4 4 #cje4 ,sense of ,congress on the mission of the ,national ,health ,care ,workforce ,commission ,it is the sense of ,congress that the ,national ,health ,care ,workforce ,commission established by section #eaja of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #bidq7 should1 in carrying out its assigned duties under that section1 give attention to the needs of racial and ethnic minorities1 individuals with lower socioeconomic status1 individuals with mental1 developmental1 and physical disabilities1 lesbian1 gay1 bisexual1 and transgender populations1 and individuals who are members of multiple minority or special population groups4 #cjf4 ,scholarship and fellowship programs ,subtitle ,a of title ,,xxxiv of the ,public ,health ,service ,act1 as added by section #cja1 is further amended by inserting after section #cdag the following3 #cdah4 ,david ,satcher ,public ,health and ,health ,services ,corps 7a7 ,in general ,the ,administrator of the ,health ,resources and ,services ,administration and the ,director of the ,centers for ,disease ,control and ,prevention1 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health1 shall award grants to eligible entities to increase awareness among postprimary and postsecondary students of career opportunities in the health professions4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an entity shall-- 7#a7 be a clinical1 public health1 or health services organization1 community-based or nonprofit entity1 or other entity determined appropriate by the ,director of the ,centers for ,disease ,control and ,prevention2 7#b7 serve a health professional shortage area1 as determined by the ,secretary2 7#c7 work with students1 including those from racial and ethnic minority backgrounds1 that have expressed an interest in the health professions2 and 7#d7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,grant awards under subsection 7a7 shall be used to support internships that will increase awareness among students of non-research-based1 career opportunities in the following health professions3 7#a7 ,medicine4 7#b7 ,nursing4 7#c7 ,public ,health4 7#d7 ,pharmacy4 7#e7 ,health administration and management4 7#f7 ,health policy4 7#g7 ,psychology4 7#h7 ,dentistry4 7#i7 ,international health4 7#aj7 ,social work4 7#aa7 ,allied health4 7#ab7 ,psychiatry4 7#ac7 ,hospice care4 7#ad7 ,other professions deemed appropriate by the ,director of the ,centers for ,disease ,control and ,prevention4 7d7 ,priority ,in awarding grants under subsection 7a71 the ,director of the ,centers for ,disease ,control and ,prevention shall give priority to those entities that-- 7#a7 serve a high proportion of individuals from disadvantaged backgrounds2 7#b7 have experience in health disparity elimination programs2 7#c7 facilitate the entry of disadvantaged individuals into institutions of higher education2 and 7#d7 provide counseling or other services designed to assist disadvantaged individuals in successfully completing their education at the postsecondary level4 7e7 ,stipends ,the ,secretary may approve stipends under this section for individuals for any period of education in student-enhancement programs 7other than regular courses7 at health professions schools1 programs1 or entities1 except that such a stipend may not be provided to an individual for more than #f months1 and such a stipend may not exceed #bj per day 7notwithstanding any other provision of law regarding the amount of stipends74 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjbj4 #cdai4 ,louis ,stokes ,public ,health ,scholars ,program 7a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention1 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health1 shall award scholarships to postsecondary students who seek a career in public health4 7b7 ,eligibility ,to be eligible to receive a scholarship under subsection 7a71 an individual shall-- 7#a7 have interest1 knowledge1 or skill in public health research or public health practice1 or other health professions as determined appropriate by the ,director of the ,centers for ,disease ,control and ,prevention2 7#b7 reside in a health professional shortage area as determined by the ,secretary2 7#c7 demonstrate promise for becoming a leader in public health2 7#d7 secure admission to a #d-year institution of higher education2 7#e7 comply with subsection 7e72 and 7#f7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,amounts received under an award under subsection 7a7 shall be used to support opportunities for students to become public health professionals4 7d7 ,priority ,in awarding grants under subsection 7a71 the ,director shall give priority to those students that-- 7#a7 are from disadvantaged backgrounds2 7#b7 have secured admissions to a minority-serving institution2 and 7#c7 have identified a health professional as a mentor at their school or institution and an academic advisor to assist in the completion of their baccalaureate degree4 7e7 ,scholarships ,the ,secretary may approve payment of scholarships under this section for such individuals for any period of education in student undergraduate tenure1 except that such a scholarship may not be provided to an individual for more than #d years1 and such scholarships may not exceed #aj1jjj per academic year 7notwithstanding any other provision of law regarding the amount of scholarship74 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjbj4 #cdbj4 ,patsy ,mink ,health and ,gender ,research ,fellowship ,program 7a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention1 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health1 the ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration1 and the ,director of the ,indian ,health ,services1 shall award research fellowships to post-baccalaureate students to conduct research that will examine gender and health disparities and to pursue a career in the health professions4 7b7 ,eligibility ,to be eligible to receive a fellowship under subsection 7a7 an individual shall-- 7#a7 have experience in health research or public health practice2 7#b7 reside in a health professional shortage area as determined by the ,secretary2 7#c7 have expressed an interest in the health professions2 7#d7 demonstrate promise for becoming a leader in the field of women's health2 7#e7 secure admission to a health professions school or graduate program with an emphasis in gender studies2 7#f7 comply with subsection 7f72 and 7#g7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,amounts received under an award under subsection 7a7 shall be used to support opportunities for students to become researchers and advance the research base on the intersection between gender and health4 7d7 ,priority ,in awarding grants under subsection 7a71 the ,director of the ,centers for ,disease ,control and ,prevention shall give priority to those applicants that-- 7#a7 are from disadvantaged backgrounds2 and 7#b7 have identified a mentor and academic advisor who will assist in the completion of their graduate or professional degree and have secured a research assistant position with a researcher working in the area of gender and health4 7e7 ,fellowships ,the ,director of the ,centers for ,disease ,control and ,prevention may approve fellowships for individuals under this section for any period of education in the student's graduate or health profession tenure1 except that such a fellowship may not be provided to an individual for more than #c years1 and such a fellowship may not exceed #ah1jjj per academic year 7notwithstanding any other provision of law regarding the amount of fellowship74 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjbj4 #cdbj;,a4 ,paul ,david ,wellstone ,international ,health ,fellowship ,program 7a7 ,in general ,the ,director of the ,agency for ,healthcare ,research and ,quality1 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health1 shall award research fellowships to college students or recent graduates to advance their understanding of international health4 7b7 ,eligibility ,to be eligible to receive a fellowship under subsection 7a7 an individual shall-- 7#a7 have educational experience in the field of international health2 7#b7 reside in a health professional shortage area as determined by the ,secretary2 7#c7 demonstrate promise for becoming a leader in the field of international health2 7#d7 be a college senior or recent graduate of a four-year higher education institution2 7#e7 comply with subsection 7e72 and 7#f7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,amounts received under an award under subsection 7a7 shall be used to support opportunities for students to become health professionals and to advance their knowledge about international issues relating to health care access and quality4 7d7 ,priority ,in awarding grants under subsection 7a71 the ,director shall give priority to those applicants that-- 7#a7 are from a disadvantaged background2 and 7#b7 have identified a mentor at a health professions school or institution1 an academic advisor to assist in the completion of their graduate or professional degree1 and an advisor from an international health non-governmental organization1 private volunteer organization1 or other international institution or program that focuses on increasing health care access and quality for residents in developing countries4 7e7 ,fellowships ,the ,secretary shall approve fellowships for college seniors or recent graduates1 except that such a fellowship may not be provided to an individual for more than #f months1 may not be awarded to a graduate that has not been enrolled in school for more than #a year1 and may not exceed #d1jjj per academic year 7notwithstanding any other provision of law regarding the amount of fellowship74 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section1 such sums as may be necessary for each of fiscal years #bjae through #bjbj4 #cdbj;,b4 ,edward ,r4 ,roybal ,health ,scholar ,program 7a7 ,in general ,the ,director of the ,agency for ,healthcare ,research and ,quality1 the ,director of the ,centers for ,medicare and ,medicaid ,services1 and the ,administrator for ,health ,resources and ,services ,administration1 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health1 shall award grants to eligible entities to expose entering graduate students to the health professions4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an entity shall-- 7#a7 be a clinical1 public health1 or health services organization1 community-based1 academic1 or nonprofit entity1 or other entity determined appropriate by the ,director of the ,agency for ,healthcare ,research and ,quality2 7#b7 serve in a health professional shortage area as determined by the ,secretary2 7#c7 work with students obtaining a degree in the health professions2 and 7#d7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,amounts received under a grant awarded under subsection 7a7 shall be used to support opportunities that expose students to non-research-based health professions1 including-- 7#a7 public health policy2 7#b7 health care and pharmaceutical policy2 7#c7 health care administration and management2 7#d7 health economics2 and 7#e7 other professions determined appropriate by the ,director of the ,agency for ,healthcare ,research and ,quality1 the ,director of the ,centers for ,medicare and ,medicaid ,services1 and the ,administrator for ,health ,resources and ,services ,administration4 7d7 ,priority ,in awarding grants under subsection 7a71 the ,director of the ,agency for ,healthcare ,research and ,quality shall give priority to those entities that-- 7#a7 have experience with health disparity elimination programs2 7#b7 facilitate training in the fields described in subsection 7c72 and 7#c7 provide counseling or other services designed to assist such individuals in successfully completing their education at the postsecondary level4 7e7 ,stipends ,the ,secretary may approve the payment of stipends for individuals under this section for any period of education in student-enhancement programs 7other than regular courses7 at health professions schools or entities1 except that such a stipend may not be provided to an individual for more than #b months1 and such a stipend may not exceed #ajj per day 7notwithstanding any other provision of law regarding the amount of stipends74 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjbj4 4 #cjg4 ,mc,nair ,postbaccalaureate ,achievement ,program ,section #djb;,e of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajgj;a-#ae7 is amended by striking subsection 7g7 and inserting the following3 7g7 ,collaboration in ,health profession ,diversity training programs ,the ,secretary shall coordinate with the ,secretary of ,health and ,human ,services to ensure that there is collaboration between the goals of the program under this section and programs of the ,health ,resources and ,services ,administration that promote health workforce diversity4 ,the ,secretary of ,education shall take such measures as may be necessary to encourage students participating in projects assisted under this section to consider health profession careers4 7h7 ,funding ,from amounts appropriated pursuant to the authority of section #djb;,a7g71 the ,secretary shall1 to the extent practicable1 allocate funds for projects authorized by this section in an amount which is not less than #ca1jjj1jjj for each of the fiscal years #bjae through #bjba4 4 #cjh4 ,rules for determination of full-time equivalent residents for cost-reporting periods 7a7 ,,dgme determinations ,section #ahhf7;h77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77#d77 is amended-- 7#a7 in subparagraph 7,e71 by striking ,subject to subparagraphs 7,j7 and 7,k71 such rules and inserting ,subject to subparagraphs 7,j71 7,k71 and 7,l71 such rules2 7#b7 in subparagraph 7,j71 by striking ,such rules and inserting ,subject to subparagraph 7,l71 such rules2 7#c7 in subparagraph 7,k71 by striking ,in determining and inserting ,subject to subparagraph 7,l71 in determining2 and 7#d7 by adding at the end the following new subparagraph3 7,l7 ,for purposes of cost-reporting periods beginning on or after ,october #a1 #bjad1 in determining the hospital's number of full-time equivalent residents for purposes of this paragraph1 all the time spent by an intern or resident in an approved medical residency training program shall be counted toward the determination of full-time equivalency if the hospital-- 7i7 is recognized as a subsection 7d7 hospital2 7ii7 is recognized as a subsection 7d7 ,puerto ,rico hospital2 7iii7 is reimbursed under a reimbursement system authorized under section #ahad7;b77#c72 or 7iv7 is a provider-based hospital outpatient department4 4 7b7 ,,ime determinations ,section #ahhf7;d77#e77;,b77x7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77x77 is amended-- 7#a7 in subclause 7,,ii71 by striking ,in determining and inserting ,subject to subclause 7x77,,iv71 in determining2 7#b7 in subclause 7,,iii71 by striking ,in determining and inserting ,subject to subclause 7x77,,iv71 in determining2 and 7#c7 by adding at the end the following new subclause3 7,,iv7 ,the provisions of subparagraph 7,l7 of subsection 7h77#d7 shall apply under this subparagraph in the same manner as they apply under such subsection4 4 #cji4 ,developing and implementing strategies for local health equity 7a7 ,grants ,the ,secretaries of ,health and ,human ,services1 ,education1 and ,labor1 acting jointly1 shall make grants to academic institutions for the purposes of-- 7#a7 in accordance with subsection 7b71 developing capacity-- 7,a7 to build an evidence base for successful strategies for increasing local health equity2 and 7,b7 to serve as national models of driving local health equity2 7#b7 in accordance with subsection 7c71 developing a strategic partnership with the community in which the academic institution is located2 and 7#c7 collecting data on1 and periodically evaluating1 the effectiveness of the institution's programs funded through this section to enable the institution to adapt accordingly for maximum efficiency and success4 7b7 ,developing capacity for increasing local health equity ,as a condition on receipt of a grant under subsection 7a71 an academic institution shall agree to use the grant to build an evidence base for successful strategies for increasing local health equity1 and to serve as a national model of driving local health equity1 by supporting-- 7#a7 resources to strengthen institutional metrics and capacity to execute institutionwide health workforce goals that can serve as models for increasing health equity in communities across the country2 7#b7 collaborations among a cohort of institutions in implementing systemic change1 partnership development1 and programmatic efforts supportive of health equity goals across disciplines and populations2 and 7#c7 enhanced or newly developed data systems and research infrastructure capable of informing current and future workforce efforts and building a foundation for a broader research agenda targeting urban health disparities4 7c7 ,strategic partnerships ,as a condition on receipt of a grant under subsection 7a71 an academic institution shall agree to use the grant to develop a strategic partnership with the community in which the institution is located for the purposes of-- 7#a7 strengthening connections between the institution and the community-- 7,a7 to improve evaluation of and address the community's health and health workforce needs2 and 7,b7 to engage the community in health workforce development2 7#b7 developing1 enhancing1 or accelerating innovative undergraduate and graduate programs in the biomedical sciences and health professions2 and 7#c7 strengthening pipeline programs in the biomedical sciences and health professions1 including by developing partnerships between institutions of higher education and elementary and secondary schools to recruit the next generation of health professionals earlier in the pipeline to a health care career4 #caj4 ,loan forgiveness for mental and behavioral health social workers ,section #dee of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajhg;e7 is amended by adding at the end the following new subsection3 7r7 ,repayment plan for mental and behavioral health social workers 7#a7 ,in general ,the ,secretary shall cancel the balance of interest and principal due on any eligible ,federal ,direct ,loan not in default for a borrower who-- 7,a7 has made #abj monthly payments on the eligible ,federal ,direct ,loan after ,october #a1 #bjad1 pursuant to any one or a combination of the following-- 7i7 payments under an income-based repayment plan under section #dic;,c2 7ii7 payments under a standard repayment plan under subsection 7d77#a77;,a71 based on a #aj-year repayment period2 7iii7 monthly payments under a repayment plan under subsection 7d77#a7 or 7g7 of not less than the monthly amount calculated under subsection 7d77#a77;,a71 based on a #aj-year repayment period2 or 7iv7 payments under an income contingent repayment plan under subsection 7d77#a77;,d72 and 7,b7 7i7 is employed as a mental health or behavioral health social worker1 as defined by the ,secretary by regulation1 at the time of such forgiveness2 and 7ii7 has been employed as such a mental health or behavioral health social worker during the period in which the borrower makes each of the #abj payments as described in subparagraph 7,a74 7#b7 ,loan cancellation amount ,after the conclusion of the employment period described in paragraph 7#a71 the ,secretary shall cancel the obligation to repay the balance of principal and interest due as of the time of such cancellation1 on the eligible ,federal ,direct ,loans made to the borrower under this part4 7#c7 ,ineligibility for double benefits ,no borrower may1 for the same employment as a mental heath or behavioral health social worker1 receive a reduction of loan obligations under both this subsection and section #dee7m71 #dbh;,j1 #dbh,k1 #dbh,l1 or #dfj4 7#d7 ,definition of eligible ,federal ,direct ,loan ,in this subsection1 the term eligible ,federal ,direct ,loan means a ,federal ,direct ,stafford ,loan1 ,federal ,direct ,,plus ,loan1 ,federal ,direct ,unsubsidized ,stafford ,loan1 or a ,federal ,direct ,consolidation ,loan4 4 #caa4 ,health ,professions ,workforce ,fund 7a7 ,purpose ,it is the purpose of this section to establish a ,health ,professions ,workforce ,fund to be administered through the ,health ,resources and ,services ,administration within the ,department of ,health and ,human ,services to provide for expanded and sustained national investment in the health professions and nursing workforce development programs under title ,,vii and title ,,viii of the ,public ,health ,service ,act4 7b7 ,establishing the ,health ,professions ,workforce ,fund ,there is authorized to be appropriated1 and there is appropriated1 out of any monies in the ,treasury not otherwise appropriated1 to the ,health ,professions ,workforce ,fund-- 7#a7 #cee1jjj1jjj for fiscal year #bjae2 7#b7 #cge1jjj1jjj for fiscal year #bjaf2 7#c7 #cib1jjj1jjj for fiscal year #bjag2 7#d7 #dab1jjj1jjj for fiscal year #bjah2 7#e7 #dcb1jjj1jjj for fiscal year #bjai2 7#f7 #ded1jjj1jjj for fiscal year #bjbj2 7#g7 #dgf1jjj1jjj for fiscal year #bjba2 7#h7 #ejj1jjj1jjj for fiscal year #bjbb2 7#i7 #ebe1jjj1jjj for fiscal year #bjbc2 and 7#aj7 #eeb1jjj1jjj for fiscal year #bjbd4 7c7 ,funding 7#a7 ,for the purpose of carrying out health professions education programs authorized under title ,,vii of the ,public ,health ,service ,act1 in addition to any other amounts authorized to be appropriated for such purpose1 there is authorized to be appropriated out of any monies in the ,health ,professions ,workforce ,fund1 the following3 7,a7 #bdj1jjj1jjj for fiscal year #bjae4 7,b7 #bec1jjj1jjj for fiscal year #bjaf4 7,c7 #bfe1jjj1jjj for fiscal year #bjag4 7,d7 #bgh1jjj1jjj for fiscal year #bjah4 7,e7 #bib1jjj1jjj for fiscal year #bjai4 7,f7 #cjg1jjj1jjj for fiscal year #bjbj4 7,g7 #cbb1jjj1jjj for fiscal year #bjba4 7,h7 #cch1jjj1jjj for fiscal year #bjbb4 7,i7 #cee1jjj1jjj for fiscal year #bjbc4 7,j7 #cgc1jjj1jjj for fiscal year #bjbd4 7#b7 ,for the purpose of carrying out nursing workforce development programs authorized under ,title ,,viii of the ,public ,health ,service ,act1 in addition to any other amounts authorized to be appropriated for such purpose1 there is authorized to be appropriated out of any monies in the ,health ,professions ,workforce ,fund1 the following3 7,a7 #aae1jjj1jjj for fiscal year #bjae4 7,b7 #abb1jjj1jjj for fiscal year #bjaf4 7,c7 #abg1jjj1jjj for fiscal year #bjag4 7,d7 #acd1jjj1jjj for fiscal year #bjah4 7,e7 #adj1jjj1jjj for fiscal year #bjai4 7,f7 #adg1jjj1jjj for fiscal year #bjbj4 7,g7 #aed1jjj1jjj for fiscal year #bjba4 7,h7 #afb1jjj1jjj for fiscal year #bjbb4 7,i7 #agj1jjj1jjj for fiscal year #bjbc4 7,j7 #agi1jjj1jjj for fiscal year #bjbd4 #cab4 ,findings2 sense of ,congress relating to graduate medical education 7a7 ,findings ,congress finds the following3 7#a7 ,projections by the ,association of ,american ,medical ,colleges 7,,aamc7 and other expert entities1 such as the ,health ,resources and ,services ,administration 7,,hrsa71 have indicated a nationwide shortage of up to #acj1fjj physicians1 split evenly between primary care and specialists1 by #bjbe4 7#b7 ,the coverage of an additional #be million uninsured ,americans under the ,patient ,protection and ,affordable ,care ,act is expected to increase the projected shortage by #be percent4 7#c7 ,the ,united ,states ,census projects that the ,nation's population will grow from #caj million in #bjaj to #djj million in #bjdd1 with the ,nation becoming majority-minority in #bjdc1 and the number of ,medicare beneficiaries increasing from #ej4g million in #bjab to #ij million in #bjde4 7#d7 ,one-third of currently practicing physicians are over #ee years of age and likely to retire in the next #bj years4 7#e7 ,a nationwide physician shortage will result in many ,americans waiting longer and traveling farther for health care2 seeking nonemergent care in emergency departments2 and delaying treatment until their health care needs become more serious1 complex1 and costly4 7#f7 ,changing demographics 7such as an aging population71 new health care delivery models 7such as medical homes71 and other factors 7such as disaster preparedness7 are contributing to a shortage of both generalist and specialist physicians4 7#g7 ,these shortages will have the most severe impact on vulnerable and underserved populations1 including racial_/ethnic minorities and the approximately #bj percent of ,americans who live in rural or inner-city locations designated as health professional shortage areas4 7#h7 ,united ,states medical schools have committed to and have initiated a #cj percent increase in enrollment by #bjag to help reduce the ,nation's shortage of quality physicians4 7#i7 ,an increase in ,united ,states medical school graduates must be accompanied by an increase of #d1jjj graduate medical education 7,,gme7 training positions each year4 7#aj7 ,graduate medical education programs and teaching hospitals provide venues in which the next generation of physicians learns to work collaboratively with other physicians and health professionals1 adopt more efficient care delivery models 7such as care coordination and medical homes71 incorporate health information technology and electronic health records in every aspect of their work1 apply new methods of assuring quality and safety1 and participate in groundbreaking clinical and public health research4 7#aa7 ,the ,medicare ,program under title ,,xviii of the ,social ,security ,act 7having more beneficiaries than any other health care program71 supports its fair share of the costs associated with graduate medical education 7,,gme74 7#ab7 ,in general1 the level of support of graduate medical education by the ,medicare ,program has been capped since #aiig and has not been increased to support the expansion of graduate medical education programs needed to avert the projected physician shortage or to accommodate the increase in ,united ,states medical school graduates4 7b7 ,sense of ,congress ,it is the sense of ,congress that eliminating the limit of the number of residency positions that receive some level of ,medicare support under section #ahhf7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h771 also referred to as the ,medical graduate medical education cap1 is critical to-- 7#a7 ensuring an appropriate supply of physicians to meet the ,nation's health care needs2 7#b7 facilitating equitable access for all who seek health care2 and 7#c7 mitigating disparities in health and health care4 #cac4 ,career support for skilled internationally educated health professionals 7a7 ,findings ,congress finds the following3 7#a7 ,according to the ,association of ,schools of ,public ,health1 projections indicate a nationwide shortage of up to #bej1jjj public health workers needed by #bjbj4 7#b7 ,similar trends are projected for other health professions indicating shortages across disciplines1 including within the fields of nursing1 dentistry1 pharmacy1 mental and behavioral health1 primary care1 and community and allied health4 7#c7 ,a nationwide health workforce shortage will result in serious health threats and more severe and costly health care needs1 due to1 in part1 a delayed response to food-borne outbreaks1 emerging infectious diseases1 and natural disasters1 fewer cancer screenings and delayed treatment4 7#d7 ,vulnerable and underserved populations and health professional shortage areas will be most severely impacted by the health workforce shortage4 7#e7 ,according to the ,migration ,policy ,institute1 over #b million college-educated immigrants in the ,united ,states today are unemployed or underemployed in low- or semi-skilled jobs that fail to draw on their education and expertise4 7#f7 ,approximately two out of every five internationally educated immigrants are unemployed or underemployed4 7#g7 ,according to ,drexel ,university ,center for ,labor ,markets and ,policy1 underemployment for internationally educated immigrant women is #bh percent higher than for their male counterparts4 7#h7 ,according to the ,drexel ,university ,center for ,labor ,markets and ,policy1 the mean annual earnings of underemployed immigrants were #cb1jjj1 or #dc percent less than ,u4,s4-born college graduates employed in the college labor market4 7#i7 ,according to ,upwardly ,global and the ,welcome ,back ,initiative1 with proper guidance and support underemployed skilled immigrants typically increase their income by #bae percent to #ijj percent4 7#aj7 ,according to the ,brookings ,institution and the ,partnership for a ,new ,american ,economy1 immigrants working in the health workforce are1 on average1 better-educated than ,u4,s4-born workers in the health workforce4 7b7 ,grants to eligible entities 7#a7 ,authority to provide grants ,the ,secretary of ,health and ,human ,services1 acting through the ,bureau of ,health ,workforce within the ,health ,resources and ,services ,administration1 the ,national ,institute on ,minority ,health and ,health ,disparities1 or the ,office of ,minority ,health 7in this section referred to as the ,secretary71 may award grants to eligible entities to carry out activities described in subsection 7c74 7#b7 ,eligibility ,to be eligible to receive a grant under this section1 an entity shall-- 7,a7 be a clinical1 public health1 or health services organization1 a community-based or nonprofit entity1 an academic institution1 a faith-based organization1 a ,state1 county1 or local government1 a ,national ,area ,health ,education ,center1 or another entity determined appropriate by the ,secretary2 and 7,b7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,authorized activities ,a grant awarded under this section shall be used-- 7#a7 to provide services to assist unemployed and underemployed skilled immigrants1 residing in the ,united ,states1 who have legal1 permanent work authorization and who are internationally educated health professions1 enter into the ,american health workforce with employment matching their health professional skills and education1 and advance in employment to positions that better match their health professional education and expertise2 7#b7 to reduce disparities in incomes between skilled health professional immigrants and other workers in the health workforce2 7#c7 to reduce barriers to entry and advancement in the health workforce for internationally educated skilled immigrants2 and 7#d7 to educate employers regarding the abilities and capacities of internationally educated health professionals4 7d7 ,definitions ,in this section3 7#a7 ,the term health professional means an individual trained for employment or intended employment in the field of public health1 health management1 dentistry1 health administration1 medicine1 nursing1 pharmacy1 psychology1 social work1 psychiatry1 other mental and behavioral health1 allied health1 community health1 social work1 or wellness work1 including fitness and nutrition1 or other fields as determined appropriate by the ,secretary4 7#b7 ,the term underemployed means being employed at less skilled tasks than an employee's training or abilities would otherwise permit4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjai4 ,,iv ,improvement of ,health ,care ,services ,a ,health ,empowerment ,zones #dja4 ,short title ,this subtitle may be cited as the ,health ,empowerment ,zone ,act of #bjad4 #djb4 ,findings ,the ,congress finds the following3 7#a7 ,numerous studies and reports1 including the #bjab ,national ,healthcare ,disparities ,report of the ,administration on ,healthcare ,research and ,quality and the #bjjb ,unequal ,treatment ,report of the ,institute of ,medicine1 document the extensiveness to which health disparities exist across the country4 7#b7 ,these studies have found that1 on average1 racial and ethnic minorities are disproportionately afflicted with chronic and acute conditions--such as cancer1 diabetes1 musculoskeletal disease1 obesity1 and hypertension--and suffer worse health outcomes1 worse health status1 and higher mortality rates than their ,white counterparts4 7#c7 ,several recent studies also show that health disparities are a function of not only access to health care1 but also the social determinants of health--including the environment1 the physical structure of communities1 nutrition and food options1 educational attainment1 employment1 race1 ethnicity1 geography1 and language preference--that directly and indirectly affect the health1 health care1 and wellness of individuals and communities4 7#d7 ,integrally involving and fully supporting the communities most affected by health inequities in the assessment1 planning1 launch1 and evaluation of health disparity elimination efforts are among the leading recommendations made to adequately address and ultimately reduce health disparities4 7#e7 ,recommendations also include supporting the efforts of community stakeholders from a broad cross section--including1 but not limited to local businesses1 local departments of commerce1 education1 labor1 urban planning1 and transportation1 and community-based and other nonprofit organizations--to find areas of common ground around health disparity elimination and collaborate to improve the overall health and wellness of a community and its residents4 #djc4 ,designation of health empowerment zones 7a7 ,in general ,at the request of an eligible community partnership1 the ,secretary may designate an eligible area as a health empowerment zone4 7b7 ,eligibility criteria 7#a7 ,eligible community partnership ,a community partnership is eligible to submit a request under this section if the partnership-- 7,a7 demonstrates widespread public support from key individuals and entities in the eligible area1 including members of the target community1 ,state and local governments1 nonprofit organizations1 and community and industry leaders1 for designation of the eligible area as a health empowerment zone2 and 7,b7 includes representatives of-- 7i7 a broad cross section of stakeholders and residents from communities in the eligible area experiencing disproportionate disparities in health status and health care2 and 7ii7 organizations1 facilities1 and institutions that have a history of working within and serving such communities4 7#b7 ,eligible area ,an area is eligible to be designated as a health empowerment zone under this section if one or more communities in the area experience disproportionate disparities in health status and health care4 ,in determining whether a community experiences such disparities1 the ,secretary shall consider the data collected by the ,department of ,health and ,human ,services focusing on the following areas3 7,a7 ,access to affordable1 high-quality health services4 7,b7 ,the prevalence of disproportionate rates of certain illnesses or diseases including the following3 7i7 ,arthritis1 osteoporosis1 chronic back conditions1 and other musculoskeletal diseases4 7ii7 ,cancer4 7iii7 ,chronic kidney disease4 7iv7 ,diabetes4 7v7 ,injury 7intentional and unintentional74 7vi7 ,violence 7intimate and nonintimate74 7vii7 ,maternal and paternal illnesses and diseases4 7viii7 ,infant mortality4 7ix7 ,mental illness and other disabilities4 7x7 ,substance abuse treatment and prevention1 including underage drinking4 7xi7 ,nutrition1 obesity1 and overweight conditions4 7xii7 ,heart disease4 7xiii7 ,hypertension4 7xiv7 ,cerebrovascular disease or stroke4 7xv7 ,tuberculosis4 7xvi7 ,,hiv_/,,aids and other sexually transmitted diseases4 7xvii7 ,viral hepatitis4 7xviii7 ,asthma4 7xix7 ,tooth decay and other oral health issues4 7,c7 ,within the target community1 the historical and persistent presence of conditions that have been found to contribute to health disparities including any such conditions respecting the following3 7i7 ,poverty4 7ii7 ,educational status and the quality of community schools4 7iii7 ,income4 7iv7 ,access to high-quality affordable health care4 7v7 ,work and work environment4 7vi7 ,environmental conditions in the community1 including with respect to clean water1 clean air1 and the presence or absence of pollutants4 7vii7 ,language and ,english proficiency4 7viii7 ,access to affordable healthy food4 7ix7 ,access to ethnically and culturally diverse health and human service providers and practitioners4 7x7 ,access to culturally and linguistically competent health and human services and health and human service providers4 7xi7 ,health-supporting infrastructure4 7xii7 ,health insurance that is adequate and affordable4 7xiii7 ,race1 racism1 and bigotry 7conscious and unconscious74 7xiv7 ,sexual orientation4 7xv7 ,health literacy4 7xvi7 ,place of residence 7such as urban areas1 rural areas1 and tribal reservations74 7xvii7 ,stress4 7c7 ,procedure 7#a7 ,request ,a request under subsection 7a7 shall-- 7,a7 describe the bounds of the area to be designated as a health empowerment zone and the process used to select those bounds2 7,b7 demonstrate that the partnership submitting the request is an eligible community partnership described in subsection 7b77#a72 7,c7 demonstrate that the area is an eligible area described in subsection 7b77#b72 7,d7 include a comprehensive assessment of disparities in health status and health care experience by one or more communities in the area2 7,e7 set forth-- 7i7 a vision and a set of values for the area2 and 7ii7 a comprehensive and holistic set of goals to be achieved in the area through designation as a health empowerment zone2 and 7,f7 include a strategic plan and an action plan for achieving the goals described in subparagraph 7,e77ii74 7#b7 ,approval ,not later than #fj days after the receipt of a request for designation of an area as a health empowerment zone under this section1 the ,secretary shall approve or disapprove the request4 7d7 ,minimum number ,the ,secretary-- 7#a7 shall designate not more than #aaj health empowerment zones under this section2 and 7#b7 shall designate at least one health empowerment zone in each of the several ,states1 the ,district of ,columbia1 and each territory or possession of the ,united ,states4 #djd4 ,assistance to those seeking designation ,at the request of any organization or entity seeking to submit a request under section #djc7;a71 the ,secretary shall provide technical assistance1 and may award a grant1 to assist such organization or entity-- 7#a7 to form an eligible community partnership described in section #djc7;b77#a72 7#b7 to complete a health assessment1 including an assessment of health disparities under section #djc7;c77#a77;,d72 or 7#c7 to prepare and submit a request1 including a strategic plan1 in accordance with section #djc4 #dje4 ,benefits of designation 7a7 ,priority ,in awarding any competitive grant1 a ,federal official shall give priority to any applicant that-- 7#a7 meets the eligibility criteria for the grant2 7#b7 proposes to use the grant for activities in a health empowerment zone2 and 7#c7 demonstrates that such activities will directly and significantly further the goals of the strategic plan approved for such zone under section #djc4 7b7 ,grants for initial implementation of strategic plan 7#a7 ,in general ,upon designating an eligible area as a health empowerment zone at the request of an eligible community partnership1 the ,secretary shall1 subject to the availability of appropriations1 make a grant to the community partnership for implementation of the strategic plan for such zone4 7#b7 ,grant period ,a grant under paragraph 7#a7 for a health empowerment zone shall be for a period of #b years and may be renewed1 except that the total period of grants under paragraph 7#a7 for such zone may not exceed #aj years4 7#c7 ,limitation ,in awarding grants under this subsection1 the ,secretary shall not give less priority to an applicant or reduce the amount of a grant because the ,secretary rendered technical assistance or made a grant to the same applicant under section #djd4 7#d7 ,reporting ,the ,secretary shall require each recipient of a grant under this subsection to report to the ,secretary not less than every #f months on the progress in implementing the strategic plan for the health empowerment zone4 #djf4 ,definition ,in this subtitle1 the term ,secretary means the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,health ,resources and ,services ,administration and the ,deputy ,assistant ,secretary for ,minority ,health1 and in cooperation with the ,director of the ,office of ,community ,services and the ,director of the ,national ,institute for ,minority ,health and ,health ,disparities4 #djg4 ,authorization of appropriations ,to carry out this subtitle1 there is authorized to be appropriated #ajj1jjj1jjj for fiscal year #bjae4 ,b ,other ,improvements of ,health ,care ,services #a ,expansion of ,coverage #daa4 ,amendment to the ,public ,health ,service ,act ,title ,,xxxiv of the ,public ,health ,service ,act1 as amended by titles ,i1 ,,ii1 ,,iii1 and ,,ix of this ,act1 is further amended by inserting after subtitle ,c the following3 ,d ,reconstruction and ,improvement ,grants for ,public ,health ,care ,facilities ,serving ,pacific ,islanders and the ,insular ,areas #cdea4 ,grant support for quality improvement initiatives 7a7 ,in general ,the ,secretary1 in collaboration with the ,administrator of the ,health ,resources and ,services ,administration1 the ,director of the ,agency for ,healthcare ,research and ,quality1 and the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall award grants to eligible entities for the conduct of demonstration projects to improve the quality of and access to health care4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an entity shall-- 7#a7 be a health center1 hospital1 health plan1 health system1 community clinic4 or other health entity determined appropriate by the ,secretary-- 7,a7 that1 by legal mandate or explicitly adopted mission1 provides patients with access to services regardless of their ability to pay2 7,b7 that provides care or treatment for a substantial number of patients who are uninsured1 are receiving assistance under a ,state program under title ,,xix of the ,social ,security ,act1 or are members of vulnerable populations1 as determined by the ,secretary2 and 7,c7 7i7 with respect to which1 not less than #ej percent of the entity's patient population is made up of racial and ethnic minorities2 or 7ii7 that-- 7,i7 serves a disproportionate percentage of local1 minority racial and ethnic patients1 or that has a patient population1 at least #ej percent of which is limited-,english-proficient2 and 7,,ii7 provides an assurance that amounts received under the grant will be used only to support quality improvement activities in the racial and ethnic population served2 and 7#b7 prepare and submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,priority ,in awarding grants under subsection 7a71 the ,secretary shall give priority to applicants under subsection 7b77#b7 that-- 7#a7 demonstrate an intent to operate as part of a health care partnership1 network1 collaborative1 coalition1 or alliance where each member entity contributes to the design1 implementation1 and evaluation of the proposed intervention2 or 7#b7 intend to use funds to carry out systemwide changes with respect to health care quality improvement1 including-- 7,a7 improved systems for data collection and reporting2 7,b7 innovative collaborative or similar processes2 7,c7 group programs with behavioral or self-management interventions2 7,d7 case management services2 7,e7 physician or patient reminder systems2 7,f7 educational interventions2 or 7,g7 other activities determined appropriate by the ,secretary4 7d7 ,use of funds ,an entity shall use amounts received under a grant under subsection 7a7 to support the implementation and evaluation of health care quality improvement activities or minority health and health care disparity reduction activities that include-- 7#a7 with respect to health care systems1 activities relating to improving-- 7,a7 patient safety2 7,b7 timeliness of care2 7,c7 effectiveness of care2 7,d7 efficiency of care2 7,e7 patient centeredness2 and 7,f7 health information technology2 and 7#b7 with respect to patients1 activities relating to-- 7,a7 staying healthy2 7,b7 getting well1 mentally and physically2 7,c7 living effectively with illness or disability2 and 7,d7 coping with end-of-life issues4 7e7 ,common data systems ,the ,secretary shall provide financial and other technical assistance to grantees under this section for the development of common data systems4 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjbj4 #cdeb4 ,centers of excellence 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall designate centers of excellence at public hospitals1 and other health systems serving large numbers of minority patients1 that-- 7#a7 meet the requirements of section #cdea7;b77#a72 7#b7 demonstrate excellence in providing care to minority populations2 and 7#c7 demonstrate excellence in reducing disparities in health and health care4 7b7 ,requirements ,a hospital or health system that serves as a center of excellence under subsection 7a7 shall-- 7#a7 design1 implement1 and evaluate programs and policies relating to the delivery of care in racially1 ethnically1 and linguistically diverse populations2 7#b7 provide training and technical assistance to other hospitals and health systems relating to the provision of quality health care to minority populations2 and 7#c7 develop activities for graduate or continuing medical education that institutionalize a focus on cultural competence training for health care providers4 7c7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section1 such sums as may be necessary for each of fiscal years #bjae through #bjbj4 #cdec4 ,reconstruction and improvement grants for ,public ,health care facilities serving ,pacific ,islanders and the insular areas 7a7 ,in general ,the ,secretary shall provide direct financial assistance to designated health care providers and community health centers in ,american ,samoa1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,united ,states ,virgin ,islands1 ,puerto ,rico1 and ,hawaii for the purposes of reconstructing and improving health care facilities and services in a culturally competent and sustainable manner4 7b7 ,eligibility ,to be eligible to receive direct financial assistance under subsection 7a71 an entity shall be a public health facility or community health center located in ,american ,samoa1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,united ,states ,virgin ,islands1 ,puerto ,rico1 or ,hawaii that-- 7#a7 is owned or operated by-- 7,a7 the ,government of ,american ,samoa1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,united ,states ,virgin ,islands1 ,puerto ,rico1 or ,hawaii or a unit of local government2 or 7,b7 a nonprofit organization2 and 7#b7 7,a7 provides care or treatment for a substantial number of patients who are uninsured1 receiving assistance under a ,state program under a title ,,xviii of the ,social ,security ,act1 or a ,state program under title ,,xix of such ,act1 or who are members of a vulnerable population1 as determined by the ,secretary2 or 7,b7 serves a disproportionate percentage of local1 minority racial and ethnic patients4 7c7 ,report ,not later than #ahj days after the date of enactment of this title and annually thereafter1 the ,secretary shall submit to the ,congress and the ,president a report that includes an assessment of health resources and facilities serving populations in ,american ,samoa1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,united ,states ,virgin ,islands1 ,puerto ,rico1 and ,hawaii4 ,in preparing such report1 the ,secretary shall-- 7#a7 consult with and obtain information on all health care facilities needs from the entities described in subsection 7b72 7#b7 include all amounts of ,federal assistance received by each entity in the preceding fiscal year2 7#c7 review the total unmet needs of each jurisdiction for health care facilities1 including needs for renovation and expansion of existing facilities2 7#d7 include a strategic plan for addressing the needs of each jurisdiction identified in the report2 and 7#e7 evaluate the effectiveness of the care provided by measuring patient outcomes and cost measures4 7d7 ,authorization of appropriations ,there are authorized to be appropriated such sums as necessary to carry out this section4 4 #dab4 ,removing citizenship and immigration barriers to access to affordable health care under the ,,aca 7a7 ,in general 7#a7 ,premium tax credits ,section #cf;,b of the ,internal ,revenue ,code of #aihf is amended-- 7,a7 in subsection 7c77#a77;,b7-- 7i7 by amending the subparagraph heading to read as follows3 ,special rule for certain individuals ineligible for ,medicaid due to status1 and 7ii7 in clause 7ii71 by striking lawfully present in the ,united ,states1 but and inserting who1 and 7,b7 by striking subsection 7e74 7#b7 ,cost-sharing reductions ,section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7 is amended by striking subsection 7e74 7#c7 ,preexisting condition insurance plan ,section #aaja7;d7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjja7;d77 is amended by striking paragraph 7#a7 and redesignating paragraphs 7#b7 and 7#c7 as paragraphs 7#a7 and 7#b71 respectively4 7#d7 ,basic health program eligibility ,section #acca7;e77#a77;,b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjea7;e77#a77;,b77 is amended by striking lawfully present in the ,united ,states14 7#e7 ,restrictions on ,federal payments ,section #adab of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjhb7 is amended by striking subsection 7d74 7#f7 ,requirement to maintain minimum essential coverage ,subsection 7d7 of section #ejjj;,a of the ,internal ,revenue ,code of #aihf is amended by striking paragraph 7#c7 and by redesignating paragraph 7#d7 as paragraph 7#c74 7b7 ,conforming amendment 7#a7 ,section #adaa7;a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjha7;a77 is amended by striking paragraph 7#a7 and redesignating paragraphs 7#b71 7#c71 and 7#d7 as paragraphs 7#a71 7#b71 and 7#c71 respectively4 7#b7 ,section #acab7;f7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjcb7;f77 is amended-- 7,a7 in the subsection heading1 by striking employers2 and all that follows through residents2 and 7,b7 by striking paragraph 7#c74 #dac4 ,study on the uninsured 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall-- 7#a7 conduct a study1 in accordance with the standards under section #caja of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjkk71 on the demographic characteristics of the population of individuals who do not have health insurance coverage2 and 7#b7 predict1 based on such study1 the demographic characteristics of the population of individuals who would remain without health insurance coverage after the end of open enrollment or any special enrollment period4 7b7 ,reporting requirements 7#a7 ,in general ,not later than #ab months after the date of the enactment of this ,act1 the ,secretary shall submit to the ,congress the results of the study under subsection 7a77#a7 and the prediction made under subsection 7a77#b74 7#b7 ,reporting of demographic characteristics ,the ,secretary shall report the demographic characteristics under paragraphs 7#a7 and 7#b7 of subsection 7a7 on the basis of racial and ethnic group1 and shall stratify the reporting on each racial and ethnic group by other demographic characteristics that can impact access to health insurance coverage1 such as sexual orientation1 gender identity1 primary language1 disability status1 sex1 socioeconomic status1 age group1 and citizenship and immigration status1 in a manner consistent with title ,i of this ,act4 #dad4 ,medicaid payment parity for the territories 7a7 ,elimination of funding limitations for ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 and ,american ,samoa 7#a7 ,in general ,section #aajh of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7 is amended-- 7,a7 in subsection 7f71 in the matter preceding paragraph 7#a71 by striking subsection 7g7 and inserting subsections 7g7 and 7h72 7,b7 in subsection 7g77#b71 in the matter preceding subparagraph 7,a7-- 7i7 by striking ,notwithstanding subsection 7f7 and subject to and and inserting ,notwithstanding subsection 7f7 and subject to2 and 7ii7 by striking paragraphs 7#c7 and 7#e7 and inserting 1 paragraphs 7#c7 and 7#e7 of this subsection1 and subsection 7h74 7,c7 by adding at the end the following new subsection3 7h7 ,sunset of funding limitations for ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 and ,american ,samoa ,subsections 7f7 and 7g7 shall not apply to ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 and ,american ,samoa for any fiscal year after fiscal year #bjae4 4 7#b7 ,conforming amendment ,section #aijc7u7 of such ,act 7#db ,u4,s4,c4 #acif;c7u77 is amended by striking paragraph 7#d74 7#c7 ,effective date ,the amendments made by this subsection shall apply beginning with fiscal year #bjaf4 7b7 ,parity in ,,fmap 7#a7 ,in general ,section #aije7;b7 of such ,act 7#db ,u4,s4,c4 #acif;d7b77 is amended by inserting after and ,american ,samoa shall be #ee percent1 the following3 7except that1 beginning with fiscal year #bjah1 the ,federal medical assistance percentage for ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 and ,american ,samoa shall be the ,federal medical assistance percentage determined by the ,secretary in consultation 7for the ,united ,states ,virgin ,islands1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 and ,american ,samoa7 with the ,secretary of the ,interior74 7#b7 #b-;fiscal-year transition ,notwithstanding any other provision of law1 during fiscal years #bjaf and #bjag1 the ,federal medical assistance percentage established under section #aije7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b77 for ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 and ,american ,samoa shall be the highest such ,federal medical assistance percentage applicable to any of the #ej ,states or the ,district of ,columbia for the fiscal year involved4 7#c7 ,per capita income data 7,a7 ,report to ,congress ,not later than ,october #a1 #bjaf1 the ,secretary of ,health and ,human ,services shall submit to ,congress a report that describes the per capita income data used to promulgate the ,federal medical assistance percentage in the territories and how such data differ from the per capita income data used to promulgate ,federal medical assistance percentages for the #ej ,states and the ,district of ,columbia4 ,the report should include recommendations on how the ,federal medical assistance percentages can be calculated for the territories to ensure parity with the #ej ,states and the ,district of ,columbia4 7,b7 ,application ,section #aaja7;a77#h77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7;a77#h77;,b77 is amended-- 7i7 by striking 7other than ,puerto ,rico1 the ,united ,states ,virgin ,islands1 and ,guam7 and inserting 7including ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 and ,american ,samoa72 and 7ii7 by inserting 7or1 if such satisfactory data are not available in the case of the ,united ,states ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa1 satisfactory data available from the ,department of the ,interior for the same period1 or if such satisfactory data are not available in the case of ,puerto ,rico1 satisfactory data available from the government of the ,commonwealth of ,puerto ,rico for the same period7 after ,department of ,commerce4 #dae4 ,extension of ,medicare secondary payer 7a7 ,in general ,section #ahfb7;b77#a77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7b77#a77;,c77 is amended-- 7#a7 in the last sentence1 by inserting 1 and before ,january #a1 #bjae after prior to such date72 and 7#b7 by adding at the end the following new sentence3 ,effective for items and services furnished on or after ,january #a1 #bjae 7with respect to periods beginning on or after the date that is #db months prior to such date71 clauses 7i7 and 7ii7 shall be applied by substituting #db-month for #ab-month each place it appears in the first sentence44 7b7 ,effective date ,the amendments made by this section shall take effect on the date of enactment of this ,act4 ,for purposes of determining an individual's status under section #ahfb7;b77#a77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7b77#a77;,c771 as amended by subsection 7a71 an individual who is within the coordinating period as of the date of enactment of this ,act shall have that period extended to the full #db months described in the last sentence of such section1 as added by the amendment made by subsection 7a77#b74 #daf4 ,border health grants 7a7 ,eligible entity defined ,in this section1 the term eligible entity means a ,state1 public institution of higher education1 local government1 tribal government1 nonprofit health organization1 community health center1 or community clinic receiving assistance under section #ccj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b71 that is located in the border area4 7b7 ,authorization ,from funds appropriated under subsection 7f71 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary71 acting through the ,united ,states members of the ,united ,states-,mexico ,border ,health ,commission1 shall award grants to eligible entities to address priorities and recommendations to improve the health of border area residents that are established by-- 7#a7 the ,united ,states members of the ,united ,states-,mexico ,border ,health ,commission2 7#b7 the ,state border health offices2 and 7#c7 the ,secretary4 7c7 ,application ,an eligible entity that desires a grant under subsection 7b7 shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7d7 ,use of funds ,an eligible entity that receives a grant under subsection 7b7 shall use the grant funds for-- 7#a7 programs relating to-- 7,a7 maternal and child health2 7,b7 primary care and preventative health2 7,c7 public health and public health infrastructure2 7,d7 musculoskeletal health and obesity2 7,e7 health education and promotion2 7,f7 oral health2 7,g7 mental and behavioral health2 7,h7 substance abuse2 7,i7 health conditions that have a high prevalence in the border area2 7,j7 medical and health services research2 7,k7 workforce training and development2 7,l7 community health workers or promotoras2 7,m7 health care infrastructure problems in the border area 7including planning and construction grants72 7,n7 health disparities in the border area2 7,o7 environmental health2 and 7,p7 outreach and enrollment services with respect to ,federal programs 7including programs authorized under titles ,,xix and ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acif and #acig;aa772 and 7#b7 other programs determined appropriate by the ,secretary4 7e7 ,supplement1 not supplant ,amounts provided to an eligible entity awarded a grant under subsection 7b7 shall be used to supplement and not supplant other funds available to the eligible entity to carry out the activities described in subsection 7d74 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section1 #bjj1jjj1jjj for fiscal year #bjae1 and such sums as may be necessary for each succeeding fiscal year4 #dag4 ,removing ,medicare barrier to health care 7a7 ,part ,a ,section #ahah7;a77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#b7;a77#c77 is amended by striking 7,b7 and all that follows through under this section and inserting 7,b7 an individual who is lawfully present in the ,united ,states4 7b7 ,part ,b ,section #ahcf7b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieo7#b77 is amended by striking 7,b7 and all that follows through under this part and inserting 7,b7 an individual who is lawfully present in the ,united ,states4 #dah4 #ajj percent ,,fmap for medical assistance provided by urban ,indian health centers 7a7 ,in general ,the third sentence of section #aije7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif7;b771 as amended by section #dae7;c71 is further amended by inserting or are received through a program operated by an urban ,indian organization through a grant or contract under title ,v of such ,act after 7as defined in section #d of the ,indian ,health ,care ,improvement ,act74 7b7 ,effective date ,the amendment made by this section shall apply to medical assistance provided on or after the date of enactment of this ,act4 #dai4 #ajj percent ,,fmap for medical assistance provided to a ,native ,hawaiian through a federally qualified health center or a ,native ,hawaiian health care system under the ,medicaid program 7a7 ,in general ,the third sentence of section #aije7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b771 as amended by section #dai1 is amended by inserting 2 and1 with respect to medical assistance provided to a ,native ,hawaiian 7as defined in section #ab7b7 of the ,native ,hawaiian ,health ,care ,improvement ,act7 through a federally qualified health center or a ,native ,hawaiian health care system 7as defined in section #ab7f7 of such ,act71 whether directly1 by referral1 or under contract or other arrangement between such federally qualified health center or ,native ,hawaiian health care system and another health care provider before the period4 7b7 ,effective date ,the amendment made by this section shall apply to medical assistance provided on or after the date of enactment of this ,act4 #b ,expansion of ,access #dba4 ,grants for racial and ethnic approaches to community health 7a7 ,purpose ,it is the purpose of this section to provide for the awarding of grants to assist communities in mobilizing and organizing resources in support of effective and sustainable programs that will reduce or eliminate disparities in health and health care experienced by racial and ethnic minority individuals4 7b7 ,authority ,to ,award ,grants ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall award grants to eligible entities to assist in designing1 implementing1 and evaluating culturally and linguistically appropriate1 science-based1 and community-driven sustainable strategies to eliminate racial and ethnic health and health care disparities4 7c7 ,eligible ,entities ,to be eligible to receive a grant under this section1 an entity shall-- 7#a7 represent a coalition-- 7,a7 whose principal purpose is to develop and implement interventions to reduce or eliminate a health or health care disparity in a targeted racial or ethnic minority group in the community served by the coalition2 and 7,b7 that includes-- 7i7 members selected from among-- 7,i7 public health departments2 7,,ii7 community-based organizations2 7,,iii7 university and research organizations2 7,,iv7 ,american ,indian tribal organizations1 national ,american ,indian organizations1 ,indian ,health ,service1 or organizations serving ,alaska ,natives2 and 7,v7 interested public or private health care providers or organizations as deemed appropriate by the ,secretary2 and 7ii7 at least #a member from a community-based organization that represents the targeted racial or ethnic minority group2 and 7#b7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require1 which shall include-- 7,a7 a description of the targeted racial or ethnic populations in the community to be served under the grant2 7,b7 a description of at least #a health disparity that exists in the racial or ethnic targeted populations1 including health issues such as infant mortality1 breast and cervical cancer screening and management1 musculoskeletal diseases and obesity1 prostate cancer screening and management1 cardiovascular disease1 diabetes1 child and adult immunization levels1 or other health priority areas as designated by the ,secretary2 and 7,c7 a demonstration of a proven record of accomplishment of the coalition members in serving and working with the targeted community4 7d7 ,sustainability ,the ,secretary shall give priority to an eligible entity under this section if the entity agrees that1 with respect to the costs to be incurred by the entity in carrying out the activities for which the grant was awarded1 the entity 7and each of the participating partners in the coalition represented by the entity7 will maintain its expenditures of non-,federal funds for such activities at a level that is not less than the level of such expenditures during the fiscal year immediately preceding the first fiscal year for which the grant is awarded4 7e7 ,nonduplication ,funds provided through this grant program should supplement1 not supplant1 existing ,federal funding1 and the funds should not be used to duplicate the activities of the other health disparity grant programs in this ,act4 7f7 ,technical ,assistance ,the ,secretary may1 either directly or by grant or contract1 provide any entity that receives a grant under this section with technical and other nonfinancial assistance necessary to meet the requirements of this section4 7g7 ,dissemination ,the ,secretary shall encourage and enable grantees to share best practices1 evaluation results1 and reports with communities not affiliated with grantees using the ,internet1 conferences1 and other pertinent information regarding the projects funded by this section1 including the outreach efforts of the ,office of ,minority ,health and ,health ,disparity ,elimination and the ,centers for ,disease ,control and ,prevention4 7h7 ,administrative ,burdens ,the ,secretary shall make every effort to minimize duplicative or unnecessary administrative burdens on grantees4 7i7 ,definition ,in this section1 the term ,secretary means the ,secretary of ,health and ,human ,services4 7j7 ,authorization of appropriations ,there are authorized to be appropriated such sums as may be necessary to carry out this section4 #dbb4 ,critical access hospital improvements 7a7 ,elimination of isolation test for cost-,based ambulance reimbursement 7#a7 ,in general ,section #ahcd7l77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77#h77 is amended-- 7,a7 in subparagraph 7,b7-- 7i7 by striking owned and2 and 7ii7 by inserting 7including when such services are provided by the entity under an arrangement with the hospital7 after hospital2 and 7,b7 by striking the comma at the end of subparagraph 7,b7 and all that follows and inserting a period4 7#b7 ,effective date ,the amendments made by this subsection shall apply to services furnished on or after ,january #a1 #bjae4 7b7 ,provision of a more flexible alternative to the ,,cah designation #be inpatient bed limit requirement 7#a7 ,in general ,section #ahbj7;c77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#d7;c77#b77 is amended-- 7,a7 in subparagraph 7,b77iii71 by striking provides not more than and inserting subject to subparagraph 7,f71 provides not more than2 and 7,b7 by adding at the end the following new subparagraph3 7,f7 ,alternative to #be inpatient bed limit requirement 7i7 ,in general ,a ,state may elect to treat a facility1 with respect to the designation of the facility for a cost-reporting period1 as satisfying the requirement of subparagraph 7,b77iii7 relating to a maximum number of acute care inpatient beds if the facility elects1 in accordance with a method specified by the ,secretary and before the beginning of the cost reporting period1 to meet the requirement under clause 7ii74 7ii7 ,alternate requirement ,the requirement under this clause1 with respect to a facility and a cost-reporting period1 is that the total number of inpatient bed days described in subparagraph 7,b77iii7 during such period will not exceed #g1cjj4 ,for purposes of this subparagraph1 an individual who is an inpatient in a bed in the facility for a single day shall be counted as one inpatient bed day4 7iii7 ,withdrawal of election ,the option described in clause 7i7 shall not apply to a facility for a cost-reporting period if the facility 7for any two consecutive cost-reporting periods during the previous #e cost-reporting periods7 was treated under such option and had a total number of inpatient bed days for each of such two cost-reporting periods that exceeded the number specified in such clause4 4 7#b7 ,effective date ,the amendments made by paragraph 7#a7 shall apply to cost-reporting periods beginning on or after the date of the enactment of this ,act4 #dbc4 ,establishment of ,rural ,community ,hospital 7,,rch7 ,program 7a7 ,in general ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 as amended by section #bjc7;b77#a71 is amended by adding at the end of the following new subsection3 7jjj7 ,rural ,community ,hospital2 ,rural ,community ,hospital ,services 7#a7 ,the term rural community hospital means a hospital 7as defined in subsection 7e77 that-- 7,a7 is located in a rural area 7as defined in section #ahhf7;d77#b77;,d77 or treated as being so located pursuant to section #ahhf7;d77#h77;,e72 7,b7 subject to paragraph 7#b71 has less than #ea acute care inpatient beds1 as reported in its most recent cost report2 7,c7 makes available #bd-;hour emergency care services2 7,d7 subject to paragraph 7#c71 has a provider agreement in effect with the ,secretary and is open to the public as of ,january #a1 #bjaj2 and 7,e7 applies to the ,secretary for such designation4 7#b7 ,for purposes of paragraph 7#a77;,b71 beds in a psychiatric or rehabilitation unit of the hospital which is a distinct part of the hospital shall not be counted4 7#c7 ,paragraph 7#a77;,d7 shall not be construed to prohibit any of the following from qualifying as a rural community hospital3 7,a7 ,a replacement facility 7as defined by the ,secretary in regulations in effect on ,january #a1 #bjab7 with the same service area 7as defined by the ,secretary in regulations in effect on such date74 7,b7 ,a facility obtaining a new provider number pursuant to a change of ownership4 7,c7 ,a facility which has a binding written agreement with an outside1 unrelated party for the construction1 reconstruction1 lease1 rental1 or financing of a building as of ,january #a1 #bjab4 7#d7 ,nothing in this subsection shall be construed as prohibiting a critical access hospital from qualifying as a rural community hospital if the critical access hospital meets the conditions otherwise applicable to hospitals under subsection 7e7 and section #ahff4 7#e7 ,nothing in this subsection shall be construed as prohibiting a rural community hospital participating in the demonstration program under section #daj;,a of the ,medicare ,prescription ,drug1 ,improvement1 and ,modernization ,act of #bjjc 7,public ,law #ajh-agc2 #aag ,stat4 #bcac7 from qualifying as a rural community hospital if the rural community hospital meets the conditions otherwise applicable to hospitals under subsection 7e7 and section #ahff4 4 7b7 ,payment 7#a7 ,inpatient hospital services ,section #ahad of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7 is amended by adding at the end the following new subsection3 7m7 ,payment for ,inpatient ,services ,furnished in ,rural ,community ,hospitals ,the amount of payment under this part for inpatient hospital services furnished in a rural community hospital1 other than such services furnished in a psychiatric or rehabilitation unit of the hospital which is a distinct part1 is1 at the election of the hospital in the application referred to in section #ahfa7;jjj77#a77;,e7-- 7#a7 #aja percent of the reasonable costs of providing such services1 without regard to the amount of the customary or other charge1 or 7#b7 the amount of payment provided for under the prospective payment system for inpatient hospital services under section #ahhf7;d74 4 7#b7 ,outpatient services ,section #ahcd of such ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following new subsection3 7p7 ,payment for outpatient services furnished in rural community hospitals ,the amount of payment under this part for outpatient services furnished in a rural community hospital is1 at the election of the hospital in the application referred to in section #ahfa7;jjj77#a77;,e7-- 7#a7 #aja percent of the reasonable costs of providing such services1 without regard to the amount of the customary or other charge and any limitation under section #ahfa7v77#a77,u71 or 7#b7 the amount of payment provided for under the prospective payment system for covered ,,opd services under section #ahcc7t74 4 7#c7 ,exemption from #cj-percent reduction in reimbursement for bad debt ,section #ahfa7v77#a77,t7 of such ,act 7#db ,u4,s4,c4 #aciex7v77#a77,t77 is amended by inserting 7other than for a rural community hospital7 after ,in determining such reasonable costs for hospitals4 7c7 ,beneficiary cost-,sharing for outpatient services ,section #ahcd7p7 of such ,act 7as added by subsection 7b77#b77 is amended-- 7#a7 by redesignating paragraphs 7#a7 and 7#b7 as subparagraphs 7,a7 and 7,b71 respectively2 7#b7 by inserting 7#a7 after 7p72 and 7#c7 by adding at the end the following3 7#b7 ,the amounts of beneficiary cost-sharing for outpatient services furnished in a rural community hospital under this part shall be as follows3 7,a7 ,for items and services that would have been paid under section #ahcc7t7 if provided by a hospital1 the amount of cost-sharing determined under paragraph 7#h7 of such section4 7,b7 ,for items and services that would have been paid under section #ahcc7;h7 if furnished by a provider or supplier1 no cost-sharing shall apply4 7,c7 ,for all other items and services1 the amount of cost-sharing that would apply to the item or service under the methodology that would be used to determine payment for such item or service if provided by a physician1 provider1 or supplier1 as the case may be4 4 7d7 ,conforming amendments 7#a7 ,part ,a payment ,section #ahad7;b7 of such ,act 7#db ,u4,s4,c4 #acie;f7b77 is amended in the matter preceding paragraph 7#a7 by inserting other than inpatient hospital services furnished by a rural community hospital1 after critical access hospital services14 7#b7 ,part ,b payment ,section #ahcc7;a7 of such ,act 7#db ,u4,s4,c4 #aciel7a771 as amended by section #bjc7;b77#b71 is amended-- 7,a7 in paragraph 7#b71 in the matter before subparagraph 7,a71 by striking and 7,i7 and inserting 7,i71 and 7,k72 7,b7 by striking and at the end of paragraph 7#i72 7,c7 by striking the period at the end of paragraph 7#aj7 and inserting 2 and2 and 7,d7 by adding at the end the following3 7#aa7 in the case of outpatient services furnished by a rural community hospital1 the amounts described in section #ahcd7p74 4 7#c7 ,technical amendments 7,a7 ,consultation with ,state agencies ,section #ahfc of such ,act 7#db ,u4,s4,c4 #aciez7 is amended by striking and 7dd77#b7 and inserting 7dd77#b71 7mm77#a71 and 7jjj77#a74 7,b7 ,provider agreements ,section #ahff7;a77#b77;,a7 of such ,act 7#db ,u4,s4,c4 #acie;cc7a77#b77;,a77 is amended by inserting section #ahcd7p77#b71 after section #ahcc7;b714 7e7 ,effective date ,the amendments made by this section shall apply to items and services furnished on or after ,october #a1 #bjad4 #dbd4 ,medicare remote monitoring pilot projects 7a7 ,pilot projects 7#a7 ,in general ,not later than #i months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall conduct pilot projects under title ,,xviii of the ,social ,security ,act for the purpose of providing incentives to home health agencies to utilize home monitoring and communications technologies that-- 7,a7 enhance health outcomes for ,medicare beneficiaries2 and 7,b7 reduce expenditures under such title4 7#b7 ,site requirements 7,a7 ,urban and ,rural ,the ,secretary shall conduct the pilot projects under this section in both urban and rural areas4 7,b7 ,site in a small ,state ,the ,secretary shall conduct at least #c of the pilot projects in a ,state with a population of less than #a1jjj1jjj4 7#c7 ,definition of home health agency ,in this section1 the term home health agency has the meaning given that term in section #ahfa7o7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7o774 7b7 ,medicare beneficiaries within the scope of projects ,the ,secretary shall specify the criteria for identifying those ,medicare beneficiaries who shall be considered within the scope of the pilot projects under this section for purposes of the application of subsection 7c7 and for the assessment of the effectiveness of the home health agency in achieving the objectives of this section4 ,such criteria may provide for the inclusion in the projects of ,medicare beneficiaries who begin receiving home health services under title ,,xviii of the ,social ,security ,act after the date of the implementation of the projects4 7c7 ,incentives 7#a7 ,performance targets ,the ,secretary shall establish for each home health agency participating in a pilot project under this section a performance target using one of the following methodologies1 as determined appropriate by the ,secretary3 7,a7 ,adjusted historical performance target ,the ,secretary shall establish for the agency-- 7i7 a base expenditure amount equal to the average total payments made to the agency under parts ,a and ,b of title ,,xviii of the ,social ,security ,act for ,medicare beneficiaries determined to be within the scope of the pilot project in a base period determined by the ,secretary2 and 7ii7 an annual per capita expenditure target for such beneficiaries1 reflecting the base expenditure amount adjusted for risk and adjusted growth rates4 7,b7 ,comparative performance target ,the ,secretary shall establish for the agency a comparative performance target equal to the average total payments under such parts ,a and ,b during the pilot project for comparable individuals in the same geographic area that are not determined to be within the scope of the pilot project4 7#b7 ,incentive ,subject to paragraph 7#c71 the ,secretary shall pay to each participating home care agency an incentive payment for each year under the pilot project equal to a portion of the ,medicare savings realized for such year relative to the performance target under paragraph 7#a74 7#c7 ,limitation on expenditures ,the ,secretary shall limit incentive payments under this section in order to ensure that the aggregate expenditures under title ,,xviii of the ,social ,security ,act 7including incentive payments under this subsection7 do not exceed the amount that the ,secretary estimates would have been expended if the pilot projects under this section had not been implemented4 7d7 ,waiver authority ,the ,secretary may waive such provisions of titles ,,xi and ,,xviii of the ,social ,security ,act as the ,secretary determines to be appropriate for the conduct of the pilot projects under this section4 7e7 ,report to ,congress ,not later than #e years after the date that the first pilot project under this section is implemented1 the ,secretary shall submit to ,congress a report on the pilot projects4 ,such report shall contain a detailed description of issues related to the expansion of the projects under subsection 7f7 and recommendations for such legislation and administrative actions as the ,secretary considers appropriate4 7f7 ,expansion ,if the ,secretary determines that any of the pilot projects under this section enhance health outcomes for ,medicare beneficiaries and reduce expenditures under title ,,xviii of the ,social ,security ,act1 the ,secretary may initiate comparable projects in additional areas4 7g7 ,incentive payments have no effect on other ,medicare payments to agencies ,an incentive payment under this section-- 7#a7 shall be in addition to the payments that a home health agency would otherwise receive under title ,,xviii of the ,social ,security ,act for the provision of home health services2 and 7#b7 shall have no effect on the amount of such payments4 #dbe4 ,rural health quality advisory commission and demonstration projects 7a7 ,rural ,health ,quality ,advisory ,commission 7#a7 ,establishment ,not later than #f months after the date of the enactment of this section1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall establish a commission to be known as the ,rural ,health ,quality ,advisory ,commission 7in this section referred to as the ,commission74 7#b7 ,duties of commission 7,a7 ,national plan ,the ,commission shall develop1 coordinate1 and facilitate implementation of a national plan for rural health quality improvement4 ,the national plan shall-- 7i7 identify objectives for rural health quality improvement2 7ii7 identify strategies to eliminate known gaps in rural health system capacity and improve rural health quality2 and 7iii7 provide for ,federal programs to identify opportunities for strengthening and aligning policies and programs to improve rural health quality4 7,b7 ,demonstration projects ,the ,commission shall design demonstration projects to test alternative models for rural health quality improvement1 including with respect to both personal and population health4 7,c7 ,monitoring ,the ,commission shall monitor progress toward the objectives identified pursuant to paragraph 7#a77;,a74 7#c7 ,membership 7,a7 ,number ,the ,commission shall be composed of #aa members appointed by the ,secretary4 7,b7 ,selection ,the ,secretary shall select the members of the ,commission from among individuals with significant rural health care and health care quality expertise1 including expertise in clinical health care1 health care quality research1 population or public health1 or purchaser organizations4 7#d7 ,contracting authority ,subject to the availability of funds1 the ,commission may enter into contracts and make other arrangements1 as may be necessary to carry out the duties described in paragraph 7#b74 7#e7 ,staff ,upon the request of the ,commission1 the ,secretary may detail1 on a reimbursable basis1 any of the personnel of the ,office of ,rural ,health ,policy of the ,health ,resources and ,services ,administration1 the ,agency for ,healthcare ,quality and ,research1 or the ,centers for ,medicare ,medicaid ,services to the ,commission to assist in carrying out this subsection4 7#f7 ,reports to congress ,not later than #a year after the establishment of the ,commission1 and annually thereafter1 the ,commission shall submit a report to the ,congress on rural health quality4 ,each such report shall include the following3 7,a7 ,an inventory of relevant programs and recommendations for improved coordination and integration of policy and programs4 7,b7 ,an assessment of achievement of the objectives identified in the national plan developed under paragraph 7#b7 and recommendations for realizing such objectives4 7,c7 ,recommendations on ,federal legislation1 regulations1 or administrative policies to enhance rural health quality and outcomes4 7b7 ,rural ,health ,quality ,demonstration ,projects 7#a7 ,in general ,not later than #bgj days after the date of the enactment of this section1 the ,secretary1 in consultation with the ,rural ,health ,quality ,advisory ,commission1 the ,office of ,rural ,health ,policy of the ,health ,resources and ,services ,administration1 the ,agency for ,healthcare ,research and ,quality1 and the ,centers for ,medicare ,medicaid ,services1 shall make grants to eligible entities for #e demonstration projects to implement and evaluate methods for improving the quality of health care in rural communities4 ,each such demonstration project shall include-- 7,a7 alternative community models that-- 7i7 will achieve greater integration of personal and population health services2 and 7ii7 address safety1 effectiveness1 patient- or community-centeredness1 timeliness1 efficiency1 and equity 7the #f aims identified by the ,institute of ,medicine of the ,national ,academies in its report entitled ,crossing the ,quality ,chasm3 ,a ,new ,health ,system for the #bast ,century released on ,march #a1 #bjja72 7,b7 innovative approaches to the financing and delivery of health services to achieve rural health quality goals2 and 7,c7 development of quality improvement support structures to assist rural health systems and professionals 7such as workforce support structures1 quality monitoring and reporting1 clinical care protocols1 and information technology applications74 7#b7 ,eligible entities ,in this subsection1 the term eligible entity means a consortium that-- 7,a7 shall include-- 7i7 at least one health care provider or health care delivery system located in a rural area2 and 7ii7 at least one organization representing multiple community stakeholders2 and 7,b7 may include other partners such as rural research centers4 7#c7 ,consultation ,in developing the program for awarding grants under this subsection1 the ,secretary shall consult with the ,administrator of the ,agency for ,healthcare ,research and ,quality1 rural health care providers1 rural health care researchers1 and private and nonprofit groups 7including national associations7 which are undertaking similar efforts4 7#d7 ,expedited waivers ,the ,secretary shall expedite the processing of any waiver that-- 7,a7 is authorized under title ,,xviii or ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq472 and 7,b7 is necessary to carry out a demonstration project under this subsection4 7#e7 ,demonstration project sites ,the ,secretary shall ensure that the #e demonstration projects funded under this subsection are conducted at a variety of sites representing the diversity of rural communities in the ,nation4 7#f7 ,duration ,each demonstration project under this subsection shall be for a period of #d years4 7#g7 ,independent evaluation ,the ,secretary shall enter into an arrangement with an entity that has experience working directly with rural health systems for the conduct of an independent evaluation of the program carried out under this subsection4 7#h7 ,report ,not later than #a year after the conclusion of all of the demonstration projects funded under this subsection1 the ,secretary shall submit a report to the ,congress on the results of such projects4 ,the report shall include-- 7,a7 an evaluation of patient access to care1 patient outcomes1 and an analysis of the cost effectiveness of each such project2 and 7,b7 recommendations on ,federal legislation1 regulations1 or administrative policies to enhance rural health quality and outcomes4 7c7 ,appropriation 7#a7 ,in general ,out of funds in the ,treasury not otherwise appropriated1 there are appropriated to the ,secretary to carry out this section #cj1jjj1jjj for the period of fiscal years #bjae through #bjai4 7#b7 ,availability 7,a7 ,in general ,funds appropriated under paragraph 7#a7 shall remain available for expenditure through fiscal year #bjai4 7,b7 ,report ,for purposes of carrying out subsection 7b77#h71 funds appropriated under paragraph 7#a7 shall remain available for expenditure through fiscal year #bjbj4 7#c7 ,reservation ,of the amount appropriated under paragraph 7#a71 the ,secretary shall reserve-- 7,a7 #e1jjj1jjj to carry out subsection 7a72 and 7,b7 #be1jjj1jjj to carry out subsection 7b71 of which-- 7i7 #b percent shall be for the provision of technical assistance to grant recipients2 and 7ii7 #e percent shall be for independent evaluation under subsection 7b77#g74 #dbf4 ,rural health care services ,section #ccj;,a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c7 is amended to read as follows3 #ccj;,a4 ,rural health care services outreach1 rural health network development1 ,delta rural disparities and health systems development1 and small rural health care provider quality improvement grant programs 7a7 ,purpose ,the purpose of this section is to provide for grants-- 7#a7 under subsection 7b71 to promote rural health care services outreach2 7#b7 under subsection 7c71 to provide for the planning and implementation of integrated health care networks in rural areas2 7#c7 under subsection 7d71 to assist rural communities in the ,delta ,region to reduce health disparities and to promote and enhance health system development2 and 7#d7 under subsection 7e71 to provide for the planning and implementation of small rural health care provider quality improvement activities4 7b7 ,rural health care services outreach grants 7#a7 ,grants ,the ,director of the ,office of ,rural ,health ,policy of the ,health ,resources and ,services ,administration may award grants to eligible entities to promote rural health care services outreach by expanding the delivery of health care services to include new and enhanced services in rural areas4 ,the ,director may award the grants for periods of not more than #c years4 7#b7 ,eligibility ,to be eligible to receive a grant under this subsection for a project1 an entity-- 7,a7 shall be a rural public or rural nonprofit private entity1 a facility that qualifies as a rural health clinic under title ,,xviii of the ,social ,security ,act1 a public or nonprofit entity existing exclusively to provide services to migrant and seasonal farm workers in rural areas1 or a tribal government whose grant-funded activities will be conducted within federally recognized tribal areas2 7,b7 shall represent a consortium composed of members-- 7i7 that include #c or more independently owned health care entities2 and 7ii7 that may be nonprofit or for-profit entities2 and 7,c7 shall not previously have received a grant under this subsection for the same or a similar project1 unless the entity is proposing to expand the scope of the project or the area that will be served through the project4 7#c7 ,applications ,to be eligible to receive a grant under this subsection1 an eligible entity shall prepare and submit to the ,director an application at such time1 in such manner1 and containing such information as the ,director may require1 including-- 7,a7 a description of the project that the eligible entity will carry out using the funds provided under the grant2 7,b7 a description of the manner in which the project funded under the grant will meet the health care needs of rural populations in the local community or region to be served2 7,c7 a plan for quantifying how health care needs will be met through identification of the target population and benchmarks of service delivery or health status1 such as-- 7i7 quantifiable measurements of health status improvement for projects focusing on health promotion2 or 7ii7 benchmarks of increased access to primary care1 including tracking factors such as the number and type of primary care visits1 identification of a medical home1 or other general measures of such access2 7,d7 a description of how the local community or region to be served will be involved in the development and ongoing operations of the project2 7,e7 a plan for sustaining the project after ,federal support for the project has ended2 7,f7 a description of how the project will be evaluated2 7,g7 the administrative capacity to submit annual performance data electronically as specified by the ,director2 and 7,h7 other such information as the ,director determines to be appropriate4 7c7 ,rural health network development grants 7#a7 ,grants 7,a7 ,in general ,the ,director may award rural health network development grants to eligible entities to promote1 through planning and implementation1 the development of integrated health care networks that have combined the functions of the entities participating in the networks in order to-- 7i7 achieve efficiencies and economies of scale2 7ii7 expand access to1 coordinate1 and improve the quality of the health care delivery system through development of organizational efficiencies2 7iii7 implement health information technology to achieve efficiencies1 reduce medical errors1 and improve quality2 7iv7 coordinate care and manage chronic illness2 and 7v7 strengthen the rural health care system as a whole in such a manner as to show a quantifiable return on investment to the participants in the network4 7,b7 ,grant periods ,the ,director may award such a rural health network development grant-- 7i7 for a period of #c years for implementation activities2 or 7ii7 for a period of #a year for planning activities to assist in the initial development of an integrated health care network1 if the proposed participants in the network do not have a history of collaborative efforts and a #c-year grant would be inappropriate4 7#b7 ,eligibility ,to be eligible to receive a grant under this subsection1 an entity-- 7,a7 shall be a rural public or rural nonprofit private entity1 a facility that qualifies as a rural health clinic under title ,,xviii of the ,social ,security ,act1 a public or nonprofit entity existing exclusively to provide services to migrant and seasonal farm workers in rural areas1 or a tribal government whose grant-funded activities will be conducted within federally recognized tribal areas2 7,b7 shall represent a network composed of participants-- 7i7 that include #c or more independently owned health care entities2 and 7ii7 that may be nonprofit or for-profit entities2 and 7,c7 shall not previously have received a grant under this subsection 7other than a #a-year grant for planning activities7 for the same or a similar project4 7#c7 ,applications ,to be eligible to receive a grant under this subsection1 an eligible entity1 in consultation with the appropriate ,state office of rural health or another appropriate ,state entity1 shall prepare and submit to the ,director an application at such time1 in such manner1 and containing such information as the ,director may require1 including-- 7,a7 a description of the project that the eligible entity will carry out using the funds provided under the grant2 7,b7 an explanation of the reasons why ,federal assistance is required to carry out the project2 7,c7 a description of-- 7i7 the history of collaborative activities carried out by the participants in the network2 7ii7 the degree to which the participants are ready to integrate their functions2 and 7iii7 how the local community or region to be served will benefit from and be involved in the activities carried out by the network2 7,d7 a description of how the local community or region to be served will experience increased access to quality health care services across the continuum of care as a result of the integration activities carried out by the network1 including a description of-- 7i7 return on investment for the community and the network members2 and 7ii7 other quantifiable performance measures that show the benefit of the network activities2 7,e7 a plan for sustaining the project after ,federal support for the project has ended2 7,f7 a description of how the project will be evaluated2 7,g7 the administrative capacity to submit annual performance data electronically as specified by the ,director2 and 7,h7 other such information as the ,director determines to be appropriate4 7d7 ,delta rural disparities and health systems development grants 7#a7 ,grants ,the ,director may award grants to eligible entities to support reduction of health disparities1 improve access to health care1 and enhance rural health system development in the ,delta ,region4 7#b7 ,eligibility ,to be eligible to receive a grant under this subsection1 an entity shall be a rural public or rural nonprofit private entity1 a facility that qualifies as a rural health clinic under title ,,xviii of the ,social ,security ,act1 a public or nonprofit entity existing exclusively to provide services to migrant and seasonal farm workers in rural areas1 or a tribal government whose grant-funded activities will be conducted within federally recognized tribal areas4 7#c7 ,applications ,to be eligible to receive a grant under this subsection1 an eligible entity shall prepare and submit to the ,director an application at such time1 in such manner1 and containing such information as the ,director may require1 including-- 7,a7 a description of the project that the eligible entity will carry out using the funds provided under the grant2 7,b7 an explanation of the reasons why ,federal assistance is required to carry out the project2 7,c7 a description of the manner in which the project funded under the grant will meet the health care needs of the ,delta ,region2 7,d7 a description of how the local community or region to be served will experience increased access to quality health care services as a result of the activities carried out by the entity2 7,e7 a description of how health disparities will be reduced or the health system will be improved2 7,f7 a plan for sustaining the project after ,federal support for the project has ended2 7,g7 a description of how the project will be evaluated including process and outcome measures related to the quality of care provided or how the health care system improves its performance2 7,h7 a description of how the grantee will develop an advisory group made up of representatives of the communities to be served to provide guidance to the grantee to best meet community need2 and 7,i7 other such information as the ,director determines to be appropriate4 7e7 ,small rural health care provider quality improvement grants 7#a7 ,grants ,the ,director may award grants to provide for the planning and implementation of small rural health care provider quality improvement activities4 ,the ,director may award the grants for periods of #a to #c years4 7#b7 ,eligibility ,to be eligible for a grant under this subsection1 an entity-- 7,a7 shall be-- 7i7 a rural public or rural nonprofit private health care provider or provider of health care services1 such as a rural health clinic2 or 7ii7 another rural provider or network of small rural providers identified by the ,director as a key source of local care2 and 7,b7 shall not previously have received a grant under this subsection for the same or a similar project4 7#c7 ,preference ,in awarding grants under this subsection1 the ,director shall give preference to facilities that qualify as rural health clinics under title ,,xviii of the ,social ,security ,act4 7#d7 ,applications ,to be eligible to receive a grant under this subsection1 an eligible entity shall prepare and submit to the ,director an application at such time1 in such manner1 and containing such information as the ,director may require1 including-- 7,a7 a description of the project that the eligible entity will carry out using the funds provided under the grant2 7,b7 an explanation of the reasons why ,federal assistance is required to carry out the project2 7,c7 a description of the manner in which the project funded under the grant will assure continuous quality improvement in the provision of services by the entity2 7,d7 a description of how the local community or region to be served will experience increased access to quality health care services as a result of the activities carried out by the entity2 7,e7 a plan for sustaining the project after ,federal support for the project has ended2 7,f7 a description of how the project will be evaluated including process and outcome measures related to the quality of care provided2 and 7,g7 other such information as the ,director determines to be appropriate4 7f7 ,general requirements 7#a7 ,prohibited uses of funds ,an entity that receives a grant under this section may not use funds provided through the grant-- 7,a7 to build or acquire real property2 or 7,b7 for construction4 7#b7 ,coordination with other agencies ,the ,director shall coordinate activities carried out under grant programs described in this section1 to the extent practicable1 with ,federal and ,state agencies and nonprofit organizations that are operating similar grant programs1 to maximize the effect of public dollars in funding meritorious proposals4 7g7 ,report ,not later than ,september #cj1 #bjaf1 the ,secretary shall prepare and submit to the appropriate committees of ,congress a report on the progress and accomplishments of the grant programs described in subsections 7b71 7c71 7d71 and 7e74 7h7 ,definitions ,in this section3 7#a7 ,the term ,delta ,region has the meaning given to the term region in section #chb;,a of the ,consolidated ,farm and ,rural ,development ,act 7#g ,u4,s4,c4 #bjji;aa74 7#b7 ,the term ,director means the ,director of the ,office of ,rural ,health ,policy of the ,health ,resources and ,services ,administration4 7i7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #dj1jjj1jjj for fiscal year #bjae1 and such sums as may be necessary for each of fiscal years #bjaf through #bjai4 4 #dbg4 ,community health center collaborative access expansion ,section #ccj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7 is amended by adding at the end the following3 7t7 ,miscellaneous ,provisions 7#a7 ,rule of construction with respect to rural health clinics ,nothing in this section shall be construed to prevent a community health center from contracting with a federally certified rural health clinic 7as defined by section #ahfa7;aa77#b7 of the ,social ,security ,act7 for the delivery of primary health care and other mental1 dental1 and physical health services that are available at the rural health clinic to individuals who would otherwise be eligible for free or reduced cost care if that individual were able to obtain that care at the community health center4 ,such services may be limited in scope to those primary health care and other mental1 dental1 and physical health services available in that rural health clinic4 7#b7 ,enabling services ,to the extent possible1 enabling services such as transportation and translation assistance shall be provided by rural health clinics described in paragraph 7#a74 7#c7 ,assurances ,in order for a rural health clinic to receive funds under this section through a contract with a community health center for the delivery of primary health care and other services described in paragraph 7#a71 such rural health clinic shall establish policies to ensure-- 7,a7 nondiscrimination based upon the ability of a patient to pay2 7,b7 the establishment of a sliding fee scale for low-income patients2 and 7,c7 any such services should be subject to full reimbursement according to the ,prospective ,payment ,system scale4 4 #dbh4 ,facilitating the provision of telehealth services across ,state lines 7a7 ,in general ,for purposes of expediting the provision of telehealth services1 for which payment is made under the ,medicare ,program1 across ,state lines1 the ,secretary of ,health and ,human ,services shall1 in consultation with representatives of ,states1 physicians1 health care practitioners1 and patient advocates1 encourage and facilitate the adoption of provisions allowing for multistate practitioner practice across ,state lines4 7b7 ,definitions ,in subsection 7a73 7#a7 ,telehealth service ,the term telehealth service has the meaning given that term in subparagraph 7,f7 of section #ahcd7m77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d774 7#b7 ,physician1 practitioner ,the terms physician and practitioner have the meaning given those terms in subparagraphs 7,d7 and 7,e71 respectively1 of such section4 7#c7 ,medicare program ,the term ,medicare ,program means the program of health insurance administered by the ,secretary of ,health and ,human ,services under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 #dbi4 ,scoring of preventive health savings ,section #bjb of the ,congressional ,budget and ,impoundment ,control ,act of #aigd 7#b ,u4,s4,c4 #fjb7 is amended by adding at the end the following new subsection3 7h7 ,scoring of preventive health savings 7#a7 ,determination by the ,director ,upon a request by the chairman or ranking minority member of the ,committee on the ,budget of the ,senate1 or by the chairman or ranking minority member of the ,committee on the ,budget of the ,house of ,representatives1 the ,director shall determine if a proposed measure would result in reductions in budget outlays in budgetary outyears through the use of preventive health and preventive health services4 7#b7 ,projections ,if the ,director determines that a measure would result in substantial reductions in budget outlays as described in paragraph 7#a71 the ,director-- 7,a7 shall include1 in any projection prepared by the ,director1 a description and estimate of the reductions in budget outlays in the budgetary outyears and a description of the basis for such conclusions2 and 7,b7 may prepare a budget projection that includes some or all of the budgetary outyears1 notwithstanding the time periods for projections described in subsection 7e7 and sections #cjh1 #djb1 and #dbd4 7#c7 ,definitions ,as used in this subsection-- 7,a7 the term preventive health means an action that focuses on the health of the public1 individuals1 and defined populations in order to protect1 promote1 and maintain health1 wellness1 and functional ability1 and prevent disease1 disability1 and premature death that is demonstrated by credible and publicly available epidemiological projection models1 incorporating clinical trials or observational studies in humans1 to avoid future health care costs2 and 7,b7 the term budgetary outyears means the #b consecutive #aj-year periods beginning with the first fiscal year that is #aj years after the budget year provided for in the most recently agreed to concurrent resolution on the budget4 4 #dcj4 ,sense of ,congress ,it is the sense of the ,congress that-- 7#a7 the maintenance of effort provisions added to sections #aijb and #baje7;d7 of the ,social ,security ,act by sections #bjja7;b7 and #baja7;b7 of the ,patient ,protection and ,affordable ,care ,act were written to maintain the eligibility standards for the ,medicaid program under title ,,xix of the ,social ,security ,act and ,children's ,health ,insurance ,program under title ,,xxi of such ,act until the ,american ,health ,benefit ,exchanges in the ,states are fully operational2 7#b7 it is imperative that the maintenance of effort provisions are enforced to the strict standard intended by the ,congress2 7#c7 waiving the maintenance of effort provisions should not be permitted1 except in the case of a request for a waiver that meets the explicit nonapplication requirements2 7#d7 the maintenance of effort provisions ensure the continued success of the ,medicaid program and ,children's ,health ,insurance ,program and were written deliberately to specifically protect vulnerable and disabled individuals1 children1 and senior citizens1 many of whom are also members of communities of color2 and 7#e7 the maintenance of effort provisions must be strictly enforced and proposals to weaken the maintenance of effort provisions must not be considered4 #dca4 ,repeal of requirement for documentation evidencing citizenship or nationality under the ,medicaid program 7a7 ,repeal ,subsections 7i77#bb7 and 7x7 of section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 are each repealed4 7b7 ,conforming amendments 7#a7 ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended-- 7,a7 by amending paragraph 7#df7 of subsection 7a7 to read as follows3 7#df7 provide that information is requested and exchanged for purposes of income and eligibility verification in accordance with a ,state system which meets the requirements of section #aacg of this ,act2 2 7,b7 in subsection 7e77#ac77;,a77i7-- 7i7 in the matter preceding subclause 7,i71 by striking sections #aijb7;a77#df77;,b7 and #aacg7;d7 and inserting section #aacg7;d72 and 7ii7 in subclause 7,,iv71 by striking #aijb7;a77#df77;,b7 or2 and 7,c7 by striking subsection 7ee74 7#b7 ,section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 is amended-- 7,a7 in subsection 7i71 by redesignating paragraphs 7#bc7 through 7#bf7 as paragraphs 7#bb7 through 7#be71 respectively2 and 7,b7 by redesignating subsections 7y7 and 7z7 as subsections 7x7 and 7y71 respectively4 7#c7 ,subsection 7c7 of section #fjcf of the ,deficit ,reduction ,act of #bjje 7#db ,u4,s4,c4 #acif;b note7 is repealed4 7c7 ,effective date ,the repeals and amendments made by this section shall take effect as if included in the enactment of the ,deficit ,reduction ,act of #bjje4 #dcb4 ,office of ,minority ,health in ,veterans ,health ,administration of ,department of ,veterans ,affairs 7a7 ,establishment and functions ,subchapter ,i of chapter #gc of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new section3 #gcaj4 ,office of ,minority ,health 7a7 ,establishment ,there is established in the ,department within the ,office of the ,under ,secretary for ,health an office to be known as the ,office of ,minority ,health 7in this section referred to as the ,office74 7b7 ,head ,the ,director of the ,office of ,minority ,health shall be the head of the ,office4 ,the ,director of the ,office of ,minority ,health shall be appointed by the ,under ,secretary of ,health from among individuals qualified to perform the duties of the position4 7c7 ,functions ,the functions of the ,office are as follows3 7#a7 ,to establish short-range and long-range goals and objectives and coordinate all other activities within the ,veterans ,health ,administration that relate to disease prevention1 health promotion1 health care services delivery1 and health care research concerning veterans who are members of a racial or ethnic minority group4 7#b7 ,to support research1 demonstrations1 and evaluations to test new and innovative models for the discharge of activities described in paragraph 7#a74 7#c7 ,to increase knowledge and understanding of health risk factors for veterans who are members of a racial or ethnic minority group4 7#d7 ,to develop mechanisms that support better health care information dissemination1 education1 prevention1 and services delivery to veterans from disadvantaged backgrounds1 including veterans who are members of a racial or ethnic minority group4 7#e7 ,to enter into contracts or agreements with appropriate public and nonprofit private entities to develop and carry out programs to provide bilingual or interpretive services to assist veterans who are members of a racial or ethnic minority group and who lack proficiency in speaking the ,english language in accessing and receiving health care services through the ,veterans ,health ,administration4 7#f7 ,to carry out programs to improve access to health care services through the ,veterans ,health ,administration for veterans with limited proficiency in speaking the ,english language1 including the development and evaluation of demonstration and pilot projects for that purpose4 7#g7 ,to advise the ,under ,secretary of ,health on matters relating to the development1 implementation1 and evaluation of health professions education in decreasing disparities in health care outcomes between veterans who are members of a racial or ethnic minority group and other veterans1 including cultural competency as a method of eliminating such health disparities4 7#h7 ,to perform such other functions and duties as the ,secretary or the ,under ,secretary for ,health considers appropriate4 7d7 ,definitions ,in this section3 7#a7 ,the term racial or ethnic minority group means the following3 7,a7 ,american ,indians 7including ,alaska ,natives1 ,eskimos1 and ,aleuts74 7,b7 ,asian-,americans4 7,c7 ,native ,hawaiians and other ,pacific ,islanders4 7,d7 ,blacks4 7,e7 ,hispanics4 7#b7 ,the term ,hispanic means individuals whose origin is ,mexican1 ,puerto ,rican1 ,cuban1 ,central or ,south ,american1 or any other ,spanish-speaking country4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item relating to section #gcji the following new item3 #gcaj4 ,office of ,minority ,health4 4 #dcc4 ,indian defined in ,,ppaca 7a7 ,definition of ,indian ,section #acjd of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbd7 is amended by adding at the end the following3 7f7 ,indian 7#a7 ,in general ,in this title1 the term ,indian means any individual-- 7,a7 described in paragraph 7#ac7 or 7#bh7 of section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc72 7,b7 who is eligible for health services provided by the ,indian ,health ,service under section #hji of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afgi72 7,c7 who is of ,indian descent and belongs to the ,indian community served by the local facilities and program of the ,indian ,health ,service2 or 7,d7 who is described in paragraph 7#b74 7#b7 ,included individuals ,the following individuals shall be considered to be an ,indian3 7,a7 ,a member of a federally recognized ,indian tribe4 7,b7 ,a resident of an urban center who meets #a or more of the following #d criteria3 7i7 ,membership in a tribe1 band1 or other organized group of ,indians1 including those tribes1 bands1 or groups terminated since #aidj and those recognized as of the date of enactment of the ,health ,equity and ,accountability ,act of #bjad or later by the ,state in which they reside1 or being a descendant1 in the first or second degree1 of any such member4 7ii7 ,is an ,eskimo or ,aleut or other ,alaska ,native4 7iii7 ,is considered by the ,secretary of the ,interior to be an ,indian for any purpose4 7iv7 ,is determined to be an ,indian under regulations promulgated by the ,secretary4 7,c7 ,an individual who is considered by the ,secretary of the ,interior to be an ,indian for any purpose4 7,d7 ,an individual who is considered by the ,secretary to be an ,indian for purposes of eligibility for ,indian health care services1 including as a ,california ,indian1 ,eskimo1 ,aleut1 or other ,alaska ,native4 4 7b7 ,conforming amendments 7#a7 ,affordable choices health benefit plans ,section #acaa7;c77#f77;,d7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77#f77;,d77 is amended by striking section #d of the ,indian ,health ,care ,improvement ,act and inserting section #acjd7;f74 7#b7 ,reduced cost-sharing for individuals enrolling in qualified health plans ,section #adjb7;d7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7;d77 is amended-- 7,a7 in paragraph 7#a71 in the matter preceding subparagraph 7,a71 by striking section #d7;d7 of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej;b7d77 and inserting section #acjd7;f72 and 7,b7 in paragraph 7#b71 in the matter preceding subparagraph 7,a71 by striking 7as so defined7 and inserting 7as defined in section #acjd7;f774 7#c7 ,exemption from penalty for not maintaining minimum essential coverage ,section #ejjj;,a7e7 of the ,internal ,revenue ,code of #aihf is amended by striking paragraph 7#c7 and inserting the following3 7#c7 ,indians ,any applicable individual who is an ,indian 7as defined in section #acjd7;f7 of the ,patient ,protection and ,affordable ,care ,act74 4 #dcd4 ,study of ,,dsh payments to ensure hospital access for low-income patients 7a7 ,in general ,not later than ,january #a1 #bjaf1 the ,comptroller ,general of the ,united ,states shall conduct a study on how certain amendments made by the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 to titles ,,xviii and ,,xix of the ,social ,security ,act affect the timely access to health care services for low-income patients4 ,such study shall-- 7#a7 evaluate and examine whether ,states electing to make medical assistance available under section #aijb7;a77#aj77;,a77i77,,viii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77i77,,viii77 7including ,states making such an election through a waiver of the ,state plan7 to individuals described in such section mitigates the need for payments to disproportionate share hospitals under section #ahhf7;d77#e77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,f77 and section #aibc of such ,act 7#db ,u4,s4,c4 #acifr-#d71 including the impact of such ,states electing to make medical assistance available to such individuals on-- 7,a7 the number of individuals in the ,united ,states who are without health insurance and the distribution of such individuals in relation to areas primarily served by disproportionate share hospitals2 and 7,b7 the low-income utilization rate of such hospitals and the resulting fiscal sustainability of such hospitals2 7#b7 evaluate the appropriate level and distribution of such payments among disproportionate hospitals for purposes of-- 7,a7 sufficiently accounting for the level of uncompensated care provided by such hospitals to low-income patients2 and 7,b7 providing timely access to health services for individuals in medically underserved areas2 and 7#c7 assess1 with respect to disproportionate hospitals-- 7,a7 the role played by such hospitals in providing critical access to emergency1 inpatient1 and outpatient health services1 as well as the location of such hospitals in relation to medically underserved areas2 and 7,b7 the extent to which such hospitals satisfy the requirements established for charitable hospital organizations under section #eja7r7 of the ,internal ,revenue ,code of #aihf with respect to community health needs assessments1 financial assistance policy requirements1 limitations on charges1 and billing and collection requirements4 7b7 ,reports 7#a7 ,report to ,congress ,not later than #ahj days after the date on which the study under subsection 7a7 is completed1 the ,comptroller ,general of the ,united ,states shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate a report that contains-- 7,a7 the results of the study2 7,b7 recommendations to ,congress for any legislative changes to the payments to disproportionate share hospitals under section #ahhf7;d77#e77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,f77 and section #aibc of such ,act 7#db ,u4,s4,c4 #acifr-#d7 that are needed to ensure access to health services for low-income patients that-- 7i7 are based on the number of individuals without health insurance1 the amount of uncompensated care provided by such hospitals1 and the impact of reduced payments levels on low-income communities2 and 7ii7 takes into account any reports submitted by the ,secretary of the ,treasury1 in consultation with the ,secretary of ,health and ,human ,services1 to ,congressional committees regarding the costs incurred by charitable hospital organizations for charity care1 bad debt1 nonreimbursed expenses for services provided to individuals under the ,medicare ,program under title ,,xviii of the ,social ,security ,act and the ,medicaid ,program under title ,,xix of such ,act1 and any community benefit activities provided by such organizations4 7#b7 ,report to the ,secretary of ,health and ,human ,services ,not later than #ahj days after the date on which the study under subsection 7a7 is completed1 the ,comptroller ,general of the ,united ,states shall submit to the ,secretary of ,health and ,human ,services a report that contains-- 7,a7 the results of the study2 and 7,b7 any recommendations for purposes of assisting in the development of the methodology for the adjustment of payments to disproportionate share hospitals1 as required under section #ahhf7r7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7r77 and the reduction of such payments section #aibc7;f77#g7 of such ,act 7#db ,u4,s4,c4 #acifr-#d7;f77#g771 taking into account the reports referred to in paragraph 7#a77;,b77ii74 #dce4 ,assistant ,secretary of the ,indian ,health ,service 7a7 ,references ,any reference in a law1 regulation1 document1 paper1 or other record of the ,united ,states to the ,director of the ,indian ,health ,service shall be deemed to be a reference to the ,assistant ,secretary of the ,indian ,health ,service4 7b7 ,executive ,schedule ,section #ecae of title #e1 ,united ,states ,code1 is amended in the matter relating to the ,assistant ,secretaries of ,health and ,human ,services by striking 7#f7 and inserting 7#g71 #a of whom shall be the ,assistant ,secretary of the ,indian ,health ,service4 7c7 ,conforming amendment ,section #ecaf of title #e1 ,united ,states ,code1 is amended by striking ,director1 ,indian ,health ,service1 ,department of ,health and ,human ,services44 #dcf4 ,reauthorization of the ,native ,hawaiian ,health ,care ,improvement ,act 7a7 ,native ,hawaiian health care systems ,section #f7;h77#a7 of the ,native ,hawaiian ,health ,care ,improvement ,act 7#db ,u4,s4,c4 #aagje7;h77#a77 is amended by striking may be necessary for fiscal years #aiic through #bjai and inserting are necessary4 7b7 ,administrative grant for papa ola lokahi ,section #g7;b7 of the ,native ,hawaiian ,health ,care ,improvement ,act 7#db ,u4,s4,c4 #aagjf7;b77 is amended by striking may be necessary for fiscal years #aiic through #bjai and inserting are necessary4 7c7 ,native ,hawaiian health scholarships ,section #aj7;c7 of the ,native ,hawaiian ,health ,care ,improvement ,act 7#db ,u4,s4,c4 #aagji7;c77 is amended by striking may be necessary for fiscal years #aiic through #bjai and inserting are necessary4 ,v ,,improving ,,health ,,outcomes ,,for ,,women1 ,,children1 ,,and ,,families #eja4 ,grants to promote positive health behaviors in women and children ,part ,q of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq47 is amended by adding at the end the following3 #cii,z-#b4 ,grants to promote positive health behaviors in women and children 7a7 ,grants ,authorized ,the ,secretary1 in collaboration with the ,administrator of the ,health ,resources and ,services ,administration and other ,federal officials determined appropriate by the ,secretary1 is authorized to award grants to eligible entities to promote positive health behaviors for women and children in target populations1 especially racial and ethnic minority women and children in medically underserved communities4 7b7 ,use of ,funds ,grants awarded pursuant to subsection 7a7 may be used to support the activities of community health workers1 including such activities-- 7#a7 to educate and provide outreach regarding enrollment in health insurance including the ,state ,children's ,health ,insurance ,program under title ,,xxi of the ,social ,security ,act1 ,medicare under title ,,xviii of such ,act1 and ,medicaid under title ,,xix of such ,act2 7#b7 to educate1 guide1 and provide outreach in a community setting regarding health problems prevalent among women and children and especially among racial and ethnic minority women and children2 7#c7 to educate1 guide1 and provide experiential learning opportunities that target risk factors that impede achieving healthy behaviors and good health outcomes1 including-- 7,a7 poor nutrition2 7,b7 physical inactivity2 7,c7 being overweight or obese2 7,d7 tobacco use2 7,e7 alcohol and substance use2 7,f7 injury and violence2 7,g7 risky sexual behavior2 7,h7 mental health problems2 7,i7 musculoskeletal health and arthritis2 7,j7 dental and oral health problems2 7,k7 understanding informed consent2 and 7,l7 stigma2 7#d7 to educate and guide regarding effective strategies to promote positive health behaviors within the family2 7#e7 to promote community wellness and awareness2 and 7#f7 to educate and refer target populations to appropriate health care agencies and community-based programs and organizations in order to increase access to quality health care services1 including preventive health services4 7c7 ,application 7#a7 ,in general ,each eligible entity that desires to receive a grant under subsection 7a7 shall submit an application to the ,secretary1 at such time1 in such manner1 and accompanied by such additional information as the ,secretary may require4 7#b7 ,contents ,each application submitted pursuant to paragraph 7#a7 shall-- 7,a7 describe the activities for which assistance under this section is sought2 7,b7 contain an assurance that1 with respect to each community health worker program receiving funds under the grant awarded1 such program provides in-language training and supervision to community health workers to enable such workers to provide authorized program activities in 7at least7 the most commonly used languages within a particular geographic region2 7,c7 contain an assurance that the applicant will evaluate the effectiveness of community health worker programs receiving funds under the grant2 7,d7 contain an assurance that each community health worker program receiving funds under the grant will provide culturally competent services in the linguistic context most appropriate for the individuals served by the program2 7,e7 contain a plan to document and disseminate project descriptions and results to other ,states and organizations as identified by the ,secretary2 and 7,f7 describe plans to enhance the capacity of individuals to utilize health services and health-related social services under ,federal1 ,state1 and local programs by-- 7i7 assisting individuals in establishing eligibility under the programs and in receiving the services or other benefits of the programs2 and 7ii7 providing other services1 as the ,secretary determines to be appropriate1 which may include transportation and translation services4 7d7 ,priority ,in awarding grants under subsection 7a71 the ,secretary shall give priority to those applicants-- 7#a7 who propose to target geographic areas that-- 7,a7 7i7 have a high percentage of residents who are uninsured or underinsured 7if the targeted geographic area is located in a ,state that has elected to make medical assistance available under section #aijb7;a77#aj77;,a77i77,,viii7 of the ,social ,security ,act to individuals described in such section72 or 7ii7 have a high percentage of underinsured residents in a particular geographic area 7if the targeted geographic area is located in a ,state that has not so elected72 and 7,b7 have a high percentage of families for whom ,english is not their primary language or including smaller limited-,english-proficient communities within the region that are not otherwise reached by linguistically appropriate health services2 7#b7 with experience in providing health or health-related social services to individuals who are underserved with respect to such services2 and 7#c7 with documented community activity and experience with community health workers4 7e7 ,collaboration ,with ,academic ,institutions ,the ,secretary shall encourage community health worker programs receiving funds under this section to collaborate with academic institutions1 including minority-serving institutions4 ,nothing in this section shall be construed to require such collaboration4 7f7 ,quality ,assurance and ,cost ,effectiveness ,the ,secretary shall establish guidelines for ensuring the quality of the training and supervision of community health workers under the programs funded under this section and for ensuring the cost effectiveness of such programs4 7g7 ,monitoring ,the ,secretary shall monitor community health worker programs identified in approved applications and shall determine whether such programs are in compliance with the guidelines established under subsection 7f74 7h7 ,technical ,assistance ,the ,secretary may provide technical assistance to community health worker programs identified in approved applications with respect to planning1 developing1 and operating programs under the grant4 7i7 ,report to ,congress 7#a7 ,in general ,not later than #d years after the date on which the ,secretary first awards grants under subsection 7a71 the ,secretary shall submit to ,congress a report regarding the grant project4 7#b7 ,contents ,the report required under paragraph 7#a7 shall include the following3 7,a7 ,a description of the programs for which grant funds were used4 7,b7 ,the number of individuals served4 7,c7 ,an evaluation of-- 7i7 the effectiveness of these programs2 7ii7 the cost of these programs2 and 7iii7 the impact of the project on the health outcomes of the community residents4 7,d7 ,recommendations for sustaining the community health worker programs developed or assisted under this section4 7,e7 ,recommendations regarding training to enhance career opportunities for community health workers4 7j7 ,definitions ,in this section3 7#a7 ,community health worker ,the term community health worker means an individual who promotes health or nutrition within the community in which the individual resides-- 7,a7 by serving as a liaison between communities and health care agencies2 7,b7 by providing guidance and social assistance to community residents2 7,c7 by enhancing community residents' ability to effectively communicate with health care providers2 7,d7 by providing culturally and linguistically appropriate health or nutrition education2 7,e7 by advocating for individual and community health1 including dental1 oral1 mental1 and environmental health1 or nutrition needs2 7,f7 by taking into consideration the needs of the communities served1 including the prevalence rates of risk factors that impede achieving healthy behaviors and good health outcomes among women and children1 especially among racial and ethnic minority women and children2 and 7,g7 by providing referral and followup services4 7#b7 ,community setting ,the term community setting means a home or a community organization that serves a population4 7#c7 ,eligible entity ,the term eligible entity means-- 7,a7 a unit of ,state1 territorial1 local1 or tribal government 7including a federally recognized tribe or ,alaska ,native village72 or 7,b7 a community-based organization4 7#d7 ,medically underserved community ,the term medically underserved community means a community-- 7,a7 that has a substantial number of individuals who are members of a medically underserved population1 as defined by section #ccj7;b77#c72 7,b7 a significant portion of which is a health professional shortage area as designated under section #ccb2 and 7,c7 that includes populations that are linguistically isolated1 such as geographic areas with a shortage of health professionals able to provide linguistically appropriate services4 7#e7 ,support ,the term support means the provision of training1 supervision1 and materials needed to effectively deliver the services described in subsection 7b71 reimbursement for services1 and other benefits4 7#f7 ,target population ,the term target population means women of reproductive age1 regardless of their current childbearing status and children under #ba years of age4 7k7 ,authorization of ,appropriations ,there are authorized to be appropriated to carry out this section #ae1jjj1jjj for each of fiscal years #bjae through #bjai4 4 #ejb4 ,removing barriers to health care and nutrition assistance for children1 pregnant women1 and lawfully present individuals 7a7 ,medicaid ,section #aijc7v7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7v77 is amended by striking paragraph 7#d7 and inserting the following new paragraph3 7#d7 7,a7 ,notwithstanding sections #dja7;a71 #djb7;b71 #djc1 and #dba of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif and paragraph 7#a71 payment shall be made to a ,state under this section for medical assistance furnished to an alien under this title 7including an alien described in such paragraph7 who meets any of the following conditions3 7i7 ,the alien is otherwise eligible for such assistance under the ,state plan approved under this title 7other than the requirement of the receipt of aid or assistance under title ,,iv1 supplemental security income benefits under title ,,xvi1 or a ,state supplementary payment7 within either or both of the following eligibility categories3 7,i7 ,children under #ba years of age1 including any optional targeted low-income child 7as such term is defined in section #aije7u77#b77;,b774 7,,ii7 ,pregnant women during pregnancy and during the #fj-;day period beginning on the last day of the pregnancy4 7ii7 ,the alien is lawfully present in the ,united ,states4 7,b7 ,no debt shall accrue under an affidavit of support against any sponsor of an alien who meets the conditions specified in subparagraph 7,a7 on the basis of the provision of medical assistance to such alien under this paragraph and the cost of such assistance shall not be considered as an unreimbursed cost4 4 7b7 ,,schip ,subparagraph 7,j7 of section #bajg7;e77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77 is amended to read as follows3 7,j7 ,paragraph 7#d7 of section #aijc7v7 7relating to coverage of categories of children1 pregnant women1 and other lawfully present individuals74 4 7c7 ,supplemental nutrition assistance ,notwithstanding sections #dja7;a71 #djb7;a71 and #djc7;a7 of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afaa7;a72 #afab7;a72 #afac7;a77 and section #f7;f7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjae7;f771 persons who are lawfully present in the ,united ,states shall be not be ineligible for benefits under the supplemental nutrition assistance program on the basis of their immigration status or date of entry into the ,united ,states4 7d7 ,eligibility for families with children ,section of the #dba7;d77#c7 of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afca7;d77#c77 is amended by striking to the extent that a qualified alien is eligible under section #djb7;a77#b77;,j7 and inserting1 to the extent that a child is a member of a household under the supplemental nutrition assistance program4 7e7 ,ensuring proper screening ,section #aa7;e77#b77;,b7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjbj7;e77#b77;,b77 is amended-- 7#a7 by redesignating clauses 7vi7 and 7vii7 as clauses 7vii7 and 7viii72 and 7#b7 by inserting after clause 7v7 the following3 7vi7 shall provide a method for implementing section #dba of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afca7 that does not require any unnecessary information from persons who may be exempt from that provision2 4 #ejc4 ,repeal of denial of benefits ,section #aae of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#ba ,u4,s4,c4 #hfb;a7 is amended-- 7#a7 in subsection 7a7 by striking paragraph 7#b72 7#b7 in subsection 7b7 by striking paragraph 7#b72 and 7#c7 in subsection 7e7 by striking paragraph 7#b74 #ejd4 ,birth defects prevention1 risk reduction1 and awareness 7a7 ,in general ,the ,secretary shall establish and implement a birth defects prevention and public awareness program1 consisting of the activities described in subsections 7c7 and 7d74 7b7 ,definitions ,in this section3 7#a7 ,the term pregnancy and breastfeeding information services includes only-- 7,a7 information services to provide accurate1 evidence-based1 clinical information regarding maternal exposures during pregnancy that may be associated with birth defects or other health risks1 such as exposures to medications1 chemicals1 infections1 foodborne pathogens1 illnesses1 nutrition1 or lifestyle factors2 7,b7 information services to provide accurate1 evidence-based1 clinical information regarding maternal exposures during breastfeeding that may be associated with health risks to a breast-fed infant1 such as exposures to medications1 chemicals1 infections1 foodborne pathogens1 illnesses1 nutrition1 or lifestyle factors2 7,c7 the provision of accurate1 evidence-based information weighing risks of exposures during breastfeeding against the benefits of breastfeeding2 and 7,d7 the provision of information described in subparagraph 7,a71 7,b71 or 7,c7 through counselors1 ,web sites1 fact sheets1 telephonic or electronic communication1 community outreach efforts1 or other appropriate means4 7#b7 ,the term ,secretary means the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,centers for ,disease ,control and ,prevention4 7c7 ,nationwide media campaign ,in carrying out subsection 7a71 the ,secretary shall conduct or support a nationwide media campaign to increase awareness among health care providers and at-risk populations about pregnancy and breastfeeding information services4 7d7 ,grants for pregnancy and breastfeeding information services 7#a7 ,in general ,in carrying out subsection 7a71 the ,secretary shall award grants to ,state or regional agencies or organizations for any of the following3 7,a7 ,information services ,the provision of1 or campaigns to increase awareness about1 pregnancy and breastfeeding information services4 7,b7 ,surveillance and research ,the conduct or support of-- 7i7 surveillance of or research on-- 7,i7 maternal exposures and maternal health conditions that may influence the risk of birth defects1 prematurity1 or other adverse pregnancy outcomes2 and 7,,ii7 maternal exposures that may influence health risks to a breastfed infant2 or 7ii7 networking to facilitate surveillance or research described in this subparagraph4 7#b7 ,preference for certain ,states ,the ,secretary1 in making any grant under this subsection1 shall give preference to ,states1 otherwise equally qualified1 that have or had a pregnancy and breastfeeding information service in place on or after ,january #a1 #bjjf4 7#c7 ,matching funds ,the ,secretary may only award a grant under this subsection to a ,state or regional agency or organization that agrees1 with respect to the costs to be incurred in carrying out the grant activities1 to make available 7directly or through donations from public or private entities7 non-,federal funds toward such costs in an amount equal to not less than #be percent of the amount of the grant4 7#d7 ,coordination ,the ,secretary shall ensure that activities funded through a grant under this subsection are coordinated1 to the maximum extent practicable1 with other birth defects prevention and environmental health activities of the ,federal ,government1 including with respect to pediatric environmental health specialty units and children's environmental health centers4 7e7 ,evaluation ,in furtherance of the program under subsection 7a71 the ,secretary shall provide for an evaluation of pregnancy and breastfeeding information services to identify efficient and effective models of-- 7#a7 providing information2 7#b7 raising awareness and increasing knowledge about birth defects prevention measures and targeting education to at-risk groups2 7#c7 modifying risk behaviors2 or 7#d7 other outcome measures as determined appropriate by the ,secretary4 7f7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated #e1jjj1jjj for fiscal year #bjae1 #f1jjj1jjj for fiscal year #bjaf1 #g1jjj1jjj for fiscal year #bjag1 #h1jjj1jjj for fiscal year #bjah1 and #i1jjj1jjj for fiscal year #bjai4 #eje4 ,uniform ,state maternal mortality review committees on pregnancy-related deaths 7a7 ,in general ,title ,v of the ,social ,security ,act 7#db ,u4,s4,c4 #gja et seq47 is amended by adding at the end the following new section3 #ead4 ,uniform ,state maternal mortality review committees on pregnancy-related deaths 7a7 ,grants 7#a7 ,in general ,notwithstanding any other provision of this title1 for each of fiscal years #bjae through #bjba1 in addition to payments from allotments for ,states under section #ejb for such year1 the ,secretary shall1 subject to paragraph 7#c7 and in accordance with the criteria established under paragraph 7#b71 award grants to ,states to-- 7,a7 carry out the activities described in subsection 7b77#a72 7,b7 establish a ,state maternal mortality review committee1 in accordance with subsection 7b77#b71 to carry out the activities described in subsection 7b77#b77;,a71 and to establish the processes described in subsection 7b77#a72 7,c7 ensure the ,state department of health carries out the applicable activities described in subsection 7b77#c71 with respect to pregnancy-related deaths occurring within the ,state during such fiscal year2 7,d7 implement and use the comprehensive case abstraction form developed under subsection 7c71 in accordance with such subsection2 and 7,e7 provide for public disclosure of information1 in accordance with subsection 7e74 7#b7 ,criteria ,the ,secretary shall establish criteria for determining eligibility for and the amount of a grant awarded to a ,state under paragraph 7#a74 ,such criteria shall provide that in the case of a ,state that receives such a grant for a fiscal year and is determined by the ,secretary to have not used such grant in accordance with this section1 such ,state shall not be eligible for such a grant for any subsequent fiscal year4 7#c7 ,authorization of appropriations ,for purposes of carrying out the grant program under this section1 including for administrative purposes1 there is authorized to be appropriated #aj1jjj1jjj for each of fiscal years #bjae through #bjba4 7b7 ,pregnancy-,related death review 7#a7 ,review of pregnancy-related death and pregnancy-associated death cases ,for purposes of subsection 7a71 with respect to a ,state that receives a grant under subsection 7a71 the following shall apply3 7,a7 ,mandatory reporting of pregnancy-related deaths 7i7 ,in general ,the ,state shall1 through the ,state maternal mortality review committee1 develop a process1 separate from any reporting process established by the ,state department of health prior to the date of the enactment of this section1 that provides for mandatory and confidential case reporting by individuals and entities described in clause 7ii7 of pregnancy-related deaths to the ,state department of health4 7ii7 ,individuals and ,entities described ,individuals and entities described in this clause include each of the following3 7,i7 ,health care providers4 7,,ii7 ,medical examiners4 7,,iii7 ,medical coroners4 7,,iv7 ,hospitals4 7,v7 ,free-standing birth centers4 7,,vi7 ,federally qualified health centers4 7,,vii7 ,other health care facilities4 7,,viii7 ,any other individuals responsible for completing death certificates4 7,,ix7 ,any other appropriate individuals or entities specified by the ,secretary4 7,b7 ,voluntary reporting of pregnancy-related and pregnancy-associated deaths 7i7 ,the ,state shall1 through the ,state maternal mortality review committee1 develop a process for and encourage1 separate from any reporting process established by the ,state department of health prior to the date of the enactment of this section1 voluntary and confidential case reporting by individuals described in clause 7ii7 of pregnancy-associated deaths to the ,state department of health4 7ii7 ,the ,state shall1 through the ,state maternal mortality review committee1 develop a process for voluntary and confidential reporting by family members of the deceased and by other individuals on possible pregnancy-related and pregnancy-associated deaths to the ,state department of health4 ,such process shall include-- 7,i7 making publicly available on the ,internet ,web site of the ,state department of health a telephone number1 ,internet ,web link1 and email address for such reporting2 and 7,,ii7 publicizing to local professional organizations1 community organizations1 and social services agencies the availability of the telephone number1 ,internet ,web link1 and email address made available under subclause 7,i74 7,c7 ,development of case-finding ,the ,state1 through the vital statistics unit of the ,state1 shall annually identify pregnancy-related and pregnancy-associated deaths occurring in such ,state during the year involved by-- 7i7 matching all death records1 with respect to such year1 for women of childbearing age to live birth certificates and infant death certificates to identify deaths of women that occurred during pregnancy and within one year after the end of a pregnancy2 7ii7 identifying deaths reported during such year as having an underlying or contributing cause of death related to pregnancy1 regardless of the time that has passed between the end of the pregnancy and the death2 7iii7 collecting data from medical examiner and coroner reports2 and 7iv7 any other methods the ,states may devise to identify maternal deaths1 such as through review of a random sample of reported deaths of women of childbearing age to ascertain cases of pregnancy-related and pregnancy-associated deaths that are not discernable from a review of death certificates alone4 ,when feasible and for purposes of effectively collecting and obtaining data on pregnancy-related and pregnancy-associated deaths1 the ,state shall adopt the most recent standardized birth and death certificates1 as issued by the ,national ,center for ,vital ,health ,statistics1 including the recommended checkbox section for pregnancy on the death certificates4 7,d7 ,case investigation and development of case summaries ,following receipt of reports by the ,state department of health pursuant to subparagraph 7,a7 or 7,b7 and collection by the vital statistics unit of the ,state of possible cases of pregnancy-related and pregnancy-associated deaths pursuant to subparagraph 7,c71 the ,state1 through the ,state maternal mortality review committee established under subsection 7a71 shall investigate each case1 utilizing the case abstraction form described in subsection 7c71 and prepare de-identified case summaries1 which shall be reviewed by the committee and included in applicable reports4 ,for purposes of subsection 7a71 under the processes established under subparagraphs 7,a71 7,b71 and 7,c71 a ,state department of health or vital statistics unit of a ,state shall provide to the ,state maternal mortality review committee access to information collected pursuant to such subparagraphs as necessary to carry out this subparagraph4 ,data and information collected for the case summary and review are for purposes of public health activities1 in accordance with ,,hipaa privacy and security law 7as defined in section #cjji7;a77#b7 of the ,public ,health ,service ,act74 ,such case investigations shall include data and information obtained through-- 7i7 medical examiner and autopsy reports of the woman involved2 7ii7 medical records of the woman1 including such records related to health care prior to pregnancy1 prenatal and postnatal care1 labor and delivery care1 emergency room care1 hospital discharge records including immunization status and screening status for prevalent diseases1 and any care delivered up until the time of death of the woman for purposes of public health activities1 in accordance with ,,hipaa privacy and security law 7as defined in section #cjji7;a77#b7 of the ,public ,health ,service ,act72 7iii7 oral and written interviews of individuals directly involved in the maternal care of the woman during and immediately following the pregnancy of the woman1 including health care1 mental health1 and social service providers in-language when possible1 as applicable2 7iv7 optional oral or written interviews of the family of the woman2 7v7 socioeconomic and other relevant background information about the woman2 7vi7 information collected in subparagraph 7,c77i72 and 7vii7 other information on the cause of death of the woman1 such as social services and child welfare reports1 including experiences with intimate partner violence4 7#b7 ,state maternal mortality review committees 7,a7 ,duties 7i7 ,required committee activities ,for purposes of subsection 7a71 a maternal mortality review committee established by a ,state pursuant to a grant under such subsection shall carry out the following pregnancy-related death and pregnancy-associated death review activities and shall include all information relevant to the death involved on the case abstraction form developed under subsection 7d73 7,i7 ,with respect to a case of pregnancy-related or pregnancy-associated death of a woman1 review the case summaries prepared under subparagraphs 7,a71 7,b71 7,c71 and 7,d7 of paragraph 7#a74 7,,ii7 ,review aggregate statistical reports developed by the vital statistics unit of the ,state under paragraph 7#a77;,c7 regarding pregnancy-related and pregnancy-associated deaths to identify trends1 patterns1 and disparities in adverse outcomes and address medical1 nonmedical1 and system-related factors that may have contributed to such pregnancy-related and pregnancy-associated deaths and disparities4 7,,iii7 ,develop recommendations1 based on the review of the case summaries under paragraph 7#a77;,d7 and aggregate statistical reports under subclause 7,,ii71 to improve maternal care1 social and health services1 and public health policy and institutions1 including with respect to improving access to maternal care1 improving the availability of social services1 and eliminating disparities in maternal care and outcomes4 7ii7 ,optional committee activities ,for purposes of subsection 7a71 a maternal mortality review committee established by a ,state under such subsection may present findings and recommendations regarding a specific case or set of circumstances directly to a health care facility or its local or ,state professional organization for the purpose of instituting policy changes1 educational activities1 or otherwise improving the quality of care provided by the facilities4 7,b7 ,composition of maternal mortality review committees 7i7 ,in ,general ,each ,state maternal mortality review committee established pursuant to a grant under subsection 7a7 shall be multidisciplinary1 consisting of health care1 behavioral health1 and social service providers1 public health officials1 other persons with professional expertise on maternal health and mortality1 and patient and community advocates who represent those communities within such ,state that are the most affected by maternal mortality4 ,membership on such a committee of a ,state shall be reviewed annually by the ,state department of health to ensure that membership representation requirements are being fulfilled in accordance with this paragraph4 7ii7 ,required membership ,each such review committee shall include-- 7,i7 representatives from medical specialties providing care to pregnant and postpartum patients1 including obstetricians 7including generalists and maternal fetal medicine specialists71 and family practice physicians2 7,,ii7 representatives from midwifery specialties 7including certified professional midwives and certified midwives72 7,,iii7 advanced practice nurses2 7,,iv7 hospital-based nurses2 7,v7 representatives of the ,state department of health maternal and child health department2 7,,vi7 social service providers or social workers2 7,,vii7 the chief medical examiners or designees2 7,,viii7 facility representatives1 such as from hospitals or free-standing birth centers2 and 7,,ix7 community or patient advocates who represent those communities within the ,state that are the most affected by maternal mortality4 7iii7 ,additional members ,each such review committee may also include representatives from other relevant academic1 health1 social service1 or policy professions1 or community organizations1 on an ongoing basis1 or as needed1 as determined beneficial by the review committee1 including-- 7,i7 anesthesiologists2 7,,ii7 emergency physicians2 7,,iii7 pathologists2 7,,iv7 epidemiologists or biostatisticians2 7,v7 intensivists2 7,,vi7 orthopedic surgeons and_/or orthopedic physicians2 7,,vii7 vital statistics officers2 7,,viii7 nutritionists2 7,,ix7 mental health professionals2 7,x7 substance abuse treatment specialists2 7,,xi7 representatives of relevant advocacy groups2 7,,xii7 academics2 7,,xiii7 representatives of beneficiaries of the ,state plan under the ,medicaid ,program under title ,,xix2 7,,xiv7 paramedics2 7,,xv7 lawyers2 7,,xvi7 risk management specialists2 7,,xvii7 representatives of the departments of health or public health of major cities in the ,state involved2 and 7,,xviii7 policymakers4 7iv7 ,diverse community membership ,the composition of such a committee1 with respect to a ,state1 shall include-- 7,i7 representatives from diverse communities1 particularly those communities within such ,state most severely affected by pregnancy-related deaths or pregnancy-associated deaths and by a lack of access to relevant maternal care services1 from community maternal child health organizations1 and from minority advocacy groups2 7,,ii7 members1 including health care providers1 from different geographic regions in the ,state1 including any rural1 urban1 and tribal areas2 and 7,,iii7 health care and social service providers who work in communities that are diverse with regard to race1 ethnicity1 immigration status1 indigenous status1 and ,english proficiency4 7v7 ,maternal mortality review staff ,staff of each such review committee shall include-- 7,i7 vital health statisticians1 maternal child health statisticians1 or epidemiologists2 7,,ii7 a coordinator of the ,state maternal mortality review committee1 to be designated by the ,state2 and 7,,iii7 administrative staff4 7,c7 ,option for ,states to form regional maternal mortality reviews ,states with a low rate of occurrence of pregnancy-associated or pregnancy-related deaths may choose to partner with one or more neighboring ,states to fulfill the activities described in paragraph 7#a77;,c74 ,in such a case1 with respect to ,states in such a partnership1 any requirement under this section relating to the reporting of information related to such activities shall be deemed to be fulfilled by each such ,state if a single such report is submitted for the partnership4 7#c7 ,state ,department of ,health ,activities ,for purposes of subsection 7a71 a ,state department of health of a ,state receiving a grant under such subsection shall-- 7,a7 in consultation with the maternal mortality review committee of the ,state and in conjunction with relevant professional organizations1 develop a plan for ongoing health care provider education1 based on the findings and recommendations of the committee1 in order to improve the quality of maternal care2 and 7,b7 take steps to widely disseminate the findings and recommendations of the ,state maternal mortality review committees of the ,state and to implement the recommendations of such committee4 7c7 ,case abstraction form 7#a7 ,development ,the ,director of the ,centers for ,disease ,control and ,prevention shall develop a uniform1 comprehensive case abstraction form and make such form available to ,states for ,state maternal mortality review committees for use by such committees in order to-- 7,a7 ensure that the cases and information collected and reviewed by such committees can be pooled for review by the ,department of ,health and ,human ,services and its agencies2 and 7,b7 preserve the uniformity of the information and its use for ,federal public health purposes4 7#b7 ,permissible ,state modification ,each ,state may modify the form developed under paragraph 7#a7 for implementation and use by such ,state or by the ,state maternal mortality review committee of such ,state by including on such form additional information to be collected1 but may not alter the standard questions on such form1 in order to ensure that the information can be collected and reviewed centrally at the ,federal level4 7d7 ,treatment as public health authority for purposes of ,,hipaa ,for purposes of applying ,,hipaa privacy and security law 7as defined in section #cjji7;a77#b7 of the ,public ,health ,service ,act71 a ,state maternal mortality review committee of a ,state established pursuant to this section to carry out activities described in subsection 7b77#b77;,a7 shall be deemed to be a public health authority described in section #afd4eja 7and referenced in section #afd4eab7;b77#a77;i77 of title #de1 ,code of ,federal ,regulations 7or any successor regulation71 carrying out public health activities and purposes described in such section #afd4eab7;b77#a77;i7 7or any such successor regulation74 7e7 ,public disclosure of information 7#a7 ,in general ,for fiscal year #bjae or a subsequent fiscal year1 each ,state receiving a grant under this section for such year shall1 subject to paragraph 7#c71 provide for the public disclosure1 and submission to the information clearinghouse established under paragraph 7#b71 of the information included in the report of the ,state under section #ejf7;a77#b77;,f7 for such year 7relating to the findings for such year of the ,state maternal mortality review committee established by the ,state under this section74 7#b7 ,information clearinghouse ,the ,secretary of ,health and ,human ,services shall establish an information clearinghouse1 that shall be administered by the ,director of the ,centers for ,disease ,control and ,prevention1 that will maintain findings and recommendations submitted pursuant to paragraph 7#a7 and provide such findings and recommendations for public review and research purposes by ,state health departments1 maternal mortality review committees1 and health providers and institutions4 7#c7 ,confidentiality of information ,in no case shall any individually identifiable health information be provided to the public1 or submitted to the information clearinghouse1 under paragraph 7#a74 7f7 ,confidentiality of review committee proceedings 7#a7 ,in general ,all proceedings and activities of a ,state maternal mortality review committee under this section1 opinions of members of such a committee formed as a result of such proceedings and activities1 and records obtained1 created1 or maintained pursuant to this section1 including records of interviews1 written reports1 and statements procured by the ,department of ,health and ,human ,services or by any other person1 agency1 or organization acting jointly with the ,department1 in connection with morbidity and mortality reviews under this section1 shall be confidential1 and not subject to discovery1 subpoena1 or introduction into evidence in any civil1 criminal1 legislative1 or other proceeding4 ,such records shall not be open to public inspection4 7#b7 ,testimony of members of committee 7,a7 ,in general ,members of a ,state maternal mortality review committee under this section may not be questioned in any civil1 criminal1 legislative1 or other proceeding regarding information presented in1 or opinions formed as a result of1 a meeting or communication of the committee4 7,b7 ,clarification ,nothing in this subsection shall be construed to prevent a member of such a committee from testifying regarding information that was obtained independent of such member's participation on the committee1 or that is public information4 7#c7 ,availability of information for research purposes ,nothing in this subsection shall prohibit the publishing by such a committee or the ,department of ,health and ,human ,services of statistical compilations and research reports that-- 7,a7 are based on confidential information1 relating to morbidity and mortality review2 and 7,b7 do not contain identifying information or any other information that could be used to ultimately identify the individuals concerned4 7g7 ,definitions ,for purposes of this section3 7#a7 ,the term pregnancy-associated death means the death of a woman while pregnant or during the one-year period following the date of the end of pregnancy1 irrespective of the cause of such death4 7#b7 ,the term pregnancy-related death means the death of a woman while pregnant or during the one-year period following the date of the end of pregnancy1 irrespective of the duration or site of the pregnancy1 from any cause related to or aggravated by the pregnancy or its management1 but not from any accidental or incidental cause4 7#c7 ,the term woman of childbearing age means a woman who is at least #aj years of age and not more than #ed years of age4 4 7b7 ,inclusion of findings of review committees in required reports 7#a7 ,state triennial reports ,paragraph 7#b7 of section #ejf7;a7 of such ,act 7#db ,u4,s4,c4 #gjf7;a77 is amended by inserting after subparagraph 7,e7 the following new subparagraph3 7,f7 ,in the case of a ,state receiving a grant under section #ead1 beginning for the first fiscal year beginning after #c years after the date of establishment of the ,state maternal mortality review committee established by the ,state pursuant to such grant and once every #c years thereafter1 information containing the findings and recommendations of such committee and information on the implementation of such recommendations during the period involved4 4 7#b7 ,annual reports to ,congress ,paragraph 7#c7 of such section is amended-- 7,a7 in subparagraph 7,d71 at the end1 by striking and2 7,b7 in subparagraph 7,e71 at the end1 by striking the period and inserting 2 and2 and 7,c7 by adding at the end the following new subparagraph3 7,f7 ,for fiscal year #bjae and each subsequent fiscal year1 taking into account the findings1 recommendations1 and implementation information submitted by ,states pursuant to paragraph 7#b77;,f71 on the status of pregnancy-related deaths and pregnancy-associated deaths in the ,united ,states and including recommendations on methods to prevent such deaths in the ,united ,states4 4 #ejf4 ,eliminating disparities in maternity health outcomes ,part ,b of title ,,iii of the ,public ,health ,service ,act is amended by inserting after section #cag,v1 as added1 the following new section3 #cag,w4 ,eliminating disparities in maternity health outcomes 7a7 ,in general ,the ,secretary 7in consultation with the ,deputy ,assistant ,secretary for ,minority ,health1 the ,director of the ,national ,institutes of ,health1 the ,director of the ,centers for ,disease ,control and ,prevention1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 and the ,administrator of the ,agency for ,healthcare ,research ,quality1 and in consultation with relevant national stakeholder organizations such as national medical specialty organizations1 national maternal child health organizations1 national groups that represent minority populations1 and national health disparity organizations7 shall carry out the following activities to eliminate disparities in maternal health outcomes3 7#a7 ,conduct research into the determinants and the distribution of disparities in maternal care1 health risks1 and health outcomes1 and improve the capacity of the performance measurement infrastructure to measure such disparities4 7#b7 ,expand access to services that have been demonstrated to improve the quality and outcomes of maternity care for vulnerable populations4 7#c7 ,establish a demonstration project to compare the effectiveness of interventions to reduce disparities in maternity services and outcomes1 and implement and assess effective interventions4 7b7 ,scope and selection of ,states for demonstration project ,the demonstration project under subsection 7a77#c7 shall be conducted in no more than #h ,states1 which shall be selected by the ,secretary based on-- 7#a7 applications submitted by ,states1 which specify which regions and populations the ,state involved will serve under the demonstration project2 7#b7 criteria designed by the ,secretary to ensure that1 as a whole1 the demonstration project is1 to the greatest extent possible1 representative of the demographic and geographic composition of communities most affected by disparities2 7#c7 criteria designed by the ,secretary to ensure that a variety of types of models are tested through the demonstration project and that such models include interventions that have an existing evidence base for effectiveness2 and 7#d7 criteria designed by the ,secretary to assure that the demonstration projects and models will be carried out in consultation with local and regional provider organizations1 such as community health centers1 hospital systems1 and medical societies representing providers of maternity services4 7c7 ,duration of demonstration project ,the demonstration project under subsection 7a77#c7 shall begin on ,january #a1 #bjae1 and end on ,december #ca1 #bjai4 7d7 ,grants for evaluation and monitoring ,the ,secretary may make grants to ,states and health care providers participating in the demonstration project under subsection 7a77#c7 for the purpose of collecting data necessary for the evaluation and monitoring of such project4 7e7 ,reports 7#a7 ,state reports ,each ,state that participates in the demonstration project under subsection 7a77#c7 shall report to the ,secretary1 in a time1 form1 and manner specified by the ,secretary1 the data necessary to-- 7,a7 monitor the-- 7i7 outcomes of the project2 7ii7 costs of the project2 and 7iii7 quality of maternity care provided under the project2 and 7,b7 evaluate the rationale for the selection of the items and services included in any bundled payment made by the ,state under the project4 7#b7 ,final report ,not later than ,december #ca1 #bjbj1 the ,secretary shall submit to ,congress a report on the results of the demonstration project under subsection 7a77#c74 4 #ejg4 ,decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood 7a7 ,establishment ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,health ,resources and ,services ,administration and in consultation with the ,director of the ,centers for ,disease ,control and ,prevention and the ,director of the ,national ,institutes of ,health 7in this section referred to as the ,secretary71 shall establish and implement a culturally competent public health awareness and education campaign to provide information that is focused on decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood1 including educating individuals about safe sleep environments1 sleep positions1 and reducing exposure to smoking during pregnancy and after birth4 7b7 ,targeted ,populations ,the campaign under subsection 7a7 shall be designed to reduce health disparities through the targeting of populations with high rates of sudden unexpected infant death and sudden unexplained death in childhood4 7c7 ,consultation ,in establishing and implementing the campaign under subsection 7a71 the ,secretary shall consult with national organizations representing health care providers1 including nurses and physicians1 parents1 child care providers1 children's advocacy and safety organizations1 maternal and child health programs1 nutrition professionals focusing on women1 infants1 and children1 and other individuals and groups determined necessary by the ,secretary for such establishment and implementation4 7d7 ,grants 7#a7 ,in general ,in carrying out the campaign under subsection 7a71 the ,secretary shall award grants to national organizations1 ,state and local health departments1 and community-based organizations for the conduct of education and outreach programs for nurses1 parents1 child care providers1 public health agencies1 and community organizations4 7#b7 ,application ,to be eligible to receive a grant under paragraph 7#a71 an entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjai4 #ejh4 ,reducing unintended teenage pregnancies ,title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bda et seq47 is amended by adding at the end the following new part3 ,w ,youth ,pregnancy ,prevention ,programs #cii,,oo4 ,purpose ,it is the purpose of this part to develop and carry out research and demonstration projects on new and existing program interventions to provide youth in communities at disproportionate risk for unintended teen pregnancy 7particularly youth in racial or ethnic minority or immigrant communities1 youth in the foster care system1 youth in the juvenile justice system1 rural youth1 and ,,lgbt youth7 the information and skills needed to prevent unintended teenage pregnancies1 build healthy relationships1 and improve overall health and well-being4 #cii,,oo-#a4 ,limitation ,no ,federal funds provided under this ,act may be used for health education programs or media awareness campaigns that-- 7#a7 deliberately withhold life-saving information about the human immunodeficiency virus 7,,hiv72 7#b7 undermine young people's confidence in the effectiveness of contraception2 7#c7 are medically inaccurate or have been scientifically shown to be ineffective2 7#d7 promote gender1 racial1 or ethnic stereotypes2 7#e7 are insensitive and unresponsive to the needs of sexually active youth or ,,lgbt youth2 7#f7 are inconsistent with the ethical imperatives of medicine and public health2 or 7#g7 stigmatize and shame youth who are parenting or choose to parent4 #cii,,oo-#b4 ,demonstration grants to reduce unintended teenage pregnancies 7a7 ,in general ,the ,secretary shall award competitive grants to eligible entities for establishing or expanding programs to provide youth in communities at disproportionate risk for unintended teen pregnancy 7particularly youth in racial or ethnic minority or immigrant communities1 youth in the foster care system1 youth in the juvenile justice system1 rural youth1 and ,,lgbt youth7 the information and skills needed to prevent unintended teenage pregnancy and develop healthy relationships4 7b7 ,priority ,in awarding grants under this section1 the ,secretary shall give priority to applicants-- 7#a7 proposing to carry out projects in communities at disproportionate risk for unintended teen pregnancy 7particularly youth in racial or ethnic minority or immigrant communities1 youth in the foster care system1 youth in the juvenile justice system1 rural youth1 and ,,lgbt youth72 7#b7 that have a demonstrated history of effectively working with such targeted communities2 7#c7 that have a demonstrated history of engaging in a meaningful and significant partnership with such targeted communities2 or 7#d7 that have an integrated approach that also promotes the skills necessary to build healthy relationships and recognize abusive or unhealthy behaviors4 7c7 ,program settings ,programs funded through a grant under subsection 7a7 shall be provided-- 7#a7 through classroom-based settings1 such as school health education1 humanities1 language arts1 or family and consumer science education2 after-school programs2 community-based programs2 workforce development programs2 and health care settings1 including community health centers2 or 7#b7 in collaboration with systems that serve large numbers of at-risk youth such as juvenile justice or foster care systems4 7d7 ,project requirements ,as a condition of receipt of a grant under this section1 an entity shall agree that1 with respect to information and skills provided through the grant-- 7#a7 such information and skills will be-- 7,a7 age-appropriate2 7,b7 evidence-based or evidence-informed2 7,c7 provided in accordance with section #cii,,oo-#f7;b72 and 7,d7 culturally sensitive and relevant to the target populations2 and 7#b7 any information provided about contraceptives shall include the health benefits and side effects of all contraceptives and barrier methods4 7e7 ,evaluation ,of the total amount made available to carry out this section for a fiscal year1 the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention and other agencies as appropriate1 shall allot up to #aj percent of such amount to carry out a rigorous1 independent evaluation to determine the extent and the effectiveness of activities funded through this section during such fiscal year in changing attitudes and behavior of teenagers with respect to healthy relationships and childbearing4 7f7 ,grants for ,indian tribes or tribal organizations ,of the total amount made available to carry out this section for a fiscal year1 the ,secretary shall reserve #e percent of such amount to award grants under this section to ,indian tribes and tribal organizations in such manner1 and subject to such requirements1 as the ,secretary1 in consultation with ,indian tribes and tribal organizations1 determines appropriate4 7g7 ,eligible entity defined 7#a7 ,in general ,in this section1 the term eligible entity means a ,state1 local1 or tribal agency2 a school or postsecondary institution2 an after-school program2 a nonprofit organization2 or a community or faith-based organization4 7#b7 ,preventing exclusion of smaller community-based organizations ,in carrying out this section1 the ,secretary shall ensure that the amounts and requirements of grants provided under this section do not preclude receipt of such grants by community-based organizations with a demonstrated history of effectively working with adolescents in racial or ethnic minority or immigrant communities or engaged in meaningful and significant partnership with such communities4 #cii,,oo-#c4 ,multimedia campaigns to reduce unintended teenage pregnancies 7a7 ,in general ,the ,secretary shall award competitive grants to public and private entities to carry out multimedia campaigns to provide public education and increase public awareness regarding unintended teenage pregnancy and related social and emotional issues1 such as violence prevention4 7b7 ,priority ,in awarding grants under this section1 the ,secretary shall give priority to applicants proposing to carry out campaigns developed for communities at disproportionate risk for unintended teen pregnancy 7particularly youth in racial or ethnic minority or immigrant communities1 youth in the foster care system1 youth in the juvenile justice system1 rural youth1 and ,,lgbt youth74 7c7 ,information ,to be provided ,as a condition of receipt of a grant under this section1 an entity shall agree to use the grant to carry out multimedia campaigns described in subsection 7a7 that-- 7#a7 at a minimum1 shall provide information on-- 7,a7 the prevention of unintended teenage pregnancy2 and 7,b7 healthy relationship development2 and 7#b7 may provide information on the prevention of dating violence and sexual assault4 #cii,,oo-#d4 ,research on reducing unintended teenage pregnancies and teenage dating violence and improving healthy relationships 7a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall make grants to public and private entities to conduct1 support1 or coordinate research on unintended teenage pregnancy1 dating violence1 and healthy relationships among racial or ethnic minority or immigrant communities that-- 7#a7 improves data collection on-- 7,a7 sexual and reproductive health1 including unintended teenage pregnancies and births1 among all minority communities and subpopulations in which such data are not collected1 including ,american ,indian and ,alaska ,native youth2 7,b7 sexual behavior1 reproductive and sexual coercion1 and teenage contraceptive use patterns at the ,state level1 as appropriate2 7,c7 unintended teenage pregnancies among youth in and aging out of foster care or juvenile justice systems and the underlying factors that lead to unintended teenage pregnancy among youth in foster care or juvenile justice systems2 and 7,d7 sexual and reproductive health1 including teenage pregnancies and births1 sexual behavior1 reproductive and sexual coercion1 and teenage contraceptive use among-- 7i7 ,,lgbt youth2 and 7ii7 rural youth2 7#b7 investigates-- 7,a7 the variance in the rates of unintended teenage pregnancy by-- 7i7 racial and ethnic group 7such as ,hispanic1 ,asian-,american1 ,african-,american1 ,pacific ,islander1 ,american ,indian1 and ,alaska ,native72 and 7ii7 socioeconomic status1 based on the income of the family and education attainment2 7,b7 factors affecting the risk for youth of unintended teenage pregnancy or dating violence1 including the physical and social environment1 level of acculturation1 access to health care1 aspirations for the future1 and history of physical or sexual violence or abuse2 7,c7 the role that violence and abuse play in teenage sex1 pregnancy1 and childbearing2 7,d7 strategies to address the disproportionate rates of unintended teenage pregnancies and dating violence in racial or ethnic minority or immigrant communities2 7,e7 how effective interventions can be replicated or adapted in other settings to serve racial or ethnic minority or immigrant communities in a culturally appropriate manner2 and 7,f7 the effectiveness of media campaigns in addressing healthy relationship development1 dating violence prevention1 and unintended teenage pregnancy2 and 7#c7 tests research-based strategies for addressing high rates of unintended teenage pregnancy through programs that emphasize healthy relationships and violence prevention4 7b7 ,priority ,in carrying out this section1 the ,secretary shall give priority to research that incorporates-- 7#a7 interdisciplinary approaches2 7#b7 a strong emphasis on community-based participatory research2 or 7#c7 translational research4 #cii,,oo-#e4 ,,hhs adolescent health work group 7a7 ,purpose ,not later than #cj days after the date of the enactment of this part1 the ,secretary shall direct the interagency adolescent health workgroup within the ,office of ,adolescent ,health of the ,department of ,health and ,human ,services to-- 7#a7 include in the work of the group strategies for teenage dating violence prevention and healthy teenage relationships with a particular focus among racial or ethnic minority or immigrant communities2 and 7#b7 with respect to including such strategies1 consult1 to the greatest extent possible1 with the ,federal ,interagency ,workgroup on ,teen ,dating ,violence formed under the leadership of the ,national ,institute of ,justice of the ,department of ,justice4 7b7 ,report ,requirement ,the ,secretary1 through the ,office of ,adolescent ,health1 shall periodically submit to ,congress a report that-- 7#a7 includes a review of the evidence-based programs on preventing unintended teenage pregnancy1 which are carried out and identified by the ,office2 and 7#b7 identifies the programs of the ,department of ,health and ,human ,services that include teenage dating violence prevention and the promotion of healthy teenage relationships as part of a strategy to prevent unintended teenage pregnancy4 #cii,,oo-#f4 ,general grant provisions 7a7 ,applications ,to seek a grant under this part1 an entity shall submit an application to the ,secretary in such form1 in such manner1 and containing such agreements1 assurances1 and information as the ,secretary may require4 7b7 ,additional requirements ,a grant may be made under this part only if the applicant involved agrees that information1 activities1 and services provided under the grant-- 7#a7 will be evidence-based or evidence-informed2 7#b7 will be factually and medically accurate and complete2 and 7#c7 if directed to a particular population group1 will be provided in an appropriate language and cultural context4 7c7 ,training and technical assistance 7#a7 ,in general ,of the total amount made available to carry out this part for a fiscal year1 the ,secretary shall use #aj percent to provide1 directly or through a competitive grant process1 training and technical assistance to the grant recipients under this part1 including by disseminating research and information regarding effective and promising practices1 providing consultation and resources on a broad array of teenage and unintended pregnancy and violence prevention strategies1 and developing resources and materials4 7#b7 ,collaboration ,in carrying out this subsection1 the ,secretary shall collaborate with entities that have expertise in the prevention of teenage pregnancy1 healthy relationship development1 minority health and health disparities1 and violence prevention4 #cii,,oo-#g4 ,definitions ,in this part3 7#a7 ,medically accurate and complete ,the term medically accurate and complete means1 with respect to information1 activities1 or services1 verified or supported by the weight of research conducted in compliance with accepted scientific methods and-- 7,a7 published in peer-reviewed journals1 where applicable2 or 7,b7 comprising information that leading professional organizations and agencies with relevant expertise in the field recognize as accurate1 objective1 and complete4 7#b7 ,,lgbt youth ,the term ,,lgbt youth means lesbian1 gay1 bisexual1 and transgender youth4 7#c7 ,racial or ethnic minority or immigrant communities ,the term racial or ethnic minority or immigrant communities means communities with a substantial number of residents who are members of racial or ethnic minority groups or who are immigrants4 7#d7 ,reproductive and sexual coercion ,the term reproductive and sexual coercion-- 7,a7 means1 with respect to a person1 coercive behavior that interferes with the ability of such person to control the reproductive decisionmaking of such person1 such as intentionally exposing such person to sexually transmitted infections2 in the case such person is a female1 attempting to impregnate such person against her will2 intentionally interfering with the person's birth control2 or threatening or acting violent if the person does not comply with the perpetrator's wishes regarding contraception or the decision whether to terminate or continue a pregnancy2 and 7,b7 includes a range of behaviors that a partner may use related to sexual decision-making to pressure or coerce a person to have sex without using physical force1 such as repeatedly pressuring a partner to have sex when he or she does not want to2 threatening to end a relationship if a person does not have sex2 and threatening retaliation if notified of a positive sexually transmitted disease test result4 7#e7 ,youth ,the term youth means individuals who are #aa to #ai years of age4 #cii,,oo-#h4 ,reports 7a7 ,report on use of funds ,not later than #a year after the date of the enactment of this part1 the ,secretary shall submit to ,congress a report on the use of funds provided pursuant to this part4 7b7 ,report on impact of programs ,not later than ,march #a1 #bjai1 the ,secretary shall submit to ,congress a report on the impact of the programs under this part on reducing unintended teenage pregnancies4 #cii,,oo-#i4 ,authorization of appropriations 7a7 ,in general ,there are authorized to be appropriated to carry out this part such sums as may be necessary for each of the fiscal years #bjae through #bjai4 7b7 ,availability ,amounts appropriated pursuant to subsection 7a7-- 7#a7 are authorized to remain available until expended2 and 7#b7 are in addition to amounts otherwise made available for such purposes4 4 #eji4 ,gestational diabetes ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq47 is amended by adding after section #cag;,h the following3 #cag;,h-#a4 ,gestational diabetes 7a7 ,understanding and monitoring gestational diabetes 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 in consultation with the ,diabetes ,mellitus ,interagency ,coordinating ,committee established under section #dbi and representatives of appropriate national health organizations1 shall develop a multisite gestational diabetes research project within the diabetes program of the ,centers for ,disease ,control and ,prevention to expand and enhance surveillance data and public health research on gestational diabetes4 7#b7 ,areas to be addressed ,the research project developed under paragraph 7#a7 shall address-- 7,a7 procedures to establish accurate and efficient systems for the collection of gestational diabetes data within each ,state and commonwealth1 territory1 or possession of the ,united ,states2 7,b7 the progress of collaborative activities with the ,national ,vital ,statistics ,system1 the ,national ,center for ,health ,statistics1 and ,state health departments with respect to the standard birth certificate1 in order to improve surveillance of gestational diabetes2 7,c7 postpartum methods of tracking women with gestational diabetes after delivery as well as targeted interventions proven to lower the incidence of type #b diabetes in that population2 7,d7 variations in the distribution of diagnosed and undiagnosed gestational diabetes1 and of impaired fasting glucose tolerance and impaired fasting glucose1 within and among groups of women2 and 7,e7 factors and culturally sensitive interventions that influence risks and reduce the incidence of gestational diabetes and related complications during childbirth1 including cultural1 behavioral1 racial1 ethnic1 geographic1 demographic1 socioeconomic1 and genetic factors4 7#c7 ,report ,not later than #b years after the date of the enactment of this section1 and annually thereafter1 the ,secretary shall generate a report on the findings and recommendations of the research project including prevalence of gestational diabetes in the multisite area and disseminate the report to the appropriate ,federal and non-,federal agencies4 7b7 ,expansion of gestational diabetes research 7#a7 ,in ,general ,the ,secretary shall expand and intensify public health research regarding gestational diabetes4 ,such research may include-- 7,a7 developing and testing novel approaches for improving postpartum diabetes testing or screening and for preventing type #b diabetes in women with a history of gestational diabetes2 and 7,b7 conducting public health research to further understanding of the epidemiologic1 socioenvironmental1 behavioral1 translation1 and biomedical factors and health systems that influence the risk of gestational diabetes and the development of type #b diabetes in women with a history of gestational diabetes4 7#b7 ,authorization of ,appropriations ,there is authorized to be appropriated to carry out this subsection #e1jjj1jjj for each of fiscal years #bjae through #bjai4 7c7 ,demonstration grants ,to lower the rate of gestational diabetes 7#a7 ,in ,general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall award grants1 on a competitive basis1 to eligible entities for demonstration projects that implement evidence-based interventions to reduce the incidence of gestational diabetes1 the recurrence of gestational diabetes in subsequent pregnancies1 and the development of type #b diabetes in women with a history of gestational diabetes4 7#b7 ,priority ,in making grants under this subsection1 the ,secretary shall give priority to projects focusing on-- 7,a7 helping women who have #a or more risk factors for developing gestational diabetes2 7,b7 working with women with a history of gestational diabetes during a previous pregnancy2 7,c7 providing postpartum care for women with gestational diabetes2 7,d7 tracking cases where women with a history of gestational diabetes developed type #b diabetes2 7,e7 educating mothers with a history of gestational diabetes about the increased risk of their child developing diabetes2 7,f7 working to prevent gestational diabetes and prevent or delay the development of type #b diabetes in women with a history of gestational diabetes2 and 7,g7 achieving outcomes designed to assess the efficacy and cost-effectiveness of interventions that can inform decisions on long-term sustainability1 including third-party reimbursement4 7#c7 ,application ,an eligible entity desiring to receive a grant under this subsection shall submit to the ,secretary-- 7,a7 an application at such time1 in such manner1 and containing such information as the ,secretary may require2 and 7,b7 a plan to-- 7i7 lower the rate of gestational diabetes during pregnancy2 or 7ii7 develop methods of tracking women with a history of gestational diabetes and develop effective interventions to lower the incidence of the recurrence of gestational diabetes in subsequent pregnancies and the development of type #b diabetes4 7#d7 ,uses of ,funds ,an eligible entity receiving a grant under this subsection shall use the grant funds to carry out demonstration projects described in paragraph 7#a71 including-- 7,a7 expanding community-based health promotion education1 activities1 and incentives focused on the prevention of gestational diabetes and development of type #b diabetes in women with a history of gestational diabetes2 7,b7 aiding ,state- and tribal-based diabetes prevention and control programs to collect1 analyze1 disseminate1 and report surveillance data on women with1 and at risk for1 gestational diabetes1 the recurrence of gestational diabetes in subsequent pregnancies1 and1 for women with a history of gestational diabetes1 the development of type #b diabetes2 and 7,c7 training and encouraging health care providers-- 7i7 to promote risk assessment1 high-quality care1 and self-management for gestational diabetes and the recurrence of gestational diabetes in subsequent pregnancies2 and 7ii7 to prevent the development of type #b diabetes in women with a history of gestational diabetes1 and its complications in the practice settings of the health care providers4 7#e7 ,report ,not later than #d years after the date of the enactment of this section1 the ,secretary shall prepare and submit to the ,congress a report concerning the results of the demonstration projects conducted through the grants awarded under this subsection4 7#f7 ,definition of ,eligible ,entity ,in this subsection1 the term eligible entity means a nonprofit organization 7such as a nonprofit academic center or community health center7 or a ,state1 tribal1 or local health agency4 7#g7 ,authorization of ,appropriations ,there is authorized to be appropriated to carry out this subsection #e1jjj1jjj for each of fiscal years #bjae through #bjai4 7d7 ,postpartum followup regarding gestational diabetes ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall work with the ,state- and tribal-based diabetes prevention and control programs assisted by the ,centers to encourage postpartum followup after gestational diabetes1 as medically appropriate1 for the purpose of reducing the incidence of gestational diabetes1 the recurrence of gestational diabetes in subsequent pregnancies1 the development of type #b diabetes in women with a history of gestational diabetes1 and related complications4 4 #eaj4 ,emergency contraception education and information programs 7a7 ,emergency ,contraception ,public ,education ,program 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall develop and disseminate to the public information on emergency contraception4 7#b7 ,dissemination ,the ,secretary may disseminate information under paragraph 7#a7 directly or through arrangements with nonprofit organizations1 consumer groups1 institutions of higher education1 clinics1 the media1 and ,federal1 ,state1 and local agencies4 7#c7 ,information ,the information disseminated under paragraph 7#a7 shall include1 at a minimum1 a description of emergency contraception and an explanation of the use1 safety1 efficacy1 and availability of such contraception4 7b7 ,emergency ,contraception ,information ,program for ,health ,care ,providers 7#a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration and in consultation with major medical and public health organizations1 shall develop and disseminate to health care providers information on emergency contraception4 7#b7 ,information ,the information disseminated under paragraph 7#a7 shall include1 at a minimum-- 7,a7 information describing the use1 safety1 efficacy1 and availability of emergency contraception2 7,b7 a recommendation regarding the use of such contraception in appropriate cases2 and 7,c7 information explaining how to obtain copies of the information developed under subsection 7a7 for distribution to the patients of the providers4 7c7 ,definitions ,in this section3 7#a7 ,emergency contraception ,the term emergency contraception means a drug or device 7as the terms are defined in section #bja of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cba77 or a drug regimen that-- 7,a7 is used postcoitally2 7,b7 prevents pregnancy primarily by preventing or delaying ovulation1 and does not terminate an established pregnancy2 and 7,c7 is approved by the ,food and ,drug ,administration4 7#b7 ,health care provider ,the term health care provider means an individual who is licensed or certified under ,state law to provide health care services and who is operating within the scope of such license4 ,such term shall include a pharmacist4 7#c7 ,institution of higher education ,the term institution of higher education has the same meaning given such term in section #aja7;a7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja7;a774 7#d7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7d7 ,authorization of ,appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of the fiscal years #bjae through #bjai4 #eaa4 ,supporting healthy adolescent development 7a7 ,in ,general ,the ,secretary may award a grant to each eligible ,state to conduct programs of sex education described in subsection 7b71 including education on both abstinence and contraception for the prevention of teenage pregnancy and sexually transmitted diseases1 including ,,hiv_/,,aids and viral hepatitis4 7b7 ,requirements for ,sex ,education ,programs ,a program of sex education described in this subsection is a program that-- 7#a7 is age appropriate and medically accurate2 7#b7 stresses the value of abstinence while not ignoring those young people who have been or are sexually active2 7#c7 includes information providing a factual understanding of male and female reproductive anatomy2 7#d7 provides information about the health benefits and side effects of contraceptive and barrier methods used-- 7,a7 as a means to prevent pregnancy2 and 7,b7 to reduce the risk of contracting sexually transmitted disease1 including ,,hiv_/,,aids and viral hepatitis2 7#e7 encourages family communication between parent and child about sexuality2 7#f7 cultivates a respectful dialogue about sexuality1 including sexual orientation and gender identity1 and embraces the principles of nondiscrimination based on sexual orientation and gender identity2 7#g7 counters the perpetuation of narrow gender roles1 including the sexualization of female children1 adolescents1 and adults2 7#h7 teaches young people the skills to make responsible decisions about sexuality1 including how to avoid unwanted verbal1 physical1 and sexual advances and how to avoid making verbal1 physical1 and sexual advances that are not wanted by the other party2 7#i7 develops healthy relationships1 including the prevention of dating and sexual violence2 7#aj7 teaches young people how alcohol and drug use can affect responsible decisionmaking2 and 7#aa7 does not teach or promote religion4 7c7 ,additional ,activities ,in carrying out a program of sex education1 a ,state may expend grant funds awarded under subsection 7a7 to carry out educational and motivational activities that help young people-- 7#a7 gain knowledge about the physical1 emotional1 biological1 and hormonal changes of adolescence and subsequent stages of human maturation2 7#b7 develop the knowledge and skills necessary-- 7,a7 to ensure and protect their sexual and reproductive health from unintended pregnancy and sexually transmitted disease1 including ,,hiv_/,,aids1 throughout their lifespan2 7,b7 to be aware that certain racial and ethnic groups are more affected by certain sexually transmitted diseases2 and 7,c7 to receive the education to prevent further transmission2 7#c7 gain knowledge about the specific involvement and responsibility of each individual in sexual decisionmaking2 7#d7 develop healthy attitudes and values about adolescent growth and development1 body image1 gender roles1 racial and ethnic diversity1 sexual orientation and gender identity1 and other subjects2 7#e7 develop and practice healthy life skills including goal-setting1 decisionmaking1 negotiation1 communication1 and stress management2 and 7#f7 promote self-esteem and positive interpersonal skills focusing on relationship dynamics1 including friendships1 dating1 romantic involvement1 marriage1 and family interactions4 7d7 ,matching funds ,the ,secretary may not make payments to a ,state under this section in an amount exceeding ,federal medical assistance percentage for such ,state 7as such term is defined in section #aije7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b777 of the costs of the programs conducted by the ,state under this section4 7e7 ,evaluation of programs 7#a7 ,in ,general ,for the purpose of evaluating the effectiveness of programs of sex education carried out with a grant under this section1 evaluations shall be carried out in accordance with paragraphs 7#b7 and 7#c74 7#b7 ,national ,evaluation 7,a7 ,method ,the ,secretary shall provide for a national evaluation of a representative sample of programs of sex education carried out with grants under this section to determine-- 7i7 the effectiveness of such programs in helping to delay the initiation of sexual intercourse and other high-risk behaviors2 7ii7 the effectiveness of such programs in preventing adolescent pregnancy2 7iii7 the effectiveness of such programs in preventing sexually transmitted disease1 including ,,hiv_/,,aids and viral hepatitis2 7iv7 the effectiveness of such programs in increasing contraceptive knowledge and contraceptive behaviors when sexual intercourse occurs2 and 7v7 a list of best practices that-- 7,i7 is based upon essential programmatic components of evaluated programs that have led to success described in clauses 7i7 through 7iv72 and 7,,ii7 documents the racial and ethnic minority populations that are recipients of grant funds under this section or are served by programs of sex education funded under this section4 7,b7 ,grant condition ,a condition for the receipt of a grant to a ,state under this section is that the ,state cooperate with the evaluation under subparagraph 7,a74 7,c7 ,report ,the ,secretary shall submit to the ,congress-- 7i7 not later than the end of each fiscal year during the #e-year period beginning with fiscal year #bjae1 an interim report on the national evaluation under subparagraph 7,a72 and 7ii7 not later than ,march #ca1 #bjbj1 a final report providing the results of such national evaluation4 7#c7 ,individual ,state ,evaluations ,a condition for the receipt of a grant under this section is that the ,state evaluate the programs of sex education funded through such grant in accordance with the following requirements3 7,a7 ,the evaluation will be conducted by an external1 independent entity4 7,b7 ,the purposes of the evaluation will be the determination of-- 7i7 the effectiveness of such programs in helping to delay the initiation of sexual intercourse and other high-risk behaviors2 7ii7 the effectiveness of such programs in preventing adolescent pregnancy2 7iii7 the effectiveness of such programs in preventing sexually transmitted disease1 including ,,hiv_/,,aids2 and 7iv7 the effectiveness of such programs in increasing contraceptive and barrier method knowledge and contraceptive behaviors when sexual intercourse occurs4 7f7 ,limitations on use of funds 7#a7 ,limitations on ,secretary ,of the amounts appropriated for a fiscal year for purposes of this section1 the ,secretary may not use more than-- 7,a7 #g percent of such amounts for administrative expenses related to carrying out this section for that fiscal year2 and 7,b7 #aj percent of such amounts for the national evaluation under subsection 7e77#b74 7#b7 ,limitations to ,states ,of amounts provided to an eligible ,state under this subsection1 the ,state may not use more than #aj percent of the grant to conduct any evaluation under subsection 7e77#c74 7g7 ,nondiscrimination required ,programs funded under this section shall not discriminate on the basis of sex1 race1 ethnicity1 national origin1 disability1 religion1 marital status1 familial status1 sexual orientation1 or gender identity4 ,nothing in this section shall be construed to invalidate or limit rights1 remedies1 procedures1 or legal standards available to victims of discrimination under any other ,federal law or any law of a ,state or a political subdivision of a ,state1 including title ,,vi of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;d et seq471 title ,,ix of the ,education ,amendments of #aigb 7#bj ,u4,s4,c4 #afha et seq471 section #ejd of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gid71 and the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abaja et seq474 7h7 ,definitions ,for purposes of this section3 7#a7 ,the term age appropriate means1 with respect to topics1 messages1 and teaching methods1 those suitable to particular ages or age groups of children1 adolescents1 and adults1 based on developing cognitive1 emotional1 and behavioral capacity typical for the age or age group4 7#b7 ,the term eligible ,state means a ,state that submits to the ,secretary an application for a grant under this section that is in such form1 is made in such manner1 and contains such agreements1 assurances1 and information as the ,secretary determines to be necessary to carry out this section4 7#c7 ,the term ,,hiv_/,,aids means the human immunodeficiency virus1 and includes acquired immune deficiency syndrome4 7#d7 ,the term medically accurate1 with respect to information1 means information that is supported by research1 recognized as accurate and objective by leading medical1 psychological1 psychiatric1 and public health organizations and agencies1 and1 published in journals that are peer reviewed4 7#e7 ,the term ,state means the #ej ,states1 the ,district of ,columbia1 the ,commonwealth of ,puerto ,rico1 the ,commonwealth of the ,northern ,mariana ,islands1 ,american ,samoa1 ,guam1 the ,united ,states ,virgin ,islands1 and any other territory or possession of the ,united ,states4 7i7 ,authorization of appropriations ,for the purpose of carrying out this section1 there is authorized to be appropriated #ej1jjj1jjj for each of the fiscal years #bjae through #bjai4 #eab4 ,compassionate assistance for rape emergencies 7a7 ,medicare 7#a7 ,limitation on payment ,section #ahff7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77 is amended-- 7,a7 by striking and at the end of subparagraph 7,v72 7,b7 in the subparagraph 7,w7 added by section #cjje7a77;,c7 of ,public ,law #aaa-adh-- 7i7 by striking the period at the end and inserting a comma2 7ii7 by moving the indentation #b ems to the left2 and 7iii7 by moving such subparagraph to immediately follow subparagraph 7,v72 7,c7 in the subparagraph 7,w7 added by section #fdjf7;b77#c7 of ,public ,law #aaa-adh-- 7i7 by striking the period at the end and inserting 1 and2 7ii7 by moving the indentation #b ems to the left2 7iii7 by redesignating such subparagraph as subparagraph 7,x72 and 7iv7 by moving such subparagraph to immediately follow subparagraph 7,w71 as moved under paragraph 7#b77;,c72 and 7,d7 by inserting after the subparagraph 7,x71 as redesignated and moved under paragraph 7#c71 the following3 7,y7 in the case of a hospital or critical access hospital1 to adopt and enforce a policy to ensure compliance with the requirements of subsection 7l7 and to meet the requirements of such subsection4 4 7#b7 ,assistance to victims ,section #ahff of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7 is amended by adding at the end the following new subsection3 7l7 ,compassionate assistance for rape emergencies 7#a7 ,in general ,for purposes of section #ahff7;a77#a77,y71 a hospital meets the requirements of this subsection if the hospital provides each of the services described in paragraph 7#b7 to each female individual1 whether or not eligible for benefits under this title or under any other form of health insurance4 who comes to the hospital on or after ,january #a1 #bjae1 and-- 7,a7 who states to hospital personnel that she is a victim of sexual assault2 7,b7 who is accompanied by an individual who states to hospital personnel that the female individual is a victim of sexual assault2 or 7,c7 whom hospital personnel1 during the course of treatment and care for the female individual1 have reason to believe is a victim of sexual assault4 7#b7 ,required services described ,for purposes of paragraph 7#a71 the services described in this subparagraph are the following3 7,a7 ,provision of medically and factually accurate and unbiased written and oral information about emergency contraception that-- 7i7 is written in clear and concise language2 7ii7 is readily comprehensible2 7iii7 includes an explanation that-- 7,i7 emergency contraception has been approved by the ,food and ,drug ,administration as an over-the-counter medication for female individuals1 and is a safe and effective way to prevent pregnancy after unprotected intercourse or contraceptive failure if taken in a timely manner2 7,,ii7 emergency contraception is more effective the sooner it is taken2 and 7,,iii7 emergency contraception does not cause an abortion and cannot interrupt an established pregnancy2 7iv7 meets such conditions regarding the provision of such information in languages other than ,english as the ,secretary may establish2 and 7v7 is provided without regard to the ability of the individual or her family to pay costs associated with the provision of such information to the individual4 7,b7 ,prompt offer to provide emergency contraception to the individual1 and in the case that the individual accepts such offer1 prompt provision of such contraception to such individual without regard to the inability of the individual or her family to pay costs associated with the offer and provision of such contraception4 7#c7 ,definitions ,for purposes of this paragraph3 7,a7 ,the term emergency contraception means a drug or device 7as such terms are defined in section #bja of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cba77 or a drug regimen that-- 7i7 is used postcoitally2 7ii7 prevents pregnancy primarily by preventing or delaying ovulation1 and does not terminate an established pregnancy2 and 7iii7 is approved by the ,food and ,drug ,administration4 7,b7 ,the term hospital includes a critical access hospital1 as defined in section #ahfa7mm77#a74 7,c7 ,the term sexual assault means coitus in which the individual involved does not consent or lacks the legal capacity to consent4 4 7b7 ,limitation on payment under ,medicaid ,section #aijc7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7i77 is amended by inserting after paragraph 7#aa7 the following new paragraph3 7#ab7 with respect to any amount expended for care or services furnished under the plan by a hospital on or after ,january #a1 #bjae1 unless such hospital meets the requirements specified in section #ahff7l7 for purposes of title ,,xviii4 4 #eac4 ,access to birth control duties of pharmacies to ensure provision of ,,fda-approved contraception ,part ,b of title ,,ii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bch et seq47 is amended by adding at the end the following3 #bdi4 ,duties of pharmacies to ensure provision of ,,fda-approved contraception 7a7 ,in general ,subject to subsection 7c71 a pharmacy that receives ,food and ,drug ,administration-approved drugs or devices in interstate commerce shall maintain compliance with the following3 7#a7 ,if a customer requests a contraceptive that is in stock1 the pharmacy shall ensure that the contraceptive is provided to the customer without delay4 7#b7 ,if a customer requests a contraceptive that is not in stock and the pharmacy in the normal course of business stocks contraception1 the pharmacy shall immediately inform the customer that the contraceptive is not in stock and without delay offer the customer the following options3 7,a7 ,if the customer prefers to obtain the contraceptive through a referral or transfer1 the pharmacy shall-- 7i7 locate a pharmacy of the customer's choice or the closest pharmacy confirmed to have the contraceptive in stock2 and 7ii7 refer the customer or transfer the prescription to that pharmacy4 7,b7 ,if the customer prefers for the pharmacy to order the contraceptive1 the pharmacy shall obtain the contraceptive under the pharmacy's standard procedure for expedited ordering of medication and notify the customer when the contraceptive arrives4 7#c7 ,the pharmacy shall ensure that its employees do not-- 7,a7 intimidate1 threaten1 or harass customers in the delivery of services relating to a request for contraception2 7,b7 interfere with or obstruct the delivery of services relating to a request for contraception2 7,c7 intentionally misrepresent or deceive customers about the availability of contraception or its mechanism of action2 7,d7 breach medical confidentiality with respect to a request for contraception or threaten to breach such confidentiality2 or 7,e7 refuse to return a valid1 lawful prescription for contraception upon customer request4 7b7 ,contraceptives not ordinarily stocked ,nothing in subsection 7a77#b7 shall be construed to require any pharmacy to comply with such subsection if the pharmacy does not ordinarily stock contraceptives in the normal course of business4 7c7 ,refusals pursuant to standard pharmacy practice ,this section does not prohibit a pharmacy from refusing to provide a contraceptive to a customer in accordance with any of the following3 7#a7 ,if it is unlawful to dispense the contraceptive to the customer without a valid1 lawful prescription and no such prescription is presented4 7#b7 ,if the customer is unable to pay for the contraceptive4 7#c7 ,if the employee of the pharmacy refuses to provide the contraceptive on the basis of a professional clinical judgment4 7d7 ,rule of construction ,nothing in this section shall be construed to invalidate or limit rights1 remedies1 procedures1 or legal standards under title ,,vii of the ,civil ,rights ,act of #aifd4 7e7 ,preemption ,this section does not preempt any provision of ,state law or any professional obligation made applicable by a ,state board or other entity responsible for licensing or discipline of pharmacies or pharmacists1 to the extent that such ,state law or professional obligation provides protections for customers that are greater than the protections provided by this section4 7f7 ,enforcement 7#a7 ,civil penalty ,a pharmacy that violates a requirement of subsection 7a7 is liable to the ,united ,states for a civil penalty in an amount not exceeding #a1jjj per day of violation1 not to exceed #ajj1jjj for all violations adjudicated in a single proceeding4 7#b7 ,private cause of action ,any person aggrieved as a result of a violation of a requirement of subsection 7a7 may1 in any court of competent jurisdiction1 commence a civil action against the pharmacy involved to obtain appropriate relief1 including actual and punitive damages1 injunctive relief1 and a reasonable attorney's fee and cost4 7#c7 ,limitations ,a civil action under paragraph 7#a7 or 7#b7 may not be commenced against a pharmacy after the expiration of the #e-year period beginning on the date on which the pharmacy allegedly engaged in the violation involved4 7g7 ,definitions ,in this section3 7#a7 ,the term contraception or contraceptive means any drug or device approved by the ,food and ,drug ,administration to prevent pregnancy4 7#b7 ,the term employee means a person hired1 by contract or any other form of an agreement1 by a pharmacy4 7#c7 ,the term pharmacy means an entity that-- 7,a7 is authorized by a ,state to engage in the business of selling prescription drugs at retail2 and 7,b7 employs one or more employees4 7#d7 ,the term product means a ,food and ,drug ,administration-approved drug or device4 7#e7 ,the term professional clinical judgment means the use of professional knowledge and skills to form a clinical judgment1 in accordance with prevailing medical standards4 7#f7 ,the term without delay1 with respect to a pharmacy providing1 providing a referral for1 or ordering contraception1 or transferring the prescription for contraception1 means within the usual and customary timeframe at the pharmacy for providing1 providing a referral for1 or ordering other products1 or transferring the prescription for other products1 respectively4 7h7 ,effective date ,this section shall take effect on the #cast day after the date of the enactment of this section1 without regard to whether the ,secretary has issued any guidance or final rule regarding this section4 4 #ead4 ,additional focus area for the ,office on ,women's ,health ,section #bbi7;b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bcg;a7b77 is amended-- 7#a7 in paragraph 7#f71 at the end1 by striking and2 7#b7 in paragraph 7#g71 at the end1 by striking the period and inserting 2 and2 and 7#c7 by adding at the end the following new paragraph3 7#h7 facilitate policymakers1 health system leaders and providers1 consumers1 and other stakeholders in understanding optimal maternity care and support for the provision of such care1 including the priorities of-- 7,a7 protecting1 promoting1 and supporting the innate capacities of childbearing women and their newborns for childbirth1 breastfeeding1 and attachment2 7,b7 using obstetric interventions only when such interventions are supported by strong1 high-quality evidence1 and minimizing overuse of maternity practices that have been shown to have benefit in limited situations and that can expose women1 infants1 or both to risk of harm if used routinely and indiscriminately1 including continuous electronic fetal monitoring1 labor induction1 epidural analgesia1 primary cesarean section1 and routine repeat cesarean birth2 7,c7 reliably incorporating noninvasive1 evidence-based practices that have documented correlation with considerable improvement in outcomes with no detrimental side effects1 such as smoking cessation programs in pregnancy and proven models of group prenatal care that integrate health assessment1 education1 and support into a unified program2 7,d7 a shared understanding of the qualifications of licensed providers of maternity care and the best evidence about the safety1 satisfaction1 outcomes1 and costs of their care1 and appropriate deployment of such caregivers within the maternity care workforce to address the needs of childbearing women and newborns and the growing shortage of maternity caregivers2 7,e7 a shared understanding of the results of the best available research comparing hospital1 birth center1 and planned home births1 including information about each setting's safety1 satisfaction1 outcomes1 and costs2 and 7,f7 high-quality1 evidence-based childbirth education that promotes a natural1 healthy1 and safe approach to pregnancy1 childbirth1 and early parenting2 is taught by certified educators1 peer counselors1 and health professionals2 and promotes informed decisionmaking by childbearing women4 4 #eae4 ,interagency coordinating committee on the promotion of optimal maternity outcomes 7a7 ,in general ,part ,a of title ,,ii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bjb et seq47 is amended by adding at the end the following new section3 #bbi;,a4 ,interagency coordinating committee on the promotion of optimal maternity outcomes 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,deputy ,assistant ,secretary for ,women's ,health under section #bbi and in collaboration with the ,federal officials specified in subsection 7b71 shall establish the ,interagency ,coordinating ,committee on the ,promotion of ,optimal ,maternity ,outcomes 7referred to in this subsection as the ,,iccpom74 7b7 ,other agencies ,the officials specified in this subsection are the ,secretary of ,labor1 the ,secretary of ,defense1 the ,secretary of ,veterans ,affairs1 the ,surgeon ,general1 the ,director of the ,centers for ,disease ,control and ,prevention1 the ,administrator of the ,health ,resources and ,services ,agency1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 the ,director of the ,indian ,health ,service1 the ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration1 the ,director of the ,national ,institute on ,child ,health and ,development1 the ,director of the ,agency for ,healthcare ,research and ,quality1 the ,assistant ,secretary for ,children and ,families1 the ,deputy ,assistant ,secretary for ,minority ,health1 the ,director of the ,office of ,personnel ,management1 and such other ,federal officials as the ,secretary of ,health and ,human ,services determines to be appropriate4 7c7 ,chair ,the ,deputy ,assistant ,secretary for ,women's ,health shall serve as the chair of the ,,iccpom4 7d7 ,duties ,the ,,iccpom shall guide policy and program development across the ,federal ,government with respect to promotion of optimal maternity care1 provided1 however1 that nothing in this section shall be construed as transferring regulatory or program authority from an agency to the ,,iccpom4 7e7 ,consultations ,the ,,iccpom shall actively seek the input of1 and shall consult with1 all appropriate and interested stakeholders1 including ,state health departments1 public health research and interest groups1 foundations1 childbearing women and their advocates1 and maternity care professional associations and organizations1 reflecting racially1 ethnically1 demographically1 and geographically diverse communities4 7f7 ,annual report 7#a7 ,in general ,the ,secretary1 on behalf of the ,,iccpom1 shall annually submit to ,congress a report that summarizes-- 7,a7 all programs and policies of ,federal agencies 7including the ,medicare ,program under title ,,xviii of the ,social ,security ,act and the ,medicaid program under title ,,xix of such ,act7 designed to promote optimal maternity care1 focusing particularly on programs and policies that support the adoption of evidence based maternity care1 as defined by timely1 scientifically sound systematic reviews2 7,b7 all programs and policies of ,federal agencies 7including the ,medicare ,program under title ,,xviii of the ,social ,security ,act and the ,medicaid program under title ,,xix of such ,act7 designed to address the problems of maternal mortality and morbidity1 infant mortality1 prematurity1 and low birth weight1 including such programs and policies designed to address racial and ethnic disparities with respect to each of such problems2 7,c7 the extent of progress in reducing maternal mortality and infant mortality1 low birth weight1 and prematurity at ,state and national levels2 and 7,d7 such other information regarding optimal maternity care as the ,secretary determines to be appropriate4 ,the information specified in subparagraph 7,c7 shall be included in each such report in a manner that disaggregates such information by race1 ethnicity1 and indigenous status in order to determine the extent of progress in reducing racial and ethnic disparities and disparities related to indigenous status4 7#b7 ,certain information ,each report under paragraph 7#a7 shall include information 7disaggregated by race1 ethnicity1 and indigenous status1 as applicable7 on the following rates and costs by ,state3 7,a7 ,the rate of primary cesarean deliveries and repeat cesarean deliveries4 7,b7 ,the rate of vaginal births after cesarean4 7,c7 ,the rate of vaginal breech births4 7,d7 ,the rate of induction of labor4 7,e7 ,the rate of freestanding birth center births4 7,f7 ,the rate of planned and unplanned home birth4 7,g7 ,the rate of attended births by provider1 including by an obstetrician-gynecologist1 family practice physician1 obstetrician-gynecologist physician assistant1 certified nurse-midwife1 certified midwife1 and certified professional midwife4 7,h7 ,the cost of maternity care disaggregated by place of birth and provider of care1 including-- 7i7 uncomplicated vaginal birth2 7ii7 complicated vaginal birth2 7iii7 uncomplicated cesarean birth2 and 7iv7 complicated cesarean birth4 7g7 ,authorization of appropriations ,there is authorized to be appropriated1 in addition to such amounts authorized to be appropriated under section #bbi7;e71 to carry out this section #a1jjj1jjj for each of the fiscal years #bjae through #bjai4 4 7b7 ,conforming amendments 7#a7 ,inclusion as duty of ,,hhs office on women's health ,section #bbi7;b7 of such ,act 7#db ,u4,s4,c4 #bcg;a7b771 as amended1 is amended-- 7,a7 in paragraph 7#g71 at the end1 by striking and2 7,b7 in paragraph 7#h71 at the end1 by striking the period and inserting 2 and2 and 7,c7 by adding at the end the following new paragraph3 7#i7 establish the ,interagency ,coordinating ,committee on the ,promotion of ,optimal ,maternity ,outcomes in accordance with section #bbi;,a4 4 7#b7 ,treatment of biennial reports ,section #bbi7;d7 of such ,act 7#db ,u4,s4,c4 #bcg;a7d77 is amended by inserting 7other than under subsection 7b77#i77 after under this section4 #eaf4 ,consumer education campaign ,section #bbi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bcg;a71 as amended1 is further amended in subsection 7b7-- 7#a7 in paragraph 7#h71 at the end1 by striking and2 7#b7 in paragraph 7#i71 at the end1 by striking the period and inserting 2 and2 and 7#c7 by adding at the end the following new paragraph3 7#aj7 not later than one year after the date of the enactment of the ,health ,equity and ,accountability ,act of #bjad1 develop and implement a #d-year culturally and linguistically appropriate multimedia consumer education campaign that is designed to promote understanding and acceptance of evidence-based maternity practices and models of care for optimal maternity outcomes among women of childbearing ages and families of such women and that-- 7,a7 highlights the importance of protecting1 promoting1 and supporting the innate capacities of childbearing women and their newborns for childbirth1 breastfeeding1 and attachment2 7,b7 promotes understanding of the importance of using obstetric interventions when medically necessary and when supported by strong1 high-quality evidence2 7,c7 highlights the widespread overuse of maternity practices that have been shown to have benefit when used appropriately in situations of medical necessity1 but which can expose women1 infants1 or both to risk of harm if used routinely and indiscriminately1 including continuous fetal monitoring1 labor induction1 epidural anesthesia1 elective primary cesarean section1 and repeat cesarean delivery2 7,d7 emphasizes the noninvasive maternity practices that have strong proven correlation or may be associated with considerable improvement in outcomes with no detrimental side effects1 and are significantly underused in the ,united ,states1 including smoking cessation programs in pregnancy1 group model prenatal care1 continuous labor support1 nonsupine positions for birth1 and external version to turn breech babies at term2 7,e7 educates consumers about the qualifications of licensed providers of maternity care and the best evidence about their safety1 satisfaction1 outcomes1 and costs2 7,f7 informs consumers about the best available research comparing birth center births1 planned home births1 and hospital births1 including information about each setting's safety1 satisfaction1 outcomes1 and costs2 7,g7 fosters participation in high-quality1 evidence-based childbirth education that promotes a natural1 healthy1 and safe approach to pregnancy1 childbirth1 and early parenting2 is taught by certified educators1 peer counselors1 and health professionals2 and promotes informed decisionmaking by childbearing women2 and 7,h7 is pilot tested for consumer comprehension1 cultural sensitivity1 and acceptance of the messages across geographically1 racially1 ethnically1 and linguistically diverse populations4 4 #eag4 ,bibliographic database of systematic reviews for care of childbearing women and newborns 7a7 ,in general ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 through the ,agency for ,healthcare ,research and ,quality1 shall-- 7#a7 make publicly available an online bibliographic database identifying systematic reviews1 including an explanation of the level and quality of evidence1 for care of childbearing women and newborns2 and 7#b7 initiate regular updates that incorporate newly issued and updated systematic reviews4 7b7 ,sources ,to aim for a comprehensive inventory of systematic reviews relevant to maternal and newborn care1 the database shall identify reviews from diverse sources1 including-- 7#a7 scientific peer-reviewed journals2 7#b7 databases1 including ,cochrane ,database of ,systematic ,reviews1 ,clinical ,evidence1 and ,database of ,abstracts of ,reviews of ,effects2 and 7#c7 ,internet ,web sites of agencies and organizations throughout the world that produce such systematic reviews4 7c7 ,features ,the database shall-- 7#a7 provide bibliographic citations for each record within the database1 and for each such citation include an explanation of the level and quality of evidence2 7#b7 include abstracts1 as available2 7#c7 provide reference to companion documents as may exist for each review1 such as evidence tables and guidelines or consumer educational materials developed from the review2 7#d7 provide links to the source of the full review and to any companion documents2 7#e7 provide links to the source of a previous version or update of the review2 7#f7 be searchable by intervention or other topic of the review1 reported outcomes1 author1 title1 and source2 and 7#g7 offer to users periodic electronic notification of database updates relating to users' topics of interest4 7d7 ,outreach ,not later than the first date the database is made publicly available and periodically thereafter1 the ,secretary of ,health and ,human ,services shall publicize the availability1 features1 and uses of the database under this section to the stakeholders described in subsection 7e74 7e7 ,consultation ,for purposes of developing the database under this section and maintaining and updating such database1 the ,secretary of ,health and ,human ,services shall convene and consult with an advisory committee composed of relevant stakeholders1 including-- 7#a7 ,federal ,medicaid administrators and ,state agencies administrating ,state plans under title ,,xix of the ,social ,security ,act pursuant to section #aijb7;a77#e7 of such ,act 7#db ,u4,s4,c4 #acif;a7a77#e772 7#b7 providers of maternity and newborn care from both academic and community-based settings1 including obstetrician-gynecologists1 family physicians1 certified nurse midwives1 certified midwives1 certified professional midwives1 physician assistants1 perinatal nurses1 pediatricians1 and nurse practitioners2 7#c7 maternal-fetal medicine specialists2 7#d7 neonatologists2 7#e7 childbearing women and advocates for such women1 including childbirth educators certified by a nationally accredited program1 representing communities that are diverse in terms of race1 ethnicity1 indigenous status1 and geographic area2 7#f7 employers and purchasers2 7#g7 health facility and system leaders1 including both hospital and birth center facilities2 7#h7 journalists2 and 7#i7 bibliographic informatics specialists4 7f7 ,authorization of appropriations ,there is authorized to be appropriated #b1ejj1jjj for each of the fiscal years #bjae through #bjag for the purpose of developing the database and such sums as may be necessary for each subsequent fiscal year for updating the database and providing outreach and notification to users1 as described in this section4 #eah4 ,maternity care health professional shortage areas ,section #ccb of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7 is amended by adding at the end the following new subsection3 7k7 7#a7 ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall designate maternity care health professional shortage areas in the ,states1 publish a descriptive list of the area's population groups1 medical facilities1 and other public facilities so designated1 and at least annually review and1 as necessary1 revise such designations4 7#b7 ,for purposes of paragraph 7#a71 a complete descriptive list shall be published in the ,federal ,register not later than one year after the date of the enactment of the ,health ,equity and ,accountability ,act of #bjad and annually thereafter4 7#c7 ,the provisions of subsections 7b71 7c71 7e71 7f71 7g71 7h71 7i71 and 7j7 7other than 7j77#a77;,b77 of this section shall apply to the designation of a maternity care health professional shortage area in a similar manner and extent as such provisions apply to the designation of health professional shortage areas1 except in applying subsection 7b77#c71 the reference in such subsection to physicians shall be deemed to be a reference to nationally certified and ,state licensed obstetricians1 family practice physicians who practice full-scope maternity care1 certified nurse midwives1 certified midwives1 certified professional midwives1 and physician's assistants who practice full scope maternity care4 7#d7 ,for purposes of this subsection1 the term maternity care health professional shortage area means-- 7,a7 an area in an urban or rural area 7which need not conform to the geographic boundaries of a political subdivision and which is a rational area for the delivery of health services7 which the ,secretary determines has a shortage of providers of maternity care health services including those referenced in paragraph 7#c7 or an urban or rural area that the ,secretary determines has lost a significant number of such providers during the #aj-year period beginning with #bjjd or has no obstetrical providers licensed to provide operative obstetrical services2 7,b7 an area in an urban or rural area 7which need not conform to the geographic boundaries of a political subdivision and which is a rational area for the delivery of health services7 which the ,secretary determines has a shortage of hospital or labor and delivery units1 hospital birth center units1 or freestanding birth centers or an area that lost a significant number of these units during the #aj-year period beginning with #bjjd2 or 7,c7 a population group which the ,secretary determines has such a shortage of providers or facilities4 4 #eai4 ,expansion of ,,cdc prevention research centers program to include centers on optimal maternity outcomes 7a7 ,in general ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 shall support the establishment of additional ,prevention ,research ,centers under the ,prevention ,research ,center ,program administered by the ,centers for ,disease ,control and ,prevention4 ,such additional centers shall each be known as a ,center for ,excellence on ,optimal ,maternity ,outcomes4 7b7 ,research ,each ,center for ,excellence on ,optimal ,maternity ,outcomes shall-- 7#a7 conduct at least one focused program of research to improve maternity outcomes1 including the reduction of cesarean birth rates1 elective inductions1 prematurity rates1 and low birth weight rates within an underserved population that has a disproportionately large burden of suboptimal maternity outcomes1 including maternal mortality and morbidity1 infant mortality1 prematurity1 or low birth weight2 7#b7 work with partners on special interest projects1 as specified by the ,centers for ,disease ,control and ,prevention and other relevant agencies within the ,department of ,health and ,human ,services1 and on projects funded by other sources2 and 7#c7 involve a minimum of two distinct birth setting models1 such as a hospital labor and delivery model and freestanding birth center model2 or a hospital labor and delivery model and planned home birth model4 7c7 ,interdisciplinary providers ,each ,center for ,excellence on ,optimal ,maternity ,outcomes shall include the following interdisciplinary providers of maternity care3 7#a7 ,obstetrician-gynecologists4 7#b7 ,at least two of the following providers3 7,a7 ,family practice physicians4 7,b7 ,nurse practitioners4 7,c7 ,physician assistants4 7,d7 ,certified professional midwives4 7d7 ,services ,research conducted by each ,center for ,excellence on ,optimal ,maternity ,outcomes shall include at least #b 7and preferably more7 of the following supportive provider services3 7#a7 ,mental health4 7#b7 ,doula labor support4 7#c7 ,nutrition education4 7#d7 ,childbirth education4 7#e7 ,social work4 7#f7 ,physical therapy or occupation therapy4 7#g7 ,substance abuse services4 7#h7 ,home visiting4 7e7 ,coordination ,the programs of research at each of the two ,centers of ,excellence on ,optimal ,maternity ,outcomes shall compliment and not replicate the work of the other4 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #b1jjj1jjj for each of the fiscal years #bjae through #bjai4 #ebj4 ,expanding models allowed to be tested by ,center for ,medicare and ,medicaid ,innovation to include maternity care models ,section #aaae;,a7b77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,b77 is amended by adding at the end the following new clause3 7xxi7 ,promoting evidence-based models of care that have been associated with reductions in maternal and infant health disparities1 including incorporating the use of doula and promotoras support for pregnant and childbearing women into evidence-based models of prenatal care1 labor and delivery1 and postpartum care1 and supporting the appropriate use of out-of-hospital birth models1 including births at home and in freestanding birth centers4 4 #eba4 ,development of interprofessional maternity care educational models and tools 7a7 ,in general ,not later than #f months after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 acting in conjunction with the ,administrator of ,health ,resources and ,services ,administration1 shall convene1 for a #a-year period1 an ,interprofessional ,maternity ,provider ,education ,commission to discuss and make recommendations for-- 7#a7 a consensus standard physiologic maternity care curriculum that takes into account the core competencies for basic midwifery practice such as those developed by the ,american ,college of ,nurse ,midwives and the ,north ,american ,registry of ,midwives1 and the educational objectives for physicians practicing in obstetrics and gynecology as determined by the ,council on ,resident ,education in ,obstetrics and ,gynecology2 7#b7 suggestions for multidisciplinary use of the consensus physiologic curriculum2 7#c7 strategies to integrate and coordinate education across maternity care disciplines1 including recommendations to increase medical and midwifery student exposure to out-of-hospital birth2 and 7#d7 pilot demonstrations of interprofessional educational models4 7b7 ,participants ,the ,commission shall include maternity care educators1 curriculum developers1 service leaders1 certification leaders1 and accreditation leaders from the various professions that provide maternity care in this country4 ,such professions shall include obstetrician gynecologists1 certified nurse midwives or certified midwives1 family practice physicians1 nurse practitioners1 physician assistants1 certified professional midwives1 and perinatal nurses4 ,additionally1 the ,commission shall include representation from maternity care consumer advocates4 7c7 ,curriculum ,the consensus standard physiologic maternity care curriculum described in subsection 7a77#a7 shall-- 7#a7 have a public health focus with a foundation in health promotion and disease prevention2 7#b7 foster physiologic childbearing and woman and family centered care2 7#c7 integrate strategies to reduce maternal and infant morbidity and mortality2 7#d7 incorporate recommendations to ensure respectful1 safe1 and seamless consultation1 referral1 transport1 and transfer of care when necessary2 and 7#e7 include cultural sensitivity and strategies to decrease disparities in maternity outcomes4 7d7 ,report ,not later than #f months after the final meeting of the ,commission1 the ,secretary of ,health and ,human ,services shall-- 7#a7 submit to ,congress a report containing the recommendations made by the ,commission under this section2 and 7#b7 make such report publicly available4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #a1jjj1jjj for each of the fiscal years #bjae and #bjaf1 and such sums as are necessary for each of the fiscal years #bjag through #bjai4 #ebb4 ,including within inpatient hospital services under ,medicare services furnished by certain students1 interns1 and residents supervised by certified nurse midwives 7a7 ,in general ,section #ahfa7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7b77 is amended-- 7#a7 in paragraph 7#f71 by striking 2 or and inserting 1 or in the case of services in a hospital or osteopathic hospital by a student midwife or an intern or resident-in-training under a teaching program previously described in this paragraph who is in the field of obstetrics and gynecology1 if such student midwife1 intern1 or resident-in-training is supervised by a certified nurse-midwife to the extent permitted under applicable ,state law and as may be authorized by the hospital22 7#b7 in paragraph 7#g71 by striking the period at the end and inserting 2 or2 and 7#c7 by adding at the end the following new paragraph3 7#h7 a certified nurse-midwife where the hospital has a teaching program approved as specified in paragraph 7#f71 if 7,a7 the hospital elects to receive any payment due under this title for reasonable costs of such services1 and 7,b7 all certified nurse-midwives in such hospital agree not to bill charges for professional services rendered in such hospital to individuals covered under the insurance program established by this title4 4 7b7 ,effective date ,the amendments made by subsection 7a7 shall apply to services furnished on or after the date of the enactment of this ,act4 #ebc4 ,grants to professional organizations to increase diversity in maternity care professionals 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 through the ,administrator of the ,health ,resources and ,services ,administration1 shall carry out a grant program under which the ,secretary may make to eligible health professional organizations-- 7#a7 for fiscal year #bjae1 planning grants described in subsection 7b72 and 7#b7 for the subsequent #d-year period1 implementation grants described in subsection 7c74 7b7 ,planning grants 7#a7 ,in general ,planning grants described in this subsection are grants for the following purposes3 7,a7 ,to collect data and identify any workforce disparities1 with respect to a health profession1 at each of the following areas along the health professional continuum3 7i7 ,pipeline availability with respect to students at the high school and college or university levels considering and working toward entrance in the profession4 7ii7 ,entrance into the training program for the profession4 7iii7 ,graduation from such training program4 7iv7 ,entrance into practice4 7v7 ,retention in practice for more than a #e-year period4 7,b7 ,to develop one or more strategies to address the workforce disparities within the health profession1 as identified under 7and in response to the findings pursuant to7 subparagraph 7,a74 7#b7 ,application ,to be eligible to receive a grant under this subsection1 an eligible health professional organization shall submit to the ,secretary of ,health and ,human ,services an application in such form and manner and containing such information as specified by the ,secretary4 7#c7 ,amount ,each grant awarded under this subsection shall be for an amount not to exceed #cjj1jjj4 7#d7 ,report ,each recipient of a grant under this subsection shall submit to the ,secretary of ,health and ,human ,services a report containing-- 7,a7 information on the extent and distribution of workforce disparities identified through the grant2 and 7,b7 reasonable objectives and strategies developed to address such disparities within a #e-1 #aj-1 and #be-year period4 7c7 ,implementation grants 7#a7 ,in general ,implementation grants described in this subsection are grants to implement one or more of the strategies developed pursuant to a planning grant awarded under subsection 7b74 7#b7 ,application ,to be eligible to receive a grant under this subsection1 an eligible health professional organization shall submit to the ,secretary of ,health and ,human ,services an application in such form and manner as specified by the ,secretary4 ,each such application shall contain information on the capability of the organization to carry out a strategy described in paragraph 7#a71 involvement of partners or coalitions1 plans for developing sustainability of the efforts after the culmination of the grant cycle1 and any other information specified by the ,secretary4 7#c7 ,amount ,each grant awarded under this subsection shall be for an amount not to exceed #ejj1jjj each year during the #d-year period of the grant4 7#d7 ,reports ,for each of the first #c years for which an eligible health professional organization is awarded a grant under this subsection1 the organization shall submit to the ,secretary of ,health and ,human ,services a report on the activities carried out by such organization through the grant during such year and objectives for the subsequent year4 ,for the fourth year for which an eligible health professional organization is awarded a grant under this subsection1 the organization shall submit to the ,secretary a report that includes an analysis of all the activities carried out by the organization through the grant and a detailed plan for continuation of out-reach efforts4 7d7 ,eligible health professional organization defined ,for purposes of this section1 the term eligible health professional organization means a professional organization representing obstetrician-gynecologists1 certified nurse midwives1 certified midwives1 family practice physicians1 nurse practitioners whose scope of practice includes maternity care1 physician assistants whose scope of practice includes obstetrical care1 or certified professional midwives4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #b1jjj1jjj for fiscal year #bjae and #c1jjj1jjj for each of the fiscal years #bjaf through #bjai4 ,,vi ,,mental ,,health #fja4 ,coverage of marriage and family therapist services1 mental health counselor services1 and substance abuse counselor services under part ,b of the ,medicare program 7a7 ,coverage of ,services 7#a7 ,in general ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is amended-- 7,a7 in subparagraph 7,,ee71 by striking and at the end2 7,b7 in subparagraph 7,,ff71 by inserting and at the end2 and 7,c7 by adding at the end the following new subparagraph3 7,,gg7 marriage and family therapist services 7as defined in subsection 7kkk77#a77 and mental health counselor services 7as defined in subsection 7kkk77#c77 and substance abuse counselor services 7as defined in subsection 7kkk77#e772 4 7#b7 ,definitions ,section #ahfa of such ,act 7#db ,u4,s4,c4 #aciex71 as amended by sections #bjb7;b77#a77;,a7 and #dbc7;a71 is amended by adding at the end the following new subsection3 7kkk7 ,marriage and ,family ,therapist ,services2 ,marriage and ,family ,therapist2 ,mental ,health ,counselor ,services2 ,mental ,health ,counselor 7#a7 ,the term marriage and family therapist services means services performed by a marriage and family therapist 7as defined in paragraph 7#b77 for the diagnosis and treatment of mental illnesses1 which the marriage and family therapist is legally authorized to perform under ,state law 7or the ,state regulatory mechanism provided by ,state law7 of the ,state in which such services are performed1 as would otherwise be covered if furnished by a physician or as an incident to a physician's professional service1 but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services4 7#b7 ,the term marriage and family therapist means an individual who-- 7,a7 possesses a master's or doctoral degree which qualifies for licensure or certification as a marriage and family therapist pursuant to ,state law2 7,b7 after obtaining such degree has performed at least #b years of clinical supervised experience in marriage and family therapy2 and 7,c7 in the case of an individual performing services in a ,state that provides for licensure or certification of marriage and family therapists1 is licensed or certified as a marriage and family therapist in such ,state4 7#c7 ,the term mental health counselor services means services performed by a mental health counselor 7as defined in paragraph 7#d77 for the diagnosis and treatment of mental illnesses which the mental health counselor is legally authorized to perform under ,state law 7or the ,state regulatory mechanism provided by the ,state law7 of the ,state in which such services are performed1 as would otherwise be covered if furnished by a physician or as incident to a physician's professional service1 but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services4 7#d7 ,the term mental health counselor means an individual who-- 7,a7 possesses a master's or doctor's degree in mental health counseling or a related field2 7,b7 after obtaining such a degree has performed at least #b years of supervised mental health counselor practice2 and 7,c7 in the case of an individual performing services in a ,state that provides for licensure or certification of mental health counselors or professional counselors1 is licensed or certified as a mental health counselor or professional counselor in such ,state4 7#e7 ,the term substance abuse counselor services means services performed by a substance abuse counselor 7as defined in paragraph 7#f77 for the diagnosis and treatment of substance abuse and addiction which the substance abuse counselor is legally authorized to perform under ,state law 7or the ,state regulatory mechanism provided by the ,state law7 of the ,state in which such services are performed1 as would otherwise be covered if furnished by a physician or as incident to a physician's professional service1 but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services4 7#f7 ,the term substance abuse counselor means an individual who-- 7,a7 has performed at least #b years of supervised substance abuse counselor practice2 7,b7 in the case of an individual performing services in a ,state that provides for licensure or certification of substance abuse counselors or professional counselors1 is licensed or certified as a substance abuse counselor or professional counselor in such ,state2 or 7,c7 the individual is a drug and alcohol counselor as defined in section #dj4bha of title #di1 ,code of ,federal ,regulations4 4 7#c7 ,provision for payment under part ,b ,section #ahcb7;a77#b77;,b7 of such ,act 7#db ,u4,s4,c4 #aciek7a77#b77;,b77 is amended by adding at the end the following new clause3 7v7 marriage and family therapist services1 mental health counselor services1 and substance abuse counselor services2 4 7#d7 ,amount of payment ,section #ahcc7;a77#a7 of such ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7,a7 by striking and 7,z7 and inserting 7,z72 and 7,b7 by inserting before the semicolon at the end the following3 1 and 7,,aa7 with respect to marriage and family therapist services1 mental health counselor services1 and substance abuse counselor services under section #ahfa7s77#b77;,,gg71 the amounts paid shall be #hj percent of the lesser of the actual charge for the services or #ge percent of the amount determined for payment of a psychologist under subparagraph 7,l74 7#e7 ,exclusion of marriage and family therapist services and mental health counselor services from skilled nursing facility prospective payment system ,section #ahhh7;e77#b77;,a77ii7 of such ,act 7#db ,u4,s4,c4 #acieyy7e77#b77;,a77ii77 is amended by inserting marriage and family therapist services 7as defined in section #ahfa7kkk77#a771 mental health counselor services 7as defined in section #ahfa7kkk77#c771 after qualified psychologist services14 7#f7 ,inclusion of marriage and family therapists1 mental health counselors1 and substance abuse counselors as practitioners for assignment of claims ,section #ahdb7;b77#ah77;,c7 of such ,act 7#db ,u4,s4,c4 #acieu7b77#ah77;,c77 is amended by adding at the end the following new clauses3 7vii7 ,a marriage and family therapist 7as defined in section #ahfa7kkk77#b774 7viii7 ,a mental health counselor 7as defined in section #ahfa7kkk77#d774 7ix7 ,a substance abuse counselor 7as defined in section #ahfa 7kkk77#f774 4 7b7 ,coverage of ,certain ,mental ,health ,services ,provided in ,certain ,settings 7#a7 ,rural health clinics and federally qualified health centers ,section #ahfa7;aa77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#a77;,b77 is amended by striking or by a clinical social worker 7as defined in subsection 7hh77#a771 and inserting 1 by a clinical social worker 7as defined in subsection 7hh77#a771 by a marriage and family therapist 7as defined in subsection 7kkk77#b771 or by a mental health counselor 7as defined in subsection 7kkk77#d771 or by a substance abuse counselor 7as defined in section #ahfa 7kkk77#f7744 7#b7 ,hospice programs ,section #ahfa7;dd77#b77;,b77i77,,iii7 of such ,act 7#db ,u4,s4,c4 #aciex7dd77#b77;,b77i77,,iii77 is amended by inserting or one marriage and family therapist 7as defined in subsection 7kkk77#b77 after social worker4 7c7 ,authorization of ,marriage and ,family ,therapists ,to ,develop ,discharge ,plans for ,post-,hospital ,services ,section #ahfa7;ee77#b77;,g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ee77#b77;,g77 is amended by inserting marriage and family therapist 7as defined in subsection 7kkk77#b771 after social worker14 7d7 ,effective ,date ,the amendments made by this section shall apply with respect to services furnished on or after ,january #a1 #bjae4 #fjb4 ,minority ,fellowship ,program ,title ,v of the ,public ,health ,service ,act is amended by inserting after section #ejf;,b of such ,act 7#db ,u4,s4,c4 #bij;aa-#e;b7 the following3 #ejf;,c4 ,minority ,fellowship ,program 7a7 ,fellowships ,the ,administrator shall maintain a program1 to be known as the ,minority ,fellowship ,program1 under which the ,administrator awards grants or contracts to national associations or other appropriate entities for the financial support of graduate students1 postdoctoral fellows1 and residents in the professions of psychology1 psychiatry1 social work1 psychiatric advance-practice nursing1 marriage and family therapy1 and professional counseling to students who demonstrate a commitment to clinical or research careers focused on racial and ethnic minority populations4 7b7 ,term of financial support ,financial support provided to an individual pursuant to subsection 7a7 shall be for a term of not more than #ab months and may be renewed thereafter4 7c7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #aj1jjj1jjj for each of fiscal years #bjae through #bjai4 4 #fjc4 ,integrated ,health ,care ,demonstration ,program ,part ,d of title ,v of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;dd et seq47 is amended by adding at the end the following3 #edd4 ,interprofessional health care teams for provision of behavioral health care in primary care settings 7a7 ,grants ,the ,secretary1 acting through the ,deputy ,assistant ,secretary for ,minority ,health1 shall award grants to eligible entities for the purpose of providing technical assistance and training regarding the effective development and implementation of integrated interprofessional health care teams that provide behavioral health care4 7b7 ,eligible entities ,to be eligible to receive a grant under this section1 an entity shall be a federally qualified health center 7as defined in section #ahfa7;aa7 of the ,social ,security ,act7 serving a high proportion of individuals from racial and ethnic minority groups 7as defined in section #agjg7;g774 7c7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #bj1jjj1jjj for each of fiscal years #bjad through #bjaf4 4 #fjd4 ,addressing racial and ethnic minority mental health disparities research gaps ,not later than #f months after the date of the enactment of this ,act1 the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities shall enter into an arrangement with the ,institute of ,medicine 7or1 if the ,institute declines to enter into such an arrangement1 another appropriate entity7-- 7#a7 to conduct a study with respect to mental and behavioral health disparities in racial and ethnic minority groups 7as defined in section #agjg7;g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g772 and 7#b7 to submit to the ,congress a report on the results of such study1 including-- 7,a7 a compilation of information on the dynamics of mental disorders in such racial and ethnic minority groups2 7,b7 an identification of gaps in knowledge and research needs2 and 7,c7 recommendations for an interprofessional research agenda at the ,national ,institutes of ,health aimed at reducing and ultimately eliminating mental and behavioral health disparities in such racial and ethnic minority groups4 #fje4 ,health professions competencies to address racial and ethnic minority mental health disparities 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration1 shall award grants to qualified national organizations for the purpose of developing1 and disseminating to health professional educational programs1 curricula or core competencies addressing mental health disparities among racial and ethnic minority groups4 7b7 ,use of funds ,organizations receiving funds under subsection 7a7 shall use the funds to develop and disseminate curricula or core competencies1 as described in such subsection1 for use in the training of students in the professions of social work1 psychology1 psychiatry1 marriage and family therapy1 mental health counseling1 and substance abuse counseling4 7c7 ,allowable activities ,organizations receiving funds under subsection 7a7 may use the funds to engage in the following activities related to the development and dissemination of curricula or core competencies3 7#a7 ,formation of committees or working groups comprised of experts from accredited health professions schools to identify core competencies relating to mental health disparities among racial and ethnic minority groups4 7#b7 ,planning of workshops in national fora to allow for public input into the educational needs associated with mental health disparities among racial and ethnic minority groups4 7#c7 ,dissemination and promotion of the use of curricula or core competencies in undergraduate and graduate health professions training programs nationwide4 7d7 ,definitions ,in this section3 7#a7 ,the term qualified national organization means a national organization that focuses on the education of students in programs of social work1 psychology1 psychiatry1 and marriage and family therapy4 7#b7 ,the term racial and ethnic minority group has the meaning given to such term in section #agjg7;g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g774 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjad through #bjah4 ,,vii ,,addressing ,,high ,,impact ,,minority ,,diseases ,a ,cancer #gja4 ,lung cancer mortality reduction 7a7 ,short title ,this section may be cited as the ,lung ,cancer ,mortality ,reduction ,act of #bjad4 7b7 ,findings ,congress makes the following findings3 7#a7 ,lung cancer is the leading cause of cancer death for both men and women1 accounting for #bh percent of all cancer deaths4 7#b7 ,lung cancer kills more people annually than breast cancer1 prostate cancer1 colon cancer1 liver cancer1 melanoma1 and kidney cancer combined4 7#c7 ,since the ,national ,cancer ,act of #aiga 7,public ,law #ib-bah2 #he ,stat4 #ggh71 coordinated and comprehensive research has raised the #e-year survival rates for breast cancer to #hh percent1 for prostate cancer to #ii percent1 and for colon cancer to #fd percent4 7#d7 ,however1 the #e-year survival rate for lung cancer is still only #ae percent and a similar coordinated and comprehensive research effort is required to achieve increases in lung cancer survivability rates4 7#e7 ,sixty percent of lung cancer cases are now diagnosed nonsmokers or former smokers4 7#f7 ,two-thirds of nonsmokers diagnosed with lung cancer are women4 7#g7 ,certain minority populations1 such as ,african-,american males1 have disproportionately high rates of lung cancer incidence and mortality1 notwithstanding their similar smoking rate4 7#h7 ,members of the baby boomer generation are entering their sixties1 the most common age at which people develop lung cancer4 7#i7 ,tobacco addiction and exposure to other lung cancer carcinogens such as ,agent ,orange and other herbicides and battlefield emissions are serious problems among military personnel and war veterans4 7#aj7 ,significant and rapid improvements in lung cancer mortality can be expected through greater use and access to lung cancer screening tests for at-risk individuals4 7#aa7 ,additional strategies are necessary to further enhance the existing tests and therapies available to diagnose and treat lung cancer in the future4 7#ab7 ,the ,august #bjja ,report of the ,lung ,cancer ,progress ,review ,group of the ,national ,cancer ,institute stated that funding for lung cancer research was far below the levels characterized for other common malignancies and far out of proportion to its massive health impact4 7#ac7 ,the ,report of the ,lung ,cancer ,progress ,review ,group identified as its highest priority the creation of integrated1 multidisciplinary1 multi-institutional research consortia organized around the problem of lung cancer rather than around specific research disciplines4 7#ad7 ,the ,united ,states must enhance its response to the issues raised in the ,report of the ,lung ,cancer ,progress ,review ,group1 and this can be accomplished through the establishment of a coordinated effort designed to reduce the lung cancer mortality rate by #ej percent by #bjae and targeted funding to support this coordinated effort4 7c7 ,sense of ,congress concerning investment in lung cancer research ,it is the sense of the ,congress that-- 7#a7 lung cancer mortality reduction should be made a national public health priority2 and 7#b7 a comprehensive mortality reduction program coordinated by the ,secretary of ,health and ,human ,services is justified and necessary to adequately address and reduce lung cancer mortality4 7d7 ,lung ,cancer ,mortality ,reduction ,program 7#a7 ,in ,general ,subpart #a of part ,c of title ,,iv of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe et seq47 is amended by adding at the end the following3 #dag;,h4 ,lung ,cancer ,mortality ,reduction ,program 7a7 ,in ,general ,not later than #f months after the date of the enactment of this section1 the ,secretary1 in consultation with the ,secretary of ,defense1 the ,secretary of ,veterans ,affairs1 the ,director of the ,national ,institutes of ,health1 the ,director of the ,centers for ,disease ,control and ,prevention1 the ,commissioner of ,food and ,drugs1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities1 and other members of the ,lung ,cancer ,advisory ,board established under section #gja of the ,health ,equity and ,accountability ,act of #bjad1 shall implement a comprehensive program1 to be known as the ,lung ,cancer ,mortality ,reduction ,program1 to achieve a reduction of at least #be percent in the mortality rate of lung cancer by #bjbj4 7b7 ,requirements ,the ,program shall include at least the following3 7#a7 ,with respect to the ,national ,institutes of ,health-- 7,a7 a strategic review and prioritization by the ,national ,cancer ,institute of research grants to achieve the goal of the ,lung ,cancer ,mortality ,reduction ,program in reducing lung cancer mortality2 7,b7 the provision of funds to enable the ,airway ,biology and ,disease ,branch of the ,national ,heart1 ,lung1 and ,blood ,institute to expand its research programs to include predispositions to lung cancer1 the interrelationship between lung cancer and other pulmonary and cardiac disease1 and the diagnosis and treatment of these interrelationships2 7,c7 the provision of funds to enable the ,national ,institute of ,biomedical ,imaging and ,bioengineering to expedite the development of computer-assisted diagnostic1 surgical1 treatment1 and drug-testing innovations to reduce lung cancer mortality1 such as through expansion of the ,institute's ,quantum ,grant ,program and ,image-,guided ,interventions programs2 and 7,d7 the provision of funds to enable the ,national ,institute of ,environmental ,health ,sciences to implement research programs relative to the lung cancer incidence4 7#b7 ,with respect to the ,food and ,drug ,administration-- 7,a7 activities under section #ecj of the ,federal ,food1 ,drug1 and ,cosmetic ,act2 and 7,b7 activities under section #efa of the ,federal ,food1 ,drug1 and ,cosmetic ,act to expand access to investigational drugs and devices for the diagnosis1 monitoring1 or treatment of lung cancer4 7#c7 ,with respect to the ,centers for ,disease ,control and ,prevention1 the establishment of an early disease research and management program under section #aeaa4 7#d7 ,with respect to the ,agency for ,healthcare ,research and ,quality1 the conduct of a biannual review of lung cancer screening1 diagnostic1 and treatment protocols1 and the issuance of updated guidelines4 7#e7 ,the cooperation and coordination of all minority and health disparity programs within the ,department of ,health and ,human ,services to ensure that all aspects of the ,lung ,cancer ,mortality ,reduction ,program under this section adequately address the burden of lung cancer on minority and rural populations4 7#f7 ,the cooperation and coordination of all tobacco control and cessation programs within agencies of the ,department of ,health and ,human ,services to achieve the goals of the ,lung ,cancer ,mortality ,reduction ,program under this section with particular emphasis on the coordination of drug and other cessation treatments with early detection protocols4 4 7#b7 ,federal ,food1 ,drug1 and ,cosmetic ,act ,subchapter ,b of chapter ,v of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cfj;aaa et seq47 is amended by adding at the end the following3 #ecj4 ,drugs relating to lung cancer 7a7 ,in general ,the provisions of this subchapter shall apply to a drug described in subsection 7b7 to the same extent and in the same manner as such provisions apply to a drug for a rare disease or condition4 7b7 ,qualified drugs ,a drug described in this subsection is-- 7#a7 a chemoprevention drug for precancerous conditions of the lung2 7#b7 a drug for targeted therapeutic treatments1 including any vaccine1 for lung cancer2 and 7#c7 a drug to curtail or prevent nicotine addiction4 7c7 ,board ,the ,board established under the ,health ,equity and ,accountability ,act of #bjad shall monitor the program implemented under this section4 4 7#c7 ,access to ,unapproved ,therapies ,section #efa7;e7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cfj;bbb7e77 is amended by inserting before the period the following3 and shall include expanding access to drugs under section #ecj1 with substantial consideration being given to whether the totality of information available to the ,secretary regarding the safety and effectiveness of an investigational drug1 as compared to the risk of morbidity and death from the disease1 indicates that a patient may obtain more benefit than risk if treated with the drug4 7#d7 ,,cdc ,title ,,xv of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjk et seq47 is amended by adding at the end the following3 #aeaa4 ,early disease research and management program ,the ,secretary shall establish and implement an early disease research and management program targeted at the high incidence and mortality rates of lung cancer among minority and low-income populations4 4 7e7 ,department of defense and the department of veterans affairs ,the ,secretary of ,defense and the ,secretary of ,veterans ,affairs shall coordinate with the ,secretary of ,health and ,human ,services-- 7#a7 in the development of the ,lung ,cancer ,mortality ,reduction ,program under section #dag;,h2 7#b7 in the implementation within the ,department of ,defense and the ,department of ,veterans ,affairs of an early detection and disease management research program for military personnel and veterans whose smoking history and exposure to carcinogens during active duty service has increased their risk for lung cancer2 and 7#c7 in the implementation of coordinated care programs for military personnel and veterans diagnosed with lung cancer4 7f7 ,lung cancer advisory board 7#a7 ,in ,general ,the ,secretary of ,health and ,human ,services shall convene a ,lung ,cancer ,advisory ,board 7referred to in this section as the ,board7-- 7,a7 to monitor the programs established under this section 7and the amendments made by this section72 and 7,b7 to provide annual reports to the ,congress concerning benchmarks1 expenditures1 lung cancer statistics1 and the public health impact of such programs4 7#b7 ,composition ,the ,board shall be composed of-- 7,a7 the ,secretary of ,health and ,human ,services2 7,b7 the ,secretary of ,defense2 7,c7 the ,secretary of ,veterans ,affairs2 and 7,d7 two representatives each from the fields of clinical medicine focused on lung cancer1 lung cancer research1 imaging1 drug development1 and lung cancer advocacy1 to be appointed by the ,secretary of ,health and ,human ,services4 7g7 ,authorization of appropriations 7#a7 ,in general ,to carry out this section 7and the amendments made by this section71 there are authorized to be appropriated such sums as may be necessary for each of fiscal years #bjae through #bjai4 7#b7 ,lung ,cancer ,mortality ,reduction ,program ,of the amounts authorized to be appropriated by subsection 7a71 there are authorized to be appropriated-- 7,a7 #be1jjj1jjj for fiscal year #bjae1 and such sums as may be necessary for each of fiscal years #bjaf through #bjai1 for the activities described in section #dag;,h7b77#a77;,b7 of the ,public ,health ,service ,act1 as added by subsection 7d77#a72 7,b7 #be1jjj1jjj for fiscal year #bjae1 and such sums as may be necessary for each of fiscal years #bjaf through #bjai1 for the activities described in section #dag;,h7b77#a77;,c7 of such ,act2 7,c7 #aj1jjj1jjj for fiscal year #bjae1 and such sums as may be necessary for each of fiscal years #bjaf through #bjai1 for the activities described in section #dag;,h7b77#a77;,d7 of such ,act2 and 7,d7 #ae1jjj1jjj for fiscal year #bjae1 and such sums as may be necessary for each of fiscal years #bjaf through #bjai1 for the activities described in section #dag;,h7b77#c7 of such ,act4 #gjb4 ,expanding prostate cancer research1 outreach1 screening1 testing1 access1 and treatment effectiveness 7a7 ,short ,title ,this section may be cited as the ,prostate ,research1 ,outreach1 ,screening1 ,testing1 ,access1 and ,treatment ,effectiveness ,act of #bjad or the ,,prostate ,act4 7b7 ,findings ,congress makes the following findings3 7#a7 ,prostate cancer is the second leading cause of cancer death among men4 7#b7 ,in #bjaj1 more than #bag1gcj new patients were diagnosed with prostate cancer and more than #cb1jjj men died from this disease4 7#c7 ,roughly #b1jjj1jjj ,americans are living with a diagnosis of prostate cancer and its consequences4 7#d7 ,while prostate cancer generally affects older individuals1 younger men are also at risk for the disease1 and when prostate cancer appears in early middle age it frequently takes on a more aggressive form4 7#e7 ,there are significant racial and ethnic disparities that demand attention1 namely ,african-,americans have prostate cancer mortality rates that are more than double those in the ,white population4 7#f7 ,underserved rural populations have higher rates of mortality compared to their urban counterparts1 and innovative and cost-efficient methods to improve rural access to high quality care should take advantage of advances in telehealth to diagnose and treat prostate cancer when appropriate4 7#g7 ,certain veterans populations may have nearly twice the incidence of prostate cancer as the general population of the ,united ,states4 7#h7 ,urologists may constitute the specialists who diagnose and treat the vast majority of prostate cancer patients4 7#i7 ,although much basic and translational research has been completed and much is currently known1 there are still many unanswered questions4 ,for example1 it is not fully understood how much of known disparities are attributable to disease etiology1 access to care1 or education and awareness in the community4 7#aj7 ,causes of prostate cancer are not known4 ,there is not good information regarding how to differentiate accurately1 early on1 between aggressive and indolent forms of the disease4 ,as a result1 there is significant overtreatment in prostate cancer4 ,there are no treatments that can durably arrest growth or cure prostate cancer once it has metastasized4 7#aa7 ,a significant proportion 7roughly #bc to #ed percent7 of cases may be clinically indolent and overdiagnosed1 resulting in significant overtreatment4 ,more accurate tests will allow men and their families to face less physical1 psychological1 financial1 and emotional trauma and billions of dollars could be saved in private and public health care systems in an area that has been identified by the ,medicare ,program as one of eight high-volume1 high-cost areas in the ,resource ,utilization ,report ,program authorized by ,congress under the ,medicare ,improvements for ,patients and ,providers ,act of #bjjh4 7#ab7 ,prostate cancer research and health care programs across ,federal agencies should be coordinated to improve accountability and actively encourage the translation of research into practice1 to identify and implement best practices1 in order to foster an integrated and consistent focus on effective prevention1 diagnosis1 and treatment of this disease4 7c7 ,prostate cancer coordination and education 7#a7 ,interagency prostate cancer coordination and education task force ,not later than #ahj days after the date of the enactment of this section1 the ,secretary of ,veterans ,affairs1 in cooperation with the ,secretary of ,defense and the ,secretary of ,health and ,human ,services1 shall establish an ,interagency ,prostate ,cancer ,coordination and ,education ,task ,force 7in this section referred to as the ,prostate ,cancer ,task ,force74 7#b7 ,duties ,the ,prostate ,cancer ,task ,force shall-- 7,a7 develop a summary of advances in prostate cancer research supported or conducted by ,federal agencies relevant to the diagnosis1 prevention1 and treatment of prostate cancer1 including psychosocial impairments related to prostate cancer treatment1 and compile a list of best practices that warrant broader adoption in health care programs2 7,b7 consider establishing1 and advocating for1 a guidance to enable physicians to allow screening of men who are over age #gd1 on a case-by-case basis1 taking into account quality of life and family history of prostate cancer2 7,c7 share and coordinate information on ,federal research and health care program activities1 including activities related to-- 7i7 determining how to improve research and health care programs1 including psychosocial impairments related to prostate cancer treatment2 7ii7 identifying any gaps in the overall research inventory and in health care programs2 7iii7 identifying opportunities to promote translation of research into practice2 and 7iv7 maximizing the effects of ,federal efforts by identifying opportunities for collaboration and leveraging of resources in research and health care programs that serve those susceptible to or diagnosed with prostate cancer2 7,d7 develop a comprehensive interagency strategy and advise relevant ,federal agencies in the solicitation of proposals for collaborative1 multidisciplinary research and health care programs1 including proposals to evaluate factors that may be related to the etiology of prostate cancer1 that would-- 7i7 result in innovative approaches to study emerging scientific opportunities or eliminate knowledge gaps in research to improve the prostate cancer research portfolio of the ,federal ,government2 7ii7 outline key research questions1 methodologies1 and knowledge gaps2 and 7iii7 ensure consistent action1 as outlined by section #djb7;b7 of the ,public ,health ,service ,act2 7,e7 develop a coordinated message related to screening and treatment for prostate cancer to be reflected in educational and beneficiary materials for ,federal health programs as such documents are updated2 and 7,f7 not later than #b years after the date of the establishment of the ,prostate ,cancer ,task ,force1 submit to the ,expert ,advisory ,panel to be reviewed and returned within #cj days1 and then within #ij days submitted to ,congress recommendations-- 7i7 regarding any appropriate changes to research and health care programs1 including recommendations to improve the research portfolio of the ,department of ,veterans ,affairs1 ,department of ,defense1 ,national ,institutes of ,health1 and other ,federal agencies to ensure that scientifically based strategic planning is implemented in support of research and health care program priorities2 7ii7 designed to ensure that the research and health care programs and activities of the ,department of ,veterans ,affairs1 the ,department of ,defense1 the ,department of ,health and ,human ,services1 and other ,federal agencies are free of unnecessary duplication2 7iii7 regarding public participation in decisions relating to prostate cancer research and health care programs to increase the involvement of patient advocates1 community organizations1 and medical associations representing a broad geographical area2 7iv7 on how to best disseminate information on prostate cancer research and progress achieved by health care programs2 7v7 about how to expand partnerships between public entities1 including ,federal agencies1 and private entities to encourage collaborative1 cross-cutting research and health care delivery2 7vi7 assessing any cost savings and efficiencies realized through the efforts identified and supported in this section and recommending expansion of those efforts that have proved most promising while also ensuring against any conflicts in directives from other congressional or statutory mandates or enabling statutes2 7vii7 identifying key priority action items from among the recommendations2 and 7viii7 with respect to the level of funding needed by each agency to implement the recommendations contained in the report4 7#c7 ,members of the ,prostate ,cancer ,task ,force ,the ,prostate ,cancer ,task ,force described in subsection 7a7 shall be composed of representatives from such ,federal agencies1 as each ,secretary determines necessary1 to coordinate a uniform message relating to prostate cancer screening and treatment where appropriate1 including representatives of the following3 7,a7 ,the ,department of ,veterans ,affairs1 including representatives of each relevant program areas of the ,department of ,veterans ,affairs4 7,b7 ,the ,prostate ,cancer ,research ,program of the ,congressionally ,directed ,medical ,research ,program of the ,department of ,defense4 7,c7 ,the ,department of ,health and ,human ,services1 including at a minimum representatives of the following3 7i7 ,the ,national ,institutes of ,health4 7ii7 ,national research institutes and centers1 including the ,national ,cancer ,institute1 the ,national ,institute of ,allergy and ,infectious ,diseases1 and the ,office of ,minority ,health4 7iii7 ,the ,centers for ,medicare ,medicaid ,services4 7iv7 ,the ,food and ,drug ,administration4 7v7 ,the ,centers for ,disease ,control and ,prevention4 7vi7 ,the ,agency for ,healthcare ,research and ,quality4 7vii7 ,the ,health ,resources and ,services ,administration4 7#d7 ,appointing expert advisory panels ,the ,prostate ,cancer ,task ,force shall appoint expert advisory panels1 as determined appropriate1 to provide input and concurrence from individuals and organizations from the medical1 prostate cancer patient and advocate1 research1 and delivery communities with expertise in prostate cancer diagnosis1 treatment1 and research1 including practicing urologists1 primary care providers1 and others and individuals with expertise in education and outreach to underserved populations affected by prostate cancer4 7#e7 ,meetings ,the ,prostate ,cancer ,task ,force shall convene not less than twice a year1 or more frequently as the ,secretary determines to be appropriate4 7#f7 ,submission of recommendations to ,congress ,the ,secretary of ,veterans ,affairs shall submit to ,congress any recommendations submitted to the ,secretary under paragraph 7#b77;,e74 7#g7 ,federal ,advisory ,committee ,act 7,a7 ,in general ,except as provided in subparagraph 7,b71 the ,federal ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 shall apply to the ,prostate ,cancer ,task ,force4 7,b7 ,exception ,section #ad7;a77#b77;,b7 of such ,act 7relating to the termination of advisory committees7 shall not apply to the ,prostate ,cancer ,task ,force4 7#h7 ,sunset ,date ,the ,prostate ,cancer ,task ,force shall terminate at the end of fiscal year #bjai4 7d7 ,prostate cancer research 7#a7 ,research coordination ,the ,secretary of ,veterans ,affairs1 in coordination with the ,secretaries of ,defense and of ,health and ,human ,services1 shall establish and carry out a program to coordinate and intensify prostate cancer research as needed4 ,specifically1 such research program shall-- 7,a7 develop advances in diagnostic and prognostic methods and tests1 including biomarkers and an improved prostate cancer screening blood test1 including improvements or alternatives to the prostate specific antigen test and additional tests to distinguish indolent from aggressive disease2 7,b7 better understand the etiology of the disease 7including an analysis of lifestyle factors proven to be involved in higher rates of prostate cancer1 such as obesity and diet1 and in different ethnic1 racial1 and socioeconomic groups1 such as the ,african-,american1 ,latino or ,hispanic1 and ,american ,indian populations and men with a family history of prostate cancer7 to improve prevention efforts2 7,c7 expand basic research into prostate cancer1 including studies of fundamental molecular and cellular mechanisms2 7,d7 identify and provide clinical testing of novel agents for the prevention and treatment of prostate cancer2 7,e7 establish clinical registries for prostate cancer2 7,f7 use the ,national ,institute of ,biomedical ,imaging and ,bioengineering and the ,national ,cancer ,institute for assessment of appropriate imaging modalities2 and 7,g7 address such other matters relating to prostate cancer research as may be identified by the ,federal agencies participating in the program under this section4 7#b7 ,prostate ,cancer ,advisory ,board ,there is established in the ,office of the ,chief ,scientist of the ,food and ,drug ,administration a ,prostate ,cancer ,scientific ,advisory ,board4 ,such board shall be responsible for accelerating real-time sharing of the latest research data and accelerating movement of new medicines to patients4 7#c7 ,underserved minority grant program ,in carrying out such program1 the ,secretary shall-- 7,a7 award grants to eligible entities to carry out components of the research outlined in paragraph 7#a72 7,b7 integrate and build upon existing knowledge gained from comparative effectiveness research2 and 7,c7 recognize and address-- 7i7 the racial and ethnic disparities in the incidence and mortality rates of prostate cancer and men with a family history of prostate cancer2 7ii7 any barriers in access to care and participation in clinical trials that are specific to racial1 ethnic1 and other underserved minorities and men with a family history of prostate cancer2 7iii7 needed outreach and educational efforts to raise awareness in these communities2 and 7iv7 appropriate access and utilization of imaging modalities4 7e7 ,telehealth and rural access pilot project 7#a7 ,in general ,the ,secretary of ,veterans ,affairs1 the ,secretary of ,defense1 and the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretaries7 shall establish #d-year telehealth pilot projects for the purpose of analyzing the clinical outcomes and cost effectiveness associated with telehealth services in a variety of geographic areas that contain high proportions of medically underserved populations1 including ,african-,americans1 ,latino or ,hispanic1 ,american ,indians_/,alaska ,natives1 and those in rural areas4 ,such projects shall promote efficient use of specialist care through better coordination of primary care and physician extender teams in underserved areas and more effectively employ tumor boards to better counsel patients4 7#b7 ,eligible entities 7,a7 ,in general ,the ,secretaries shall select eligible entities to participate in the pilot projects under this section4 7,b7 ,priority ,in selecting eligible entities to participate in the pilot projects under this section1 the ,secretaries shall give priority to such entities located in medically underserved areas1 particularly those that include ,african-,americans1 ,latinos and ,hispanics1 and facilities of the ,indian ,health ,service1 including ,indian ,health ,service operated facilities1 tribally operated facilities1 and ,urban ,indian ,clinics1 and those in rural areas4 7#c7 ,evaluation ,the ,secretaries shall1 through the pilot projects1 evaluate-- 7,a7 the effective and economic delivery of care in diagnosing and treating prostate cancer with the use of telehealth services in medically underserved and tribal areas including collaborative uses of health professionals and integration of the range of telehealth and other technologies2 7,b7 the effectiveness of improving the capacity of nonmedical providers and nonspecialized medical providers to provide health services for prostate cancer in medically underserved and tribal areas1 including the exploration of innovative medical home models with collaboration between urologists1 other relevant medical specialists1 including oncologists1 radiologists1 and primary care teams and coordination of care through the efficient use of primary care teams and physician extenders2 and 7,c7 the effectiveness of using telehealth services to provide prostate cancer treatment in medically underserved areas1 including the use of tumor boards to facilitate better patient counseling4 7#d7 ,report ,not later than #ab months after the completion of the pilot projects under this subsection1 the ,secretaries shall submit to ,congress a report describing the outcomes of such pilot projects1 including any cost savings and efficiencies realized1 and providing recommendations1 if any1 for expanding the use of telehealth services4 7f7 ,education and awareness 7#a7 ,in general ,the ,secretary of ,veterans ,affairs shall develop a national education campaign for prostate cancer4 ,such campaign shall involve the use of written educational materials and public service announcements consistent with the findings of the ,prostate ,cancer ,task ,force under subsection 7c71 that are intended to encourage men to seek prostate cancer screening when appropriate4 7#b7 ,racial disparities and the population of men with a family history of prostate cancer ,in developing the national campaign under paragraph 7#a71 the ,secretary shall ensure that such educational materials and public service announcements are more readily available in communities experiencing racial disparities in the incidence and mortality rates of prostate cancer and by men of any race classification with a family history of prostate cancer4 7#c7 ,grants ,in carrying out the national campaign under this section1 the ,secretary shall award grants to nonprofit private entities to enable such entities to test alternative outreach and education strategies4 7g7 ,authorization of appropriations 7#a7 ,in general ,there is authorized to be appropriated to carry out this section for the period of fiscal years #bjae through #bjai an amount equal to the savings described in paragraph 7#b74 7#b7 ,corresponding reduction ,the amount authorized to be appropriated by provisions of law other than this section for the period of fiscal years #bjae through #bjai for ,federal research and health care program activities related to prostate cancer is reduced by the amount of ,federal savings projected to be achieved over such period by implementation of subsection 7c77#b77;,c7 of this section4 #gjc4 ,improved ,medicaid coverage for certain breast and cervical cancer patients in the territories 7a7 ,elimination of funding limitations 7#a7 ,in general ,section #aajh7;g77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7;g77#d77 is amended by adding at the end the following3 ,with respect to fiscal years beginning with fiscal year #bjae1 payment for medical assistance for individuals who are eligible for such assistance only on the basis of section #aijb7;a77#aj77;,a77ii77,,xviii7 shall not be taken into account in applying subsection 7f7 7as increased in accordance with paragraphs 7#a71 7#b71 7#c71 and 7#e7 of this subsection7 to such commonwealth or territory for such fiscal year44 7#b7 ,technical amendment ,such section is further amended by striking 7#c71 and 7#d7 and inserting 7#c71 and 7#e74 7b7 ,application of enhanced ,,fmap for highest ,state ,section #aije7;b7 of such ,act 7#db ,u4,s4,c4 #acif;d7b77 is amended by adding at the end the following3 ,notwithstanding the first sentence of this subsection1 with respect to medical assistance described in clause 7#d7 of such sentence that is furnished in ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 or ,american ,samoa in a fiscal year1 the ,federal medical assistance percentage is equal to the highest such percentage applied under such clause for such fiscal year for any of the #ej ,states or the ,district of ,columbia that provides such medical assistance for any portion of such fiscal year4 7c7 ,effective date ,the amendments made by this section shall apply to payment for medical assistance for items and services furnished on or after ,october #a1 #bjad4 #gjd4 ,cancer prevention and treatment demonstration for ethnic and racial minorities 7a7 ,demonstration 7#a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall conduct demonstration projects 7in this section referred to as demonstration projects7 for the purpose of developing models and evaluating methods that-- 7,a7 improve the quality of items and services provided to target individuals in order to facilitate reduced disparities in early detection and treatment of cancer2 7,b7 improve clinical outcomes1 satisfaction1 quality of life1 appropriate use of items and services covered under the ,medicare ,program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 and referral patterns with respect to target individuals with cancer2 7,c7 eliminate disparities in the rate of preventive cancer screening measures1 such as ,pap smears1 prostate cancer screenings1 colon cancer screenings1 breast cancer screenings1 and computed tomography 7,,ct7 scans1 for lung cancer among target individuals2 7,d7 promote collaboration with community-based organizations to ensure cultural competency of health care professionals and linguistic access for target individuals who are persons with limited-,english proficiency2 and 7,e7 encourage the incorporation of community health workers to increase the efficiency and appropriateness of cancer screening programs4 7#b7 ,community health worker defined ,in this section1 the term community health worker includes a community health advocate1 a lay health worker1 a community health representative1 a peer health promotor1 a community health outreach worker1 and a promotore de salud1 who promotes health or nutrition within the community in which the individual resides4 7#c7 ,target individual defined ,in this section1 the term target individual means an individual of a racial and ethnic minority group1 as defined in section #agjg7;g77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a771 who is entitled to benefits under part ,a1 and enrolled under part ,b1 of title ,,xviii of the ,social ,security ,act4 7b7 ,program design 7#a7 ,initial design ,not later than #a year after the date of the enactment of this ,act1 the ,secretary shall evaluate best practices in the private sector1 community programs1 and academic research of methods that reduce disparities among individuals of racial and ethnic minority groups in the prevention and treatment of cancer and shall design the demonstration projects based on such evaluation4 7#b7 ,number and project areas ,not later than #b years after the date of the enactment of this ,act1 the ,secretary shall implement at least nine demonstration projects1 including the following3 7,a7 ,two projects1 each of which shall target different ethnic subpopulations1 for each of the four following major racial and ethnic minority groups3 7i7 ,american ,indians and ,alaska ,natives1 ,eskimos and ,aleuts4 7ii7 ,asian-,americans4 7iii7 ,blacks_/,african-,americans4 7iv7 ,latinos or ,hispanics4 7v7 ,native ,hawaiians and other ,pacific ,islanders4 7,b7 ,one project within the ,pacific ,islands or ,united ,states insular areas4 7,c7 ,at least one project each in a rural area and inner-city area4 7#c7 ,expansion of projects2 implementation of demonstration project results ,if the initial report under subsection 7c7 contains an evaluation that demonstration projects-- 7,a7 reduce expenditures under the ,medicare ,program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq472 or 7,b7 do not increase expenditures under the ,medicare ,program and reduce racial and ethnic health disparities in the quality of health care services provided to target individuals and increase satisfaction of ,medicare beneficiaries and health care providers2 the ,secretary shall continue the existing demonstration projects and may expand the number of demonstration projects4 7c7 ,report to congress 7#a7 ,in general ,not later than #b years after the date the ,secretary implements the initial demonstration projects1 and biannually thereafter1 the ,secretary shall submit to ,congress a report regarding the demonstration projects4 7#b7 ,contents of report ,each report under paragraph 7#a7 shall include the following3 7,a7 ,a description of the demonstration projects4 7,b7 ,an evaluation of-- 7i7 the cost effectiveness of the demonstration projects2 7ii7 the quality of the health care services provided to target individuals under the demonstration projects2 and 7iii7 beneficiary and health care provider satisfaction under the demonstration projects4 7,c7 ,any other information regarding the demonstration projects that the ,secretary determines to be appropriate4 7d7 ,waiver authority ,the ,secretary shall waive compliance with the requirements of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 to such extent and for such period as the ,secretary determines is necessary to conduct demonstration projects4 #gje4 ,reducing cancer disparities within ,medicare 7a7 ,development of measures of disparities in quality of cancer care 7#a7 ,development of measures ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall enter into an agreement with an entity that specializes in developing quality measures for cancer care under which the entity shall develop a uniform set of measures to evaluate disparities in the quality of cancer care and annually update such set of measures4 7#b7 ,measures to be included ,such set of measures shall include1 with respect to the treatment of cancer1 measures of patient outcomes1 the process for delivering medical care related to such treatment1 patient counseling and engagement in decisionmaking1 patient experience of care1 resource use1 and practice capabilities1 such as care coordination4 7b7 ,establishment of reporting process 7#a7 ,in general ,the ,secretary shall establish a reporting process that requires and provides for a method for health care providers specified under paragraph 7#b7 to submit to the ,secretary and make public data on the performance of such providers during each reporting period through use of the measures developed pursuant to subsection 7a74 ,such data shall be submitted in a form and manner and at a time specified by the ,secretary4 7#b7 ,specification of providers to report on measures ,the ,secretary shall specify the classes of ,medicare providers of services and suppliers1 including hospitals1 cancer centers1 physicians1 primary care providers1 and specialty providers1 that will be required under such process to publicly report on the measures specified under subsection 7a74 7#c7 ,assessment of changes ,under such reporting process1 the ,secretary shall establish a format that assesses changes in both the absolute and relative disparities in cancer care over time4 ,these measures shall be presented in an easily comprehensible format1 such as those presented in the final publications relating to ,healthy ,people #bjaj or the ,national ,healthcare ,disparities ,report4 7#d7 ,initial implementation ,the ,secretary shall implement the reporting process under this subsection for reporting periods beginning not later than #f months after the date that measures are first established under subsection 7a74 ,b ,viral ,hepatitis and ,liver ,cancer ,control and ,prevention #gaa4 ,viral hepatitis and liver cancer control and prevention 7a7 ,short title ,this subtitle may be cited as the ,viral ,hepatitis and ,liver ,cancer ,control and ,prevention ,act of #bjad4 7b7 ,findings ,congress finds the following3 7#a7 ,approximately #e1cjj1jjj ,americans are chronically infected with the hepatitis ,b virus 7referred to in this section as ,,hbv71 the hepatitis ,c virus 7referred to in this section as ,,hcv71 or both4 7#b7 ,in the ,united ,states1 chronic ,,hbv and ,,hcv are the most common cause of liver cancer1 one of the most lethal and fastest growing cancers in this country4 ,it is the most common cause of chronic liver disease1 liver cirrhosis1 and the most common indication for liver transplantation4 ,at least #ae1jjj deaths per year in the ,united ,states can be attributed to chronic ,,hbv and ,,hcv4 ,chronic ,,hcv is also a leading cause of death in ,americans living with ,,hiv_/,,aids1 many of those living with ,,hiv_/,,aids are coinfected with chronic ,,hbv1 chronic ,,hcv1 or both4 7#c7 ,according to the ,centers for ,disease ,control and ,prevention 7referred to in this section as the ,,cdc71 approximately #b percent of the population of the ,united ,states is living with chronic ,,hbv1 chronic ,,hcv1 or both4 ,the ,,cdc has recognized ,,hcv as the ,nation's most common chronic bloodborne virus infection and ,,hbv as the deadliest vaccine-preventable disease4 7#d7 ,,hbv is easily transmitted and is #ajj times more infectious than ,,hiv4 ,according to the ,,cdc1 ,,hbv is transmitted through contact with infectious blood1 semen1 or other body fluids4 ,,hcv is transmitted by contact with infectious blood1 particularly through percutaneous exposures 7i4e4 puncture through the skin74 7#e7 ,the ,,cdc conservatively estimates that in #bjaj approximately #ag1jjj ,americans were newly infected with ,,hcv and more than #ce1jjj ,americans were newly infected with ,,hbv4 ,these estimates could be much higher due to many reasons1 including lack of screening education and awareness1 and perceived marginalization of the populations at risk4 7#f7 ,in #bjab1 ,,cdc released new guidelines recommending every person born between #aide and #aife receive a one-time test4 ,among the estimated #ajb million 7#a4f million chronically ,,hcv-infected7 eligible for screening1 birth-cohort screening leads to #hd1jjj fewer cases of decompensated cirrhosis1 #df1jjj fewer cases of hepatocellular carcinoma1 #aj1jjj fewer liver transplants1 and #gh1jjj fewer ,,hcv-related deaths gained versus risk-based screening4 7#g7 ,in #bjac1 the ,united ,states ,preventive ,task ,force 7,,uspstf7 issued a ,grade ,b rating for screening for the hepatitis ,c virus 7,,hcv7 infection in persons at high risk for infection and adults born between #aide and #aife4 ,in #bjad1 the ,,uspstf issued a ,grade ,b for screening for the hepatitis ,b virus 7,,hbv7 in persons at high-risk of hepatitis ,b infection4 ,in #bjji1 the ,,uspstf issued a ,grade ,a for screening pregnant women for the hepatitis ,b virus 7,,hbv7 during their first prenatal visit4 7#h7 ,there were #ce outbreaks 7#ai of ,,hbv1 #af of ,,hcv7 reported to ,,cdc for investigation from #bjjh through #bjab related to health care acquired infection of ,,hbv and ,,hcv1 #cc of which occurred in nonhospital settings4 ,there were more than #ii1ige patients potentially exposed to one of the viruses4 7#i7 ,chronic ,,hbv and chronic ,,hcv usually do not cause symptoms early in the course of the disease1 but after many years of a clinically silent phase1 ,,cdc estimates show more than #cc percent of infected individuals will develop cirrhosis1 end-stage liver disease1 or liver cancer4 ,since most individuals with chronic ,,hbv1 ,,hcv1 or both are unaware of their infection1 they do not know to take precautions to prevent the spread of their infection and can unknowingly exacerbate their own disease progression4 7#aj7 ,,hbv and ,,hcv disproportionately affect certain populations in the ,united ,states4 ,although representing only #f percent of the population1 ,asian-,americans and ,pacific ,islanders account for over half of the #a1djj1jjj domestic chronic ,,hbv cases4 ,baby boomers 7those born between #aide and #aife7 account for more than half of domestic chronic hepatitis ,c cases4 ,in addition1 ,african-,americans1 ,latinos 7,latinas71 and ,american ,indian_/,native ,alaskans are among the groups which have disproportionately high rates of ,,hbv and_/or ,,hcv infections in the ,united ,states4 7#aa7 ,for both chronic ,,hbv and chronic ,,hcv1 behavioral changes can slow disease progression if diagnosis is made early4 ,early diagnosis1 which is determined through simple blood tests1 can reduce the risk of transmission and disease progression through education and vaccination of household members and other susceptible persons at risk4 7#ab7 ,advancements have led to the development of improved diagnostic tests for viral hepatitis4 ,these tests1 including rapid1 point of care testing and others in development1 can facilitate testing1 notification of results and post-test counseling1 and referral to care at the time of the testing visit4 ,in particular1 these tests are also advantageous because they can be used simultaneously with ,,hiv rapid testing for persons at risk for both ,,hcv and ,,hiv infections4 7#ac7 ,for those chronically infected with ,,hbv or ,,hcv1 regular monitoring can lead to the early detection of liver cancer at a stage where a cure is still possible4 ,liver cancer is the second deadliest cancer in the ,united ,states2 however1 liver cancer has received little funding for research1 prevention1 or treatment4 7#ad7 ,treatment for chronic ,,hcv can eradicate the disease in approximately #ge percent of those currently treated4 ,the treatment of chronic ,,hbv can effectively suppress viral replication in the overwhelming majority 7over #hj percent7 of those treated1 thereby reducing the risk of transmission and progression to liver scarring or liver cancer1 even though a complete cure is much less common than for ,,hcv4 7#ae7 ,to combat the viral hepatitis epidemic in the ,united ,states1 in ,may #bjaa1 the ,department of ,health and ,human ,services released ,combating the ,silent ,epidemic of ,viral ,hepatitis3 ,action ,plan for the ,prevention1 ,care ,treatment of ,viral ,hepatitis 7hereafter referred to as the ,,hhs ,action ,plan74 ,the ,institute of ,medicine 7,,iom7 of the ,national ,academies produced a #bjaj report on the ,federal response to ,,hbv and ,,hcv titled3 ,hepatitis and ,liver ,cancer3 ,a ,national ,strategy for ,prevention and ,control of ,hepatitis ,b and ,c4 ,these recommendations and guidelines provide a framework for ,,hbv and ,,hcv prevention1 education1 control1 research1 and medical management programs4 7#af7 ,the annual health care costs attributable to ,,hbv and ,,hcv in the ,united ,states are significant4 ,for ,,hbv1 it is estimated to be approximately #b1ejj1jjj1jjj 7#b1jjj per infected person74 ,in #bjjj1 the lifetime cost of ,,hbv---before the availability of most current therapies---was approximately #hj1jjj per chronically infected person1 totaling more than #ajj1jjj1jjj1jjj4 ,for ,,hcv1 medical costs for patients are expected to increase from #cj1jjj1jjj1jjj in #bjji to over #he1jjj1jjj1jjj in #bjbd4 ,avoiding these costs by screening and diagnosing individuals earlier--and connecting them to appropriate treatment and care1 will save lives and critical health care dollars4 ,currently1 without a comprehensive screening1 testing1 and diagnosis program1 most patients are diagnosed too late when they need a liver transplant costing at least #cad1jjj for uncomplicated cases or when they have liver cancer or end stage liver disease which costs #cj1ihj to #aaj1egf per hospital admission4 ,as health care costs continue to grow1 it is critical that the ,federal ,government invests in effective mechanisms to avoid documented cost drivers4 7#ag7 ,according to the ,,iom report in #bjaj 7described in paragraph 7#ae771 chronic ,,hbv and ,,hcv infections cause substantial morbidity and mortality despite being preventable and treatable4 ,deficiencies in the implementation of established guidelines for the prevention1 diagnosis1 and medical management of chronic ,,hbv and ,,hcv infections perpetuate personal and economic burdens4 ,existing grants are not sufficient for the scale of the health burden presented by ,,hbv and ,,hcv4 7#ah7 ,screening and testing for ,,hbv and ,,hcv is aligned with the ,healthy ,people #bjbj goal to increase immunization rates and reduce preventable infectious diseases4 ,awareness of disease and access to prevention and treatment remain essential components for reducing infectious disease transmission4 7#ai7 ,federal support is necessary to increase knowledge and awareness of ,,hbv and ,,hcv and to assist ,state and local prevention and control efforts in reducing the morbidity and mortality of these epidemics4 7#bj7 ,the ,secretary of ,health and ,human ,services has the discretion to carry out this ,act directly and through whichever of the agencies of the ,public ,health ,service the ,secretary determines to be appropriate1 which may 7in the ,secretary's discretion7 include the ,centers for ,disease ,control and ,prevention1 the ,health ,resources and ,services ,administration1 the ,substance ,abuse and ,mental ,health ,services ,administration1 the ,national ,institutes of ,health 7including the ,national ,institute on ,minority ,health and ,health ,disparities71 and other agencies of such ,service4 7c7 ,biennial assessment of ,,hhs hepatitis ,b and hepatitis ,c prevention1 education1 research1 and medical management plan ,title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bda et seq47 is amended-- 7#a7 by striking section #cag,n 7#db ,u4,s4,c4 #bdg;b-#ae72 and 7#b7 by adding at the end the following3 ,w ,biennial assessment of ,,hhs ,hepatitis ,b and ,hepatitis ,c prevention1 education1 research1 and medical management plan #cii,,nn4 ,biennial ,update of the ,plan 7a7 ,in general ,the ,secretary shall conduct a biennial assessment of the ,secretary's plan for the prevention1 control1 and medical management of1 and education and research relating to1 hepatitis ,b and hepatitis ,c1 for the purposes of-- 7#a7 incorporating into such plan new knowledge or observations relating to hepatitis ,b and hepatitis ,c 7such as knowledge and observations that may be derived from clinical1 laboratory1 and epidemiological research and disease detection1 prevention1 and surveillance outcomes72 7#b7 addressing gaps in the coverage or effectiveness of the plan2 and 7#c7 evaluating and1 if appropriate1 updating recommendations1 guidelines1 or educational materials of the ,centers for ,disease ,control and ,prevention or the ,national ,institutes of ,health for health care providers or the public on viral hepatitis in order to be consistent with the plan4 7b7 ,publication of notice of assessments ,not later than ,october #a of the first even-numbered year beginning after the date of the enactment of this part1 and ,october #a of each even-numbered year thereafter1 the ,secretary shall publish in the ,federal ,register a notice of the results of the assessments conducted under paragraph 7#a74 ,such notice shall include-- 7#a7 a description of any revisions to the plan referred to in subsection 7a7 as a result of the assessment2 7#b7 an explanation of the basis for any such revisions1 including the ways in which such revisions can reasonably be expected to further promote the original goals and objectives of the plan2 and 7#c7 in the case of a determination by the ,secretary that the plan does not need revision1 an explanation of the basis for such determination4 #cii,,nn-#a4 ,elements of program 7a7 ,education and awareness programs ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 the ,administrator of the ,health ,resources and ,services ,administration1 and the ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration1 and in accordance with the plan referred to in section #cii,,nn7a71 shall implement programs to increase awareness and enhance knowledge and understanding of hepatitis ,b and hepatitis ,c4 ,such programs shall include-- 7#a7 the conduct of culturally and language appropriate health education in primary and secondary schools1 college campuses1 public awareness campaigns1 and community outreach activities 7especially to the ethnic communities with high rates of chronic hepatitis ,b and chronic hepatitis ,c and other high-risk groups7 to promote public awareness and knowledge about the value of hepatitis ,a and hepatitis ,b immunization1 risk factors1 the transmission and prevention of hepatitis ,b and hepatitis ,c1 the value of screening for the early detection of hepatitis ,b and hepatitis ,c1 and options available for the treatment of chronic hepatitis ,b and chronic hepatitis ,c2 7#b7 the promotion of immunization programs that increase awareness and access to hepatitis ,a and hepatitis ,b vaccines for susceptible adults and children2 7#c7 the training of health care professionals regarding the importance of vaccinating individuals infected with hepatitis ,c and individuals who are at risk for hepatitis ,c infection against hepatitis ,a and hepatitis ,b2 7#d7 the training of health care professionals regarding the importance of vaccinating individuals chronically infected with hepatitis ,b and individuals who are at risk for chronic hepatitis ,b infection against the hepatitis ,a virus2 7#e7 the training of health care professionals and health educators to make them aware of the high rates of chronic hepatitis ,b and chronic hepatitis ,c in certain adult ethnic populations1 and the importance of prevention1 detection1 and medical management of hepatitis ,b and hepatitis ,c and of liver cancer screening2 7#f7 the development and distribution of health education curricula 7including information relating to the special needs of individuals infected with hepatitis ,b and hepatitis ,c1 such as the importance of prevention and early intervention1 regular monitoring1 the recognition of psychosocial needs1 appropriate treatment1 and liver cancer screening7 for individuals providing hepatitis ,b and hepatitis ,c counseling2 and 7#g7 support for the implementation curricula described in paragraph 7#f7 by ,state and local public health agencies4 7b7 ,immunization1 prevention1 and control programs 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall support the integration of activities described in paragraph 7#c7 into existing clinical and public health programs at ,state1 local1 territorial1 and tribal levels 7including community health clinics1 programs for the prevention and treatment of ,,hiv_/,,aids1 sexually transmitted diseases1 and substance abuse1 and programs for individuals in correctional settings74 7#b7 ,coordination of development of ,federal screening guidelines 7,a7 ,references ,for purposes of this subsection1 the term ,,cdc ,director means the ,director of the ,centers for ,disease ,control and ,prevention1 and the term ,,ahrq ,director means the ,director of the ,agency for ,healthcare ,research and ,quality4 7,b7 ,agency for healthcare research and quality ,due to the rapidly evolving standard of care associated with diagnosing and treating viral hepatitis infection1 the ,,ahrq ,director shall convene the ,preventive ,services ,task ,force under section #iae7;a7 of the ,public ,health ,service ,act to review its recommendation for screening for ,,hbv and ,,hcv infection every #c years4 7#c7 ,activities 7,a7 ,voluntary testing programs 7i7 ,in general ,the ,secretary shall establish a mechanism by which to support and promote the development of ,state1 local1 territorial1 and tribal voluntary hepatitis ,b and hepatitis ,c testing programs to screen the high-prevalence populations to aid in the early identification of chronically infected individuals4 7ii7 ,confidentiality of the test results ,the ,secretary shall prohibit the use of the results of a hepatitis ,b or hepatitis ,c test conducted by a testing program developed or supported under this subparagraph for any of the following3 7,i7 ,issues relating to health insurance4 7,,ii7 ,to screen or determine suitability for employment4 7,,iii7 ,to discharge a person from employment4 7,b7 ,counseling regarding viral hepatitis ,the ,secretary shall support ,state1 local1 territorial1 and tribal programs in a wide variety of settings1 including those providing primary and specialty health care services in nonprofit private and public sectors1 to-- 7i7 provide individuals with ongoing risk factors for hepatitis ,b and hepatitis ,c infection with client-centered education and counseling which concentrates on-- 7,i7 promoting testing of individuals that have been exposed to their blood1 family members1 and their sexual partners2 and 7,,ii7 changing behaviors that place individuals at risk for infection2 7ii7 provide individuals chronically infected with hepatitis ,b or hepatitis ,c with education1 health information1 and counseling to reduce their risk of-- 7,i7 dying from end-stage liver disease and liver cancer2 and 7,,ii7 transmitting viral hepatitis to others2 and 7iii7 provide women chronically infected with hepatitis ,b or hepatitis ,c who are pregnant or of childbearing age with culturally and language appropriate health information1 such as how to prevent hepatitis ,b perinatal infection1 and to alleviate fears associated with pregnancy or raising a family4 7,c7 ,immunization ,the ,secretary shall support ,state1 local1 territorial1 and tribal efforts to expand the current vaccination programs to protect every child in the country and all susceptible adults1 particularly those infected with hepatitis ,c and high-prevalence ethnic populations and other high-risk groups1 from the risks of acute and chronic hepatitis ,b infection by-- 7i7 ensuring continued funding for hepatitis ,b vaccination for all children #ai years of age or younger through the ,vaccines for ,children ,program2 7ii7 ensuring that the recommendations of the ,advisory ,committee on ,immunization ,practices are followed regarding the birth dose of hepatitis ,b vaccinations for newborns2 7iii7 requiring proof of hepatitis ,b vaccination for entry into public or private daycare1 preschool1 elementary school1 secondary school1 and institutions of higher education2 7iv7 expanding the availability of hepatitis ,b vaccination for all susceptible adults to protect them from becoming acutely or chronically infected1 including ethnic and other populations with high prevalence rates of chronic hepatitis ,b infection2 7v7 expanding the availability of hepatitis ,b vaccination for all susceptible adults1 particularly those in their reproductive age 7women and men less than #de years of age71 to protect them from the risk of hepatitis ,b infection2 7vi7 ensuring the vaccination of individuals infected1 or at risk for infection1 with hepatitis ,c against hepatitis ,a1 hepatitis ,b1 and other infectious diseases1 as appropriate1 for which such individuals may be at increased risk2 and 7vii7 ensuring the vaccination of individuals infected1 or at risk for infection1 with hepatitis ,b against hepatitis ,a virus and other infectious diseases1 as appropriate1 for which such individuals may be at increased risk4 7,d7 ,medical referral ,the ,secretary shall support ,state1 local1 territorial1 and tribal programs that support-- 7i7 referral of persons chronically infected with hepatitis ,b or hepatitis ,c-- 7,i7 for medical evaluation to determine the appropriateness for antiviral treatment to reduce the risk of progression to cirrhosis and liver cancer2 and 7,,ii7 for ongoing medical management including regular monitoring of liver function and screening for liver cancer2 and 7ii7 referral of persons infected with acute or chronic hepatitis ,b infection or acute or chronic hepatitis ,c infection for drug and alcohol abuse treatment where appropriate4 7#d7 ,increased support for adult viral hepatitis coordinators ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall provide increased support to ,adult ,viral ,hepatitis ,coordinators in ,state1 local1 territorial1 and tribal health departments in order to enhance the additional management1 networking1 and technical expertise needed to ensure successful integration of hepatitis ,b and hepatitis ,c prevention and control activities into existing public health programs4 7c7 ,epidemiological surveillance 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall support the establishment and maintenance of a national chronic and acute hepatitis ,b and hepatitis ,c surveillance program1 in order to identify-- 7,a7 trends in the incidence of acute and chronic hepatitis ,b and acute and chronic hepatitis ,c2 7,b7 trends in the prevalence of acute and chronic hepatitis ,b and acute and chronic hepatitis ,c infection among groups that may be disproportionately affected2 and 7,c7 trends in liver cancer and end-stage liver disease incidence and deaths1 caused by chronic hepatitis ,b and chronic hepatitis ,c in the high-risk ethnic populations4 7#b7 ,seroprevalence and liver cancer studies ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall prepare a report outlining the population-based seroprevalence studies currently underway1 future planned studies1 the criteria involved in determining which seroprevalence studies to conduct1 defer1 or suspend1 and the scope of those studies1 the economic and clinical impact of hepatitis ,b and hepatitis ,c1 and the impact of chronic hepatitis ,b and chronic hepatitis ,c infections on the quality of life4 ,not later than one year after the date of the enactment of this part1 the ,secretary shall submit the report to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate4 7#c7 ,confidentiality ,the ,secretary shall not disclose any individually identifiable information identified under paragraph 7#a7 or derived through studies under paragraph 7#b74 7d7 ,research ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 the ,director of the ,national ,cancer ,institute1 and the ,director of the ,national ,institutes of ,health1 shall-- 7#a7 conduct epidemiologic and community-based research to develop1 implement1 and evaluate best practices for hepatitis ,b and hepatitis ,c prevention especially in the ethnic populations with high rates of chronic hepatitis ,b and chronic hepatitis ,c and other high-risk groups2 7#b7 conduct research on hepatitis ,b and hepatitis ,c natural history1 pathophysiology1 improved treatments and prevention 7such as the hepatitis ,c vaccine71 and noninvasive tests that help to predict the risk of progression to liver cirrhosis and liver cancer2 7#c7 conduct research that will lead to better noninvasive or blood tests to screen for liver cancer1 and more effective treatments of liver cancer caused by chronic hepatitis ,b and chronic hepatitis ,c2 and 7#d7 conduct research comparing the effectiveness of screening1 diagnostic1 management1 and treatment approaches for chronic hepatitis ,b1 chronic hepatitis ,c1 and liver cancer in the affected communities4 7e7 ,underserved and disproportionately affected populations ,in carrying out this section1 the ,secretary shall provide expanded support for individuals with limited access to health education1 testing1 and health care services and groups that may be disproportionately affected by hepatitis ,b and hepatitis ,c4 7f7 ,evaluation of program ,the ,secretary shall develop benchmarks for evaluating the effectiveness of the programs and activities conducted under this section and make determinations as to whether such benchmarks have been achieved4 #cii,,nn-#b4 ,grants 7a7 ,in general ,the ,secretary may award grants to1 or enter into contracts or cooperative agreements with1 ,states1 political subdivisions of ,states1 territories1 ,indian tribes1 or nonprofit entities that have special expertise relating to hepatitis ,b1 hepatitis ,c1 or both1 to carry out activities under this part4 7b7 ,application ,to be eligible for a grant1 contract1 or cooperative agreement under subsection 7a71 an entity shall prepare and submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 #cii,,nn-#c4 ,authorization of appropriations ,there are authorized to be appropriated to carry out this part #ij1jjj1jjj for fiscal year #bjae1 #ij1jjj1jjj for fiscal year #bjaf1 #aaj1jjj1jjj for fiscal year #bjag1 #acj1jjj1jjj for fiscal year #bjah1 and #aej1jjj1jjj for fiscal year #bjai4 4 7d7 ,enhancing ,,samhsa's role in hepatitis activities ,paragraph 7#f7 of section #eja7;d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;aa7d77 is amended by striking ,,hiv or tuberculosis and inserting ,,hiv1 tuberculosis1 or hepatitis4 ,c ,acquired ,bone ,marrow ,failure ,diseases #gba4 ,acquired bone marrow failure diseases 7a7 ,short title ,this subtitle may be cited as the ,bone ,marrow ,failure ,disease ,research and ,treatment ,act of #bjad4 7b7 ,findings ,the ,congress finds the following3 7#a7 ,between #bj1jjj and #cj1jjj ,americans are diagnosed each year with myelodysplastic syndromes1 aplastic anemia1 paroxysmal nocturnal hemoglobinuria1 and other acquired bone marrow failure diseases4 7#b7 ,acquired bone marrow failure diseases have a debilitating and often fatal impact on those diagnosed with these diseases4 7#c7 ,while some treatments for acquired bone marrow failure diseases can prolong and improve the quality of patients' lives1 there is no single cure for these diseases4 7#d7 ,the prevalence of acquired bone marrow failure diseases in the ,united ,states will continue to grow as the general public ages4 7#e7 ,evidence exists suggesting that acquired bone marrow failure diseases occur more often in minority populations1 particularly in ,asian-,american and ,latino or ,hispanic populations4 7#f7 ,the ,national ,heart1 ,lung1 and ,blood ,institute and the ,national ,cancer ,institute have conducted important research into the causes of and treatments for acquired bone marrow failure diseases4 7#g7 ,the ,national ,marrow ,donor ,program ,registry has made significant contributions to the fight against bone marrow failure diseases by connecting millions of potential marrow donors with individuals and families suffering from these conditions4 7#h7 ,despite these advances1 a more comprehensive ,federal strategic effort among numerous ,federal agencies is needed to discover a cure for acquired bone marrow failure disorders4 7#i7 ,greater ,federal surveillance of acquired bone marrow failure diseases is needed to gain a better understanding of the causes of acquired bone marrow failure diseases4 7#aj7 ,the ,federal ,government should increase its research support for and engage with public and private organizations in developing a comprehensive approach to combat and cure acquired bone marrow failure diseases4 7c7 ,national ,acquired ,bone ,marrow ,failure ,disease ,registry ,part ,b of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #caa et seq47 is amended by inserting after section #cag,w1 as added1 the following3 #cag,x4 ,national ,acquired ,bone ,marrow ,failure ,disease ,registry 7a7 ,establishment of registry 7#a7 ,in general ,not later than #f months after the date of the enactment of this section1 the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall-- 7,a7 develop a system to collect data on acquired bone marrow failure diseases2 and 7,b7 establish and maintain a national and publicly available registry1 to be known as the ,national ,acquired ,bone ,marrow ,failure ,disease ,registry1 in accordance with paragraph 7#c74 7#b7 ,recommendations of advisory committee ,in carrying out this subsection1 the ,secretary shall take into consideration the recommendations of the ,advisory ,committee on ,acquired ,bone ,marrow ,failure ,diseases established under subsection 7b74 7#c7 ,purposes of registry ,the ,national ,acquired ,bone ,marrow ,failure ,disease ,registry-- 7,a7 shall identify the incidence and prevalence of acquired bone marrow failure diseases in the ,united ,states2 7,b7 shall be used to collect and store data on acquired bone marrow failure diseases1 including data concerning-- 7i7 the age1 race or ethnicity1 general geographic location1 sex1 and family history of individuals who are diagnosed with acquired bone marrow failure diseases1 and any other characteristics of such individuals determined appropriate by the ,secretary2 7ii7 the genetic and environmental factors that may be associated with developing acquired bone marrow failure diseases2 7iii7 treatment approaches for dealing with acquired bone marrow failure diseases2 7iv7 outcomes for individuals treated for acquired bone marrow failure diseases1 including outcomes for recipients of stem cell therapeutic products as contained in the database established pursuant to section #cgi;,a2 and 7v7 any other factors pertaining to acquired bone marrow failure diseases determined appropriate by the ,secretary2 and 7,c7 shall be made available-- 7i7 to the general public2 and 7ii7 to researchers to facilitate further research into the causes of1 and treatments for1 acquired bone marrow failure diseases in accordance with standard practices of the ,centers for ,disease ,control and ,preventions4 7b7 ,advisory committee 7#a7 ,establishment ,not later than #f months after the date of the enactment of this section1 the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall establish an advisory committee1 to be known as the ,advisory ,committee on ,acquired ,bone ,marrow ,failure ,diseases4 7#b7 ,members ,the members of the ,advisory ,committee on ,acquired ,bone ,marrow ,failure ,diseases shall be appointed by the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 and shall include at least one representative from each of the following3 7,a7 ,a national patient advocacy organization with experience advocating on behalf of patients suffering from acquired bone marrow failure diseases4 7,b7 ,the ,national ,institutes of ,health1 including at least one representative from each of-- 7i7 the ,national ,cancer ,institute2 7ii7 the ,national ,heart1 ,lung1 and ,blood ,institute2 and 7iii7 the ,office of ,rare ,diseases4 7,c7 ,the ,centers for ,disease ,control and ,prevention4 7,d7 ,clinicians with experience in-- 7i7 diagnosing or treating acquired bone marrow failure diseases2 and 7ii7 medical data registries4 7,e7 ,epidemiologists who have experience with data registries4 7,f7 ,publicly or privately funded researchers who have experience researching acquired bone marrow failure diseases4 7,g7 ,the entity operating the ,c4,w4 ,bill ,young ,cell ,transplantation ,program established pursuant to section #cgi and the entity operating the ,c4,w4 ,bill ,young ,cell ,transplantation ,program ,outcomes ,database4 7#c7 ,responsibilities ,the ,advisory ,committee on ,acquired ,bone ,marrow ,failure ,diseases shall provide recommendations to the ,secretary on the establishment and maintenance of the ,national ,acquired ,bone ,marrow ,failure ,disease ,registry1 including recommendations on the collection1 maintenance1 and dissemination of data4 7#d7 ,public availability ,the ,secretary shall make the recommendations of the ,advisory ,committee on ,acquired ,bone ,marrow ,failure ,disease publicly available4 7c7 ,grants ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 may award grants to1 and enter into contracts and cooperative agreements with1 public or private nonprofit entities for the management of1 as well as the collection1 analysis1 and reporting of data to be included in1 the ,national ,acquired ,bone ,marrow ,failure ,disease ,registry4 7d7 ,definition ,in this section1 the term acquired bone marrow failure disease means-- 7#a7 myelodysplastic syndromes 7,,mds72 7#b7 aplastic anemia2 7#c7 paroxysmal nocturnal hemoglobinuria 7,,pnh72 7#d7 pure red cell aplasia2 7#e7 acute myeloid leukemia that has progressed from myelodysplastic syndromes2 or 7#f7 large granular lymphocytic leukemia4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #c1jjj1jjj for each of fiscal years #bjae through #bjai4 4 7d7 ,pilot studies through the agency for toxic substances and disease registry 7#a7 ,pilot studies ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,agency for ,toxic ,substances and ,disease ,registry1 shall conduct pilot studies to determine which environmental factors1 including exposure to toxins1 may cause acquired bone marrow failure diseases4 7#b7 ,collaboration with the ,radiation ,injury ,treatment ,network ,in carrying out the directives of this section1 the ,secretary may collaborate with the ,radiation ,injury ,treatment ,network of the ,c4,w4 ,bill ,young ,cell ,transplantation ,program established pursuant to section #cgi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bgd;j7 to-- 7,a7 augment data for the pilot studies authorized by this section2 7,b7 access technical assistance that may be provided by the ,radiation ,injury ,treatment ,network2 or 7,c7 perform joint research projects4 7#c7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #a1jjj1jjj for each of fiscal years #bjae through #bjai4 7e7 ,minority-,focused programs on acquired bone marrow failure diseases ,title ,,xvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju et seq47 is amended by inserting after section #agjg;,a the following3 #agjg;,b4 ,minority-focused programs on acquired bone marrow failure diseases 7a7 ,information and referral services 7#a7 ,in general ,not later than #f months after the date of the enactment of this section1 the ,secretary1 acting through the ,deputy ,assistant ,secretary for ,minority ,health1 shall establish and coordinate outreach and informational programs targeted to minority populations affected by acquired bone marrow failure diseases4 7#b7 ,program requirements ,minority-focused outreach and informational programs authorized by this section-- 7,a7 shall make information about treatment options and clinical trials for acquired bone marrow failure diseases publicly available1 and 7,b7 shall provide referral services for treatment options and clinical trials1 at the ,national ,minority ,health ,resource ,center supported under section #agjg7;b77#h7 7including by means of the ,center's ,web site1 through appropriate locations such as the ,center's knowledge center1 and through appropriate programs such as the ,center's resource persons network7 and through minority health consultants located at each ,department of ,health and ,human ,services regional office4 7b7 ,hispanic and ,asian-,american and pacific islander outreach 7#a7 ,in general ,the ,secretary1 acting through the ,deputy ,assistant ,secretary for ,minority ,health1 shall undertake a coordinated outreach effort to connect ,hispanic1 ,asian-,american1 and ,pacific ,islander communities with comprehensive services focused on treatment of1 and information about1 acquired bone marrow failure diseases4 7#b7 ,collaboration ,in carrying out this subsection1 the ,secretary may collaborate with public health agencies1 nonprofit organizations1 community groups1 and online entities to disseminate information about treatment options and clinical trials for acquired bone marrow failure diseases4 7c7 ,grants and cooperative agreements 7#a7 ,in general ,not later than #f months after the date of the enactment of this section1 the ,secretary1 acting through the ,deputy ,assistant ,secretary for ,minority ,health1 shall award grants to1 or enter into cooperative agreements with1 entities to perform research on acquired bone marrow failure diseases4 7#b7 ,requirement ,grants and cooperative agreements authorized by this subsection shall be awarded or entered into on a competitive1 peer-reviewed basis4 7#c7 ,scope of research ,research funded under this section shall examine factors affecting the incidence of acquired bone marrow failure diseases in minority populations4 7d7 ,definition ,in this section1 the term acquired bone marrow failure disease has the meaning given to such term in section #cag,x7d74 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #b1jjj1jjj for each of fiscal years #bjae through #bjai4 4 7f7 ,diagnosis and quality of care for acquired bone marrow failure diseases 7#a7 ,grants ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality1 shall award grants to entities to improve diagnostic practices and quality of care with respect to patients with acquired bone marrow failure diseases4 7#b7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #b1jjj1jjj for each of fiscal years #bjae through #bjai4 7g7 ,definition ,in this section1 the term acquired bone marrow failure disease means-- 7#a7 myelodysplastic syndromes 7,,mds72 7#b7 aplastic anemia2 7#c7 paroxysmal nocturnal hemoglobinuria 7,,pnh72 7#d7 pure red cell aplasia2 7#e7 acute myeloid leukemia that progressed from myelodysplastic syndromes2 or 7#f7 large granular lymphocytic leukemia4 ,d ,cardiovascular ,disease1 ,chronic ,disease1 and ,other ,disease ,issues #gca4 ,guidelines for disease screening for minority patients 7a7 ,in general ,the ,secretary1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality1 shall convene a series of meetings to develop guidelines for disease screening for minority patient populations which have a higher than average risk for many chronic diseases and cancers4 7b7 ,participants ,in convening meetings under subsection 7a71 the ,secretary shall ensure that meeting participants include representatives of-- 7#a7 professional societies and associations2 7#b7 minority health organizations2 7#c7 health care researchers and providers1 including those with expertise in minority health2 7#d7 ,federal health agencies1 including the ,office of ,minority ,health1 the ,national ,institute on ,minority ,health and ,health ,disparities1 and the ,national ,institutes of ,health2 and 7#e7 other experts determined appropriate by the ,secretary4 7c7 ,diseases ,screening guidelines for minority populations shall be developed as appropriate under subsection 7a7 for-- 7#a7 hypertension2 7#b7 hypercholesterolemia2 7#c7 diabetes2 7#d7 cardiovascular disease2 7#e7 cancers1 including breast1 prostate1 colon1 cervical1 and lung cancer2 7#f7 asthma2 7#g7 diabetes2 7#h7 kidney diseases2 7#i7 eye diseases and disorders1 including glaucoma2 7#aj7 ,,hiv_/,,aids and sexually transmitted diseases2 7#aa7 uterine fibroids2 7#ab7 autoimmune disease2 7#ac7 mental health conditions2 7#ad7 dental health conditions and oral diseases1 including oral cancer2 7#ae7 environmental and related health illnesses and conditions2 7#af7 ,sickle cell disease2 7#ag7 violence and injury prevention and control2 7#ah7 genetic and related conditions2 7#ai7 heart disease and stroke2 7#bj7 tuberculosis2 7#ba7 chronic obstructive pulmonary disease2 7#bb7 musculoskeletal diseases1 arthritis1 and obesity2 and 7#bc7 other diseases determined appropriate by the ,secretary4 7d7 ,dissemination ,not later than #bd months after the date of enactment of this title1 the ,secretary shall publish and disseminate to health care provider organizations the guidelines developed under subsection 7a74 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section1 such sums as may be necessary for each of fiscal years #bjae through #bjai4 #gcb4 ,,cdc ,wisewoman ,screening ,program ,section #aeji of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjn-#d;a7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by striking the heading and inserting ,in ,general4--2 and 7,b7 in the matter preceding paragraph 7#a71 by striking may make grants and all that follows through purpose and inserting the following3 may make grants to such ,states for the purpose2 and 7#b7 in subsection 7d77#a71 by striking there are authorized and all that follows through the period and inserting there are authorized to be appropriated #bc1jjj1jjj for fiscal year #bjae1 #be1cjj1jjj for fiscal year #bjaf1 #bg1hjj1jjj for fiscal year #bjag1 #cj1hjj1jjj for fiscal year #bjah1 and #cd1jjj1jjj for fiscal year #bjai44 #gcc4 ,report on cardiovascular care for women and minorities ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq47 is amended by adding at the end the following3 #cii,v-#f4 ,report on cardiovascular care for women and minorities ,not later than ,september #cj1 #bjae1 and annually thereafter1 the ,secretary shall prepare and submit to the ,congress a report on the quality of and access to care for women and minorities with heart disease1 stroke1 and other cardiovascular diseases4 ,the report shall contain recommendations for eliminating disparities in1 and improving the treatment of1 heart disease1 stroke1 and other cardiovascular diseases in women1 racial and ethnic minorities1 those for whom ,english is not their primary language1 and individuals with disabilities4 4 #gcd4 ,coverage of comprehensive tobacco cessation services in ,medicaid 7a7 ,requiring coverage of counseling and pharmacotherapy for cessation of tobacco use ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7#a7 in subsection 7a77#d77;,d7 is amended by striking by pregnant women2 and 7#b7 in subsection 7bb7-- 7,a7 by striking by pregnant women each place it appears2 7,b7 in paragraph 7#a71 in the matter before subparagraph 7,a71 by inserting by individuals before who use tobacco2 and 7,c7 in paragraph 7#b77;,a71 by striking with respect to pregnant women4 7b7 ,exception from optional restriction under medicaid prescription drug coverage ,section #aibg7;d77#b77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7;d77#b77;,f77 is amended by striking in the case of pregnant women4 7c7 ,removal of cost sharing for counseling and pharmacotherapy for cessation of tobacco use 7#a7 ,general cost sharing limitations ,section #aiaf of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo7 is amended-- 7,a7 in subsections 7a77#b77;,b7 and 7b77#b77;,b71 by striking and counseling and pharmacotherapy for cessation of tobacco use by pregnant women 7as defined in section #aije7;bb77 and covered outpatient drugs 7as defined in subsection 7k77#b7 of section #aibg and including nonprescription drugs described in subsection 7d77#b7 of such section7 that are prescribed for purposes of promoting1 and when used to promote1 tobacco cessation by pregnant women in accordance with the ,guideline referred to in section #aije7;bb77#b77;,a7 each place it appears2 and 7,b7 in each of subsections 7a77#b77;,d7 and 7b77#b77;,d7 by inserting and counseling and pharmacotherapy for cessation of tobacco use 7as defined in section #aije7;bb77 and covered outpatient drugs 7as defined in subsection 7k77#b7 of section #aibg and including nonprescription drugs described in subsection 7d77#b7 of such section7 that are prescribed for purposes of promoting1 and when used to promote1 tobacco cessation in accordance with the ,guideline referred to in section #aije7;bb77#b77;,a71 after section #aije7;a77#d77;,c714 7#b7 ,application to alternative cost sharing ,section #aiaf;,a7b77#c77;,b7 of such ,act 7#db ,u4,s4,c4 #acifo-#a7;b77#c77;,b7#db ,u4,s4,c4 #acifo-#a7;b77#c77;,b77 is amended-- 7,a7 in clause 7iii71 by striking 1 and counseling and pharmacotherapy for cessation of tobacco use by pregnant women 7as defined in section #aije7;bb772 and 7,b7 by adding at the end the following3 7xi7 ,counseling and pharmacotherapy for cessation of tobacco use 7as defined in section #aije7;bb77 and covered outpatient drugs 7as defined in subsection 7k77#b7 of section #aibg and including nonprescription drugs described in subsection 7d77#b7 of such section7 that are prescribed for purposes of promoting1 and when used to promote1 tobacco cessation in accordance with the ,guideline referred to in section #aije7;bb77#b77;,a74 4 7d7 ,effective date ,the amendments made by this section shall take effect on ,october #a1 #bjad4 #gce4 ,clinical research funding for oral health 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall expand and intensify the conduct and support of the research activities of the ,national ,institutes of ,health and the ,national ,institute of ,dental and ,craniofacial ,research to improve the oral health of the population through the prevention and management of oral diseases and conditions4 7b7 ,included research activities ,research activities under subsection 7a7 shall include-- 7#a7 comparative effectiveness research and clinical disease management research addressing early childhood caries and oral cancer2 and 7#b7 awarding of grants and contracts to support the training and development of health services researchers1 comparative effectiveness researchers1 and clinical researchers whose research improves the oral health of the population4 #gcf4 ,participation by ,medicaid beneficiaries in approved clinical trials 7a7 ,in general ,title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is amended by inserting after section #aidc the following new section3 #aidd4 ,participation in an approved clinical trial 7a7 ,coverage of routine patient costs associated with approved clinical trials 7#a7 ,inclusion ,subject to paragraph 7#b71 routine patient costs shall include all items and services consistent with the medical assistance provided under the ,state plan that would otherwise be provided to the individual under such ,state plan if such individual was not enrolled in an approved clinical trial1 including any items or services related to the prevention1 detection1 and treatment of any medical complications that arise as a result of participation in the approved clinical trial4 7#b7 ,exclusion ,for purposes of paragraph 7#a71 routine patient costs does not include-- 7,a7 the investigational item1 device1 or service itself2 7,b7 items and services that are provided solely to satisfy data collection and analysis needs and that are not used in the direct clinical management of the patient2 or 7,c7 a service that is clearly inconsistent with widely accepted and established standards of care for a particular diagnosis4 7#c7 ,information concerning clinical trials 7,a7 ,in general ,subject to subparagraph 7,b71 the ,secretary1 in consultation with relevant stakeholders1 shall develop a single standardized electronic form for use by the individual or the referring health care provider to submit to the ,state agency administering the ,state plan in order to verify that the clinical trial meets the conditions established for an approved clinical trial 7as defined in subsection 7c774 7,b7 ,excluded information ,for purposes of subparagraph 7,a7 or any such request by the ,state agency for information regarding a clinical trial1 an individual or referring health care provider shall not be required to submit-- 7i7 the clinical protocol document for the clinical trial2 or 7ii7 subject to subparagraph 7,c71 any additional information other than such information as is required pursuant to the form described in subparagraph 7,a74 7,c7 ,optional information ,for purposes of subparagraphs 7,a7 and 7,b77ii71 the form may include a requirement that the referring health care provider attest that the individual is eligible to participate in the clinical trial pursuant to the trial protocol and that their participation in such trial would be appropriate4 7,d7 ,review of information 7i7 ,in general ,a ,state plan under this title shall establish a process for timely review by the ,state agency of the form and information submitted pursuant to subparagraph 7,a7 and1 not later than #dh hours after receipt of such form1 confirmation that the information provided in such form satisfies the requirements established under such subparagraph1 with such process to include establishment and operation of a #bd-;hour1 toll-free telephone number and e-mail address to provide for expedited communication4 7ii7 ,failure to respond ,if an individual or the referring health care provider does not receive a response or request for additional information from the ,state agency following the #dh-;hour period described in clause 7i71 the information provided in the form may be presumed to satisfy the requirements established under this paragraph4 7b7 ,encouragement of participation in approved clinical trials 7#a7 ,reasonably accessible provider ,for purposes of participation in an approved clinical trial by an individual eligible for medical assistance under this title1 the ,state agency administering the ,state plan shall make reasonable efforts to ensure that the individual is provided with access to a provider who is-- 7,a7 participating in the approved clinical trial2 7,b7 located not more than #be miles from the residence of the individual 7or1 if no such provider is available1 as close as possible to the residence of the individual72 and 7,c7 a participating provider under the ,state plan or has been deemed to be a participating provider under the ,state plan for purposes of providing medical assistance to the individual during their participation in the approved clinical trial4 7#b7 ,informational materials ,the ,state agency administering the plan approved under this title shall develop informational materials and programs to encourage participating providers to make appropriate referrals to physicians and other appropriate health care professionals who can provide individuals with access to approved clinical trials4 7c7 ,definition of approved clinical trial ,the term approved clinical trial has the same meaning as provided under section #bgji7;d7 of the ,public ,health ,service ,act4 4 7b7 ,conforming amendment ,section #aijb7;a7 of such ,act 7#db ,u4,s4,c4 #acif;a7a77 is amended by inserting after paragraph 7#gg7 the following new paragraph3 7#gh7 provide that participation in an approved clinical trial and coverage of routine patient costs associated with such trial for an individual eligible for medical assistance under this title is conducted in accordance with the requirements under section #aidd2 4 7c7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 the amendments made by this section shall apply to calendar quarters beginning on or after ,october #a1 #bjad4 7#b7 ,delay permitted for state plan amendment ,in the case of a ,state plan for medical assistance under title ,,xix of the ,social ,security ,act which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirements imposed by the amendments made by this section1 the ,state plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of such session shall be deemed to be a separate regular session of the ,state legislature4 ,e ,,hiv_/,,aids #gda4 ,statement of policy ,it is the policy of the ,united ,states to achieve an ,,aids-free generation1 and to-- 7#a7 expand access to lifesaving antiretroviral therapy for people living with ,,hiv_/,,aids and immediately link people to continuous and coordinated high-quality care when they learn they are infected with ,,hiv2 7#b7 expand targeted efforts to prevent ,,hiv infection using a combination of effective1 evidence-based approaches1 including routine ,,hiv screening1 and universal access to ,,hiv prevention tools in the communities where ,,hiv_/,,aids is most heavily concentrated1 particularly communities of color2 7#c7 ensure laws1 policies1 and regulations do not impede access to prevention1 treatment1 and care for people living with ,,hiv_/,,aids or at risk for acquiring ,,hiv2 7#d7 accelerate research for more efficacious ,,hiv prevention and treatments tools1 a cure1 and a vaccine2 and 7#e7 respect the human rights and dignity of persons living with ,,hiv_/,,aids4 #gdb4 ,findings ,the ,congress finds the following3 7#a7 ,over one million people are estimated to be living with ,,hiv in the ,united ,states according to the ,centers for ,disease ,control and ,prevention1 #ah percent of whom are unaware of their ,,hiv-positive status4 7#b7 ,annually there are over #ej1jjj new ,,hiv infections and #bj1jjj deaths in people with an ,,hiv diagnoses in #ej ,states and #f dependent areas of the ,united ,states4 7#c7 ,the ,centers for ,disease ,control and ,prevention estimates that in #bjaa there were approximately #ej1aii people newly diagnosed with ,,hiv4 ,though this number seems to be staying relatively stable1 the number of new infections is rapidly increasing among certain populations especially among young ,african-,american men who have sex with men 7,,msm7 who1 in #bjaj1 accounted for #de percent of new ,,hiv infections among black ,,msm and #ee percent of ,,hiv infections among young ,,msm overall4 7#d7 ,,hiv disproportionately affects certain populations in the ,united ,states4 ,though ,african-,americans represent less than #ac percent of the population1 ,african-,americans account for almost half 7#dd percent7 of all people living with ,,hiv in the ,united ,states4 ,men who have sex with men 7,,msm7 make up approximately #d percent of the population1 but account for #fc percent of all new ,,hiv infections and are the only risk group in which ,,hiv infections continue to increase4 7#e7 ,disparities exist among ,latinos_/,hispanics2 they make up #af percent of ,,us population and #bb percent of new infections 7#bjaa74 7#f7 ,though ,american ,indians_/,alaska ,natives represent less than #b percent of the total number of ,,hiv_/,,aids cases1 ,american ,indians and ,alaska ,natives rank fifth in rates of ,,hiv_/,,aids diagnosis1 still higher than their ,white counterparts4 7#g7 ,while ,asian-,americans1 ,native ,hawaiians1 and ,pacific ,islanders ,,hiv_/,,aids cases account for approximately #a percent of cases nationally1 between #bjaj and #bjaa1 the rate of new ,,hiv diagnoses increased for ,asian-,americans by #bb percent4 7#h7 ,the latest data from the ,,cdc 7#bjac7 indicate that women account for #a in #e 7#bj percent7 new ,,hiv infections in the ,united ,states women of color1 particularly ,black women1 have been especially hard hit and represent the majority of women living with the disease and women newly infected4 ,in addition1 ,black women accounted for nearly two-thirds 7#fd percent7 of all estimated new ,,hiv infections among women1 while only accounting for #ac percent of the female population2 ,white women accounted for #ah percent and ,latinas #ae percent of new infections4 7#i7 ,the history of ,,hiv shows that culturally relevant and gender-responsive supportive services1 including psychosocial support1 treatment literacy1 case management1 and transportation are necessary strategies to reach and engage women and girls in medical care4 7#aj7 ,the limited data available on transgender individuals point to a disproportionate burden of ,,hiv infection4 7#aa7 ,stigma and discrimination contribute to these disparities4 7#ab7 ,the ,centers for ,disease ,control and ,prevention has determined that increasing the proportion of people who know their ,,hiv status is an essential component of comprehensive ,,hiv_/,,aids treatment and prevention efforts and that early diagnosis is critical in order for people with ,,hiv_/,,aids to receive life-extending therapy4 ,additionally1 the ,centers for ,disease ,control and ,prevention recommend routine ,,hiv screening in health care settings for all patients aged #ac to #fd1 regardless of risk4 7#ac7 ,in #aiih1 ,congress created the ,national ,minority ,,aids ,initiative to provide technical assistance1 build capacity1 and strengthen outreach efforts among local institutions and community-based organizations that serve racial and ethnic minorities living with or vulnerable to ,,hiv_/,,aids4 7#ad7 ,to combat the ,,hiv epidemic in the ,united ,states1 the ,national ,,hiv_/,,aids ,strategy 7,,nhas7 from the ,white ,house ,office of ,national ,,aids ,policy provides a framework of increasing access to care1 reducing new infections1 and eliminating ,,hiv-related health disparities4 ,the vision of ,,nhas is ,the ,united ,states will become a place where new ,,hiv infections are rare and when they do occur1 every person1 regardless of age1 gender1 race_/ethnicity1 gender identity1 or socioeconomic circumstance1 will have unfettered access to high quality1 life-extending care1 free from stigma and discrimination44 7#ae7 ,in recent years1 several thousand people across the country were waiting to receive ,,aids treatment through the ,,aids ,drug ,assistance ,program authorized by the provisions popularly known as the ,ryan ,white ,,care ,act4 7#af7 ,at present1 #cd ,states and #b ,united ,states territories have criminal statutes based on exposure to ,,hiv4 ,most of these laws were adopted before the availability of effective antiretroviral treatment for ,,hiv_/,,aids4 7#ag7 ,although the cost of education1 treatment and care1 and research are not inconsequential1 they are substantially less than the annual health care cost attributable to ,,hiv in the ,united ,states4 ,the lifetime cost of ,,hiv care and treatment in #bjjd was estimated to be #dje1jjj to #fdh1jjj annually4 ,preventing #dj1jjj new infections in the ,united ,states each year would save #ab4h billion annually4 7#ah7 ,according to the ,centers for ,disease ,control and ,prevention 7,,cdc71 latex condoms1 when used consistently and correctly1 are highly effective in preventing the transmission of ,,hiv4 ,latex condoms also reduce the risk of other ,s,t,is4 ,despite the effectiveness of condoms in reducing the spread of ,s,t,is1 the ,bureau of ,prisons does not recommend their use in correctional facilities4 7#ai7 ,the distribution of condoms in correctional facilities is currently legal in certain parts of the ,united ,states and the world4 ,the ,states of ,vermont and ,mississippi1 the ,district of ,columbia1 and the cities of ,new ,york1 ,san ,francisco1 ,los ,angeles1 ,washington1 ,,dc1 and ,philadelphia allow condom distribution in their correctional facilities4 ,however1 these ,states and cities operate fewer than #a percent of all correctional facilities4 7#bj7 ,many correctional facilities in the ,united ,states do not provide comprehensive testing and treatment programs to reduce the spread of ,s,t,is4 ,fewer than half of correctional facilities provide counseling to ,,hiv-positive incarcerated persons4 7#ba7 ,incarcerated individuals living with ,,hiv_/,,aids who are eligible for ,medicaid would benefit from prompt and automatic enrollment upon their release in order to ensure their continued ability to access health services1 including antiretroviral treatment4 7#bb7 ,research shows that stable housing leads to better health outcomes for those living with ,,hiv4 ,inadequate or unstable housing is not only a barrier to effective treatment1 but also increases the likelihood of engaging in risky behaviors leading to ,,hiv infection4 ,insecure housing puts people with ,,hiv_/,,aids at risk of premature death from exposure to other diseases1 poor nutrition1 and lack of medical care4 7#bc7 ,due to advances in treatment1 many people living with ,,hiv_/,,aids 7,,plwha7 today are living healthy lives and have the ability and desire to fully participate in all aspects of community life1 including employment4 ,research associates being employed with tremendous economic1 social1 and health benefits for many people living with ,,hiv_/,,aids4 7#bd7 ,the common benefits associated with employment include income1 autonomy1 productivity1 and status within society1 daily structure1 making a contribution to one's community1 and increased skills and self-esteem4 ,research also indicates that many people with disabilities1 including ,,plwha1 report perceiving themselves as being less disabled or not disabled at all1 when working4 ,furthermore1 some studies link working with better physical and mental health outcomes for ,,plwha when compared to those who are not working4 ,preliminary data also suggest that transitioning to employment is associated with reduced ,,hiv-related health risk behavior for many people4 7#be7 ,on ,july #af1 #bjab1 the ,food and ,drug ,administration approved the first drug to reduce the risk of ,,hiv infection in uninfected individuals who are at high risk of ,,hiv infection and who may engage in sexual activity with ,,hiv-infected partners4 #gdc4 ,additional funding for ,,aids drug assistance program treatments ,section #bfbc of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#ca;b7 is amended by adding at the end the following3 7c7 ,additional funding for ,,aids drug assistance program treatments ,in addition to amounts otherwise authorized to be appropriated for carrying out this subpart1 there are authorized to be appropriated such sums as may be necessary to carry out sections #bfab7;b77#c77;,b7 and #bfaf for each of fiscal years #bjae through #bjag4 4 #gdd4 ,enhancing the national ,,hiv surveillance system 7a7 ,grants ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall make grants to ,states to support integration of public health surveillance systems into all electronic health records in order to allow rapid communications between the clinical setting and health departments1 by means that include-- 7#a7 providing technical assistance and policy guidance to ,state and local health departments1 clinical providers1 and other agencies serving individuals with ,,hiv to improve the interoperability of data systems relevant to monitoring ,,hiv care and supportive services2 7#b7 capturing longitudinal data pertaining to the initiation and ongoing prescription or dispensing of antiretroviral therapy for individuals diagnosed with ,,hiv 7such as through pharmacy-based reporting72 7#c7 obtaining information-- 7,a7 on a voluntary basis1 on sexual orientation and gender identity2 and 7,b7 on sources of coverage 7or the lack thereof7 for medical treatment 7including coverage through ,medicaid1 ,medicare1 the program under title ,,xxvi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#aa et seq42 commonly referred to as the ,ryan ,white ,,hiv_/,,aids ,program71 other public funding1 private insurance1 and health maintenance organizations72 and 7#d7 obtaining and using current geographic markers of residence 7such as current address1 zip code1 partial zip code1 and census block74 7b7 ,privacy and security safeguards ,in carrying out this section1 the ,secretary of ,health and ,human ,services shall ensure that appropriate privacy and security safeguards are met to prevent unauthorized disclosure of protected health information and compliance with the ,,hipaa privacy and security law 7as defined in section #cjji of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ai77 and other relevant laws and regulations4 7c7 ,prohibition against improper use of data ,no grant under this section may be used to allow or facilitate the collection or use of surveillance or clinical data or records-- 7#a7 for punitive measures of any kind1 civil or criminal1 against the subject of such data or records2 or 7#b7 for imposing any requirement or restriction with respect to an individual without the individual's written consent4 7d7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for each of fiscal years #bjae through #bjai4 #gde4 ,evidence-based strategies for improving linkage to and retention in appropriate care 7a7 ,strategies ,the ,secretary of ,health and ,human ,services1 in collaboration with the ,director of the ,centers for ,disease ,control and ,prevention1 the ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration1 the ,director of the ,office of ,,aids ,research1 the ,administrator of the ,health ,resources and ,services ,administration1 and the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall-- 7#a7 identify evidence-based strategies most effective at addressing the multifaceted issues that impede disease status awareness and linkage to and retention in appropriate care1 taking into consideration health care systems issues1 clinic and provider issues1 and individual psychosocial1 environmental1 and other contextual factors2 7#b7 support the wide-scale implementation of the evidence-based strategies identified pursuant to paragraph 7#a71 including through incorporating such strategies into health care coverage supported by the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 the program under title ,,xxvi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#aa et seq42 commonly referred to as the ,ryan ,white ,,hiv_/,,aids ,program71 and health plans purchased through an ,american ,health ,benefit ,exchange established pursuant to section #acaa of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca72 and 7#c7 not later than #ab months after the date of the enactment of this ,act1 submit a report to the ,congress on the status of activities under paragraphs 7#a7 and 7#b74 7b7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjae through #bjai4 #gdf4 ,improving entry into and retention in care and antiretroviral adherence for persons with ,,hiv 7a7 ,sense of congress ,it is the sense of the ,congress that ,,aids research has led to scientific advancements that have-- 7#a7 saved the lives of millions of people with ,,hiv_/,,aids2 7#b7 prevented millions of people from being infected2 and 7#c7 had broad benefits that extend far beyond helping people at risk for or living with ,,hiv4 7b7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,national ,institutes of ,health1 shall expand1 intensify1 and coordinate operational and translational research and other activities of the ,national ,institutes of ,health regarding methods-- 7#a7 to increase adoption of evidence-based adherence strategies within ,,hiv care and treatment programs2 7#b7 to increase ,,hiv testing and case detection rates2 7#c7 to reduce ,,hiv-related health disparities2 7#d7 to ensure that research to improve adherence to ,,hiv care and treatment programs address the unique concerns of women2 7#e7 to integrate ,,hiv_/,,aids prevention and care services with mental health and substance use prevention and treatment delivery systems2 and 7#f7 to increase knowledge on the implementation of preexposure prophylaxis 7,pr,e,p71 including with respect to-- 7,a7 who can benefit most from ,pr,e,p2 7,b7 how to provide ,pr,e,p safely and efficiently2 7,c7 how to integrate ,pr,e,p with other essential prevention methods such as condoms2 and 7,d7 how to ensure high levels of adherence4 7c7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjae through #bjai4 #gdg4 ,services to reduce ,,hiv_/,,aids in racial and ethnic minority communities 7a7 ,in general ,for the purpose of reducing ,,hiv_/,,aids in racial and ethnic minority communities1 the ,secretary1 acting through the ,deputy ,assistant ,secretary for ,minority ,health1 may make grants to public health agencies and faith-based organizations to conduct-- 7#a7 outreach activities related to ,,hiv_/,,aids prevention and testing activities2 7#b7 ,,hiv_/,,aids prevention activities2 and 7#c7 ,,hiv_/,,aids testing activities4 7b7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated #ej1jjj1jjj for fiscal year #bjae1 and such sums as may be necessary for fiscal years #bjaf through #bjai4 #gdh4 ,minority ,,aids initiative 7a7 ,expanded funding ,the ,secretary1 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health1 the ,director of the ,centers for ,disease ,control and ,prevention1 the ,administrator of the ,health ,resources and ,services ,administration1 and the ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration1 shall provide funds and carry out activities to expand the ,minority ,,hiv_/,,aids ,initiative4 7b7 ,use of funds ,the additional funds made available under this section may be used1 through the ,minority ,,aids ,initiative1 to support the following activities3 7#a7 ,providing technical assistance and infrastructure support to reduce ,,hiv_/,,aids in minority populations4 7#b7 ,increasing minority populations' access to ,,hiv_/,,aids prevention and care services4 7#c7 ,building strong community programs and partnerships to address ,,hiv prevention and the health care needs of specific racial and ethnic minority populations4 7c7 ,priority interventions ,within the racial and ethnic minority populations referred to in subsection 7b71 priority in conducting intervention services shall be given to-- 7#a7 men who have sex with men2 7#b7 youth2 7#c7 persons who engage in intravenous drug abuse2 7#d7 women2 7#e7 homeless individuals2 and 7#f7 individuals incarcerated or in the penal system4 7d7 ,authorization of appropriations ,for carrying out this section1 there are authorized to be appropriated #faj1jjj1jjjj for fiscal year #bjae and such sums as may be necessary for each of fiscal years #bjaf through #bjai4 #gdi4 ,health care professionals treating individuals with ,,hiv_/,,aids 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall expand1 intensify1 and coordinate workforce initiatives of the ,health ,resources and ,services ,administration to increase the capacity of the health workforce focusing primarily on ,,hiv_/,,aids to meet the demand for culturally competent care1 and may award grants for any of the following3 7#a7 ,development of curricula for training primary care providers in ,,hiv_/,,aids prevention and care1 including routine ,,hiv testing4 7#b7 ,support to expand access to culturally and linguistically accessible benefits counselors1 trained peer navigators1 and mental and behavioral health professionals with expertise in ,,hiv_/,,aids4 7#c7 ,training health care professionals to provide care to individuals with ,,hiv_/,,aids4 7#d7 ,development by grant recipients under title ,,xxvi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#aa et seq42 commonly referred to as the ,ryan ,white ,,hiv_/,,aids ,program7 and other persons1 of policies for providing culturally relevant and sensitive treatment to individuals with ,,hiv_/,,aids1 with particular emphasis on treatment to racial and ethnic minorities1 men who have sex with men1 and women1 young people1 and children with ,,hiv_/,,aids4 7#e7 ,development and implementation of programs to increase the use of telehealth to respond to ,,hiv_/,,aids-specific health care needs in rural and minority communities1 with particular emphasis given to medically underserved communities and insular areas4 7#f7 ,evaluating interdisciplinary medical provider care team models that promote high quality care1 with particular emphasis on care to racial and ethnic minorities4 7#g7 ,training health care professionals to make them aware of the high rates of chronic hepatitis ,b and chronic hepatitis ,c in adult racial and ethnic populations1 and the importance of prevention1 detection1 and medical management of hepatitis ,b and hepatitis ,c and of liver cancer screening4 7b7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjae through #bjai4 #gej4 ,,hiv_/,,aids provider loan repayment program 7a7 ,in general ,the ,secretary may enter into an agreement with any physician1 nurse practitioner1 or physician assistant under which-- 7#a7 the physician1 nurse practitioner1 or physician assistant agrees to serve as a medical provider for a period of not less than #b years-- 7,a7 at a ,ryan ,white-funded or title ,x-funded facility with a critical shortage of doctors 7as determined by the ,secretary72 or 7,b7 in an area with a high incidence of ,,hiv_/,,aids2 and 7#b7 the ,secretary agrees to make payments in accordance with subsection 7b7 on the professional education loans of the physician1 nurse practitioner1 or physician assistant4 7b7 ,manner of payments ,the payments described in subsection 7a7 shall be made by the ,secretary as follows3 7#a7 ,upon completion by the physician1 nurse practitioner1 or physician assistant for whom the payments are to be made of the first year of the service specified in the agreement entered into with the ,secretary under subsection 7a71 the ,secretary shall pay #cj percent of the principal of and the interest on the individual's professional education loans4 7#b7 ,upon completion by the physician1 nurse practitioner1 or physician assistant of the second year of such service1 the ,secretary shall pay another #cj percent of the principal of and the interest on such loans4 7#c7 ,upon completion by that individual of a third year of such service1 the ,secretary shall pay another #be percent of the principal of and the interest on such loans4 7c7 ,applicability of certain provisions ,the provisions of subpart ,,iii of part ,d of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedl et seq47 shall1 except as inconsistent with this section1 apply to the program carried out under this section in the same manner and to the same extent as such provisions apply to the ,national ,health ,service ,corps ,loan ,repayment ,program4 7d7 ,reports ,not later than #ah months after the date of the enactment of this ,act1 and annually thereafter1 the ,secretary shall prepare and submit to the ,congress a report describing the program carried out under this section1 including statements regarding the following3 7#a7 ,the number of physicians1 nurse practitioners1 and physician assistants enrolled in the program4 7#b7 ,the number and amount of loan repayments4 7#c7 ,the placement location of loan repayment recipients at facilities described in subsection 7a77#a74 7#d7 ,the default rate and actions required4 7#e7 ,the amount of outstanding default funds4 7#f7 ,to the extent that it can be determined1 the reason for the default4 7#g7 ,the demographics of individuals participating in the program4 7#h7 ,an evaluation of the overall costs and benefits of the program4 7e7 ,definitions ,in this section3 7#a7 ,the term ,,hiv_/,,aids means human immunodeficiency virus and acquired immune deficiency syndrome4 7#b7 ,the term nurse practitioner means a registered nurse who has completed an accredited graduate degree program in advanced nurse practice and has successfully passed a national certification exam4 7#c7 ,the term physician means a graduate of a school of medicine who has completed postgraduate training in general or pediatric medicine4 7#d7 ,the term physician assistant means a medical provider who completed an accredited physician assistant training program and successfully passed the ,physician ,assistant ,national ,certifying ,examination4 7#e7 ,the term professional education loan-- 7,a7 means a loan that is incurred for the cost of attendance 7including tuition1 other reasonable educational expenses1 and reasonable living costs7 at a school of medicine1 nursing1 or physician assistant training program2 and 7,b7 includes only the portion of the loan that is outstanding on the date the physician1 nurse practitioner1 or physician assistant involved begins the service specified in the agreement under subsection 7a74 7#f7 ,the term ,ryan ,white-funded means1 with respect to a facility1 receiving funds under title ,,xxvi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#aa et seq474 7#g7 ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#h7 ,the term school of medicine has the meaning given to that term in section #gii;,b of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #biep74 7#i7 ,the term title ,x-funded means1 with respect to a facility1 receiving funds under title ,x of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj et seq474 7f7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjae through #bjai4 #gea4 ,dental education loan repayment program 7a7 ,in general ,the ,secretary of ,health and ,human ,services may enter into an agreement with any dentist under which-- 7#a7 the dentist agrees to serve as a dentist for a period of not less than #b years at a facility with a critical shortage of dentists 7as determined by the ,secretary7 in an area with a high incidence of ,,hiv_/,,aids2 and 7#b7 the ,secretary agrees to make payments in accordance with subsection 7b7 on the dental education loans of the dentist4 7b7 ,manner of payments ,the payments described in subsection 7a7 shall be made by the ,secretary as follows3 7#a7 ,upon completion by the dentist for whom the payments are to be made of the first year of the service specified in the agreement entered into with the ,secretary under subsection 7a71 the ,secretary shall pay #cj percent of the principal of and the interest on the dental education loans of the dentist4 7#b7 ,upon completion by the dentist of the second year of such service1 the ,secretary shall pay another #cj percent of the principal of and the interest on such loans4 7#c7 ,upon completion by that individual of a third year of such service1 the ,secretary shall pay another #be percent of the principal of and the interest on such loans4 7c7 ,applicability of certain provisions ,the provisions of subpart ,,iii of part ,d of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedl et seq47 shall1 except as inconsistent with this section1 apply to the program carried out under this section in the same manner and to the same extent as such provisions apply to the ,national ,health ,service ,corps ,loan ,repayment ,program4 7d7 ,reports ,not later than #ah months after the date of the enactment of this ,act1 and annually thereafter1 the ,secretary shall prepare and submit to the ,congress a report describing the program carried out under this section1 including statements regarding the following3 7#a7 ,the number of dentists enrolled in the program4 7#b7 ,the number and amount of loan repayments4 7#c7 ,the placement location of loan repayment recipients at facilities described in subsection 7a77#a74 7#d7 ,the default rate and actions required4 7#e7 ,the amount of outstanding default funds4 7#f7 ,to the extent that it can be determined1 the reason for the default4 7#g7 ,the demographics of individuals participating in the program4 7#h7 ,an evaluation of the overall costs and benefits of the program4 7e7 ,definitions ,in this section3 7#a7 ,the term dental education loan-- 7,a7 means a loan that is incurred for the cost of attendance 7including tuition1 other reasonable educational expenses1 and reasonable living costs7 at a school of dentistry2 and 7,b7 includes only the portion of the loan that is outstanding on the date the dentist involved begins the service specified in the agreement under subsection 7a74 7#b7 ,the term dentist means a graduate of a school of dentistry who has completed postgraduate training in general or pediatric dentistry4 7#c7 ,the term ,,hiv_/,,aids means human immunodeficiency virus and acquired immune deficiency syndrome4 7#d7 ,the term school of dentistry has the meaning given to that term in section #gii;,b of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #biep74 7#e7 ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7f7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for each of fiscal years #bjae through #bjai4 #geb4 ,reducing new ,,hiv infections among injecting drug users 7a7 ,sense of congress ,it is the sense of the ,congress that providing sterile syringes and sterilized equipment to injecting drug users substantially reduces risk of ,,hiv infection1 increases the probability that they will initiate drug treatment1 and does not increase drug use4 7b7 ,in general ,the ,secretary of ,health and ,human ,services may provide grants and technical assistance for the purpose of reducing the rate of ,,hiv infections among injecting drug users through a comprehensive package of services for such users1 including the provision of sterile syringes1 education and outreach1 access to infectious disease testing1 overdose prevention1 and treatment for drug dependence4 7c7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjae through #bjai4 #gec4 ,support for expansion of comprehensive sexual health and education programs 7a7 ,sense of congress ,it is the sense of ,congress that-- 7#a7 federally funded sex education programs should aim to-- 7,a7 reduce unintended pregnancy and sexually transmitted infections1 including ,,hiv2 7,b7 promote safe and healthy relationships2 7,c7 use1 and be informed by1 the best scientific information available2 7,d7 be built on characteristics of effective programs2 7,e7 expand the existing body of evidence on comprehensive sex education programs through program evaluation2 7,f7 expand training programs for teachers of comprehensive sex education2 7,g7 build on the personal responsibility education programs funded under section #eac of the ,social ,security ,act 7#db ,u4,s4,c4 #gac7 and the ,president's ,teen ,pregnancy ,prevention program1 funded under title ,,ii of the ,consolidated ,appropriations ,act1 #bjaj 7,public ,law #aaa-aag2 #abc ,stat4 #cbec72 and 7,h7 promote and uphold the rights of young people to information in order to make healthy and responsible decisions about their sexual health2 and 7#b7 no ,federal funds should be used for health education programs that-- 7,a7 deliberately withhold life-saving information about ,,hiv2 7,b7 are medically inaccurate or have been scientifically shown to be ineffective2 7,c7 promote gender stereotypes2 7,d7 are insensitive and unresponsive to the needs of sexually active adolescents2 7,e7 are insensitive and unresponsive to the needs of lesbian1 gay1 bisexual1 or transgender youth2 or 7,f7 are inconsistent with the ethical imperatives of medicine and public health4 7b7 ,grants for comprehensive sex education for adolescents 7#a7 ,program authorized ,the ,secretary1 in coordination with the ,director of the ,office of ,adolescent ,health1 shall award grants1 on a competitive basis1 to eligible entities to enable such eligible entities to carry out programs that provide adolescents with comprehensive sex education1 as described in paragraph 7#f74 7#b7 ,duration ,grants awarded under this subsection shall be for a period of #e years4 7#c7 ,eligible entity ,in this subsection1 the term eligible entity means a public or private entity that focuses on adolescent health or education or has experience working with adolescents1 which may include-- 7,a7 a ,state educational agency2 7,b7 a local educational agency2 7,c7 a tribe or tribal organization1 as defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej;b72 7,d7 a ,state or local department of health2 7,e7 a ,state or local department of education2 7,f7 a nonprofit organization2 7,g7 a nonprofit or public institution of higher education2 or 7,h7 a hospital4 7#d7 ,applications ,an eligible entity desiring a grant under this subsection shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require1 including the evaluation plan described in paragraph 7#g77;,a74 7#e7 ,priority ,in awarding grants under this subsection1 the ,secretary shall give priority to eligible entities that-- 7,a7 are ,state or local public entities1 with an additional priority for ,state or local educational agencies2 and 7,b7 address health disparities among young people that are at highest risk for not less than #a of the following3 7i7 ,unintended pregnancies4 7ii7 ,sexually transmitted infections1 including ,,hiv4 7iii7 ,dating violence and sexual assault4 7#f7 ,use of funds 7,a7 ,in general ,each eligible entity that receives a grant under this subsection shall use grant funds to carry out a program that provides adolescents with comprehensive sex education that-- 7i7 replicates evidence-based sex education programs2 7ii7 substantially incorporates elements of evidence-based sex education programs2 or 7iii7 creates a demonstration project based on generally accepted characteristics of effective sex education programs4 7,b7 ,contents of sex education programs ,the sex education programs funded under this subsection shall include curricula and program materials that address-- 7i7 abstinence and delaying sexual initiation2 7ii7 the health benefits and side effects of all contraceptive and barrier methods as a means to prevent pregnancy and sexually transmitted infections1 including ,,hiv2 7iii7 healthy relationships1 including the development of healthy attitudes and skills necessary for understanding-- 7,i7 healthy relationships between oneself and family1 others1 and society2 and 7,,ii7 the prevention of sexual abuse1 teen dating violence1 bullying1 harassment1 and suicide2 7iv7 healthy life skills including goal-setting1 decisionmaking1 interpersonal skills 7such as communication1 assertiveness1 and peer refusal skills71 critical thinking1 self-esteem and self-efficacy1 and stress management2 7v7 how to make responsible decisions about sex and sexuality1 including-- 7,i7 how to avoid1 and how to avoid making1 unwanted verbal1 physical1 and sexual advances2 and 7,,ii7 how alcohol and drug use can affect responsible decisionmaking2 7vi7 the development of healthy attitudes and values about such topics as adolescent growth and development1 body image1 gender roles and gender identity1 racial and ethnic diversity1 and sexual orientation2 and 7vii7 referral services for local health clinics and services where adolescents can obtain additional information and services related to sexual and reproductive health1 dating violence and sexual assault1 and suicide prevention4 7#g7 ,evaluation2 report 7,a7 ,independent evaluation ,each eligible entity applying for a grant under this subsection shall develop and submit to the ,secretary a plan for a rigorous independent evaluation of such grant program4 ,the plan shall describe an independent evaluation that-- 7i7 uses sound statistical methods and techniques relating to the behavioral sciences1 including random assignment methodologies1 whenever possible2 7ii7 uses quantitative data for assessments and impact evaluations1 whenever possible2 and 7iii7 is carried out by an entity independent from such eligible entity4 7,b7 ,selection of evaluated programs2 budget 7i7 ,selection of evaluated programs ,the ,secretary shall select1 at random1 a subset of the eligible entities that the ,secretary has selected to receive a grant under this subsection to receive additional funding to carry out the evaluation plan described in subparagraph 7,a74 7ii7 ,budget for evaluation activities ,the ,secretary1 in coordination with the ,director of the ,office of ,adolescent ,health1 shall establish a budget for each eligible entity selected under clause 7i7 for the costs of carrying out the evaluation plan described in subparagraph 7,a74 7,c7 ,funds for evaluation ,the ,secretary shall provide eligible entities who are selected under subparagraph 7,b77i7 with additional funds1 in accordance with the budget described in subparagraph 7,b77ii71 to carry out and report to the ,secretary on the evaluation plan described in subparagraph 7,a74 7,d7 ,performance measures ,the ,secretary1 in coordination with the ,director of the ,centers for ,disease ,control and ,prevention1 shall establish a common set of performance measures to assess the implementation and impact of grant programs funded under this subsection4 ,such performance measures shall include-- 7i7 output measures1 such as the number of individuals served and the number of hours of service delivery2 7ii7 outcome measures1 including measures relating to-- 7,i7 the knowledge that youth participating in the grant program have gained about-- 7aa7 adolescent growth and development2 7bb7 relationship dynamics2 7cc7 ways to prevent unintended pregnancy and sexually transmitted infections1 including ,,hiv2 and 7dd7 sexual health2 7,,ii7 the skills that adolescents participating in the grant program have gained regarding-- 7aa7 negotiation and communication2 7bb7 decisionmaking and goal-setting2 7cc7 interpersonal skills and healthy relationships2 and 7dd7 condom use2 and 7,,iii7 the behaviors of adolescents participating in the grant program1 including data about-- 7aa7 age of first intercourse2 7bb7 number of sexual partners2 7cc7 condom and contraceptive use at first intercourse2 7dd7 recent condom and contraceptive use2 and 7ee7 dating abuse and lifetime history of domestic violence1 sexual assault1 dating violence1 bullying1 harassment1 and stalking4 7,e7 ,report to the secretary ,eligible entities receiving a grant under this subsection who have been selected to receive funds to carry out the evaluation plan described in subparagraph 7,a71 in accordance with subparagraph 7,b77i71 shall collect and report to the ,secretary-- 7i7 the results of the independent evaluation described in subparagraph 7,a72 and 7ii7 information about the performance measures described in subparagraph 7,b74 7,f7 ,effective programs ,the ,secretary1 in coordination with the ,director of the ,centers for ,disease ,control and ,prevention1 shall publish on the ,web site of the ,centers for ,disease ,control and ,prevention1 a list of programs funded under this subsection that the ,secretary has determined to be effective programs4 7c7 ,grants for comprehensive sex education at institutions of higher education 7#a7 ,program authorized ,the ,secretary1 in coordination with the ,office of ,adolescent ,health and the ,secretary of ,education1 shall award grants1 on a competitive basis1 to institutions of higher education to enable such institutions to provide young people with comprehensive sex education1 described in paragraph 7#e77;,b71 with an emphasis on reducing ,,hiv1 other sexually transmitted infections1 and unintended pregnancy through instruction about-- 7,a7 abstinence and contraception2 7,b7 reducing dating violence1 sexual assault1 bullying1 and harassment2 7,c7 increasing healthy relationships2 and 7,d7 academic achievement4 7#b7 ,duration ,grants awarded under this subsection shall be for a period of #e years4 7#c7 ,applications ,an institution of higher education desiring a grant under this subsection shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7#d7 ,priority ,in awarding grants under this subsection1 the ,secretary shall give priority to an institution of higher education that-- 7,a7 has an enrollment of needy students as defined in section #cah7;b7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajei;e7b772 7,b7 is a ,hispanic-serving institution1 as defined in section #ejb7;a7 of such ,act 7#bj ,u4,s4,c4 #aaja;a7a772 7,c7 is a ,tribal ,college or ,university1 as defined in section #caf7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;c7b772 7,d7 is an ,alaska ,native-serving institution1 as defined in section #cag7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7,e7 is a ,native ,hawaiian-serving institution1 as defined in section #cag7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7,f7 is a ,predominately ,black ,institution1 as defined in section #cah7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;e7b772 7,g7 is a ,native ,american-serving1 nontribal institution1 as defined in section #cai7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;f7b772 7,h7 is an ,asian ,american and ,native ,american ,pacific ,islander-serving institution1 as defined in section #cbj7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;g7b772 or 7,i7 is a minority institution1 as defined in section #cfe of such ,act 7#bj ,u4,s4,c4 #ajfgk71 with an enrollment of needy students1 as defined in section #cab of such ,act 7#bj ,u4,s4,c4 #ajeh74 7#e7 ,uses of funds 7,a7 ,in general ,an institution of higher education receiving a grant under this subsection may use grant funds to integrate issues relating to comprehensive sex education into the academic or support sectors of the institution of higher education in order to reach a large number of students1 by carrying out #a or more of the following activities3 7i7 ,developing educational content for issues relating to comprehensive sex education that will be incorporated into first-year orientation or core courses4 7ii7 ,developing and employing schoolwide educational programming outside of class that delivers elements of comprehensive sex education programs to students1 faculty1 and staff4 7iii7 ,creating innovative technology-based approaches to deliver sex education to students1 faculty1 and staff4 7iv7 ,developing and employing peer-outreach and education programs to generate discussion1 educate1 and raise awareness among students about issues relating to comprehensive sex education4 7,b7 ,contents of sex education programs ,each institution of higher education's program of comprehensive sex education funded under this subsection shall include curricula and program materials that address information about-- 7i7 safe and responsible sexual behavior with respect to the prevention of pregnancy and sexually transmitted infections1 including ,,hiv1 including through-- 7,i7 abstinence2 7,,ii7 a reduced number of sexual partners2 and 7,,iii7 the use of condoms and contraception2 7ii7 healthy relationships1 including the development of healthy attitudes and insights necessary for understanding-- 7,i7 relationships between oneself1 family1 partners1 others1 and society2 and 7,,ii7 the prevention of sexual abuse1 dating violence1 bullying1 harassment1 and suicide2 and 7iii7 referral services to local health clinics where young people can obtain additional information and services related to sexual and reproductive health1 dating violence and sexual assault1 and suicide prevention4 7,c7 ,optional components of sex education ,each institution of higher education's program of comprehensive sex education may also include information and skills development relating to-- 7i7 how to make responsible decisions about sex and sexuality1 including-- 7,i7 how to avoid1 and avoid making1 unwanted verbal1 physical1 and sexual advances2 and 7,,ii7 how alcohol and drug use can affect responsible decisionmaking2 7ii7 healthy life skills1 including-- 7,i7 goal-setting and decisionmaking2 7,,ii7 interpersonal skills1 such as communication1 assertiveness1 and peer refusal skills2 7,,iii7 critical thinking2 7,,iv7 self-esteem and self-efficacy2 and 7,v7 stress management2 7iii7 the development of healthy attitudes and values about such topics as body image1 gender roles and gender identity1 racial and ethnic diversity1 and sexual orientation2 and 7iv7 the responsibilities of parenting and the skills necessary to parent well4 7#f7 ,evaluation2 report ,the requirements described in section #abe;,b7g7 shall also apply to eligible entities receiving a grant under this subsection in the same manner as such requirements apply to eligible entities receiving grants under section #abe;,b4 7d7 ,grants for pre-,service and in-,service teacher training 7#a7 ,program authorized ,the ,secretary1 in coordination with the ,director of the ,centers for ,disease ,control and ,prevention and the ,secretary of ,education1 shall award grants1 on a competitive basis1 to eligible entities to enable such eligible entities to carry out the activities described in paragraph 7#e74 7#b7 ,duration ,grants awarded under this subsection shall be for a period of #e years4 7#c7 ,eligible entity ,in this subsection1 the term eligible entity means-- 7,a7 a ,state educational agency2 7,b7 a local educational agency2 7,c7 a tribe or tribal organization1 as defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej;b72 7,d7 a ,state or local department of health2 7,e7 a ,state or local department of education2 7,f7 a nonprofit institution of higher education2 7,g7 a national or statewide nonprofit organization that has as its primary purpose the improvement of provision of comprehensive sex education through effective teaching of comprehensive sex education2 or 7,h7 a consortium of nonprofit organizations that has as its primary purpose the improvement of provision of comprehensive sex education through effective teaching of comprehensive sex education4 7#d7 ,application ,an eligible entity desiring a grant under this subsection shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7#e7 ,authorized activities 7,a7 ,required activity ,each eligible entity receiving a grant under this subsection shall use grant funds to train targeted faculty and staff1 in order to increase effective teaching of comprehensive sex education for elementary school and secondary school students4 7,b7 ,permissible activities ,each eligible entity receiving a grant under this subsection may use grant funds to-- 7i7 strengthen and expand the eligible entity's relationships with-- 7,i7 institutions of higher education2 7,,ii7 ,state educational agencies2 7,,iii7 local educational agencies2 or 7,,iv7 other public and private organizations with a commitment to comprehensive sex education and the benefits of comprehensive sex education2 7ii7 support and promote research-based training of teachers of comprehensive sex education and related disciplines in elementary schools and secondary schools as a means of broadening student knowledge about issues related to human development1 relationships1 personal skills1 sexual behavior1 sexual health1 and society and culture2 7iii7 support the dissemination of information on effective practices and research findings concerning the teaching of comprehensive sex education2 7iv7 support research on-- 7,i7 effective comprehensive sex education teaching practices2 and 7,,ii7 the development of assessment instruments and strategies to document-- 7aa7 student understanding of comprehensive sex education2 and 7bb7 the effects of comprehensive sex education2 7v7 convene national conferences on comprehensive sex education1 in order to effectively train teachers in the provision of comprehensive sex education2 and 7vi7 develop and disseminate appropriate research-based materials to foster comprehensive sex education4 7,c7 ,subgrants ,each eligible entity receiving a grant under this subsection may award subgrants to nonprofit organizations1 ,state educational agencies1 or local educational agencies to enable such organizations or agencies to-- 7i7 train teachers in comprehensive sex education2 7ii7 support ,internet or distance learning related to comprehensive sex education2 7iii7 promote rigorous academic standards and assessment techniques to guide and measure student performance in comprehensive sex education2 7iv7 encourage replication of best practices and model programs to promote comprehensive sex education2 7v7 develop and disseminate effective1 research-based comprehensive sex education learning materials2 7vi7 develop academic courses on the pedagogy of sex education at institutions of higher education2 or 7vii7 convene ,state-based conferences to train teachers in comprehensive sex education and to identify strategies for improvement4 7e7 ,report to congress 7#a7 ,in general ,not later than #a year after the date of the enactment of this ,act1 and annually thereafter for a period of #e years1 the ,secretary shall prepare and submit to the appropriate committees of ,congress a report on the activities to provide adolescents and young people with comprehensive sex education funded under this section4 7#b7 ,report elements ,the report described in paragraph 7#a7 shall include information about-- 7,a7 the number of eligible entities and institutions of higher education that are receiving grant funds under subsections 7b7 and 7c72 7,b7 the specific activities supported by grant funds awarded under subsections 7b7 and 7c72 7,c7 the number of adolescents served by grant programs funded under subsection 7b72 7,d7 the number of young people served by grant programs funded under subsection 7c72 and 7,e7 the status of program evaluations described under subsections 7b7 and 7c74 7f7 ,limitation ,no ,federal funds provided under this section may be used for health education programs that-- 7#a7 deliberately withhold life-saving information about ,,hiv2 7#b7 are medically inaccurate or have been scientifically shown to be ineffective2 7#c7 promote gender stereotypes2 7#d7 are insensitive and unresponsive to the needs of sexually active youth or lesbian1 gay1 bisexual1 or transgender youth2 or 7#e7 are inconsistent with the ethical imperatives of medicine and public health4 7g7 ,definitions ,in this section3 7#a7 ,,esea definitions ,the terms elementary school1 local educational agency1 secondary school1 and ,state educational agency have the meanings given the terms in section #iaja of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja74 7#b7 ,age and developmentally appropriate ,the term age and developmentally appropriate means suitable for a particular age or age group of children and adolescents1 based on developing cognitive1 emotional1 and behavioral capacity typical for that age or age group4 7#c7 ,adolescents ,the term adolescents means individuals who are ages #aj through #ai at the time of commencement of participation in a program supported under this section4 7#d7 ,characteristics of effective programs ,the term characteristics of effective programs means the aspects of evidence-based programs1 including development1 content1 and implementation of such programs1 that-- 7,a7 have been shown to be effective in terms of increasing knowledge1 clarifying values and attitudes1 increasing skills1 and impacting upon behavior2 and 7,b7 are widely recognized by leading medical and public health agencies to be effective in changing sexual behaviors that lead to sexually transmitted infections1 including ,,hiv1 unintended pregnancy1 and dating violence and sexual assault among young people4 7#e7 ,comprehensive sex education ,the term comprehensive sex education means a program that-- 7,a7 includes age- and developmentally appropriate1 culturally and linguistically relevant information on a broad set of topics related to sexuality including human development1 relationships1 decisionmaking1 communication1 abstinence1 contraception1 and disease and pregnancy prevention2 7,b7 provides students with opportunities for developing skills as well as learning information2 7,c7 is inclusive of lesbian1 gay1 bisexual1 transgender1 and heterosexual young people2 and 7,d7 aims to-- 7i7 provide scientifically accurate and realistic information about human sexuality2 7ii7 provide opportunities for individuals to understand their own1 their families'1 and their communities' values1 attitudes1 and insights about sexuality2 7iii7 help individuals develop healthy relationships and interpersonal skills2 and 7iv7 help individuals exercise responsibility regarding sexual relationships1 which includes addressing abstinence1 pressures to become prematurely involved in sexual intercourse1 and the use of contraception and other sexual health measures4 7#f7 ,evidence-based program ,the term evidence-based program means a sex education program that has been proven through rigorous evaluation to be effective in changing sexual behavior or incorporates elements of other sex education programs that have been proven to be effective in changing sexual behavior4 7#g7 ,institution of higher education ,the term institution of higher education has the meaning given the term in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja74 7#h7 ,medically accurate and complete ,the term medically accurate and complete1 when used with respect to a sex education program1 means that-- 7,a7 the information provided through the program is verified or supported by the weight of research conducted in compliance with accepted scientific methods and is published in peer-reviewed journals1 where applicable2 or 7,b7 7i7 the program contains information that leading professional organizations and agencies with relevant expertise in the field recognize as accurate1 objective1 and complete2 and 7ii7 the program does not withhold information about the effectiveness and benefits of correct and consistent use of condoms and other contraceptives4 7#i7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#aj7 ,young people ,the term young people means individuals who are ages #aj through #bd at the time of commencement of participation in a program supported under this section4 7h7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjae through #bjai4 #ged4 ,elimination of abstinence-only education program 7a7 ,in general ,title ,v of the ,social ,security ,act 7#db ,u4,s4,c4 #gja et seq47 is amended by striking section #eaj4 7b7 ,rescission ,amounts appropriated for fiscal years #bjac and #bjad under section #eaj7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #gaj7;d77 7as in effect on the day before the date of enactment of this ,act7 that are unobligated as of the date of enactment of this ,act are rescinded4 7c7 ,reprogram of eliminated abstinence-,only funds for the personal responsibility education program 7,,prep7 ,section #eac7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #gac7;f77 is amended by striking #ge1jjj1jjj for each of fiscal years #bjaa through #bjae and inserting #ge1jjj1jjj for each of fiscal years #bjaa through #bjad1 an amount for fiscal year #bjae equal to #ge1jjj1jjj increased by an amount equal to the unobligated portion of funds appropriated for fiscal year #bjad and #bjae under section #eaj7;d7 that are rescinded by section #ged7;b7 of the ,health ,equity and ,accountability ,act of #bjad1 and #abe1jjj1jjj for each of fiscal years #bjaf and #bjag4 #gee4 ,report on impact of ,,hiv_/,,aids in vulnerable populations 7a7 ,in general ,the ,secretary shall submit to the ,congress and the ,president an annual report on the impact of ,,hiv_/,,aids for racial and ethnic minority communities1 women1 and youth aged #bd and younger4 7b7 ,contents ,the report under subsection 7a7 shall include information on the-- 7#a7 progress that has been made in reducing the impact of ,,hiv_/,,aids in such communities2 7#b7 opportunities that exist to make additional progress in reducing the impact of ,,hiv_/,,aids in such communities2 7#c7 challenges that may impede such additional progress2 and 7#d7 ,federal funding necessary to achieve substantial reductions in ,,hiv_/,,aids in racial and ethnic minority communities4 #gef4 ,national ,,hiv_/,,aids observance days 7a7 ,national observance days ,it is the sense of the ,congress that national observance days highlighting the impact of ,,hiv_/,,aids on communities of color include the following3 7#a7 ,national ,black ,,hiv_/,,aids ,awareness ,day4 7#b7 ,national ,latino ,,aids ,awareness ,day4 7#c7 ,national ,asian and ,pacific ,islander ,,hiv_/,,aids ,awareness ,day4 7#d7 ,national ,native ,american ,,hiv_/,,aids ,awareness ,day4 7#e7 ,caribbean-,american ,,hiv_/,,aids ,awareness ,day4 7#f7 ,national ,youth ,,hiv_/,,aids ,awareness ,day4 7#g7 ,national ,black ,clergy ,,hiv_/,,aids ,awareness ,sunday4 7b7 ,call to action ,it is the sense of the ,congress that the ,president should call on members of communities of color-- 7#a7 to become involved at the local community level in ,,hiv_/,,aids testing1 policy1 and advocacy2 7#b7 to become aware1 engaged1 and empowered on the ,,hiv_/,,aids epidemic within their communities2 and 7#c7 to urge members of their communities to reduce risk factors1 practice safe sex and other preventive measures1 be tested for ,,hiv_/,,aids1 and seek care when appropriate4 #geg4 ,review of all ,federal and ,state laws1 policies1 and regulations regarding the criminal prosecution of individuals for ,,hiv-related offenses 7a7 ,definitions 7#a7 ,,hiv and ,,hiv_/,,aids ,the terms ,,hiv and ,,hiv_/,,aids have the meanings given to such terms in section #bfhi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#hh74 7#b7 ,state ,the term ,state includes the ,district of ,columbia1 ,american ,samoa1 the ,commonwealth of the ,northern ,mariana ,islands1 ,guam1 ,puerto ,rico1 and the ,united ,states ,virgin ,islands4 7b7 ,sense of congress regarding laws or regulations directed at people living with ,,hiv_/,,aids ,it is the sense of the ,congress that ,federal and ,state laws1 policies1 and regulations regarding people living with ,,hiv_/,,aids-- 7#a7 should not place unique or additional burdens on such individuals solely as a result of their ,,hiv status2 and 7#b7 should instead demonstrate a public health-oriented1 evidence-based1 medically accurate1 and contemporary understanding of-- 7,a7 the multiple factors that lead to ,,hiv transmission2 7,b7 the relative risk of ,,hiv transmission routes2 7,c7 the current health implications of living with ,,hiv2 7,d7 the associated benefits of treatment and support services for people living with ,,hiv2 and 7,e7 the impact of punitive ,,hiv-specific laws and policies on public health1 on people living with or affected by ,,hiv1 and on their families and communities4 7c7 ,review of all ,federal and ,state laws1 policies1 and regulations regarding the criminal prosecution of individuals for ,,hiv-,related offenses 7#a7 ,review of federal and state laws 7,a7 ,in general ,no later than #ij days after the date of the enactment of this ,act1 the ,attorney ,general1 the ,secretary of ,health and ,human ,services1 and the ,secretary of ,defense acting jointly 7in this paragraph and paragraph 7#b7 referred to as the designated officials7 shall initiate a national review of ,federal and ,state laws1 policies1 regulations1 and judicial precedents and decisions regarding criminal and related civil commitment cases involving people living with ,,hiv_/,,aids1 including in regards to the ,uniform ,code of ,military ,justice4 7,b7 ,consultation ,in carrying out the review under subparagraph 7,a71 the designated officials shall ensure diverse participation and consultation from each ,state1 including with-- 7i7 ,state attorneys general 7or their representatives72 7ii7 ,state public health officials 7or their representatives72 7iii7 ,state judicial and court system officers1 including judges1 district attorneys1 prosecutors1 defense attorneys1 law enforcement1 and correctional officers2 7iv7 members of the ,united ,states ,armed ,forces1 including members of other ,federal services subject to the ,uniform ,code of ,military ,justice2 7v7 people living with ,,hiv_/,,aids1 particularly those who have been subject to ,,hiv-related prosecution or who are from communities whose members have been disproportionately subject to ,,hiv-specific arrests and prosecutions2 7vi7 legal advocacy and ,,hiv_/,,aids service organizations that work with people living with ,,hiv_/,,aids2 7vii7 nongovernmental health organizations that work on behalf of people living with ,,hiv_/,,aids2 and 7viii7 trade organizations or associations representing persons or entities described in clauses 7i7 through 7vii74 7,c7 ,relation to other reviews ,in carrying out the review under subparagraph 7,a71 the designated officials may utilize other existing reviews of criminal and related civil commitment cases involving people living with ,,hiv_/,,aids1 including any such review conducted by any ,federal or ,state agency or any public health1 legal advocacy1 or trade organization or association if the designated officials determine that such reviews were conducted in accordance with the principles set forth in subsection 7b74 7#b7 ,report ,no later than #ahj days after initiating the review required by paragraph 7#a71 the ,attorney ,general shall transmit to the ,congress and make publicly available a report containing the results of the review1 which includes the following3 7,a7 ,for each ,state and for the ,uniform ,code of ,military ,justice1 a summary of the relevant laws1 policies1 regulations1 and judicial precedents and decisions regarding criminal cases involving people living with ,,hiv_/,,aids1 including1 if applicable1 the following3 7i7 ,a determination of whether such laws1 policies1 regulations1 and judicial precedents and decisions place any unique or additional burdens upon people living with ,,hiv_/,,aids4 7ii7 ,a determination of whether such laws1 policies1 regulations1 and judicial precedents and decisions demonstrate a public health-oriented1 evidence-based1 medically accurate1 and contemporary understanding of-- 7,i7 the multiple factors that lead to ,,hiv transmission2 7,,ii7 the relative risk of ,,hiv transmission routes2 7,,iii7 the current health implications of living with ,,hiv2 7,,iv7 the associated benefits of treatment and support services for people living with ,,hiv2 and 7,v7 the impact of punitive ,,hiv-specific laws and policies on public health1 on people living with or affected by ,,hiv1 and on their families and communities4 7iii7 ,an analysis of the public health and legal implications of such laws1 policies1 regulations1 and judicial precedents1 including an analysis of the consequences of having a similar penal scheme applied to comparable situations involving other communicable diseases4 7iv7 ,an analysis of the proportionality of punishments imposed under ,,hiv-specific laws1 policies1 regulations1 and judicial precedents1 taking into consideration penalties attached to violation of ,state laws against similar degrees of endangerment or harm1 such as driving while intoxicated 7,,dwi7 or transmission of other communicable diseases1 or more serious harms1 such as vehicular manslaughter offenses4 7,b7 ,an analysis of common elements shared among ,state laws1 policies1 regulations1 and judicial precedents4 7,c7 ,a set of best practice recommendations directed to ,state governments1 including ,state attorneys general1 public health officials1 and judicial officers1 in order to ensure that laws1 policies1 regulations1 and judicial precedents regarding people living with ,,hiv_/,,aids are in accordance with the principles set forth in subsection 7b74 7,d7 ,recommendations for adjustments to the ,uniform ,code of ,military ,justice1 as may be necessary1 in order to ensure that laws1 policies1 regulations1 and judicial precedents regarding people living with ,,hiv_/,,aids are in accordance with the principles set forth in subsection 7b74 7#c7 ,guidance ,within #ij days of the release of the report required by paragraph 7#b71 the ,attorney ,general and the ,secretary of ,health and ,human ,services1 acting jointly1 shall develop and publicly release updated guidance for ,states based on the set of best practice recommendations required by paragraph 7#b77;,c7 in order to assist ,states dealing with criminal and related civil commitment cases regarding people living with ,,hiv_/,,aids4 7#d7 ,monitoring and evaluation system ,within #fj days of the release of the guidance required by paragraph 7#c71 the ,attorney ,general and the ,secretary of ,health and ,human ,services1 acting jointly1 shall establish an integrated monitoring and evaluation system which includes1 where appropriate1 objective and quantifiable performance goals and indicators to measure progress toward statewide implementation in each ,state of the best practice recommendations required in paragraph 7#b77;,c71 including to monitor1 track1 and evaluate the effectiveness of assistance provided pursuant to subsection 7d74 7#e7 ,adjustments to federal laws1 policies1 or regulations ,within #ij days of the release of the report required by paragraph 7#b71 the ,attorney ,general1 the ,secretary of ,health and ,human ,services1 and the ,secretary of ,defense1 acting jointly1 shall develop and transmit to the ,president and the ,congress1 and make publicly available1 such proposals as may be necessary to implement adjustments to ,federal laws1 policies1 or regulations1 including to the ,uniform ,code of ,military ,justice1 based on the recommendations required by paragraph 7#b77;,d71 either through ,executive order or through changes to statutory law4 7#f7 ,authorization of appropriations 7,a7 ,in general ,there are authorized to be appropriated such sums as may be necessary for the purpose of carrying out this subsection4 ,amounts authorized to be appropriated by the preceding sentence are in addition to amounts otherwise authorized to be appropriated for such purpose4 7,b7 ,availability of funds ,amounts appropriated pursuant to the authorization of appropriations in subparagraph 7,a7 are authorized to remain available until expended4 7d7 ,authorization ,to provide grants 7#a7 ,grants by attorney general 7,a7 ,in general ,the ,attorney ,general may provide assistance to eligible ,state and local entities and eligible nongovernmental organizations for the purpose of incorporating the best practice recommendations developed under subsection 7c77#b77;,c7 within relevant ,state laws1 policies1 regulations1 and judicial decisions regarding people living with ,,hiv_/,,aids4 7,b7 ,authorized activities ,the assistance authorized by subparagraph 7,a7 may include-- 7i7 direct technical assistance to eligible ,state and local entities in order to develop1 disseminate1 or implement ,state laws1 policies1 regulations1 or judicial decisions that conform with the best practice recommendations developed under subsection 7c77#b77;,c72 7ii7 direct technical assistance to eligible nongovernmental organizations in order to provide education and training1 including through classes1 conferences1 meetings1 and other educational activities1 to eligible ,state and local entities2 and 7iii7 subcontracting authority to allow eligible ,state and local entities and eligible nongovernmental organizations to seek technical assistance from legal and public health experts with a demonstrated understanding of the principles underlying the best practice recommendations developed under subsection 7c77#b77;,c74 7#b7 ,grants by ,secretary of ,health and ,human ,services 7,a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 may provide assistance to ,state and local public health departments and eligible nongovernmental organizations for the purpose of supporting eligible ,state and local entities to incorporate the best practice recommendations developed under subsection 7c77#b77;,c7 within relevant ,state laws1 policies1 regulations1 and judicial decisions regarding people living with ,,hiv_/,,aids4 7,b7 ,authorized activities ,the assistance authorized by subparagraph 7,a7 may include-- 7i7 direct technical assistance to ,state and local public health departments in order to support the development1 dissemination1 or implementation of ,state laws1 policies1 regulations1 or judicial decisions that conform with the set of best practice recommendations developed under subsection 7c77#b77;,c72 7ii7 direct technical assistance to eligible nongovernmental organizations in order to provide education and training1 including through classes1 conferences1 meetings1 and other educational activities1 to ,state and local public health departments2 and 7iii7 subcontracting authority to allow ,state and local public health departments and eligible nongovernmental organizations to seek technical assistance from legal and public health experts with a demonstrated understanding of the principles underlying the best practice recommendations developed under subsection 7c77#b77;,c74 7#c7 ,limitation ,as a condition of receiving assistance through this subsection1 eligible ,state and local entities1 ,state and local public health departments1 and eligible nongovernmental organizations shall agree-- 7,a7 not to place any unique or additional burdens on people living with ,,hiv_/,,aids solely as a result of their ,,hiv status2 and 7,b7 that if the entity1 department1 or organization promulgates any laws1 policies1 regulations1 or judicial decisions regarding people living with ,,hiv_/,,aids1 such actions shall demonstrate a public health-oriented1 evidence-based1 medically accurate1 and contemporary understanding of-- 7i7 the multiple factors that lead to ,,hiv transmission2 7ii7 the relative risk of ,,hiv transmission routes2 7iii7 the current health implications of living with ,,hiv2 7iv7 the associated benefits of treatment and support services for people living with ,,hiv2 and 7v7 the impact of punitive ,,hiv-specific laws and policies on public health1 on people living with or affected by ,,hiv1 and on their families and communities4 7#d7 ,report ,no later than #a year after the date of the enactment of this ,act1 and annually thereafter1 the ,attorney ,general and the ,secretary of ,health and ,human ,services1 acting jointly1 shall transmit to ,congress and make publicly available a report describing1 for each ,state1 the impact and effectiveness of the assistance provided through this ,act4 ,each such report shall include-- 7,a7 a detailed description of the progress each ,state has made1 if any1 in implementing the best practice recommendations developed under subsection 7c77#b77;,c7 as a result of the assistance provided under this subsection1 and based on the performance goals and indicators established as part of the monitoring and evaluation system in subsection 7c77#d72 7,b7 a brief summary of any outreach efforts undertaken during the prior year by the ,attorney ,general and the ,secretary of ,health and ,human ,services to encourage ,states to seek assistance under this subsection in order to implement the best practice recommendations developed under subsection 7c77#b77;,c72 7,c7 a summary of how assistance provided through this subsection is being utilized by eligible ,state and local entities1 ,state and local public health departments1 and eligible nongovernmental organizations and1 if applicable1 any contractors1 including with respect to nongovernmental organizations1 the type of technical assistance provided1 and an evaluation of the impact of such assistance on eligible ,state and local entities2 and 7,d7 a summary and description of eligible ,state and local entities1 ,state and local public health departments1 and eligible nongovernmental organizations receiving assistance through this subsection1 including if applicable1 a summary and description of any contractors selected to assist in implementing such assistance4 7#e7 ,definitions ,for the purposes of this subsection3 7,a7 ,eligible state and local entities ,the term eligible ,state and local entities means the relevant individuals1 offices1 or organizations that directly participate in the development1 dissemination1 or implementation of ,state laws1 policies1 regulations1 or judicial decisions1 including-- 7i7 ,state governments1 including ,state attorneys general1 ,state departments of justice1 and ,state ,national ,guards1 or their equivalents2 7ii7 ,state judicial and court systems1 including trial courts1 appellate courts1 ,state supreme courts and courts of appeal1 and ,state correctional facilities1 or their equivalents2 and 7iii7 local governments1 including city and county governments1 district attorneys1 and local law enforcement departments1 or their equivalents4 7,b7 ,state and local public health departments ,the term ,state and local public health departments means the following3 7i7 ,state public health departments1 or their equivalents1 including the chief officer of such departments and infectious disease and communicable disease specialists within such departments4 7ii7 ,local public health departments1 or their equivalents1 including city and county public health departments1 the chief officer of such departments1 and infectious disease and communicable disease specialists within such departments4 7iii7 ,public health departments or officials1 or their equivalents1 within ,state or local correctional facilities4 7iv7 ,public health departments or officials1 or their equivalents1 within ,state ,national ,guards4 7v7 ,any other recognized ,state or local public health organization or entity charged with carrying out official ,state or local public health duties4 7,c7 ,eligible nongovernmental organizations ,the term eligible nongovernmental organizations means the following3 7i7 ,nongovernmental organizations1 including trade organizations or associations that represent-- 7,i7 ,state attorneys general1 or their equivalents2 7,,ii7 ,state public health officials1 or their equivalents2 7,,iii7 ,state judicial and court officers1 including judges1 district attorneys1 prosecutors1 defense attorneys1 law enforcement1 and correctional officers2 7,,iv7 ,state ,national ,guards2 7,v7 people living with ,,hiv_/,,aids2 7,,vi7 legal advocacy and ,,hiv_/,,aids service organizations that work with people living with ,,hiv_/,,aids2 and 7,,vii7 nongovernmental health organizations that work on behalf of people living with ,,hiv_/,,aids4 7ii7 ,nongovernmental organizations1 including trade organizations or associations that demonstrate a public-health oriented1 evidence-based1 medically accurate1 and contemporary understanding of-- 7,i7 the multiple factors that lead to ,,hiv transmission2 7,,ii7 the relative risk of ,,hiv transmission routes2 7,,iii7 the current health implications of living with ,,hiv2 7,,iv7 the associated benefits of treatment and support services for people living with ,,hiv2 and 7,v7 the impact of punitive ,,hiv-specific laws and policies on public health1 on people living with or affected by ,,hiv1 and on their families and communities4 7#f7 ,authorization of appropriations 7,a7 ,in general ,in addition to amounts otherwise made available1 there are authorized to be appropriated to the ,attorney ,general and the ,secretary of ,health and ,human ,services such sums as may be necessary to carry out this subsection for each of the fiscal years #bjae through #bjai4 7,b7 ,availability of funds ,amounts appropriated pursuant to the authorizations of appropriations in subparagraph 7,a7 are authorized to remain available until expended4 #geh4 ,repeal of limitation against use of funds for education or information designed to promote or encourage1 directly1 homosexual or heterosexual activity or intravenous substance abuse ,section #bejj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ee7 is amended-- 7#a7 by striking subsection 7c72 and 7#b7 by redesignating subsection 7d7 as subsection 7c74 #gei4 ,expanding support for condoms in prisons 7a7 ,authority ,to allow community organizations ,to provide ,,sti counseling1 ,,sti prevention education1 and sexual barrier protection devices in ,federal correctional facilities 7#a7 ,directive to attorney general ,not later than #cj days after the date of enactment of this ,act1 the ,attorney ,general shall direct the ,bureau of ,prisons to allow community organizations to distribute sexual barrier protection devices and to engage in ,,sti counseling and ,,sti prevention education in ,federal correctional facilities4 ,these activities shall be subject to all relevant ,federal laws and regulations which govern visitation in correctional facilities4 7#b7 ,information requirement ,any community organization permitted to distribute sexual barrier protection devices under paragraph 7#a7 shall ensure that the persons to whom the devices are distributed are informed about the proper use and disposal of sexual barrier protection devices in accordance with established public health practices4 ,any community organization conducting ,,sti counseling or ,,sti prevention education under paragraph 7#a7 shall offer comprehensive sexuality education4 7#c7 ,possession of device protected ,no ,federal correctional facility may1 because of the possession or use of a sexual barrier protection device-- 7,a7 take adverse action against an incarcerated person2 or 7,b7 consider possession or use as evidence of prohibited activity for the purpose of any ,federal correctional facility administrative proceeding4 7#d7 ,implementation ,the ,attorney ,general and ,bureau of ,prisons shall implement this section according to established public health practices in a manner that protects the health1 safety1 and privacy of incarcerated persons and of correctional facility staff4 7b7 ,sense of congress regarding distribution of sexual barrier protection devices in state prison systems ,it is the sense of the ,congress that ,states should allow for the legal distribution of sexual barrier protection devices in ,state correctional facilities to reduce the prevalence and spread of ,s,t,is in those facilities4 7c7 ,survey of and report on correctional facility programs aimed at reducing the spread of ,s,t,is 7#a7 ,survey ,the ,attorney ,general1 after consulting with the ,secretary of ,health and ,human ,services1 ,state officials1 and community organizations1 shall1 to the maximum extent practicable1 conduct a survey of all ,federal and ,state correctional facilities1 not later than #ahj days after the date of enactment of this ,act and annually thereafter for #e years1 to determine the following3 7,a7 ,counseling1 treatment1 and supportive services ,whether the correctional facility requires incarcerated persons to participate in counseling1 treatment1 and supportive services related to ,s,t,is1 or whether it offers such programs to incarcerated persons4 7,b7 ,access to sexual barrier protection devices ,whether incarcerated persons can-- 7i7 possess sexual barrier protection devices2 7ii7 purchase sexual barrier protection devices2 7iii7 purchase sexual barrier protection devices at a reduced cost2 and 7iv7 obtain sexual barrier protection devices without cost4 7,c7 ,incidence of sexual violence ,the incidence of sexual violence and assault committed by incarcerated persons and by correctional facility staff4 7,d7 ,prevention education offered ,the type of prevention education1 information1 or training offered to incarcerated persons and correctional facility staff regarding sexual violence and the spread of ,s,t,is1 including whether such education1 information1 or training-- 7i7 constitutes comprehensive sexuality education2 7ii7 is compulsory for new incarcerated persons and for new staff2 and 7iii7 is offered on an ongoing basis4 7,e7 ,,sti testing ,whether the correctional facility tests incarcerated persons for ,s,t,is or gives them the option to undergo such testing-- 7i7 at intake2 7ii7 on a regular basis2 and 7iii7 prior to release4 7,f7 ,,sti test results ,the number of incarcerated persons who are tested for ,s,t,is and the outcome of such tests at each correctional facility1 disaggregated to include results for-- 7i7 the type of sexually transmitted infection tested for2 7ii7 the race and_/or ethnicity of individuals tested2 7iii7 the age of individuals tested2 and 7iv7 the gender of individuals tested4 7,g7 ,prerelease referral policy ,whether incarcerated persons are informed prior to release about ,,sti-related services or other health services in their communities1 including free and low-cost counseling and treatment options4 7,h7 ,prerelease referrals made ,the number of referrals to community-based organizations or public health facilities offering ,,sti-related or other health services provided to incarcerated persons prior to release1 and the type of counseling or treatment for which the referral was made4 7,i7 ,reinstatement of medicaid benefits ,whether the correctional facility assists incarcerated persons that were enrolled in the ,state ,medicaid program prior to their incarceration1 in reinstating their enrollment upon release and whether such individuals receive referrals as provided by subparagraph 7,g7 to entities that accept the ,state ,medicaid program1 including if applicable-- 7i7 the number of such individuals1 including those diagnosed with the human immunodeficiency virus1 that have been reinstated2 7ii7 a list of obstacles to reinstating enrollment or to making determinations of eligibility for reinstatement1 if any2 and 7iii7 the number of individuals denied enrollment4 7,j7 ,other actions taken ,whether the correctional facility has taken any other action1 in conjunction with community organizations or otherwise1 to reduce the prevalence and spread of ,s,t,is in that facility4 7#b7 ,privacy ,in conducting the survey1 the ,attorney ,general shall not request or retain the identity of any person who has sought or been offered counseling1 treatment1 testing1 or prevention education information regarding an ,,sti 7including information about sexual barrier protection devices71 or who has tested positive for an ,,sti4 7#c7 ,report ,the ,attorney ,general shall transmit to ,congress and make publicly available the results of the survey required under paragraph 7#a71 both for the ,nation as a whole and disaggregated as to each ,state and each correctional facility4 ,to the maximum extent possible1 the ,attorney ,general shall issue the first report no later than #a year after the date of enactment of this ,act and shall issue reports annually thereafter for #e years4 7d7 ,strategy 7#a7 ,directive to attorney general ,the ,attorney ,general1 in consultation with the ,secretary of ,health and ,human ,services1 ,state officials1 and community organizations1 shall develop and implement a #e-year strategy to reduce the prevalence and spread of ,s,t,is in ,federal and ,state correctional facilities4 ,to the maximum extent possible1 the strategy shall be developed1 transmitted to ,congress1 and made publicly available no later than #ahj days after the transmission of the first report required under subsection 7c77#c74 7#b7 ,contents of strategy ,the strategy shall include the following3 7,a7 ,prevention education ,a plan for improving prevention education1 information1 and training offered to incarcerated persons and correctional facility staff1 including information and training on sexual violence and the spread of ,s,t,is1 and comprehensive sexuality education4 7,b7 ,sexual barrier protection device access ,a plan for expanding access to sexual barrier protection devices in correctional facilities4 7,c7 ,sexual violence reduction ,a plan for reducing the incidence of sexual violence among incarcerated persons and correctional facility staff1 developed in consultation with the ,national ,prison ,rape ,elimination ,commission4 7,d7 ,counseling and supportive services ,a plan for expanding access to counseling and supportive services related to ,s,t,is in correctional facilities4 7,e7 ,testing ,a plan for testing incarcerated persons for ,s,t,is during intake1 during regular health exams1 and prior to release1 and that-- 7i7 is conducted in accordance with guidelines established by the ,centers for ,disease ,control and ,prevention2 7ii7 includes pretest counseling2 7iii7 requires that incarcerated persons are notified of their option to decline testing at any time2 7iv7 requires that incarcerated persons are confidentially notified of their test results in a timely manner2 and 7v7 ensures that incarcerated persons testing positive for ,s,t,is receive post-test counseling1 care1 treatment1 and supportive services4 7,f7 ,treatment ,a plan for ensuring that correctional facilities have the necessary medicine and equipment to treat and monitor ,s,t,is and for ensuring that incarcerated persons living with or testing positive for ,s,t,is receive and have access to care and treatment services4 7,g7 ,strategies for demographic groups ,a plan for developing and implementing culturally appropriate1 sensitive1 and specific strategies to reduce the spread of ,s,t,is among demographic groups heavily impacted by ,s,t,is4 7,h7 ,linkages with communities and facilities ,a plan for establishing and strengthening linkages to local communities and health facilities that-- 7i7 provide counseling1 testing1 care1 and treatment services2 7ii7 may receive persons recently released from incarceration who are living with ,s,t,is2 and 7iii7 accept payment through the ,state ,medicaid program4 7,i7 ,enrollment in ,state ,medicaid programs ,plans to ensure that incarcerated persons who were-- 7i7 enrolled in their ,state ,medicaid program prior to incarceration in a correctional facility are automatically re-enrolled in such program upon their release2 and 7ii7 not enrolled in their ,state ,medicaid program prior to incarceration1 but who are diagnosed with the human immunodeficiency virus while incarcerated in a correctional facility1 are automatically enrolled in such program upon their release4 7,j7 ,other plans ,any other plans developed by the ,attorney ,general for reducing the spread of ,s,t,is or improving the quality of health care in correctional facilities4 7,k7 ,monitoring system ,a monitoring system that establishes performance goals related to reducing the prevalence and spread of ,s,t,is in correctional facilities and which1 where feasible1 expresses such goals in quantifiable form4 7,l7 ,monitoring system performance indicators ,performance indicators that measure or assess the achievement of the performance goals described in subparagraph 7,k74 7,m7 ,cost estimate ,a detailed estimate of the funding necessary to implement the strategy at the ,federal and ,state levels for all #e years1 including the amount of funds required by community organizations to implement the parts of the strategy in which they take part4 7#c7 ,report ,the ,attorney ,general shall transmit to ,congress and make publicly available an annual progress report regarding the implementation and effectiveness of the strategy described in paragraph 7#a74 ,the progress report shall include an evaluation of the implementation of the strategy using the monitoring system and performance indicators provided for in subparagraphs 7,k7 and 7,l7 of paragraph 7#b74 7e7 ,authorization of appropriations 7#a7 ,in general ,there are authorized to be appropriated such sums as may be necessary to carry out this section for each of fiscal years #bjae through #bjbj4 7#b7 ,availability of funds ,amounts made available under paragraph 7#a7 are authorized to remain available until expended4 7f7 ,definitions ,for the purposes of this section3 7#a7 ,community organization ,the term community organization means a public health care facility or a nonprofit organization which provides health- or ,,sti-related services according to established public health standards4 7#b7 ,comprehensive sexuality education ,the term comprehensive sexuality education means sexuality education that includes information about abstinence and about the proper use and disposal of sexual barrier protection devices and which is-- 7,a7 evidence-based2 7,b7 medically accurate2 7,c7 age and developmentally appropriate2 7,d7 gender and identity sensitive2 7,e7 culturally and linguistically appropriate2 and 7,f7 structured to promote critical thinking1 self-esteem1 respect for others1 and the development of healthy attitudes and relationships4 7#c7 ,correctional facility ,the term correctional facility means any prison1 penitentiary1 adult detention facility1 juvenile detention facility1 jail1 or other facility to which persons may be sent after conviction of a crime or act of juvenile delinquency within the ,united ,states4 7#d7 ,incarcerated person ,the term incarcerated person means any person who is serving a sentence in a correctional facility after conviction of a crime4 7#e7 ,sexually transmitted infection ,the term sexually transmitted infection or ,,sti means any disease or infection that is commonly transmitted through sexual activity1 including ,,hiv_/,,aids1 gonorrhea1 chlamydia1 syphilis1 genital herpes1 viral hepatitis1 and human papillomavirus4 7#f7 ,sexual barrier protection device ,the term sexual barrier protection device means any ,,fda-approved physical device which has not been tampered with and which reduces the probability of ,,sti transmission or infection between sexual partners1 including female condoms1 male condoms1 and dental dams4 7#g7 ,state ,the term ,state includes the ,district of ,columbia1 ,american ,samoa1 the ,commonwealth of the ,northern ,mariana ,islands1 ,guam1 ,puerto ,rico1 and the ,united ,states ,virgin ,islands4 #gfj4 ,automatic reinstatement or enrollment in ,medicaid for people who test positive for ,,hiv before reentering communities 7a7 ,in general ,section #aijb7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77 is amended by adding at the end the following3 7#ae7 ,enrollment of ex-offenders 7,a7 ,automatic enrollment or reinstatement 7i7 ,in general ,the ,state plan shall provide for the automatic enrollment or reinstatement of enrollment of an eligible individual-- 7,i7 if such individual is scheduled to be released from a public institution due to the completion of sentence1 not less than #cj days prior to the scheduled date of the release2 and 7,,ii7 if such individual is to be released from a public institution on parole or on probation1 as soon as possible after the date on which the determination to release such individual was made1 and before the date such individual is released4 7ii7 ,exception ,if a ,state makes a determination that an individual is not eligible to be enrolled under the ,state plan-- 7,i7 on or before the date by which the individual would be enrolled under clause 7i71 such clause shall not apply to such individual2 or 7,,ii7 after such date1 the ,state may terminate the enrollment of such individual4 7,b7 ,relationship of enrollment to payment for services 7i7 ,in general ,subject to subparagraph 7,a77ii71 an eligible individual who is enrolled1 or whose enrollment is reinstated1 under subparagraph 7,a7 shall be eligible for medical assistance that is provided after the date that the eligible individual is released from the public institution4 7ii7 ,relationship to payment prohibition for inmates ,no provision of this paragraph may be construed to permit payment for care or services for which payment is excluded under the subdivision 7,a7 that follows paragraph 7#bi7 of section #aije7;a74 7,c7 ,treatment of continuous eligibility 7i7 ,suspension for inmates ,any period of continuous eligibility under this title shall be suspended on the date an individual enrolled under this title becomes an inmate of a public institution 7except as a patient of a medical institution74 7ii7 ,determination of remaining period ,notwithstanding any changes to ,state law related to continuous eligibility during the time that an individual is an inmate of a public institution 7except as a patient of a medical institution71 subject to clause 7iii71 with respect to an eligible individual who was subject to a suspension under clause 7i71 on the date that such individual is released from a public institution the suspension of continuous eligibility under such clause shall be lifted for a period that is equal to the time remaining in the period of continuous eligibility for such individual on the date that such period was suspended under such clause4 7iii7 ,exception ,if a ,state makes a determination that an individual is not eligible to be enrolled under the ,state plan-- 7,i7 on or before the date that the suspension of continuous eligibility is lifted under clause 7ii71 such clause shall not apply to such individual2 or 7,,ii7 after such date1 the ,state may terminate the enrollment of such individual4 7,d7 ,automatic enrollment or reinstatement of enrollment defined ,for purposes of this paragraph1 the term automatic enrollment or reinstatement of enrollment means that the ,state determines eligibility for medical assistance under the ,state plan without a program application from1 or on behalf of1 the eligible individual1 but an individual can only be automatically enrolled in the ,state ,medicaid plan if the individual affirmatively consents to being enrolled through affirmation in writing1 by telephone1 orally1 through electronic signature1 or through any other means specified by the ,secretary4 7,e7 ,eligible individual defined ,for purposes of this paragraph1 the term eligible individual means an individual who is an inmate of a public institution 7except as a patient in a medical institution7-- 7i7 who was enrolled under the ,state plan for medical assistance immediately before becoming an inmate of such an institution2 or 7ii7 is diagnosed with human immunodeficiency virus4 4 7b7 ,supplemental funding for state implementation of automatic reinstatement of medicaid benefits 7#a7 ,in general ,subject to paragraph 7#f71 for each ,state for which the ,secretary of ,health and ,human ,services has approved an application under paragraph 7#c71 the ,federal matching payments 7including payments based on the ,federal medical assistance percentage7 made to such ,state under section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 shall be increased by #e4j percentage points for payments to the ,state for the activities permitted under paragraph 7#b7 or a period of one year4 7#b7 ,use of funds ,a ,state may only use increased matching payments authorized under paragraph 7#a7-- 7,a7 to strengthen the ,state's enrollment and administrative resources for the purpose of improving processes for enrolling 7or reinstating the enrollment of7 eligible individuals 7as such term is defined in subparagraph 7,e7 of paragraph 7#ae7 of section #aijb7;e7 of the ,social ,security ,act 7as amended by subsection 7a7772 and 7,b7 for medical assistance 7as such term is defined in section #aije7;a7 of the ,social ,security ,act7 provided to such eligible individuals4 7#c7 ,application and agreement ,the ,secretary may only make payments to a ,state in the increased amount if-- 7,a7 the ,state has amended the ,state plan under section #aijb7;e7 of the ,social ,security ,act to incorporate the requirements of paragraph 7#ae7 of such section 7as added by subsection 7a772 7,b7 the ,state has submitted an application to the ,secretary that includes a plan for implementing the requirements of section #aijb7;e77#ae7 of the ,social ,security ,act under the ,state's amended ,state plan before the end of the #ij-;day period beginning on the date that the ,state receives increased matching payments under paragraph 7#a72 7,c7 the ,state's application meets the satisfaction of the ,secretary2 and 7,d7 the ,state enters an agreement with the ,secretary that states that-- 7i7 the ,state will only use the increased matching funds for the uses permitted under paragraph 7#b72 and 7ii7 at the end of the period under paragraph 7#a71 the ,state will submit to the ,secretary1 and make publicly available1 a report that contains the information required under paragraph 7#d74 7#d7 ,required report information ,the information that is required in the report under paragraph 7#c77;,d77ii7 includes-- 7,a7 the results of an evaluation of the impact of the implementation of the requirements of section #aijb7;e77#ae7 of the ,social ,security ,act on improving the ,state's processes for enrolling of individuals who are released from public institutions into the ,medicaid program2 7,b7 the number of individuals who were automatically enrolled 7or whose enrollment is reinstated7 under such section #aijb7;e77#ae7 during the period under paragraph 7#a72 and 7,c7 any other information that is required by the ,secretary4 7#e7 ,increase in cap on medicaid payments to territories ,subject to paragraph 7#f71 the amounts otherwise determined for ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa under subsections 7f7 and 7g7 of section #aajh of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7 shall each be increased by the necessary amount to allow for the increase in the ,federal matching payments under paragraph 7#a71 but only for the period under such paragraph for such ,state4 ,in the case of such an increase for a territory1 subsection 7a77#a7 of such section #aajh shall be applied without regard to any increase in payment made to the territory under part ,e of title ,,iv of such ,act that is attributable to the increase in ,federal medical assistance percentage effected under paragraph 7#a7 for the territory4 7#f7 ,limitations 7,a7 ,timing ,with respect to a ,state1 at the end of the period under paragraph 7#a71 no increased matching payments may be made to such ,state under this subsection4 7,b7 ,maintenance of eligibility 7i7 ,in general ,subject to clause 7ii71 a ,state is not eligible for an increase in its ,federal matching payments under paragraph 7#a71 or an increase in a cap amount under paragraph 7#e71 if eligibility standards1 methodologies1 or procedures under its ,state plan under title ,,xix of the ,social ,security ,act 7including any waiver under such title or under section #aaae of such ,act 7#db ,u4,s4,c4 #acae77 are more restrictive than the eligibility standards1 methodologies1 or procedures1 respectively1 under such plan 7or waiver7 as in effect on the date of enactment of this ,act4 7ii7 ,state reinstatement of eligibility permitted ,a ,state that has restricted eligibility standards1 methodologies1 or procedures under its ,state plan under title ,,xix of the ,social ,security ,act 7including any waiver under such title or under section #aaae of such ,act 7#db ,u4,s4,c4 #acae77 after the date of enactment of this ,act1 is no longer ineligible under subparagraph 7,a7 beginning with the first calendar quarter in which the ,state has reinstated eligibility standards1 methodologies1 or procedures that are no more restrictive than the eligibility standards1 methodologies1 or procedures1 respectively1 under such plan 7or waiver7 as in effect on such date4 7,c7 ,no waiver authority ,the ,secretary may not waive the application of this subsection under section #aaae of the ,social ,security ,act or otherwise4 7,d7 ,limitation of matching payments to #ajj percent ,in no case shall an increase in ,federal matching payments under this subsection result in ,federal matching payments that exceed #ajj percent4 7c7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 the amendments made by subsection 7a7 shall take effect #ahj days after the date of the enactment of this ,act and shall apply to services furnished on or after such date4 7#b7 ,rule for changes requiring ,state legislation ,in the case of a ,state plan for medical assistance under title ,,xix of the ,social ,security ,act which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirement imposed by the amendments made by this section1 the ,state plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of the enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of such session shall be deemed to be a separate regular session of the ,state legislature4 #gfa4 ,stop ,,aids in prison 7a7 ,short title ,this section may be cited as the ,stop ,,aids in ,prison ,act4 7b7 ,in general ,the ,bureau of ,prisons 7hereinafter in this section referred to as the ,bureau7 shall develop a comprehensive policy to provide ,,hiv testing1 treatment1 and prevention for inmates within the correctional setting and upon reentry4 7c7 ,purpose ,the purposes of this policy shall be as follows3 7#a7 ,to stop the spread of ,,hiv_/,,aids among inmates4 7#b7 ,to protect prison guards and other personnel from ,,hiv_/,,aids infection4 7#c7 ,to provide comprehensive medical treatment to inmates who are living with ,,hiv_/,,aids4 7#d7 ,to promote ,,hiv_/,,aids awareness and prevention among inmates4 7#e7 ,to encourage inmates to take personal responsibility for their health4 7#f7 ,to reduce the risk that inmates will transmit ,,hiv_/,,aids to other persons in the community following their release from prison4 7d7 ,consultation ,the ,bureau shall consult with appropriate officials of the ,department of ,health and ,human ,services1 the ,office of ,national ,drug ,control ,policy1 the ,office of ,national ,,aids ,policy1 and the ,centers for ,disease ,control and ,prevention regarding the development of this policy4 7e7 ,time limit ,the ,bureau shall draft appropriate regulations to implement this policy not later than #a year after the date of the enactment of this ,act4 7f7 ,requirements for policy ,the policy created under subsection 7b7 shall provide for the following3 7#a7 ,testing and counseling upon intake 7,a7 ,health care personnel shall provide routine ,,hiv testing to all inmates as a part of a comprehensive medical examination immediately following admission to a facility4 7,health care personnel need not provide routine ,,hiv testing to an inmate who is transferred to a facility from another facility if the inmate's medical records are transferred with the inmate and indicate that the inmate has been tested previously47 7,b7 ,to all inmates admitted to a facility prior to the effective date of this policy1 health care personnel shall provide routine ,,hiv testing within no more than #f months4 ,,hiv testing for these inmates may be performed in conjunction with other health services provided to these inmates by health care personnel4 7,c7 ,all ,,hiv tests under this paragraph shall comply with the opt-out provision4 7#b7 ,pre-test and post-test counseling ,health care personnel shall provide confidential pre-test and post-test counseling to all inmates who are tested for ,,hiv4 ,counseling may be included with other general health counseling provided to inmates by health care personnel4 7#c7 ,,hiv_/,,aids prevention education 7,a7 ,health care personnel shall improve ,,hiv_/,,aids awareness through frequent educational programs for all inmates4 ,,hiv_/,,aids educational programs may be provided by community-based organizations1 local health departments1 and inmate peer educators4 7,b7 ,,hiv_/,,aids educational materials shall be made available to all inmates at orientation1 at health care clinics1 at regular educational programs1 and prior to release4 ,both written and audiovisual materials shall be made available to all inmates4 7,c7 7i7 ,the ,,hiv_/,,aids educational programs and materials under this paragraph shall include information on-- 7,i7 modes of transmission1 including transmission through tattooing1 sexual contact1 and intravenous drug use2 7,,ii7 prevention methods2 7,,iii7 treatment2 and 7,,iv7 disease progression4 7ii7 ,the programs and materials shall be culturally sensitive1 written or designed for low-literacy levels1 available in a variety of languages1 and present scientifically accurate information in a clear and understandable manner4 7#d7 ,,hiv testing upon request 7,a7 ,health care personnel shall allow inmates to obtain ,,hiv tests upon request once per year or whenever an inmate has a reason to believe the inmate may have been exposed to ,,hiv4 ,health care personnel shall1 both orally and in writing1 inform inmates1 during orientation and periodically throughout incarceration1 of their right to obtain ,,hiv tests4 7,b7 ,health care personnel shall encourage inmates to request ,,hiv tests if the inmate is sexually active1 has been raped1 uses intravenous drugs1 receives a tattoo1 or if the inmate is concerned that the inmate may have been exposed to ,,hiv_/,,aids4 7,c7 ,an inmate's request for an ,,hiv test shall not be considered an indication that the inmate has put him_/herself at risk of infection and_/or committed a violation of prison rules4 7#e7 ,,hiv testing of pregnant woman 7,a7 ,health care personnel shall provide routine ,,hiv testing to all inmates who become pregnant4 7,b7 ,all ,,hiv tests under this paragraph shall comply with the opt-out provision4 7#f7 ,comprehensive treatment 7,a7 ,health care personnel shall provide all inmates who test positive for ,,hiv-- 7i7 timely1 comprehensive medical treatment2 7ii7 confidential counseling on managing their medical condition and preventing its transmission to other persons2 and 7iii7 voluntary partner notification services4 7,b7 ,health care provided under this paragraph shall be consistent with current ,department of ,health and ,human ,services guidelines and standard medical practice4 ,health care personnel shall discuss treatment options1 the importance of adherence to antiretroviral therapy1 and the side effects of medications with inmates receiving treatment4 7,c7 ,health care personnel and pharmacy personnel shall ensure that the facility formulary contains all ,food and ,drug ,administration-approved medications necessary to provide comprehensive treatment for inmates living with ,,hiv_/,,aids1 and that the facility maintains adequate supplies of such medications to meet inmates' medical needs4 ,health care personnel and pharmacy personnel shall also develop and implement automatic renewal systems for these medications to prevent interruptions in care4 7,d7 ,correctional staff1 health care personnel1 and pharmacy personnel shall develop and implement distribution procedures to ensure timely and confidential access to medications4 7#g7 ,protection of confidentiality 7,a7 ,health care personnel shall develop and implement procedures to ensure the confidentiality of inmate tests1 diagnoses1 and treatment4 ,health care personnel and correctional staff shall receive regular training on the implementation of these procedures4 ,penalties for violations of inmate confidentiality by health care personnel or correctional staff shall be specified and strictly enforced4 7,b7 ,,hiv testing1 counseling1 and treatment shall be provided in a confidential setting where other routine health services are provided and in a manner that allows the inmate to request and obtain these services as routine medical services4 7#h7 ,testing1 counseling1 and referral prior to reentry 7,a7 ,health care personnel shall provide routine ,,hiv testing to all inmates no more than #c months prior to their release and reentry into the community4 7,inmates who are already known to be infected need not be tested again47 ,this requirement may be waived if an inmate's release occurs without sufficient notice to the ,bureau to allow health care personnel to perform a routine ,,hiv test and notify the inmate of the results4 7,b7 ,all ,,hiv tests under this paragraph shall comply with the opt-out provision4 7,c7 ,to all inmates who test positive for ,,hiv and all inmates who already are known to have ,,hiv_/,,aids1 health care personnel shall provide-- 7i7 confidential prerelease counseling on managing their medical condition in the community1 accessing appropriate treatment and services in the community1 and preventing the transmission of their condition to family members and other persons in the community2 7ii7 referrals to appropriate health care providers and social service agencies in the community that meet the inmate's individual needs1 including voluntary partner notification services and prevention counseling services for people living with ,,hiv_/,,aids2 and 7iii7 a #cj-;day supply of any medically necessary medications the inmate is currently receiving4 7#i7 ,opt-out provision ,inmates shall have the right to refuse routine ,,hiv testing4 ,inmates shall be informed both orally and in writing of this right4 ,oral and written disclosure of this right may be included with other general health information and counseling provided to inmates by health care personnel4 ,if an inmate refuses a routine test for ,,hiv1 health care personnel shall make a note of the inmate's refusal in the inmate's confidential medical records4 ,however1 the inmate's refusal shall not be considered a violation of prison rules or result in disciplinary action4 ,any reference in this section to the opt-out provision shall be deemed a reference to the requirement of this paragraph4 7#aj7 ,exclusion of tests performed under section #djad7;b7 from the definition of routine ,,hiv ,testing ,,hiv testing of an inmate under section #djad7;b7 of title #ah1 ,united ,states ,code1 is not routine ,,hiv testing for the purposes of the opt-out provision4 ,health care personnel shall document the reason for testing under section #djad7;b7 of title #ah1 ,united ,states ,code1 in the inmate's confidential medical records4 7#aa7 ,timely notification of test results ,health care personnel shall provide timely notification to inmates of the results of ,,hiv tests4 7g7 ,changes in existing law 7#a7 ,screening in ,genera ,section #djad7;a7 of title #ah1 ,united ,states ,code1 is amended-- 7,a7 by striking for a period of #f months or more2 7,b7 by striking 1 as appropriate12 and 7,c7 by striking if such individual is determined to be at risk for infection with such virus in accordance with the guidelines issued by the ,bureau of ,prisons relating to infectious disease management and inserting unless the individual declines4 ,the ,attorney ,general shall also cause such individual to be so tested before release unless the individual declines44 7#b7 ,inadmissibility of ,,hiv ,test ,results in ,civil and ,criminal ,proceedings ,section #djad7;d7 of title #ah1 ,united ,states ,code1 is amended by inserting or under the ,stop ,,aids in ,prison ,act after under this section4 7#c7 ,screening as ,part of ,routine ,screening ,section #djad7;e7 of title #ah1 ,united ,states ,code1 is amended by adding at the end the following3 ,such rules shall also provide that the initial test under this section be performed as part of the routine health screening conducted at intake44 7h7 ,reporting requirements 7#a7 ,report on ,hepatitis and ,other ,diseases ,not later than #a year after the date of the enactment of this ,act1 the ,bureau shall provide a report to the ,congress on ,bureau policies and procedures to provide testing1 treatment1 and prevention education programs for hepatitis and other diseases transmitted through sexual activity and intravenous drug use4 ,the ,bureau shall consult with appropriate officials of the ,department of ,health and ,human ,services1 the ,office of ,national ,drug ,control ,policy1 the ,office of ,national ,,aids ,policy1 and the ,centers for ,disease ,control and ,prevention regarding the development of this report4 7#b7 ,annual ,reports 7,a7 ,generally ,not later than #b years after the date of the enactment of this ,act1 and then annually thereafter1 the ,bureau shall report to ,congress on the incidence among inmates of diseases transmitted through sexual activity and intravenous drug use4 7,b7 ,matters pertaining to various diseases ,reports under paragraph 7#a7 shall discuss-- 7i7 the incidence among inmates of ,,hiv_/,,aids1 hepatitis1 and other diseases transmitted through sexual activity and intravenous drug use2 and 7ii7 updates on ,bureau testing1 treatment1 and prevention education programs for these diseases4 7,c7 ,matters pertaining to ,,hiv_/,,aids only ,reports under paragraph 7#a7 shall also include-- 7i7 the number of inmates who tested positive for ,,hiv upon intake2 7ii7 the number of inmates who tested positive prior to reentry2 7iii7 the number of inmates who were not tested prior to reentry because they were released without sufficient notice2 7ix7 the number of inmates who opted-out of taking the test2 7x7 the number of inmates who were tested under section #djad7;b7 of title #ah1 ,united ,states ,code2 and 7xi7 the number of inmates under treatment for ,,hiv_/,,aids4 7,d7 ,consultation ,the ,bureau shall consult with appropriate officials of the ,department of ,health and ,human ,services1 the ,office of ,national ,drug ,control ,policy1 the ,office of ,national ,,aids ,policy1 and the ,centers for ,disease ,control and ,prevention regarding the development of reports under paragraph 7#a74 #gfb4 ,support data system review and indicators for monitoring ,,hiv care ,the ,secretary of ,health and ,human ,services1 in collaboration with the ,assistant ,secretary for ,health1 the ,director of the ,office of ,,hiv_/,,aids and ,infectious ,disease ,policy1 the ,director of the ,centers for ,disease ,control and ,prevention1 the ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration1 the ,director of the ,department of ,housing and ,urban ,development1 the ,director of the ,office of ,,aids ,research1 the ,administrator of the ,health ,resources and ,services ,administration1 and the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall expand and coordinate efforts to align metrics across agencies and modify ,federal data systems1 to-- 7#a7 adopt the ,institute of ,medicine's clinical ,,hiv care indicators as the core metrics for monitoring the quality of ,,hiv care1 mental health1 substance abuse1 and supportive services2 7#b7 better enable assessment of the impact of the ,national ,,hiv_/,,aids ,strategy and the ,patient ,protection and ,affordable ,care ,act on improving ,,hiv_/,,aids care and access to supportive services for individuals with ,,hiv2 7#c7 expand the demographic data elements to be captured by ,federal data systems relevant to ,,hiv care to permit calculation of the indicators for subgroups of the population of people with diagnosed ,,hiv infection1 including-- 7,a7 age2 7,b7 race2 7,c7 ethnicity2 7,d7 sex 7assigned at birth72 7,e7 gender identity2 7,f7 sexual orientation2 7,g7 current geographic marker of residence2 7,h7 income or poverty level2 and 7,i7 primary means of reimbursement for medical services 7including ,medicaid1 ,medicare1 the ,ryan ,white ,,hiv_/,,aids ,program1 private insurance1 health maintenance organizations1 and no coverage72 and 7#d7 streamline data collection and systematically review all existing reporting requirements for federally funded ,,hiv_/,,aids programs to ensure that only essential data are collected4 #gfc4 ,transfer of funds for implementation of national ,,hiv_/,,aids strategy ,title ,,ii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bjb et seq47 is amended by inserting after section #bda the following3 #bda;,a4 ,transfer of funds for implementation of ,national ,,hiv_/,,aids ,strategy 7a7 ,transfer authorization ,of the discretionary appropriations made available to the ,department of ,health and ,human ,services for any fiscal year for programs and activities that1 as determined by the ,secretary of ,health and ,human ,services1 pertain to ,,hiv_/,,aids1 the ,secretary1 in coordination with the ,director of the ,office of ,national ,,hiv_/,,aids ,policy1 may transfer up to #a percent of such appropriations to the ,office of the ,assistant ,secretary for ,health for implementation of the ,national ,,hiv_/,,aids ,strategy4 7b7 ,congressional notification ,not less than #cj days before making any transfer under this section1 the ,secretary shall give notice of the transfer to the ,congress4 7c7 ,definitions ,in this section3 7#a7 ,the term ,,hiv_/,,aids has the meaning given to such term in section #bfhi4 7#b7 ,the term ,national ,,hiv_/,,aids ,strategy means the ,national ,,hiv_/,,aids ,strategy for the ,united ,states issued by the ,president in ,july #bjaj and includes any subsequent revisions to such ,strategy4 4 #gfd4 ,,hiv integrated services delivery model demonstration 7a7 ,in general ,consistent with the ,national ,,hiv_/,,aids ,strategy for the ,united ,states and in accordance with this section1 the ,secretary of ,health and ,human ,services acting through the ,center for ,medicare ,medicaid ,innovation and in cooperation with ,,cdc1 ,,hrsa1 ,,samhsa1 and ,,hud1 shall conduct a #c-year demonstration project that is designed to integrate services and funding under the ,medicare and ,medicaid programs1 under ,,hiv-related programs conducted by the ,,cdc1 and under the ,ryan ,white ,,hiv_/,,aids ,program1 to reduce new ,,hiv infections1 to increase the proportion of people who know their status1 to increase access to care1 to improve health outcomes1 to reduce ,,hiv-related health disparities among ,medicaid and ,medicare beneficiaries1 and to reduce the cost of care provided to ,,hiv positive ,medicare and ,medicaid beneficiaries4 7b7 ,objectives ,the objectives of the demonstration are the following3 7#a7 ,to ensure the early identification of ,,hiv positive beneficiaries to reduce costly ,,hiv-related clinical conditions through ,,hiv screening and rapid linkage to high quality ,,hiv medical care4 7#b7 ,to reduce new ,,hiv infections among ,medicaid and ,medicare beneficiaries through routine ,,hiv testing1 prevention services for ,,hiv negative beneficiaries1 and intensive 8prevention for positive0 services for ,,hiv positive beneficiaries4 7#c7 ,to reduce morbidity1 mortality1 and high cost inpatient and specialty care among ,,hiv positive beneficiaries by ensuring access to high quality ,,hiv medical care1 ,,hiv medications1 and support services4 7#d7 ,to promote ,,hiv treatment adherence and retention in care through intensive case management1 treatment education1 and outreach services4 7#e7 ,to effectively treat behavioral health conditions among ,,hiv positive beneficiaries that impair their ,,hiv treatment adherence and lead to secondary ,,hiv infections through services funded under ,medicare and ,medicaid and programs administered by ,,samhsa4 7#f7 ,to promote independence1 treatment adherence1 and stable housing for ,,hiv positive beneficiaries through highly coordinated ,,hiv health1 housing1 and support services funded by ,,hrsa and ,,hud4 7c7 ,demonstration design 7#a7 ,in general ,the ,secretary shall design the demonstration to test both-- 7,a7 the service delivery model described in paragraph 7#b72 and 7,b7 the payment model described in paragraph 7#c74 7#b7 ,service delivery model 7,a7 ,in general ,under the service delivery model described in this paragraph1 the demonstration shall test comprehensive ,,hiv testing1 linkage to care1 ,,hiv medical care1 and ancillary services to individuals enrolled under ,medicare1 ,medicaid1 or both4 ,the service delivery model will integrate services furnished under ,medicare and ,medicaid with prevention services funded by ,,cdc for ,,hiv positive beneficiaries1 intensive case management services funded by ,,hrsa1 behavioral services funded by ,,samhsa1 and housing assistance services funded through ,,hud4 7,b7 ,core elements ,the model under this paragraph shall have the following #h core elements3 7i7 ,,hiv testing services that apply the ,,cdc's #bjjf recommendations for universal opt-out testing among ,medicare and ,medicaid beneficiary populations4 7ii7 ,rapid linkage from ,,hiv testing settings to treatment for ,,hiv positive beneficiaries to ensure they are engaged in care in a timely basis4 7iii7 ,access to high quality ,,hiv experienced medical care1 laboratory monitoring1 ,,hiv medications1 and other required services4 7iv7 ,routine screening and treatment for ,,hiv-related and other chronic conditions1 including behavioral health4 7v7 ,prevention and treatment education services1 including an adapted ,medication ,therapy ,management 7,,mtm7 program model1 to optimize the benefit of ,,hiv therapeutics4 7vi7 ,risk-stratified medical case management4 7vii7 ,provision of preventive care1 including counseling to prevent secondary ,,hiv infection4 7viii7 ,wrap-around support and housing services4 7#c7 ,payment model ,under the payment model described in this paragraph1 the demonstration shall test the following3 7,a7 ,a prepaid capitated payment model that adjusts payment for ,,hiv and behavioral health acuity1 to be applied under contracts with managed care organizations with demonstrated ,,hiv experience4 7,b7 ,use of funds under the ,ryan ,white ,,hiv_/,,aids ,program to purchase capitated services from the contracted managed care organizations4 7,c7 ,provision of additional funds to support services to the extent that ,medicaid and ,medicare coverage is limited1 including for services such as ,,hiv testing 7for ,medicaid beneficiaries71 medical case management1 prevention case management1 treatment education1 case finding1 behavioral health services1 and housing assistance4 7d7 ,beneficiary criteria ,beneficiaries eligible for participation in the demonstration are the following3 7#a7 ,medicaid ,,ffs beneficiaries ,fee-for-service ,medicaid beneficiaries #ah years of age or older4 7#b7 ,dual eligibles ,individuals who are-- 7,a7 entitled to medical assistance under ,medicaid2 and 7,b7 entitled to benefits under part ,a1 and enrolled under part ,b1 of ,medicare but are not enrolled under a ,medicare ,advantage plan under ,medicare4 7e7 ,roles and responsibilities in demonstration 7#a7 ,in general ,consistent with the ,national ,,hiv_/,,aids ,strategy for the ,united ,states1 ,federal agencies shall coordinate their funding for the selected ,states or cities covered under the demonstration to provide resources to fund the delivery of services within the demonstration4 7#b7 ,,hhs ,in carrying out the demonstration1 the ,secretary shall-- 7,a7 design the application process2 7,b7 solicit applications from #e to #g ,state ,medicaid agencies to host the demonstration2 7,c7 with respect to the service delivery model described in subsection 7c77#b71 collaborate with the ,,cdc1 ,,hrsa1 and the ,national ,institutes of ,health to design a minimum service delivery model that reflects the current standard of care as established by the ,public ,health ,service and ,,cdc guidelines and recommendations2 and 7,d7 fund an evaluation of the demonstration to ensure collection of system1 provider1 and beneficiary-level data to address their routine reporting requirements4 ,the ,secretary may carry out the ,secretary's authority under this paragraph through ,,cmmi4 7#c7 ,,cdc ,the ,,cdc shall collaborate with the ,secretary and ,,cdc-funded ,,hiv prevention grantees in the selected ,states and cities to provide technical assistance to design cost-effective ,,hiv and sexually transmitted infection 7,,sti7 screening and testing services for ,medicaid and ,medicare beneficiaries1 including partner notification services and communicable disease reporting4 ,,cdc and ,,cms shall determine the extent to which testing funds shall be supported jointly or separately by these agencies4 7#d7 ,,hrsa ,,hrsa shall allocate funds available through the ,special ,projects of ,national ,significance 7,,spns7 ,initiative ,program 7under subpart ,i of part ,f of the ,ryan ,white ,,hiv_/,,aids ,program7 to support wrap-around core and support services not covered under ,medicare or ,medicaid and shall authorize the use of ,ryan ,white ,,hiv_/,,aids ,program funds to purchase services through capitated managed care programs that meet or exceed the services covered by the ,ryan ,white ,,hiv_/,,aids ,program at rates that are no greater than current per capita expenditures4 ,,hrsa is authorized to use funds under ,,spns1 and to waive such requirements of ,,spns as may be necessary1 to carry out the demonstration4 7#e7 ,,samhsa ,,samhsa shall allocate funds through the ,minority ,,hiv_/,,aids ,initiative or other programs to support behavioral health services not covered under ,medicare or ,medicaid4 7#f7 ,,hopwa ,,hud shall directly allocate funds under the ,housing ,opportunities for ,people ,with ,,aids 7,,hopwa7 program to the ,states or cities participating in the demonstration to provide supportive housing and other housing assistance to beneficiaries who otherwise meet ,,hopwa eligibility criteria4 ,,hud is authorized to use such ,,hopwa funds1 and to waive such requirements under ,,hopwa as may be necessary1 to carry out the demonstration4 7#g7 ,state ,medicaid agencies ,single ,state agencies responsible for administration of the ,medicaid program for individuals who are accepted to participate in the demonstration shall-- 7,a7 collaborate with ,,cms to design or refine a prepaid capitated payment model1 to allocate and award contracts with capitated managed care plans1 to ensure such plans meet ,state statutory or regulatory requirements1 to contract with a coordinating agency to organize and deliver integrated ,,hiv testing1 medical care1 support1 and housing services funded under ,medicare and ,medicaid1 other ,federal1 ,state1 and local government sponsors1 and to coordinate their activities with the ,state ,,hiv_/,,aids program2 and 7,b7 identify and contract with a coordinating agency to organize the demonstration in the ,state1 to establish a coordinating body representing ,state1 local1 and provider agencies participating in the demonstration1 to establish systems of care that integrate ,,hiv prevention1 testing1 treatment1 support1 and housing services1 to establish mechanisms to gather evaluation data for reporting to ,,cmmi and other participating ,federal agencies1 and to establish a quality management program to monitor provider performance in delivering the services provided to participating beneficiaries under the demonstration4 7#h7 ,managed care organizations ,capitated managed care organizations participating in the demonstration shall organize and deliver services as specified by the minimum service delivery model established by ,,cmmi through a network of providers with demonstrated ,,hiv experience1 high quality1 and sufficient provider capacity4 7f7 ,definitions ,in this section3 7#a7 ,,cdc ,the term ,,cdc means the ,director of the ,centers for ,disease ,control and ,prevention4 7#b7 ,,cmmi ,the term ,,cmmi means the ,director of the ,center for ,medicare ,medicaid ,innovation4 7#c7 ,,cms ,the term ,,cms means the ,administrator of the ,centers for ,medicare ,medicaid ,services4 7#d7 ,demonstration ,the term demonstration means the demonstration conducted under this section4 7#e7 ,,hrsa ,the term ,,hrsa means the ,administrator of the ,health ,resources and ,services ,administration4 7#f7 ,,hud ,the term ,,hud means the ,secretary of ,housing and ,urban ,development4 7#g7 ,medicare2 ,medicaid ,the terms ,medicare and ,medicaid mean the programs under titles ,,xviii and ,,xix1 respectively1 of the ,social ,security ,act4 7#h7 ,national ,,hiv_/,,aids ,strategy for the ,united ,states ,the term ,national ,,hiv_/,,aids ,strategy for the ,united ,states has the meaning given such term under section #bda;,a7b7 of the ,public ,health ,service ,act4 7#i7 ,ryan ,white ,,hiv_/,,aids ,program ,the term ,ryan ,white ,,hiv_/,,aids ,program means the program under title ,,xxvi of the ,public ,health ,service ,act4 7#aj7 ,,samhsa ,the term ,,samhsa means the ,substance ,abuse and ,mental ,health ,services ,administration4 7#aa7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services1 acting through ,,cmmi4 #gfe4 ,report on the implementation of goal #d 7improved coordination7 of the national ,,hiv_/,,aids strategy 7a7 ,report required ,the ,president1 in consultation with the heads of all relevant ,federal departments and agencies including the ,department of ,education1 the ,department of ,health and ,human ,services1 the ,department of ,housing and ,urban ,development1 the ,department of ,justice1 the ,department of ,labor1 the ,department of ,veteran ,affairs1 and the ,social ,security ,administration1 shall transmit to the ,congress and make publicly available a report on the status of implementation of ,goal #d of the ,national ,,hiv_/,,aids ,strategy4 7b7 ,contents ,the report required by subsection 7a7 shall include a description1 an analysis1 and an evaluation of-- 7#a7 the extent to which the ,national ,,hiv_/,,aids ,strategy has improved coordination of efforts1 enhanced capacity1 and strengthened infrastructure in order to maximize the effective delivery of ,,hiv_/,,aids prevention1 care1 and treatment services at the community level1 including coordination-- 7,a7 within and among ,federal agencies and departments2 7,b7 between the ,federal ,government and ,state and local governments and health departments2 7,c7 between the ,federal ,government and nonprofit foundations and civil society organizations1 including community- and faith-based organizations focused on addressing the issue of ,,hiv_/,,aids2 and 7,d7 between the ,federal ,government and private businesses2 and 7#b7 efforts by the ,federal ,government to educate1 involve1 and establish and strengthen partnerships with civil society organizations1 including community- and faith-based organizations1 in order to implement the ,national ,,hiv_/,,aids ,strategy and achieve its goals4 7c7 ,definition ,in this section1 the term ,national ,,hiv_/,,aids ,strategy means the ,national ,,hiv_/,,aids ,strategy for the ,united ,states issued by the ,president in ,july #bjaj and includes any subsequent revisions to such ,strategy4 ,f ,diabetes #gga4 ,research1 treatment1 and education ,subpart #c of part ,c of title ,,iv of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe;c et seq47 is amended by adding at the end the following new section3 #dcd;,b4 ,diabetes in minority populations 7a7 ,in general ,the ,director of ,,nih shall expand1 intensify1 and support ongoing research and other activities with respect to prediabetes and diabetes1 particularly type #b1 in minority populations4 7b7 ,research 7#a7 ,description ,research under subsection 7a7 shall include investigation into-- 7,a7 the causes of diabetes1 including socioeconomic1 geographic1 clinical1 environmental1 genetic1 and other factors that may contribute to increased rates of diabetes in minority populations2 and 7,b7 the causes of increased incidence of diabetes complications in minority populations1 and possible interventions to decrease such incidence4 7#b7 ,inclusion of minority participants ,in conducting and supporting research described in subsection 7a71 the ,director of ,,nih shall seek to include minority participants as study subjects in clinical trials4 7c7 ,report2 comprehensive plan 7#a7 ,in general ,the ,diabetes ,mellitus ,interagency ,coordinating ,committee shall-- 7,a7 prepare and submit to the ,congress1 not later than #f months after the date of enactment of this section1 a report on ,federal research and public health activities with respect to prediabetes and diabetes in minority populations2 and 7,b7 develop and submit to the ,congress1 not later than #a year after the date of enactment of this section1 an effective and comprehensive ,federal plan 7including all appropriate ,federal health programs7 to address prediabetes and diabetes in minority populations4 7#b7 ,contents ,the report under paragraph 7#a77;,a7 shall at minimum address each of the following3 7,a7 ,research on diabetes and prediabetes in minority populations1 including such research on-- 7i7 genetic1 behavioral1 and environmental factors2 and 7ii7 prevention and complications among individuals within these populations who have already developed diabetes4 7,b7 ,surveillance and data collection on diabetes and prediabetes in minority populations1 including with respect to-- 7i7 efforts to better determine the prevalence of diabetes among ,asian-,american and ,pacific ,islander subgroups2 and 7ii7 efforts to coordinate data collection on the ,american ,indian population4 7,c7 ,community-based interventions to address diabetes and prediabetes targeting minority populations1 including-- 7i7 the evidence base for such interventions2 7ii7 the cultural appropriateness of such interventions2 and 7iii7 efforts to educate the public on the causes and consequences of diabetes4 7,d7 ,education and training programs for health professionals 7including community health workers7 on the prevention and management of diabetes and its related complications that is supported by the ,health ,resources and ,services ,administration1 including such programs supported by-- 7i7 the ,national ,health ,service ,corps2 or 7ii7 the community health centers program under section #ccj4 7d7 ,education ,the ,director of ,,nih shall-- 7#a7 through the ,national ,institute on ,minority ,health and ,health ,disparities and the ,national ,diabetes ,education ,program-- 7,a7 make grants to programs funded under section #dfdz-#d 7relating to centers of excellence7 for the purpose of establishing a mentoring program for health care professionals to be more involved in weight counseling1 obesity research1 and nutrition2 and 7,b7 provide for the participation of minority health professionals in diabetes-focused research programs2 and 7#b7 make grants for programs to establish a pipeline from high school to professional school that will increase minority representation in diabetes-focused health fields by expanding ,minority ,access to ,research ,careers 7,,marc7 program internships and mentoring opportunities for recruitment4 7e7 ,definitions ,for purposes of this section3 7#a7 ,the ,diabetes ,mellitus ,interagency ,coordinating ,committee means the ,diabetes ,mellitus ,interagency ,coordinating ,committee established under section #dbi4 7#b7 ,the term minority population means a racial and ethnic minority group1 as defined in section #agjg4 4 #ggb4 ,research1 education1 and other activities ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq47 is amended by inserting after section #cag,t the following section3 #cag,u4 ,diabetes in minority populations 7a7 ,research and other activities 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall conduct and support research and public health activities with respect to diabetes in minority populations4 7#b7 ,certain activities ,activities under paragraph 7#a7 regarding diabetes in minority populations shall include the following3 7,a7 ,further enhancing the ,national ,health and ,nutrition ,examination ,survey by over-sampling ,asian-,american1 ,native ,hawaiian1 and ,other ,pacific ,islanders in appropriate geographic areas to better determine the prevalence of diabetes in such populations as well as to improve the data collection of diabetes penetration disaggregated into major ethnic groups within such populations4 ,the ,secretary shall ensure that any such oversampling does not reduce the oversampling of other minority populations including ,african-,american and ,latino populations4 7,b7 ,through the ,division of ,diabetes ,translation-- 7i7 providing for prevention research to better understand how to influence health care systems changes to improve quality of care being delivered to such populations2 7ii7 carrying out model demonstration projects to design1 implement1 and evaluate effective diabetes prevention and control interventions for minority populations1 including culturally appropriate community-based interventions2 7iii7 developing and implementing a strategic plan to reduce diabetes in minority populations through applied research to reduce disparities and culturally and linguistically appropriate community-based interventions2 7iv7 supporting1 through the national diabetes prevention program under section #cii,v-#c1 diabetes prevention program sites in underserved regions highly impacted by diabetes2 and 7v7 implementing1 through the national diabetes prevention program under section #cii,v-#c1 a demonstration program developing new metrics measuring health outcomes related to diabetes that can be stratified by specific minority populations4 7b7 ,education ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall direct the ,division of ,diabetes ,translation to conduct and support both programs to educate the public on diabetes in minority populations and programs to educate minority populations about the causes and effects of diabetes4 7c7 ,diabetes2 health promotion1 prevention activities1 and access ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention and the ,national ,diabetes ,education ,program1 shall conduct and support programs to educate specific minority populations through culturally appropriate and linguistically appropriate information campaigns about prevention of1 and managing1 diabetes4 7d7 ,definition ,for purposes of this section1 the term minority population means a racial and ethnic minority group1 as defined in section #agjg4 4 #ggc4 ,research1 education1 and other activities ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq471 as amended1 is further amended by adding at the end the following new section3 #cii,v-#g4 ,programs to educate health providers on the causes and effects of diabetes in minority populations 7a7 ,in general ,the ,secretary1 acting through the ,director of the ,health ,resources and ,services ,administration1 shall conduct and support programs described in subsection 7b7 to educate health professionals on the causes and effects of diabetes in minority populations4 7b7 ,programs ,programs described in this subsection1 with respect to education on diabetes in minority populations1 shall include the following3 7#a7 ,giving priority1 under the primary care training and enhancement program under section #gdg-- 7,a7 to awarding grants to focus on or address diabetes2 and 7,b7 adding minority populations to the list of vulnerable populations that should be served by such grants4 7#b7 ,providing additional funds for the ,health ,careers ,opportunity ,program1 ,centers for ,excellence1 and the ,minority ,faculty ,fellowship ,program to partner with the ,office of ,minority ,health under section #agjg and the ,national ,institutes of ,health to strengthen programs for career opportunities focused on diabetes treatment and care within underserved regions highly impacted by diabetes4 7#c7 ,developing a diabetes focus within1 and providing additional funds for1 the ,national ,health ,service ,corps ,scholarship ,program-- 7,a7 to place individuals in areas that are disproportionately affected by diabetes and to provide diabetes treatment and care in such areas2 and 7,b7 to provide such individuals continuing medical education specific to diabetes care4 4 #ggd4 ,research1 education1 and other activities ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq471 as amended1 is further amended by adding at the end the following section3 #cii,v-#h4 ,research1 education1 and other activities regarding diabetes in ,american ,indian populations ,in addition to activities under sections #cag,v-#f and #dcd;,b1 the ,secretary1 acting through the ,indian ,health ,service and in collaboration with other appropriate ,federal agencies1 shall-- 7#a7 conduct and support research and other activities with respect to diabetes2 and 7#b7 coordinate the collection of data on clinically and culturally appropriate diabetes treatment1 care1 prevention1 and services by health care professionals to the ,american ,indian population4 4 #gge4 ,updated report on health disparities ,the ,secretary of ,health and ,human ,services shall seek to enter into an arrangement with the ,institute of ,medicine under which the ,institute will-- 7#a7 not later than #a year after the date of enactment of this ,act1 submit to the ,congress an updated version of the ,institute's #bjjb report entitled ,unequal ,treatment3 ,confronting ,racial and ,ethnic ,disparities in ,health ,care2 and 7#b7 in such updated version1 address how racial and ethnic health disparities have changed since the publication of the original report4 ,g ,lung ,disease #ggf4 ,expansion of the ,national ,asthma ,education and ,prevention ,program 7a7 ,in general ,not later than #b years after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall convene a working group comprised of patient groups1 nonprofit organizations1 medical societies1 and other relevant governmental and nongovernmental entities1 including those that participate in the ,national ,asthma ,education and ,prevention ,program1 to develop a report to ,congress that-- 7#a7 catalogs1 with respect to asthma prevention1 management1 and surveillance-- 7,a7 the activities of the ,federal ,government1 including identifying all ,federal programs that carry out asthma-related activities1 as well as assessment of the progress of the ,federal ,government and ,states1 with respect to achieving the goals of the ,healthy ,people #bjbj initiative2 and 7,b7 the activities of other entities that participate in the program1 including nonprofit organizations1 patient advocacy groups1 and medical societies2 and 7#b7 makes recommendations for the future direction of asthma activities1 in consultation with researchers from the ,national ,institutes of ,health and other member bodies of the ,national ,asthma ,education and ,prevention ,program who are qualified to review and analyze data and evaluate interventions1 including-- 7,a7 description of how the ,federal ,government may better coordinate and improve its response to asthma including identifying any barriers that may exist2 7,b7 description of how the ,federal ,government may continue1 expand1 and improve its private-public partnerships with respect to asthma including identifying any barriers that may exist2 7,c7 identification of steps that may be taken to reduce the-- 7i7 morbidity1 mortality1 and overall prevalence of asthma2 7ii7 financial burden of asthma on society2 7iii7 burden of asthma on disproportionately affected areas1 particularly those in medically underserved populations 7as defined in section #ccj7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c7772 and 7iv7 burden of asthma as a chronic disease2 7,d7 identification of programs and policies that have achieved the steps described in subparagraph 7,c71 and steps that may be taken to expand such programs and policies to benefit larger populations2 and 7,e7 recommendations for future research and interventions4 7b7 ,report to ,congress ,at the end of the #e-year period following the submission of the report under subsection 7a71 the ,national ,asthma ,education and ,prevention ,program shall evaluate the analyses and recommendations under such report and determine whether a new report to the ,congress is necessary1 and make appropriate recommendations to the ,congress4 #ggg4 ,asthma-related activities of the ,centers for ,disease ,control and ,prevention ,section #cag;,i of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#aj7 is amended to read as follows3 #cag;,i4 ,asthma-related activities of the centers for disease control and prevention 7a7 ,program for providing information and education to the public ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall collaborate with ,state and local health departments to conduct activities1 including the provision of information and education to the public regarding asthma including-- 7#a7 deterring the harmful consequences of uncontrolled asthma2 and 7#b7 disseminating health education and information regarding prevention of asthma episodes and strategies for managing asthma4 7b7 ,development of state asthma plans ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall collaborate with ,state and local health departments to develop ,state plans incorporating public health responses to reduce the burden of asthma1 particularly regarding disproportionately affected populations4 7c7 ,compilation of data ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall1 in cooperation with ,state and local public health officials-- 7#a7 conduct asthma surveillance activities to collect data on the prevalence and severity of asthma1 the effectiveness of public health asthma interventions1 and the quality of asthma management1 including-- 7,a7 collection of household data on the local burden of asthma2 7,b7 surveillance of health care facilities2 and 7,c7 collection of data not containing individually identifiable information from electronic health records or other electronic communications2 7#b7 compile and annually publish data regarding the prevalence and incidence of childhood asthma1 the child mortality rate1 and the number of hospital admissions and emergency department visits by children associated with asthma nationally and in each ,state and at the county level by age1 sex1 race1 and ethnicity1 as well as lifetime and current prevalence2 and 7#c7 compile and annually publish data regarding the prevalence and incidence of adult asthma1 the adult mortality rate1 and the number of hospital admissions and emergency department visits by adults associated with asthma nationally and in each ,state and at the county level by age1 sex1 race1 ethnicity1 industry1 and occupation1 as well as lifetime and current prevalence4 7d7 ,coordination of data collection ,the ,director of the ,centers for ,disease ,control and ,prevention1 in conjunction with ,state and local health departments1 shall coordinate data collection activities under subsection 7c77#b7 so as to maximize comparability of results4 7e7 ,collaboration ,the ,centers for ,disease ,control and ,prevention are encouraged to collaborate with national1 ,state1 and local nonprofit organizations to provide information and education about asthma1 and to strengthen such collaborations when possible4 7f7 ,additional funding ,in addition to any other authorization of appropriations that is available to the ,centers for ,disease ,control and ,prevention for the purpose of carrying out this section1 there are authorized to be appropriated to such ,centers such sums as may be necessary for each of fiscal years #bjae through #bjai for the purpose of carrying out this section4 4 #ggh4 ,influenza and pneumonia vaccination campaign 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall-- 7#a7 enhance the annual campaign by the ,department of ,health and ,human ,services to increase the number of people vaccinated each year for influenza and pneumonia2 and 7#b7 include in such campaign the use of written educational materials1 public service announcements1 physician education1 and any other means which the ,secretary deems effective4 7b7 ,materials and announcements ,in carrying out the annual campaign described in subsection 7a71 the ,secretary of ,health and ,human ,services shall ensure that-- 7#a7 educational materials and public service announcements are readily and widely available in communities experiencing disparities in the incidence and mortality rates of influenza and pneumonia2 and 7#b7 the campaign uses targeted1 culturally appropriate messages and messengers to reach underserved communities4 7c7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjai4 #ggi4 ,chronic obstructive pulmonary disease action plan 7a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention shall conduct1 support1 and expand public health strategies1 prevention1 diagnosis1 surveillance1 and public and professional awareness activities regarding chronic obstructive pulmonary disease4 7b7 ,national action plan 7#a7 ,development ,not later than #b years after the date of the enactment of this ,act1 the ,director of the ,national ,heart1 ,lung1 and ,blood ,institute1 in consultation with the ,director of the ,centers for ,disease ,control and ,prevention1 shall develop a national action plan to address chronic obstructive pulmonary disease in the ,united ,states with participation from patients1 caregivers1 health professionals1 patient advocacy organizations1 researchers1 providers1 public health professionals1 and other stakeholders4 7#b7 ,contents ,at a minimum1 such plan shall include recommendations for-- 7,a7 public health interventions for the purpose of implementation of the national plan2 7,b7 biomedical1 health services1 and public health research on chronic obstructive pulmonary disease2 and 7,c7 inclusion of chronic obstructive pulmonary disease in the health data collections of all ,federal agencies4 7#c7 ,consideration ,in developing such plan1 the ,director of the ,national ,heart1 ,lung1 and ,blood ,institute shall consider the recommendations and findings of the ,institute of ,medicine in the report entitled ,a ,nationwide ,framework for ,surveillance of ,cardiovascular and ,chronic ,lung ,diseases 7,july #bb1 #bjaa74 7c7 ,chronic disease prevention programs ,the ,director of the ,national ,heart1 ,lung1 and ,blood ,institute shall carry out the following3 7#a7 ,conduct public education and awareness activities with patient and professional organizations to stimulate earlier diagnosis and improve patient outcomes from treatment of chronic obstructive pulmonary disease4 ,to the extent known and relevant1 such public education and awareness activities shall reflect differences in chronic obstructive pulmonary disease by cause 7tobacco1 environmental1 occupational1 biological1 and genetic7 and include a focus on outreach to undiagnosed and1 as appropriate1 minority populations4 7#b7 ,supplement and expand upon the activities of the ,national ,heart1 ,lung1 and ,blood ,institute by making grants to nonprofit organizations1 ,state and local jurisdictions1 and ,indian tribes for the purpose of reducing the burden of chronic obstructive pulmonary disease1 especially in disproportionately impacted communities1 through public health interventions and related activities4 7#c7 ,coordinate with the ,centers for ,disease ,control and ,prevention1 the ,indian ,health ,service1 the ,health ,resources and ,services ,administration1 and the ,department of ,veterans ,affairs to develop pilot programs to demonstrate best practices for the diagnosis and management of chronic obstructive pulmonary disease4 7#d7 ,develop improved techniques and identify best practices1 in coordination with the ,secretary of ,veterans ,affairs1 for assisting chronic obstructive pulmonary disease patients to successfully stop smoking1 including identification of subpopulations with different needs4 ,initiatives under this paragraph may include research to determine whether successful smoking cessation strategies are different for chronic obstructive pulmonary disease patients compared to such strategies for patients with other chronic diseases4 7d7 ,environmental and occupational health programs ,the ,director of the ,centers for ,disease ,control and ,prevention shall-- 7#a7 support research into the environmental and occupational causes and biological mechanisms that contribute to chronic obstructive pulmonary disease2 and 7#b7 develop and disseminate public health interventions that will lessen the impact of environmental and occupational causes of chronic obstructive pulmonary disease4 7e7 ,data ,collection ,not later than #ahj days after the enactment of this ,act1 the ,director of the ,national ,heart1 ,lung1 and ,blood ,institute and the ,director of the ,centers for ,disease ,control and ,prevention1 acting jointly1 shall assess the depth and quality of information on chronic obstructive pulmonary disease that is collected in surveys and population studies conducted by the ,centers for ,disease ,control and ,prevention1 including whether there are additional opportunities for information to be collected in the ,national ,health and ,nutrition ,examination ,survey1 the ,national ,health ,interview ,survey1 and the ,behavioral ,risk ,factors ,surveillance ,system surveys4 ,the ,director of the ,national ,heart1 ,lung1 and ,blood ,institute shall include the results of such assessment in the national action plan under subsection 7b74 7f7 ,authorization of ,appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjai4 ,h ,osteoarthritis and ,musculoskeletal ,diseases #gha4 ,findings ,the ,congress finds as follows3 7#a7 ,eighty percent of ,african-,american women and nearly #gd percent of ,hispanic men are either overweight or obese1 speeding the onset and progression of arthritis4 7#b7 ,arthritis affects #df million ,americans1 and that number will rise to #fg million by the year #bjcj4 7#c7 ,twenty-seven million ,americans suffer from osteoarthritis1 the most common form of arthritis1 making it the leading cause of disability in the ,united ,states4 ,osteoarthritis is sometimes referred to as degenerative joint disease4 7#d7 ,obesity accelerates the onset of arthritis3 #gj percent of obese adults with mild osteoarthritis of the knee at age #fj will develop advanced end-stage disease by age #hj4 ,in contrast1 just #dc percent of non-obese adults will have end-stage disease over the same time period4 7#e7 ,arthritis affects one in five ,americans1 and is the single greatest cause of chronic pain and disability in the ,united ,states4 7#f7 ,women1 ,african-,americans1 and ,hispanics have more severe arthritis and functional limitations4 ,these same individuals are more likely to be obese1 diabetic1 and have higher incidence of heart disease--medical conditions that can be improved with physical activity4 ,instead of moving2 however1 these groups have an inactivity rate of #dj to #ej percent1 which continues to increase4 7#g7 ,arthritis costs #abh billion a year1 including #ha billion in direct costs 7medical7 and #dg billion in indirect costs 7lost earnings74 ,each year1 #cji billion in direct and indirect costs is lost due to disparities in osteoarthritis and musculoskeletal diseases4 7#h7 ,obesity and other chronic health conditions exacerbate the debilitating impact of arthritis1 leading to inactivity1 loss of independence1 and a perpetual cycle of comorbid chronic conditions4 7#i7 ,sixty-one percent of arthritis sufferers are women1 and women represent #fd percent of an estimated #dc million annual visits to physicians' offices and outpatient clinics where arthritis was the primary diagnosis4 ,women also represented #fj percent of approximately #a million hospitalizations that occurred in #bjjc for which arthritis was the primary diagnosis4 7#aj7 ,women ages #fe and older have up to #b times more disabilities than men of the same age4 ,higher rates of obesity and arthritis among this group explained up to #dh percent of the gender gap in disability1 above all other common chronic health conditions4 7#aa7 ,the primary indication for total knee arthroplasty 7,,tka71 also known as knee replacement1 is relief of significant1 disabling pain caused by severe arthritis4 7#ab7 ,knee replacement is surgery for people with severe knee damage4 ,knee replacement can relieve pain and allow you to be more active4 ,when you have a total knee replacement1 the surgeon removes damaged cartilage and bone from the surface of your knee joint and replaces them with a man-made surface of metal and plastic4 ,in a partial knee replacement1 the surgeon only replaces one part of your knee joint4 7#ac7 ,total hip replacement1 also called total hip arthroplasty 7,,tha71 is used if your hip pain interferes with daily activities and more-conservative treatments have not helped4 ,arthritis damage is the most common reason to need hip replacement4 7#ad7 ,the odds of a family practice physician recommending ,,tka to a male patient with moderate arthritis are twice that of a female patient1 while the odds of an orthopaedic surgeon recommending ,,tka to a male patient with moderate arthritis are #bb times that of a female patient4 7#ae7 ,african-,americans with doctor-diagnosed arthritis have a higher prevalence of severe pain attributable to arthritis1 compared with ,whites 7#cd4j percent versus #bb4f percent74 ,african-,americans1 compared to ,whites1 report a higher proportion of work limitations 7#ci4e percent versus #bh4j percent7 and a higher prevalence of arthritis-attributable work limitation 7#f4f percent versus #d4f percent74 7#af7 ,hispanics are #ej percent more likely than non-,hispanic ,whites to report needing assistance with at least one instrumental activity of daily living and to have difficulty walking4 7#ag7 ,african-,americans and ,hispanics were #a4c times more likely to have activity limitation1 #a4f times more likely to have work limitations1 and #a4i times more likely to have severe joint pain than ,whites4 7#ah7 ,in #bjjc1 the ,institute of ,medicine reported that the rates of ,,tka and ,,tha among ,african-,american and ,hispanic patients are significantly lower than for ,whites--even for those with equitable health care coverage such as through ,medicare or the ,department of ,veterans ,affairs4 7#ai7 ,according to the ,centers for ,disease ,control and ,prevention1 in #bjjj1 ,african-,american ,medicare enrollees were #cg percent less likely than ,white ,medicare enrollees to undergo total knee replacements4 ,in #bjjf1 the disparity increased to #ci percent4 7#bj7 ,even after adjusting for insurance and health access1 ,hispanics and ,african-,americans are almost #ej percent less likely to undergo total knee replacement than ,whites4 #ghb4 ,osteoarthritis and other musculoskeletal health-related activities of the ,centers for ,disease ,control and ,prevention 7a7 ,education and ,awareness activities ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall direct the ,national ,center for ,chronic ,disease ,prevention and ,health ,promotion to conduct and expand the ,health ,community ,program and ,arthritis ,program to educate the public on-- 7#a7 the causes of1 preventive health actions for1 and effects of arthritis and other musculoskeletal conditions in minority patient populations2 and 7#b7 the effects of such conditions on other comorbidities including obesity1 hypertension1 and cardiovascular disease4 7b7 ,programs on arthritis and musculoskeletal conditions ,education and awareness programs of the ,centers for ,disease ,control and ,prevention on arthritis and other musculoskeletal conditions in minority communities shall-- 7#a7 be culturally and linguistically appropriate to minority patients1 targeting musculoskeletal health promotion and prevention programs of each major ethnic group1 including-- 7,a7 ,native ,americans and ,alaska ,natives2 7,b7 ,asian-,americans2 7,c7 ,african-,americans_/,blacks2 7,d7 ,hispanic_/,latino-,americans2 and 7,e7 ,native ,hawaiians and ,pacific ,islanders2 and 7#b7 include public awareness campaigns directed toward these patient populations that emphasize the importance of musculoskeletal health1 physical activity1 diet and healthy lifestyle1 and weight reduction for overweight and obese patients4 7c7 ,authorization of ,appropriations ,to carry out this section1 there are authorized to be appropriated such sums as necessary for fiscal year #bjae and each subsequent fiscal year4 ,i ,sleep and ,circadian ,rhythm ,disorders #gia4 ,short title2 findings 7a7 ,short title ,this subtitle may be cited as the ,sleep and ,circadian ,rhythm ,disorders ,health ,disparities ,act4 7b7 ,findings ,the ,congress finds the following3 7#a7 ,decrements in sleep health such as sleep apnea1 insufficient sleep time1 and insomnia1 affect #ej-gj million ,united ,states adults4 ,twelve to eighteen million ,united ,states adults have sleep apnea1 a chronic disorder characterized by one or more pauses in breathing which can last from a few seconds to minutes4 ,they may occur #cj times or more an hour1 disrupting sleep and resulting in excessive daytime sleepiness and loss in productivity4 7#b7 ,seventy percent of high school students are not getting enough sleep on school nights1 while #cc percent of ,americans get fewer than #g hours of sleep per night and roughly #f1jjj fatal motor vehicle crashes are caused by drowsy drivers4 7#c7 ,insufficient sleep and insomnia are more prevalent in women4 ,women who are pregnant and have sleep apnea are at an increased risk of cardiovascular complications during pregnancy4 ,the impact of disparities in sleep health is associated with a growing number of health problems1 including the following3 7,a7 ,hypertension4 7,b7 ,cancer4 7,c7 ,stroke4 7,d7 ,cardiac arrhythmia4 7,e7 ,chronic heart failure and heart disease4 7,f7 ,diabetes4 7,g7 ,cognitive functioning and behavior4 7,h7 ,depression and bipolar disorder4 7,i7 ,substance abuse4 7#d7 ,a sleep disparity exists in that poor sleep quality is strongly associated with poverty and race4 ,factors such as employment1 education1 and health status1 amongst others1 significantly mediated this effect only in poor subjects1 suggesting a differential vulnerability to these factors in poor relative to non-poor individuals in the context of sleep quality4 7#e7 ,african-,americans sleep worse than ,caucasian ,americans4 ,african-,americans take longer to fall asleep1 report poorer sleep quality1 have more light and less deep sleep1 and nap more often and longer4 7#f7 ,african-,americans and individuals in lower socioeconomic status groups may be at an increased risk for sleep disturbances and associated health consequences4 7#g7 ,among young ,african-,americans1 the likelihood of having sleep disordered breathing and exhibiting risk factors for poor sleep is twice that in young ,caucasians4 ,frequent snoring is more common among ,african-,american and ,hispanic women and ,hispanic men compared to non-,hispanic ,caucasians1 independent of other factors including obesity4 7#h7 ,african-,americans with sleep disordered breathing develop symptoms at a younger age than ,caucasians but appear less likely to be diagnosed and treated in a timely manner4 ,this delay may at least in part be due to reduced access to care4 7#i7 ,sleep loss contributes to increased risk for chronic conditions such as obesity1 diabetes1 and hypertension1 all of which have increased prevalence in underserved1 underrepresented minorities4 ,racial and ethnic disparities related to obesity may also contribute to disparities in health outcomes related to sleep disordered breathing4 7#aj7 ,non-,caucasian adults report an insomnia rate of #ab4i percent compared to only #f4f percent for ,caucasians4 7#aa7 ,african-,american women have a higher incidence of insomnia than ,african-,american men1 perhaps related in part to higher risk for chronic persisting symptoms4 #gib4 ,sleep and circadian rhythm disorders research activities of the ,national ,institutes of ,health 7a7 ,in general ,the ,director of the ,national ,institutes of ,health1 acting through the ,director of the ,national ,heart1 ,lung1 and ,blood ,institute1 shall-- 7#a7 continue to expand research activities addressing sleep health disparities2 and 7#b7 continue implementation of the ,,nih ,sleep ,disorders ,research ,plan across all institutes and centers of the ,national ,institutes of ,health to improve treatment and prevention of sleep health disparities4 7b7 ,required research activities ,in conducting or supporting research relating to sleep and circadian rhythm1 the ,director of the ,national ,heart1 ,lung1 and ,blood ,institute shall-- 7#a7 advance epidemiology and clinical research to achieve a more complete understanding of disparities in domains of sleep health and across population subgroups for which cardiovascular and metabolic health disparities exist1 including-- 7,a7 prevalence and severity of sleep apnea2 7,b7 habitual sleep duration2 7,c7 sleep timing and regularity2 and 7,d7 insomnia2 7#b7 develop study designs and analytical approaches to explain and predict multilevel and life-course determinants of sleep health and to elucidate the sleep-related causes of cardiovascular and metabolic health disparities across the age spectrum1 including such determinants and causes that are-- 7,a7 environmental2 7,b7 biological or genetic2 7,c7 psychosocial2 7,d7 societal2 7,e7 political2 or 7,f7 economic2 7#c7 determine the contribution of sleep impairments such as sleep apnea1 insufficient sleep duration1 irregular sleep schedules1 and insomnia to unexplained disparities in cardiovascular and metabolic risk and disease outcomes2 7#d7 develop study designs1 data sampling and collection tools1 and analytical approaches to optimize understanding of mediating and moderating factors1 and feedback mechanisms coupling sleep to cardiovascular and metabolic health disparities2 7#e7 advance research to understand cultural and linguistic barriers 7on the person1 provider1 or system level7 to access to care1 medical diagnosis1 and treatment of sleep disorders in diverse population groups2 7#f7 develop and test multilevel interventions 7including sleep health education in diverse communities7 to reduce disparities in sleep health that will impact ability to improve disparities in cardiovascular and metabolic risk or disease2 7#g7 create opportunities to integrate sleep and health disparity science by strategically utilizing resources 7existing or anticipated cohorts71 exchanging scientific data and ideas 7cross-over into scientific meetings71 and develop multidisciplinary investigator-initiated grant applications2 and 7#h7 enhance the diversity and foster career development of young investigators involved in sleep and health disparities science4 7c7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal year #bjae and each subsequent fiscal year4 #gic4 ,sleep and circadian rhythm health disparities-related activities of the ,centers for ,disease ,control and ,prevention 7a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention shall conduct1 support1 and expand public health strategies and prevention1 diagnosis1 surveillance1 and public and professional awareness activities regarding sleep and circadian rhythm disorders4 7b7 ,findings ,the ,congress finds as follows3 7#a7 ,sleep disorders and sleep deficiency unrelated to a primary sleep disorder are underdiagnosed and are increasingly detrimental to health status4 7#b7 ,the consequences to society include additional diseases1 motor vehicle accidents1 decreased longevity1 elevated direct medical costs1 and indirect costs related to work absenteeism and property damage4 7c7 ,required surveillance and education awareness activities ,in conducting or supporting research relating to sleep and circadian rhythm disorders surveillance and education awareness activities1 the ,director of the ,centers for ,disease ,control and ,prevention shall-- 7#a7 ensure that such activities are culturally and linguistically appropriate to minority patients1 targeting sleep and circadian rhythm health promotion and prevention programs of each major ethnic group1 including-- 7,a7 ,native ,americans and ,alaska ,natives2 7,b7 ,asian-,americans2 7,c7 ,african-,americans_/,blacks2 7,d7 ,hispanic_/,latino-,americans2 and 7,e7 ,native ,hawaiians and ,pacific ,islanders2 7#b7 collect and compile national and ,state surveillance data on sleep disorders health disparities2 7#c7 continue to develop and implement new sleep questions in public health surveillance systems to increase public awareness of sleep health and sleep disorders and their impact on health2 7#d7 publish monthly reports highlighting geographic1 racial1 and ethnic disparities in sleep health1 as well as relationships between insufficient sleep and chronic disease1 health risk behaviors1 and other outcomes as determined necessary by the ,director2 and 7#e7 include public awareness campaigns that inform patient populations from major ethnic groups about the prevalence of sleep and circadian rhythm disorders and emphasize the importance of sleep health4 7d7 ,authorization of ,appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal year #bjae and each subsequent fiscal year4 ,,viii ,health ,information ,technology #hjj4 ,definitions ,in this title3 7#a7 ,the term certified ,,ehr technology has the meaning given to that term in section #cjjj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj74 7#b7 ,the term ,,ehr means an electronic health record4 ,a ,reducing ,health ,disparities ,through ,health ,,it #hja4 ,,hrsa assistance to health centers for promotion of ,health ,,it ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall expand and intensify the programs and activities of the ,administration 7directly or through grants or contracts7 to provide technical assistance and resources to health centers 7as defined in section #ccj7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7a77 to adopt and meaningfully use certified ,,ehr technology for the management of chronic diseases and health conditions and reduction of health disparities4 #hjb4 ,assessment of impact of ,health ,,it on racial and ethnic minority communities2 outreach and adoption of ,health ,,it in such communities 7a7 ,national ,coordinator for ,health ,information ,technology 7#a7 ,in general ,the ,national ,coordinator for ,health ,information ,technology shall conduct an evaluation of the level of use and accessibility of electronic health records in racial and ethnic minority communities focusing on whether patients in those communities have providers with ,e,h,rs1 stratified by disparity variables4 7#b7 ,content ,in conducting the evaluation under paragraph 7#a71 the ,national ,coordinator shall publish the results of a study regarding the #ajj1jjj providers recruited by the ,regional ,extension ,center established under section #cjab of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#cb71 including the race and ethnicity of such providers and the populations served by such providers1 with the populations stratified by disparity variables4 7b7 ,national center for health statistics ,as soon as practicable after the date of enactment of this ,act1 the ,director of the ,national ,center for ,health ,statistics shall provide to ,congress a more detailed analysis of the data presented in the ,data ,brief #gi published by such ,center in ,november #bjaa 7entitled ,electronic ,health ,record ,systems and ,intent to ,apply for ,meaningful ,use ,incentives ,among ,office-,based ,physician ,practices74 7c7 ,institute of medicine ,the ,secretary of ,health and ,human ,services may enter into an agreement with the ,institute of ,medicine of the ,national ,academies that provides such ,institute will-- 7#a7 evaluate the impact of health information technology in racial and ethnic minority communities2 and 7#b7 publish a report regarding such evaluation4 7d7 ,centers for ,medicare ,medicaid ,services 7#a7 ,in general ,as part of the process of collecting information1 with respect to a provider1 at registration and attestation for purposes of the ,medicare and ,medicaid ,electronic ,health ,records ,incentive ,programs1 the ,secretary of ,health and ,human ,services shall collect the race and ethnicity of such provider4 7#b7 ,medicare and ,medicaid ,electronic ,health ,records ,incentive ,programs defined ,for purposes of paragraph 7#a71 the term ,medicare and ,medicaid ,electronic ,health ,records ,incentive ,programs means the incentive programs under section #ahad7l77#c71 subsections 7a77#g7 and 7o7 of section #ahdh1 subsections 7l7 and 7m7 of section #ahec1 subsections 7b77#c77;,b77ix77,i7 and 7n7 of section #ahhf1 and subsections 7a77#c77;,f7 and 7t7 of section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7l77#c71 #aciew-#d1 #aciew-#bc1 #acieww1 and #acif;b74 7e7 ,national ,coordinator's assessment of impact of ,,hit ,section #cjja7;c77#f77;,c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#aa7;c77#f77;,c77 is amended-- 7#a7 in the heading by inserting 1 racial and ethnic minority communities1 after health disparities2 7#b7 by inserting 1 in communities with a high proportion of individuals from racial and ethnic minority groups 7as defined in section #agjg7;g771 including people with disabilities in these groups1 after communities with health disparities2 and 7#c7 by adding at the end the following new sentence3 ,in any publication under the previous sentence1 the ,national ,coordinator shall include best practices for encouraging partnerships between the ,federal ,government1 ,states1 and private entities to expand outreach for and the adoption of certified ,,ehr technology in communities with a high proportion of individuals from racial and ethnic minority groups 7as so defined71 while also maintaining the accessibility requirements of section #ejh of the ,rehabilitation ,act to encourage patient involvement in their own health care4 ,the ,national ,coordinator shall-- 7i7 not later than #f months after the submission to the ,congress of the report required by section #hcb of the ,health ,equity and ,accountability ,act of #bjad1 establish criteria for evaluating the impact of health information technology on communities with a high proportion of individuals from racial and ethnic minority groups 7as so defined7 taking into account the findings in such report2 and 7ii7 not later than #ab months after the submission to the ,congress of such reports1 conduct and publish the results of an evaluation of such impact4 4 ,b ,modifications ,to ,achieve ,parity in ,existing ,programs #haa4 ,extending funding to strengthen the ,health ,,it infrastructure in racial and ethnic minority communities ,section #cjaa of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ca7 is amended-- 7#a7 in subsection 7a71 by adding at the end the following new paragraph3 7#h7 ,activities described in the previous paragraphs of this subsection with respect to communities with a high proportion of individuals from racial and ethnic minority groups 7as defined in section #agjg7;g774 2 and 7#b7 by adding at the end the following new subsection3 7e7 ,annual report on expenditures ,the ,national ,coordinator shall report annually to the ,congress on activities and expenditures under this section4 4 #hab4 ,prioritizing regional extension center assistance to racial and ethnic minority groups 7a7 ,in general ,section #cjab7;c77#d77;,c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#cb7;c77#d77;,c77 is amended by inserting or individuals from racial and ethnic minority groups 7as defined in section #agjg7;g77 after medically underserved individuals4 7b7 ,biennial evaluation ,section #cjab7;c77#h7 of such ,act 7#db ,u4,s4,c4 #cjj;jj-#cb7;c77#h77 is amended-- 7#a7 by inserting3 ,each evaluation panel shall include at least one consumer advocate from a racial and ethnic minority community served by the center involved1 at least one patient or family caregiver1 and at least one representative of a minority-serving institution4 after #8and of ,federal officials42 and 7#b7 by inserting and shall determine the degree to which such center provides outreach and assistance to providers predominantly serving racial and ethnic minority groups 7as defined in section #agjg7;g77 after specified in paragraph 7#c74 #hac4 ,extending competitive grants for the development of loan programs to facilitate adoption of certified ,,ehr technology by providers serving racial and ethnic minority groups ,section #cjad7;e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#cd7;e77 is amended-- 7#a7 in paragraph 7#c71 by striking at the end or2 7#b7 in paragraph 7#d71 by striking the period at the end and inserting 2 or2 and 7#c7 by adding at the end the following new paragraph3 7#e7 carry out any of the activities described in a previous paragraph of this subsection with respect to communities with a high proportion of individuals from racial and ethnic minority groups 7as defined in section #agjg7;g774 4 #had4 ,authorization of appropriations ,section #cjah of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ch7 is amended by striking fiscal years #bjji through #bjac and inserting fiscal years #bjad through #bjba4 ,c ,additional ,research and ,studies #hca4 ,data collection and assessments conducted in coordination with minority-serving institutions ,section #cjja7;c77#f7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#aa7;c77#f77 is amended by adding at the end the following new subparagraph3 7,f7 ,data collection and assessments conducted in coordination with minority-serving institutions 7i7 ,in general ,in carrying out subparagraph 7,c7 with respect to communities with a high proportion of individuals from racial and ethnic minority groups 7as defined in section #agjg7;g771 the ,national ,coordinator shall1 to the greatest extent possible1 coordinate with an entity described in clause 7ii74 7ii7 ,minority-serving institutions ,for purposes of clause 7i71 an entity described in this clause is a historically ,black college or university1 a ,hispanic-serving institution1 a tribal college or university1 or an ,asian-,american-1 ,native ,american-1 and ,pacific ,islander-serving institution with an accredited public health1 health policy1 or health services research program4 4 #hcb4 ,study of health information technology in medically underserved communities 7a7 ,in general ,not later than #bd months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall-- 7#a7 enter into an agreement with the ,institute of ,medicine of the ,national ,academies 7or1 if the ,institute of ,medicine declines1 another appropriate public or nonprofit private entity7 to conduct a study on the development1 implementation1 and effectiveness of health information technology within medically underserved areas 7as described in subsection 7c772 and 7#b7 submit a report to ,congress describing the results of such study1 including any recommendations for legislative or administrative action4 7b7 ,study ,the study described in subsection 7a77#a7 shall-- 7#a7 identify barriers to successful implementation of health information technology in medically underserved areas2 7#b7 examine the impact of health information technology on providing quality care and reducing the cost of care to individuals in such areas1 including the impact of such technology on improved health outcomes for individuals1 including which technology worked for which population and how it improved health outcomes for that population2 7#c7 examine the impact of health information technology on improving health-care-related decisions by both patients and providers in such areas2 7#d7 identify specific best practices for using health information technology to foster the consistent provision of physical accessibility and reasonable policy accommodations in health care to individuals with disabilities in such areas2 7#e7 assess the feasibility and costs associated with the use of health information technology in such areas2 7#f7 evaluate whether the adoption and use of qualified electronic health records 7as described in section #cjjj7ac7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj7#ac77 is effective in reducing health disparities1 including analysis of clinical quality measures reported by ,medicare and ,medicaid providers pursuant to programs to encourage the adoption and use of certified ,,ehr technology2 7#g7 identify providers in medically underserved areas that are not electing to adopt and use electronic health records and determine what barriers are preventing those providers from adopting and using such records2 and 7#h7 examine urban and rural community health systems and determine the impact that health information technology may have on the capacity of primary health providers in those systems4 7c7 ,medically underserved area ,the term medically underserved area means-- 7#a7 a population that has been designated as a medically underserved population under section #ccj7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c772 7#b7 an area that has been designated as a health professional shortage area under section #ccb of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e72 7#c7 an area or population that has been designated as a medically underserved community under section #gii;,b7#f7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #biep7#f772 or 7#d7 an area or population that-- 7,a7 is not described in paragraphs 7#a7 through 7#c7 of this subsection2 7,b7 experiences significant barriers to accessing quality health services2 and 7,c7 has a high prevalence of diseases or conditions described in title ,,vii of this ,act1 with such diseases or conditions having a disproportionate impact on racial and ethnic minority groups 7as defined in section #agjg7;g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g777 or a subgroup of people with disabilities who have specific functional impairments4 ,d ,closing ,gaps in ,funding ,to ,adopt ,certified ,e,h,rs #hda4 ,application of ,medicare ,,hitech payments to hospitals in ,puerto ,rico 7a7 ,in general ,subsection 7n77#f77;,b7 of section #ahhf of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7 is amended by striking subsection 7d7 hospital and inserting hospital that is a subsection 7d7 hospital or a subsection 7d7 ,puerto ,rico hospital4 7b7 ,offsetting reduction ,subsection 7n77#b7 of section #ahhf of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7 is amended by adding at the end the following new subparagraph3 7,h7 ,budget neutrality adjustment ,the ,secretary shall reduce the applicable amounts that would otherwise be determined under this subsection with respect to-- 7i7 the first fiscal year to which this subparagraph applies by an amount that the ,secretary estimates would ensure that estimated aggregate payments under this subsection for such fiscal year are not increased as a result of the amendments made by subsection 7a7 of section #hda of the ,health ,equity and ,accountability ,act of #bjad2 or 7ii7 a succeeding fiscal year by an amount that the ,secretary estimates would ensure that estimated aggregate payments under this subsection for such fiscal year are not increased as a result of the amendments made by subsections 7a7 and 7c7 of such section4 4 7c7 ,conforming amendments 7#a7 ,subsection 7b77#c77;,b77ix7 of such section is amended-- 7,a7 in subclause 7,i71 by striking 7n77#f77;,a7 and inserting 7n77#f77;,b72 and 7,b7 in subclause 7,,ii71 by striking subsection 7d7 hospital and inserting an eligible hospital4 7#b7 ,paragraphs 7#b7 and 7#d77;,a7 of section #ahec7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bc7m77 are each amended by striking #ahhf7n77#f77;,a7 and inserting #ahhf7n77#f77;,b74 7d7 ,implementation ,notwithstanding any other provision of law1 the ,secretary of ,health and ,human ,services may implement the amendments made by subsections 7a71 7b7 and 7c7 by program instruction or otherwise4 7e7 ,effective date ,the amendments made by this section shall apply to payments for payment years for fiscal years beginning after the date of the enactment of this ,act4 #hdb4 ,extending ,medicaid ,,ehr incentive payments to rehabilitation facilities1 long-term care facilities1 and home health agencies ,section #aijc7t77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7t77#b77;,b77 is amended-- 7#a7 in clause 7i71 by striking 1 or and inserting a semicolon2 7#b7 in clause 7ii71 by striking the period at the end and inserting a semicolon2 and 7#c7 by inserting after clause 7ii7 the following new clauses3 7iii7 a rehabilitation facility 7as defined in section #ahhf7;j77#a77 that furnishes acute or subacute rehabilitation services2 7iv7 a long-term care hospital 7as defined in section #ahhf7;d77#a77;,b77iv77,i772 or 7v7 a home health agency 7as defined in section #ahfa7o774 4 #hdc4 ,extending physician assistant eligibility for ,medicaid electronic health record incentive payments 7a7 ,in general ,section #aijc7t77#c77;,b77v7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7t77#c77;,b77v77 is amended to read as follows3 7v7 physician assistant1 in the case that the assistant is a primary care provider1 including an assistant who practices in a rural health clinic that is led by a physician assistant or practices in a federally qualified health center that is so led4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply with respect to amounts expended under section #aijc7;a77#c77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#c77;,f77 for calendar quarters beginning on or after the date of the enactment of this ,act4 ,,ix ,accountability and ,evaluation #ija4 ,prohibition on discrimination in ,federal assisted health care services and research programs on the basis of sex1 race1 color1 national origin1 marital status1 familial status1 sexual orientation1 gender identity1 or disability status 7a7 ,in general ,no person in the ,united ,states shall1 on the basis of sex1 race1 color1 national origin1 marital status1 familial status1 sexual orientation1 gender identity1 or disability status1 be excluded from participation in1 be denied the benefits of1 or be subjected to discrimination under any health program or activity1 including any health research program or activity1 receiving ,federal financial assistance4 7b7 ,definition ,in this section1 the term familial status means1 with respect to one or more individuals-- 7#a7 being domiciled with any individual related by blood or affinity whose close association with the individual is the equivalent of a family relationship2 7#b7 being in the process of securing legal custody of any individual2 or 7#c7 being pregnant4 #ijb4 ,treatment of ,medicare payments under title ,,vi of the ,civil ,rights ,act of #aifd ,a payment to a provider of services1 physician1 or other supplier under part ,b1 ,c1 or ,d of title ,,xviii of the ,social ,security ,act shall be deemed a grant1 and not a contract of insurance or guaranty1 for the purposes of title ,,vi of the ,civil ,rights ,act of #aifd4 #ijc4 ,accountability and transparency within the ,department of ,health and ,human ,services ,title ,,xxxiv of the ,public ,health ,service ,act1 as amended by titles ,i1 ,,ii1 and ,,iii of this ,act1 is further amended by inserting after subtitle ,b the following3 ,c ,strengthening accountability #cdda4 ,elevation of the ,office of ,civil ,rights 7a7 ,in general ,the ,secretary shall establish within the ,office for ,civil ,rights an ,office of ,health ,disparities1 which shall be headed by a director to be appointed by the ,secretary4 7b7 ,purpose ,the ,office of ,health ,disparities shall ensure that the health programs1 activities1 and operations of health entities which receive ,federal financial assistance are in compliance with title ,,vi of the ,civil ,rights ,act1 which prohibits discrimination on the basis of race1 color1 or national origin4 ,the activities of the ,office shall include the following3 7#a7 ,the development and implementation of an action plan to address racial and ethnic health care disparities1 which shall address concerns relating to the ,office for ,civil ,rights as released by the ,united ,states ,commission on ,civil ,rights in the report entitled ,health ,care ,challenge3 ,acknowledging ,disparity1 ,confronting ,discrimination1 and ,ensuring ,equity 7,september #aiii7 in conjunction with the reports by the ,institute of ,medicine entitled ,unequal ,treatment3 ,confronting ,racial and ,ethnic ,disparities in ,health ,care1 ,crossing the ,quality ,chasm3 ,a ,new ,health ,system for the #bast ,century1 ,in the ,nation's ,compelling ,interest3 ,ensuring ,diversity in the ,health ,care ,workforce1 ,the ,national ,partnership for ,action to ,end ,health ,disparities1 and ,the ,health of ,lesbian1 ,gay1 ,bisexual1 and ,transgender ,people1 and other related reports by the ,institute of ,medicine4 ,this plan shall be publicly disclosed for review and comment and the final plan shall address any comments or concerns that are received by the ,office4 7#b7 ,investigative and enforcement actions against intentional discrimination and policies and practices that have a disparate impact on minorities4 7#c7 ,the review of racial1 ethnic1 gender identity1 sexual orientation1 sex1 disability status1 socioeconomic status1 and primary language health data collected by ,federal health agencies to assess health care disparities related to intentional discrimination and policies and practices that have a disparate impact on minorities4 7#d7 ,outreach and education activities relating to compliance with title ,,vi of the ,civil ,rights ,act4 7#e7 ,the provision of technical assistance for health entities to facilitate compliance with title ,,vi of the ,civil ,rights ,act4 7#f7 ,coordination and oversight of activities of the civil rights compliance offices established under section #cddb4 7#g7 ,ensuring-- 7,a7 at a minimum1 compliance with the #aiig ,office of ,management and ,budget ,standards for ,maintaining1 ,collecting1 and ,presenting ,federal ,data on ,race and ,ethnicity2 and 7,b7 consideration of available data and language standards such as-- 7i7 the standards for collecting and reporting data under section #caja2 and 7ii7 the ,national ,standards on ,culturally and ,linguistically ,appropriate ,services of the ,office of ,minority ,health within the ,department of ,health and ,human ,services4 7c7 ,funding and staff ,the ,secretary shall ensure the effectiveness of the ,office of ,health ,disparities by ensuring that the ,office is provided with-- 7#a7 adequate funding to enable the ,office to carry out its duties under this section2 and 7#b7 staff with expertise in-- 7,a7 epidemiology2 7,b7 statistics2 7,c7 health quality assurance2 7,d7 minority health and health disparities2 7,e7 cultural and linguistic competency2 7,f7 civil rights2 and 7,g7 social1 behavioral1 and economic determinants of health4 7d7 ,report ,not later than ,december #ca1 #bjae1 and annually thereafter1 the ,secretary1 in collaboration with the ,director of the ,office for ,civil ,rights and the ,deputy ,assistant ,secretary for ,minority ,health1 shall submit a report to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives that includes-- 7#a7 the number of cases filed1 broken down by category2 7#b7 the number of cases investigated and closed by the office2 7#c7 the outcomes of cases investigated2 7#d7 the staffing levels of the office including staff credentials2 7#e7 the number of other lingering and emerging cases in which civil rights inequities can be demonstrated2 and 7#f7 the number of cases remaining open and an explanation for their open status4 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjae through #bjbj4 #cddb4 ,establishment of ,health ,program offices for ,civil ,rights within ,federal ,health and human services agencies 7a7 ,in general ,the ,secretary shall establish civil rights compliance offices in each agency within the ,department of ,health and ,human ,services that administers health programs4 7b7 ,purpose of offices ,each office established under subsection 7a7 shall ensure that recipients of ,federal financial assistance under ,federal health programs administer their programs1 services1 and activities in a manner that-- 7#a7 does not discriminate1 either intentionally or in effect1 on the basis of race1 national origin1 language1 ethnicity1 sex1 age1 disability1 sexual orientation1 and gender identity2 and 7#b7 promotes the reduction and elimination of disparities in health and health care based on race1 national origin1 language1 ethnicity1 sex1 age1 disability1 sexual orientation1 and gender identity4 7c7 ,powers and duties ,the offices established in subsection 7a7 shall have the following powers and duties3 7#a7 ,the establishment of compliance and program participation standards for recipients of ,federal financial assistance under each program administered by an agency within the ,department of ,health and ,human ,services including the establishment of disparity reduction standards to encompass disparities in health and health care related to race1 national origin1 language1 ethnicity1 sex1 age1 disability1 sexual orientation1 and gender identity4 7#b7 ,the development and implementation of program-specific guidelines that interpret and apply ,department of ,health and ,human ,services guidance under title ,,vi of the ,civil ,rights ,act of #aifd and section #aeeg of the ,patient ,protection and ,affordable ,care ,act to each ,federal health program administered by the agency4 7#c7 ,the development of a disparity-reduction impact analysis methodology that shall be applied to every rule issued by the agency and published as part of the formal rulemaking process under sections #eee1 #eef1 and #eeg of title #e1 ,united ,states ,code4 7#d7 ,oversight of data collection1 analysis1 and publication requirements for all recipients of ,federal financial assistance under each ,federal health program administered by the agency2 compliance with1 at a minimum1 the #aiig ,office of ,management and ,budget ,standards for ,maintaining1 ,collecting1 and ,presenting ,federal ,data on ,race and ,ethnicity2 and consideration of available data and language standards such as-- 7,a7 the standards for collecting and reporting data under section #caja2 and 7,b7 the ,national ,standards on ,culturally and ,linguistically ,appropriate ,services of the ,office of ,minority ,health within the ,department of ,health and ,human ,services4 7#e7 ,the conduct of publicly available studies regarding discrimination within ,federal health programs administered by the agency as well as disparity reduction initiatives by recipients of ,federal financial assistance under ,federal health programs4 7#f7 ,annual reports to the ,committee on ,health1 ,education1 ,labor1 and ,pensions and the ,committee on ,finance of the ,senate and the ,committee on ,energy and ,commerce and the ,committee on ,ways and ,means of the ,house of ,representatives on the progress in reducing disparities in health and health care through the ,federal programs administered by the agency4 7d7 ,relationship to ,office for ,civil ,rights in the ,department of ,justice 7#a7 ,department of ,health and ,human ,services ,the ,office for ,civil ,rights in the ,department of ,health and ,human ,services shall provide standard-setting and compliance review investigation support services to the ,civil ,rights ,compliance ,office for each agency4 7#b7 ,department of ,justice ,the ,office for ,civil ,rights in the ,department of ,justice shall continue to maintain the power to institute formal proceedings when an agency ,office for ,civil ,rights determines that a recipient of ,federal financial assistance is not in compliance with the disparity reduction standards of the agency4 7e7 ,definition ,in this section1 the term ,federal health programs mean programs-- 7#a7 under the ,social ,security ,act 7#db ,u4,s4,c4 #cja et seq47 that pay for health care and services2 and 7#b7 under this ,act that provide ,federal financial assistance for health care1 biomedical research1 health services research1 and programs designed to improve the public's health1 including health service programs4 4 #ijd4 ,united ,states ,commission on ,civil ,rights 7a7 ,coordination within ,department of ,justice of activities regarding ,health disparities ,section #c7;a7 of the ,civil ,rights ,commission ,act of #aihc 7#db ,u4,s4,c4 #aige;a7a77 is amended-- 7#a7 in paragraph 7#a71 by striking and at the end2 7#b7 in paragraph 7#b71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following3 7#c7 shall1 with respect to activities carried out in health care and correctional facilities toward the goal of eliminating health disparities between the general population and members of racial or ethnic minority groups1 coordinate such activities of-- 7,a7 the ,office for ,civil ,rights within the ,department of ,justice2 7,b7 the ,office of ,justice ,programs within the ,department of ,justice2 7,c7 the ,office for ,civil ,rights within the ,department of ,health and ,human ,services2 and 7,d7 the ,office of ,minority ,health within the ,department of ,health and ,human ,services 7headed by the ,deputy ,assistant ,secretary for ,minority ,health74 4 7b7 ,authorization of appropriations ,section #e of the ,civil ,rights ,commission ,act of #aihc 7#db ,u4,s4,c4 #aige;c7 is amended by striking the first sentence and inserting the following3 ,for the purpose of carrying out this ,act1 there are authorized to be appropriated #cj1jjj1jjj for fiscal year #bjae1 and such sums as may be necessary for each of the fiscal years #bjaf through #bjbj44 #ije4 ,sense of ,congress concerning full funding of activities to eliminate racial and ethnic health disparities 7a7 ,findings ,congress makes the following findings3 7#a7 ,the health status of the ,american populace is declining and the ,united ,states currently ranks below most industrialized nations in health status measured by longevity1 sickness1 and mortality4 7#b7 ,racial and ethnic minority populations tend have the poorest health status and face substantial cultural1 social1 and economic barriers to obtaining quality health care4 7#c7 ,lesbian1 gay1 bisexual and transgender 7,,lgbt7 populations experience significant personal and structural barriers to obtaining high-quality health care4 7#d7 ,efforts to improve minority health have been limited by inadequate resources 7funding1 staffing1 and stewardship7 and lack of accountability4 7b7 ,sense of ,congress ,it is the sense of ,congress that-- 7#a7 funding should be doubled by fiscal year #bjaf for the ,national ,institute for ,minority ,health ,disparities1 the ,office of ,civil ,rights in the ,department of ,health and ,human ,services1 the ,national ,institute of ,nursing ,research1 and the ,office of ,minority ,health2 7#b7 adequate funding by fiscal year #bjaf1 and subsequent funding increases1 should be provided for health and human service professions training programs1 the ,racial and ,ethnic ,approaches to ,community ,health 7,,reach7 ,initiative at the ,centers for ,disease ,control and ,prevention1 the ,minority ,,hiv_/,,aids ,initiative1 and the ,excellence ,centers to ,eliminate ,ethnic_/,racial ,disparities 7,,exceed7 ,program at the ,agency for ,healthcare ,research and ,quality2 7#c7 funding should be fully restored to the ,racial and ,ethnic ,approaches to ,community ,health 7,,reach7 ,initiative at the ,centers for ,disease ,control and ,prevention1 which has been a successful program at the community health level1 and efforts should continue to place a strong emphasis on building community capacity to secure financial resources and technical assistance to eliminate health disparities2 7#d7 adequate funding for fiscal year #bjaf and increased funding for future years should be provided for the ,,reach ,initiative's ,united ,states ,risk ,factor ,survey to ensure adequate data collection to track health disparities1 and there should be appropriate avenues provided to disseminate findings to the general public2 7#e7 current and newly created health disparity elimination incentives1 programs1 agencies1 and departments under this ,act 7and the amendments made by this ,act7 should receive adequate staffing and funding by fiscal year #bjaf2 and 7#f7 stewardship and accountability should be provided to the ,congress and the ,president for measurable and sustainable progress toward health disparity elimination4 #ijf4 ,,gao and ,,nih reports 7a7 ,,gao report on ,,nih grant racial and ethnic diversity 7#a7 ,in general ,the ,comptroller ,general of the ,united ,states shall conduct a study on the racial and ethnic diversity among the following groups3 7,a7 ,all applicants for grants1 contracts1 and cooperative agreements awarded by the ,national ,institutes of ,health during the period beginning on ,january #a1 #aiij1 and ending ,december #ca1 #bjac4 7,b7 ,all recipients of such grants1 contracts1 and cooperative agreements4 7,c7 ,all members of the peer review panels of such applicants and recipients1 respectively4 7#b7 ,report ,not later than six months after the date of the enactment of this ,act1 the ,comptroller ,general shall complete the study under paragraph 7#a7 and submit to ,congress a report containing the results of such study4 7b7 ,,nih report on certain authority of ,national ,institute on ,minority ,health and ,health ,disparities ,not later than six months after the date of the enactment of this ,act1 and biennially thereafter1 the ,director of the ,national ,institutes of ,health1 in collaboration with the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities1 shall submit to ,congress a report that details and evaluates-- 7#a7 the steps taken during the applicable report period by the ,director of the ,national ,institutes of ,health to enforce the expanded planning1 coordination1 review1 and evaluation authority provided the ,national ,institute on ,minority ,health and ,health ,disparities under section #dfdz-#c7;h7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe7;h771 as added by section #ajccd7;c7 of the ,patient ,protection and ,affordable ,care ,act1 over all minority health and health disparity research that is conducted or supported by the ,institutes and ,centers at the ,national ,institutes of ,health2 and 7#b7 the outcomes of such steps4 7c7 ,,gao report related to recipients of ,,ppaca funding ,not later than one year after the date of the enactment of this ,act and biennially thereafter until #bjbd1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report that identifies1 with respect to minority community-based organizations that applied during the applicable report period for ,federal funding provided pursuant to the provisions of 7and amendments made by7 the ,patient ,protection and ,affordable ,care ,act for purposes of achieving health equity and eliminating health disparities1 the percentage of such organizations that were awarded such funding4 7d7 ,annual report on activities of ,national ,institute on ,minority ,health and ,health ,disparities ,the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities shall prepare an annual report on the activities carried out or to be carried out by the ,institute1 and shall submit each such report to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate1 the ,committee on ,energy and ,commerce of the ,house of ,representatives1 the ,secretary of ,health and ,human ,services1 and the ,director of the ,national ,institutes of ,health4 ,with respect to the fiscal year involved1 the report shall-- 7#a7 describe and evaluate the progress made in health disparities research conducted or supported by institutes and centers of the ,national ,institutes of ,health2 7#b7 summarize and analyze expenditures made for activities with respect to health disparities research conducted or supported by the ,national ,institutes of ,health2 7#c7 include a separate statement applying the requirements of paragraphs 7#a7 and 7#b7 specifically to minority health disparities research2 and 7#d7 contain such recommendations as the ,director of the ,institute considers appropriate4 ,x ,addressing ,social ,determinants and ,improving ,environmental ,justice #ajja4 ,definitions 7a7 ,determinants of health ,the term determinants of health-- 7#a7 refers to the range of personal1 social1 economic1 and environmental factors that influence health status2 and 7#b7 includes social determinants of health 7which are sometimes referred to as social and economic determinants of health or socioeconomic determinants of health71 environmental determinants of health1 and personal determinants of health4 7b7 ,environmental determinants of health ,the term environmental determinants of health refers to the broad physical1 psychological1 social1 and aesthetic environment4 7c7 ,personal determinants of health ,the term personal determinants of health refers to an individual's behavior1 biology1 and genetics4 7d7 ,social determinants of health ,the term social determinants of health refers to a subset of determinants of the health of individuals and environments 7such as communities1 neighborhoods1 and societies7 that describe people's social identity1 describe the social and economic resources to which people have access1 and describe the conditions in which people work1 live1 and play4 #ajjb4 ,findings ,the ,congress finds as follows3 7#a7 ,there are more opportunities to improve health for everyone when we understand that health starts1 first1 not in a medical setting1 but in our families1 in our schools and workplaces1 in our neighborhoods1 and in the air we breathe and water we drink4 7#b7 ,the social determinants of health are the largest predictors of health outcomes4 7#c7 ,healthy ,people #bjbj identifies health and health care quality as a function of not only access to health care1 but also the social determinants of health1 categorized into the following3 neighborhoods and the built environment2 social and community context2 education2 and economic stability4 ,the following examples illustrate the nexus between the unequal distribution of the social determinants of health and health disparities3 7,a7 ,the built environment influences residents' level of physical activity4 ,neighborhoods with high levels of poverty are significantly less likely to have places where children can be physically active1 such as parks1 green spaces1 and bike paths and lanes4 ,neighborhoods and communities can provide opportunities for physical activity and support active lifestyles through accessible and safe parks and open spaces and through land use policy1 zoning1 and healthy community design4 7,b7 ,emotional and physical health and well-being are directly impacted by perceived levels of safety1 such as unlit streets at night4 ,community members have expressed that safety is not only a barrier to accessing programs and services that increase quality of life but they are also not able to access physical activity in their community through the built environment4 7,c7 ,in many workplace environments1 toxic chemicals have lasting detrimental effects on employees' health4 ,the hazardous compounds found in most nail salon products affect the respiratory system1 reproductive system1 and central nervous system1 and also cause kidney and liver damage4 ,recognizing the importance of addressing occupational hazards as a matter of public health1 especially for ,asian-,american women who constitute #dj percent of nail salon technicians--with ,vietnamese-,american women accounting for #cg percent of this--the ,white ,house ,initiative on ,asian ,american ,pacific ,islanders has created an interagency working group to coordinate efforts by the ,environmental ,protection ,agency1 ,occupational and ,safety ,health ,administration1 ,food and ,drug ,administration1 and other ,federal agencies to create programming1 draft regulations1 and conduct more outreach on educating workers on health and safety issues4 7,d7 ,historical and institutional discrimination against certain racial groups in the ,united ,states has shaped the way in which social and economic resources and exposure to health promoting environments are distributed4 ,income1 education1 occupation1 neighborhood conditions1 schools1 workplaces1 the use of and health and social services1 and experiences with the criminal justice system are all highly patterned by race1 with racial minorities 7compared to ,whites7 experiencing more that is health harming4 ,finding ways to uncouple the link between race and access to resources and healthy environments is a principal means of reducing health disparities4 ,additionally1 the anticipation of racism itself causes higher psychological and cardiovascular stress levels that are linked to poor health outcomes4 ,remedying discriminatory practices at the individual and systemic levels will likely reduce health disparities caused by this unequal distribution of stress4 7,e7 ,poor health among ,native ,americans has largely been driven by post-colonial oppression and historical trauma4 ,the expropriation of native lands and territories to the ,american state had severe consequences on ,native ,american health4 ,this resulted in the deprivation of traditional food sources--and nutrients--for ,native ,americans and also the destruction of traditional economies and community organization4 ,today1 ,native ,americans have twice the rate of diabetes than non-,hispanic ,whites4 ,recognition of the origins of the diabetes as having a social and community context1 rather than just individual responsibility and genetic predisposition1 will shape better policy to provide food security4 7,f7 ,in the context of prisons1 overcrowding has led to the deterioration of the physical and mental health of individuals after they leave prison4 ,in particular1 the mass incarceration of ,african-,american males as a result of unequal contact with and treatment in the criminal justice system has contributed to an overburdening of certain infectious diseases within the ,african-,american community4 ,as a social institution1 incarceration amplifies existing adverse health conditions by concentrating diseases and harm health behaviors such as tobacco use1 drug use1 and violence4 7,g7 ,educational attainment is the strongest predictor of adult mortality4 ,it is a basic component of socioeconomic status by shaping earning potential to access resources that promote health4 ,people with more education are less likely to report that they are in poor health1 and are also less likely to have diabetes and other chronic diseases4 7,h7 ,similarly1 reading ability is a strong predictor of adult health status and is often correlated with other child health issues1 such as developmental problems1 vision and hearing impairments1 and frequent school absence due to illness4 7,i7 ,individuals with lower levels of educational attainment are much more likely to report to be current smokers4 ,in #bjaa1 smoking prevalence was #de4c percent among adults with a ,,ged diploma1 #cd4f percent with nine to #aa years of education1 and #bc4h percent with a high school diploma1 while dropping significantly to #i4c percent among adults with an undergraduate college degree and #e4j percent with a postgraduate college degree4 7,j7 ,social class differences account for a large part of health disparities4 ,for example1 children living in poverty experience poorer housing conditions1 increased exposure to indoor allergens and toxins 7such as pesticides1 lead1 mercury1 radon1 air pollution1 and carcinogens71 and more psychological stress4 ,these experiences culminate in worse adult health as compared with children with higher socioeconomic status4 ,specifically1 children living in socioeconomic neighborhoods have higher rates of asthma due to higher rates of psychological stress resulting from higher rates of violence4 7,k7 ,lesbian1 gay1 bisexual1 and transgender 7,,lgbt7 individuals face health disparities linked to societal stigma1 discrimination1 and denial of their civil and human rights4 ,discrimination against ,,lgbt individuals has been associated with high rates of psychiatric disorders1 substance abuse1 and suicide4 ,experiences of violence and victimization are frequent for ,,lgbt individuals1 and have long-lasting effects on the individual and the community4 ,personal1 family1 and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of ,,lgbt individuals4 7#d7 ,laws and regulations that improve opportunities to live in safe neighborhoods1 with more social cohesion1 attain higher education1 sustain stable employment1 and bridge class differences help foster the health and safety of individuals4 7#e7 ,the global public health community has reached consensus through the ,rio ,political ,declaration of ,social ,determinants of ,health that collaboration in coordinated and intersectoral policy actions has proven to be effective4 ,health in ,all ,policies1 together with intersectoral cooperation and action1 is one promising approach to enhance accountability in other sectors of health1 as well as the promotion of health equity and more inclusive and productive societies4 #ajjc4 ,health impact assessments 7a7 ,findings ,congress makes the following findings3 7#a7 ,health ,impact ,assessment is a tool to help planners1 health officials1 decisionmakers1 and the public make more informed decisions about the potential health effects of proposed plans1 policies1 programs1 and projects in order to maximize health benefits and minimize harms4 7#b7 ,health ,impact ,assessments can be done at a fraction of the cost and time typically required for other planning and permitting reviews4 7#c7 ,health ,impact ,assessments can build community support and reduce opposition to a project or policy1 thereby facilitating economic growth by aiding the development of consensus regarding new development proposals4 7#d7 ,health ,impact ,assessments facilitate collaboration across sectors4 7b7 ,purposes ,it is the purpose of this section to-- 7#a7 provide more information about the potential human health effects of policy decisions and the distribution of those effects2 7#b7 improve how health is considered in planning and decisionmaking processes2 and 7#c7 build stronger1 healthier communities through the use of ,health ,impact ,assessment4 7c7 ,health impact assessments ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq471 as amended1 is further amended by adding at the end the following3 #cii,v-#i4 ,health impact assessments 7a7 ,definitions ,in this section and section #cii,v-#aj3 7#a7 ,administrator ,the term ,administrator means the ,administrator of the ,environmental ,protection ,agency4 7#b7 ,built environment ,the term built environment means the components of the environment1 and the location of these components in a geographically defined space1 that are created or modified by individuals to form the physical and social characteristics of a community or enhance quality of human life1 including-- 7,a7 homes1 schools1 and places of work and worship2 7,b7 parks1 recreation areas1 and greenways2 7,c7 transportation systems2 7,d7 business1 industry1 and agriculture2 and 7,e7 land-use plans1 projects1 and policies that impact the physical or social characteristics of a community1 including access to services and amenities4 7#c7 ,director ,the term ,director means the ,director of the ,centers for ,disease ,control and ,prevention4 7#d7 ,eligible entity ,the term eligible entity means a unit of ,state or tribal government the jurisdiction of which includes individuals or populations the health of which are1 or will be1 affected by an activity or a proposed activity4 7#e7 ,eligible institution ,the term eligible institution means a public agency or private nonprofit institution that submits to the ,secretary1 in consultation with the ,administrator1 an application for a grant authorized under such section at such time1 in such manner1 and containing such agreements1 assurances1 and information as the ,secretary and ,administrator may require4 7#f7 ,health impact assessment ,the term ,health ,impact ,assessment means a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy1 plan1 program1 or project on the health of a population and the distribution of those effects within the population4 ,such term includes identifying and recommending appropriate actions on monitoring and maximizing potential benefits and minimizing the potential harms4 7#g7 ,health disparities ,the term health disparities are a particular type of health differences that are closely linked with social1 economic1 and_/or environmental disadvantage4 ,health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group2 religion2 socioeconomic status2 gender2 age2 mental health2 cognitive1 sensory1 or physical disability2 sexual orientation or gender identity2 geographic location2 or other characterisitics historically linked to discrimination or exclusion4 7#h7 ,proposed activity ,the term proposed activity means a proposed policy1 program1 plan1 or project currently under consideration by a local1 ,state1 tribal1 or ,federal agency or government4 7b7 ,establishment ,the ,secretary1 acting through the ,director and in collaboration with the ,administrator1 shall carry out the following3 7#a7 ,establish a program at the ,national ,center for ,environmental ,health at the ,centers for ,disease ,control and ,prevention focused on advancing the field of ,health ,impact ,assessment4 ,in developing and implementing the program1 the ,director of the ,national ,center for ,environmental ,health shall consult with the ,director of the ,national ,center for ,chronic ,disease ,prevention and ,health ,promotion as well as relevant offices within the ,department of ,housing and ,urban ,development1 the ,department of ,transportation1 and the ,department of ,agriculture4 ,the program shall include-- 7,a7 collecting and disseminating best practices2 7,b7 administering capacity building grants to ,states to support grantees in initiating ,health ,impact ,assessments1 in accordance with subsection 7d72 7,c7 providing technical assistance2 7,d7 developing training tools and providing training on conducting ,health ,impact ,assessment and the implementation of built environment and health indicators2 7,e7 making information available1 as appropriate1 regarding the existence of other community healthy living tools1 checklists1 and indices that help connect public health to other sectors1 and tools to help examine the effect of the indoor built environment and building codes on population health2 7,f7 conducting research and evaluations of ,health ,impact ,assessments2 and 7,g7 awarding competitive extramural research grants4 7#b7 ,in accordance with subsection 7c71 develop guidance and guidelines to conduct ,health ,impact ,assessments4 7#c7 ,in accordance with subsection 7d71 establish a grant program to allow ,states to fund eligible entities to conduct ,health ,impact ,assessments4 7c7 ,guidance ,the ,director1 in consultation with the ,director of the ,national ,center for ,environmental ,health and1 the ,director of the ,national ,center for ,chronic ,disease ,prevention and ,health ,promotion1 and relevant offices within the ,department of ,housing and ,urban ,development1 the ,department of ,transportation1 and the ,department of ,agriculture1 shall-- 7#a7 develop guidance for conducting ,health ,impact ,assessment1 including-- 7,a7 background on national and international efforts to bridge urban planning and public health institutions and disciplines1 including a review of ,health ,impact ,assessment best practices internationally2 7,b7 evidence-based direct and indirect pathways that link land-use planning1 transportation1 and housing policy and objectives to human health outcomes2 7,c7 data resources and quantitative and qualitative forecasting methods to evaluate both the status of health determinants and health effects1 including identification of existing programs that can disseminate these resources2 7,d7 best practices for inclusive public involvement in conducting ,health ,impact ,assessments2 and 7,e7 technical assistance for other agencies seeking to develop their own guidelines and procedures for ,health ,impact ,assessment2 7#b7 in developing the guidance1 consider available international ,health ,impact ,assessment guidance1 ,north ,american ,health ,impact ,assessment ,practice ,standards1 and recommendations from the ,national ,academy of ,science2 and 7#c7 not later than #a year after the date of enactment of this section1 publish the guidance4 7d7 ,grant program ,the ,secretary1 acting through the ,director and in collaboration with the ,administrator1 shall establish a program under which the ,secretary shall award grants to ,states to fund eligible entities for capacity building or to prepare ,health ,impact ,assessments1 and shall ensure that ,states receiving a grant under this subsection further support training and technical assistance for grantees under the program by funding and overseeing appropriate local1 ,state1 tribal1 ,federal1 university1 or nonprofit ,health ,impact ,assessment experts to provide technical assistance4 ,such assessments shall-- 7#a7 ensure that appropriate health factors are taken into consideration as early as practicable during the planning1 review1 or decisionmaking processes2 7#b7 assess the effect on the health of individuals and populations of proposed policies1 projects1 or plans that result in modifications to the built environment2 and 7#c7 assess the distribution of health effects across various factors1 such as race1 income1 ethnicity1 age1 disability status1 gender1 and geography4 7e7 ,applications 7#a7 ,in general ,to be eligible to receive a grant under this section1 an eligible entity shall submit to the ,secretary an application in accordance with this subsection1 at such time1 in such manner1 and containing such additional information as the ,secretary may require4 7#b7 ,inclusion ,an application under this subsection shall include a list of proposed activities that require or would benefit from conducting a ,health ,impact ,assessment within six months of awarding funds4 ,the list should be accompanied by supporting documentation1 including letters of support1 from potential conductors of ,health ,impact ,assessments for the listed proposed activities4 ,each application should also include an assessment by the eligible entity of the health of the population of its jurisdiction and describe potential adverse or positive effects on health that the proposed activities may create4 7#c7 ,preference ,preference in awarding funds under this section may be given to eligible entities that demonstrate the potential to significantly improve population health or lower health care costs as a result of potential ,health ,impact ,assessment work4 7f7 ,use of funds 7#a7 ,in general ,an eligible entity shall use amounts provided under a grant under this section to conduct ,health ,impact ,assessment capacity building or to conduct or fund subgrantees to conduct a ,health ,impact ,assessment for a proposed activity in accordance with this subsection4 7#b7 ,purposes ,the purposes of a ,health ,impact ,assessment under this subsection are-- 7,a7 to facilitate the involvement of tribal1 ,state1 and local public health officials in community planning1 transportation1 housing1 and land use decisions and other decisions affecting the built environment to identify any potential health concern or health benefit relating to an activity or proposed activity2 7,b7 to provide for an investigation of any health-related issue of concern raised in a planning process1 an environmental impact assessment process1 or policy appraisal relating to a proposed activity2 7,c7 to describe and compare alternatives 7including no-action alternatives7 to a proposed activity to provide clarification with respect to the potential health outcomes associated with the proposed activity and1 where appropriate1 to the related benefit-cost or cost-effectiveness of the proposed activity and alternatives2 7,d7 to contribute1 when applicable1 to the findings of a planning process1 policy appraisal1 or an environmental impact statement with respect to the terms and conditions of implementing a proposed activity or related mitigation recommendations1 as necessary2 7,e7 to ensure that the disproportionate distribution of negative impacts among vulnerable populations is minimized as much as possible2 7,f7 to engage affected community members and ensure adequate opportunity for public comment on all stages of the ,health ,impact ,assessment2 and 7,g7 where appropriate1 to consult with local and county health departments and appropriate organizations1 including planning1 transportation1 and housing organizations and providing them with information and tools regarding how to conduct and integrate ,health ,impact ,assessment into their work4 7#c7 ,eligible activities 7,a7 ,in general ,eligible entities funded under this subsection shall conduct an evaluation of any proposed activity to determine whether it will have a significant adverse or positive effect on the health of the affected population in the jurisdiction of the eligible entity1 based on the criteria described in subparagraph 7,b74 7,b7 ,criteria ,the criteria described in this subparagraph include1 as applicable to the proposed activity1 the following3 7i7 ,any substantial adverse effect or significant health benefit on health outcomes or factors known to influence health1 including the following3 7,i7 ,physical activity4 7,,ii7 ,injury4 7,,iii7 ,mental health4 7,,iv7 ,accessibility to health-promoting goods and services4 7,v7 ,respiratory health4 7,,vi7 ,chronic disease4 7,,vii7 ,nutrition4 7,,viii7 ,land use changes that promote local1 sustainable food sources4 7,,ix7 ,infectious disease4 7,x7 ,health disparities4 7,,xi7 ,existing air quality1 ground or surface water quality or quantity1 or noise levels2 and 7ii7 ,other factors that may be considered1 including-- 7,i7 the potential for a proposed activity to result in systems failure that leads to a public health emergency2 7,,ii7 the probability that the proposed activity will result in a significant increase in tourism1 economic development1 or employment in the jurisdiction of the eligible entity2 7,,iii7 any other significant potential hazard or enhancement to human health1 as determined by the eligible entity2 or 7,,iv7 whether the evaluation of a proposed activity would duplicate another analysis or study being undertaken in conjunction with the proposed activity4 7,c7 ,factors for consideration ,in evaluating a proposed activity under subparagraph 7,a71 an eligible entity may take into consideration any reasonable1 direct1 indirect1 or cumulative effect that can be clearly related to potential health effects and that is related to the proposed activity1 including the effect of any action that is-- 7i7 included in the long-range plan relating to the proposed activity2 7ii7 likely to be carried out in coordination with the proposed activity2 7iii7 dependent on the occurrence of the proposed activity2 or 7iv7 likely to have a disproportionate impact on high-risk or vulnerable populations4 7#d7 ,requirements ,a ,health ,impact ,assessment prepared with funds awarded under this subsection shall incorporate the following1 after conducting the screening phase 7identifying projects or policies for which a ,health ,impact ,assessment would be valuable and feasible7 through the application process3 7,a7 ,scoping ,identifying which health effects to consider and the research methods to be utilized4 7,b7 ,assessing risks and benefits ,assessing the baseline health status and factors known to influence the health status in the affected community1 which may include aggregating and synthesizing existing health assessment evidence and data from the community4 7,c7 ,developing recommendations ,suggesting changes to proposals to promote positive or mitigate adverse health effects4 7,d7 ,reporting ,synthesizing the assessment and recommendations and communicating the results to decisionmakers4 7,e7 ,monitoring and evaluating ,tracking the decision and implementation effect on health determinants and health status4 7#e7 ,plan ,an eligible entity that is awarded a grant under this section shall develop and implement a plan1 to be approved by the ,director1 for meaningful and inclusive stakeholder involvement in all phases of the ,health ,impact ,assessment4 ,stakeholders may include community-based organizations1 youth-serving organizations1 planners1 public health experts1 ,state and local public health departments and officials1 health care experts or officials1 housing experts or officials1 and transportation experts or officials4 7#f7 ,submission of findings ,an eligible entity that is awarded a grant under this section shall submit the findings of any funded ,health ,impact ,assessment activities to the ,secretary and make these findings publicly available4 7#g7 ,assessment of impacts ,an eligible entity that is awarded a grant under this section shall ensure the assessment of the distribution of health impacts 7related to the proposed activity7 across race1 ethnicity1 income1 age1 gender1 disability status1 and geography4 7#h7 ,conduct of assessment ,to the greatest extent feasible1 a ,health ,impact ,assessment shall be conducted under this section in a manner that respects the needs and timing of the decisionmaking process it evaluates4 7#i7 ,methodology ,in preparing a ,health ,impact ,assessment under this subsection1 an eligible entity or partner shall follow the guidance published under subsection 7c74 7g7 ,health impact assessment database ,the ,secretary1 acting through the ,director and in collaboration with the ,administrator1 shall establish1 maintain1 and make publicly available a ,health ,impact ,assessment database1 including-- 7#a7 a catalog of ,health ,impact ,assessments received under this section2 7#b7 an inventory of tools used by eligible entities to conduct ,health ,impact ,assessments2 and 7#c7 guidance for eligible entities with respect to the selection of appropriate tools described in paragraph 7#b74 7h7 ,evaluation of grantee activities ,the ,secretary shall award competitive grants to ,prevention ,research ,centers1 or nonprofit organizations or academic institutions with expertise in ,health ,impact ,assessments to-- 7#a7 assist grantees with the provision of training and technical assistance in the conducting of ,health ,impact ,assessments2 7#b7 evaluate the activities carried out with grants under subsection 7d72 and 7#c7 assist the ,secretary in disseminating evidence1 best practices1 and lessons learned from grantees4 7i7 ,report to congress ,not later than #a year after the date of enactment of this section1 the ,secretary shall submit to ,congress a report concerning the evaluation of the programs under this section1 including recommendations as to how lessons learned from such programs can be incorporated into future guidance documents developed and provided by the ,secretary and other ,federal agencies1 as appropriate4 7j7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary4 #cii,v-#aj4 ,additional research on the relationship between the built environment and health outcomes 7a7 ,research grant program 7#a7 ,grants ,the ,secretary1 in collaboration with the ,administrator1 shall award grants to eligible institutions to conduct and coordinate research on the built environment and its influence on human health4 ,factors that influence health that may be considered include-- 7,a7 levels of physical activity2 7,b7 consumption of nutritional foods2 7,c7 rates of crime2 7,d7 air1 water1 and soil quality2 7,e7 risk or rate of injury2 7,f7 accessibility to health-promoting goods and services2 7,g7 chronic disease rates2 7,h7 community design2 7,i7 housing2 and 7,j7 other indicators as determined appropriate by the ,secretary4 7#b7 ,research ,the ,secretary1 in consultation with the ,administrator1 shall support research under this section that-- 7,a7 investigates and defines links between the built environment and human health and identifies causal relationships2 7,b7 examines-- 7i7 the scope and intensity of the impact that the built environment 7including the various characteristics of the built environment7 has on the human health2 or 7ii7 the distribution of such impacts by-- 7,i7 location2 and 7,,ii7 population subgroup2 7,c7 is used to develop-- 7i7 measures and indicators to address health impacts and the connection of health to the built environment2 7ii7 efforts to link the measures to transportation1 land use1 and health databases2 and 7iii7 efforts to enhance the collection of built environment surveillance data2 7,d7 distinguishes carefully between personal attitudes and choices and external influences on behavior to determine how much the association between the built environment and the health of residents1 versus the lifestyle preferences of the people that choose to live in the neighborhood1 reflects the physical characteristics of the neighborhood2 and 7,e7 7i7 identifies or develops effective intervention strategies focusing on enhancements to the built environment that promote increased use physical activity1 access to nutritious foods1 or other health-promoting activities by residents2 and 7ii7 in developing the intervention strategies under clause 7i71 ensures that the intervention strategies will reach out to high-risk or vulnerable populations1 including low-income urban and rural communities and aging populations1 in addition to the general population4 7#c7 ,surveys ,the ,secretary may use funds appropriated under this section to support the expansion of national surveys and data tracking systems to provide more detailed information about the connection between the built environment and health4 7#d7 ,priority ,in providing assistance under the grant program under this section1 the ,secretary and the ,administrator shall give priority to research that incorporates-- 7,a7 interdisciplinary approaches2 or 7,b7 the expertise of the public health1 physical activity1 urban planning1 land use1 and transportation research communities in the ,united ,states and abroad4 7b7 ,authorization of appropriations ,there are authorized to be appropriated such sums as may be necessary to carry out this section4 ,not to exceed #bj percent of amounts appropriated for each fiscal year under this subsection may be used for the research component of the program under this section4 4 #ajjd4 ,implementation of recommendations by ,environmental ,protection ,agency 7a7 ,inspector general recommendations ,the ,administrator of the ,environmental ,protection ,agency shall1 as promptly as practicable1 carry out each of the following recommendations of the ,inspector ,general of the ,agency as set forth in ,report ,no4 #bjjf-,p-#jjjcd entitled ,,epa needs to conduct environmental justice reviews of its programs1 policies and activities3 7#a7 ,the recommendation that the ,agency's program and regional offices identify which programs1 policies1 and activities need environmental justice reviews and require these offices to establish a plan to complete the necessary reviews4 7#b7 ,the recommendation that the ,administrator of the ,agency ensure that these reviews determine whether the programs1 policies1 and activities may have a disproportionately high and adverse health or environmental impact on minority and low-income populations4 7#c7 ,the recommendation that each program and regional office develop specific environmental justice review guidance for conducting environmental justice reviews4 7#d7 ,the recommendation that the ,administrator designate a responsible office to compile results of environmental justice reviews and recommend appropriate actions4 7b7 ,,gao recommendations ,in developing rules under laws administered by the ,environmental ,protection ,agency1 the ,administrator of the ,agency shall1 as promptly as practicable1 carry out each of the following recommendations of the ,comptroller ,general of the ,united ,states as set forth in ,,gao ,report numbered ,,gao-#je-bhi entitled ,,epa ,should ,devote ,more ,attention to ,environmental ,justice when ,developing ,clean ,air ,rules3 7#a7 ,the recommendation that the ,administrator ensure that workgroups involved in developing a rule devote attention to environmental justice while drafting and finalizing the rule4 7#b7 ,the recommendation that the ,administrator enhance the ability of such workgroups to identify potential environmental justice issues through such steps as providing workgroup members with guidance and training to help them identify potential environmental justice problems and involving environmental justice coordinators in the workgroups when appropriate4 7#c7 ,the recommendation that the ,administrator improve assessments of potential environmental justice impacts in economic reviews by identifying the data and developing the modeling techniques needed to assess such impacts4 7#d7 ,the recommendation that the ,administrator direct appropriate ,agency officers and employees to respond fully when feasible to public comments on environmental justice1 including improving the ,agency's explanation of the basis for its conclusions1 together with supporting data4 7c7 #bjjd inspector general report ,the ,administrator of the ,environmental ,protection ,agency shall1 as promptly as practicable1 carry out each of the following recommendations of the ,inspector ,general of the ,agency as set forth in the report entitled ,,epa ,needs to ,consistently ,implement the ,intent of the ,executive ,order on ,environmental ,justice 7,report ,no4 #bjjd-,p-#jjjjg73 7#a7 ,the recommendation that the ,agency clearly define the mission of the ,office of ,environmental ,justice 7,,oej7 and provide ,agency staff with an understanding of the roles and responsibilities of the ,office4 7#b7 ,the recommendation that the ,agency establish 7through issuing guidance or a policy statement from the ,administrator7 specific timeframes for the development of definitions1 goals1 and measurements regarding environmental justice and provide the regions and program offices a standard and consistent definition for a minority and low-income community1 with instructions on how the ,agency will implement and put into operation environmental justice in the ,agency's daily activities4 7#c7 ,the recommendation that the ,agency ensure the comprehensive training program currently under development includes standard and consistent definitions of the key environmental justice concepts 7such as low-income1 minority1 and disproportionately impacted7 and instructions for implementation of those concepts4 ,the ,administrator shall submit an initial report to ,congress within #f months after the enactment of this ,act regarding the ,administrator's strategy for implementing the recommendations referred to in paragraphs 7#a71 7#b71 and 7#c74 ,thereafter1 the ,administrator shall provide semiannual reports to ,congress regarding the ,administrator's progress in implementing such recommendations and modifying the ,administrator's emergency management procedures to incorporate environmental justice in the ,agency's ,incident ,command ,structure 7in accordance with the ,december #ah1 #bjjf1 letter from the ,deputy ,administrator to the ,acting ,inspector ,general of the ,agency74 7d7 ,federal action plan for saving lives1 protecting people and their families from radon 7#a7 ,in general ,because radon is a naturally occurring radioactive gas that is recognized as the leading cause of lung cancer among nonsmokers and is a particular environmental threat for low-income and minority individuals because of the lack of information about radon levels in their own homes1 the ,administrator of the ,environmental ,protection ,agency shall within #f months after the date of the enactment of this ,act1 implement the action plan entitled ,protecting ,people and ,families from ,radon3 ,a ,federal ,action ,plan for ,saving ,lives 7,june #bj1 #bjaa71 working with the ,secretary of ,health and ,human ,services acting through the ,director of the ,centers for ,disease ,control and ,prevention1 and with the other ,federal agencies mentioned in and as set forth in the action plan4 7#b7 ,specific steps ,in carrying out paragraph 7#a71 the ,administrator shall take steps to achieve each of the following3 7,a7 ,the recommendation that the workgroup comprised of the ,federal agencies participating in the development of the action plan referred to in paragraph 7#a7 implement specific steps within the current authority and activities of each ,federal agency to reduce exposure to radon4 7,b7 ,the recommendation that such workgroup meet on the #a-year anniversary of the plan to assess and recognize achievements of the plan4 7#c7 ,report ,the ,administrator shall report to the ,congress on the #a-year assessment of the plan's implementation1 including the challenges remaining and the progress in reducing radon exposure particularly to low-income and minority families4 #ajje4 ,grant program to conduct environmental health improvement activities and to improve social determinants of health 7a7 ,definitions ,in this section3 7#a7 ,director ,the term ,director means the ,director of the ,centers for ,disease ,control and ,prevention1 acting in collaboration with the ,administrator of the ,environmental ,protection ,agency and the ,director of the ,national ,institute of ,environmental ,health ,sciences4 7#b7 ,eligible entity ,the term eligible entity means a ,state or local community that-- 7,a7 bears a disproportionate burden of exposure to environmental health hazards2 7,b7 bears a disproportionate burden of exposure to unhealthy living conditions1 low standard housing conditions1 low socioeconomic status1 poor nutrition1 less opportunity for educational attainment1 disproportionate unemployment rates1 or lower literacy levels2 7,c7 has established a coalition-- 7i7 with not less than #a community-based organization or demonstration program2 and 7ii7 with not less than #a-- 7,i7 public health entity2 7,,ii7 health care provider organization2 7,,iii7 academic institution1 including any minority-serving institution 7including a ,hispanic-serving institution1 a historically ,black college or university1 and a tribal college or university72 or 7,,iv7 child-serving institution2 7,d7 ensures planned activities and funding streams are coordinated to improve community health2 and 7,e7 submits an application in accordance with subsection 7c74 7b7 ,establishment ,the ,director shall establish a grant program under which eligible entities shall receive grants to conduct environmental health improvement activities and to improve social determinants of health4 7c7 ,application ,to receive a grant under this section1 an eligible entity shall submit an application to the ,director at such time1 in such manner1 and accompanied by such information as the ,director may require4 7d7 ,cooperative agreements ,an eligible entity may use a grant under this section-- 7#a7 to promote environmental health2 7#b7 to address environmental health disparities among all populations1 including children2 and 7#c7 to address racial and ethnic disparities in social determinants of health4 7e7 ,amount of cooperative agreement 7#a7 ,in general ,the ,director shall award grants to eligible entities at the #c different funding levels described in this subsection4 7#b7 ,level #a cooperative agreements 7,a7 ,in general ,an eligible entity awarded a grant under this paragraph shall use the funds to identify environmental health problems and solutions by-- 7i7 establishing a planning and prioritizing council in accordance with subparagraph 7,b72 and 7ii7 conducting an environmental health assessment in accordance with subparagraph 7,c74 7,b7 ,planning and prioritizing council 7i7 ,in general ,a prioritizing and planning council established under subparagraph 7,a77i7 7referred to in this paragraph as a ,,ppc7 shall assist the environmental health assessment process and environmental health promotion activities of the eligible entity4 7ii7 ,membership ,membership of a ,,ppc shall consist of representatives from various organizations within public health1 planning1 development1 and environmental services and shall include stakeholders from vulnerable groups such as children1 the elderly1 disabled1 and minority ethnic groups that are often not actively involved in democratic or decisionmaking processes4 7iii7 ,duties ,a ,,ppc shall-- 7,i7 identify key stakeholders and engage and coordinate potential partners in the planning process2 7,,ii7 establish a formal advisory group to plan for the establishment of services2 7,,iii7 conduct an in-depth review of the nature and extent of the need for an environmental health assessment1 including a local epidemiological profile1 an evaluation of the service provider capacity of the community1 and a profile of any target populations2 and 7,,iv7 define the components of care and form essential programmatic linkages with related providers in the community4 7,c7 ,environmental health assessment 7i7 ,in general ,a ,,ppc shall carry out an environmental health assessment to identify environmental health concerns4 7ii7 ,assessment process ,the ,,ppc shall-- 7,i7 define the goals of the assessment2 7,,ii7 generate the environmental health issue list2 7,,iii7 analyze issues with a systems framework2 7,,iv7 develop appropriate community environmental health indicators2 7,v7 rank the environmental health issues2 7,,vi7 set priorities for action2 7,,vii7 develop an action plan2 7,,viii7 implement the plan2 and 7,,ix7 evaluate progress and planning for the future4 7,d7 ,evaluation ,each eligible entity that receives a grant under this paragraph shall evaluate1 report1 and disseminate program findings and outcomes4 7,e7 ,technical assistance ,the ,director may provide such technical and other non-financial assistance to eligible entities as the ,director determines to be necessary4 7#c7 ,level #b cooperative agreements 7,a7 ,eligibility 7i7 ,in general ,the ,director shall award grants under this paragraph to eligible entities that have already-- 7,i7 established broad-based collaborative partnerships2 and 7,,ii7 completed environmental assessments4 7ii7 ,no level #a requirement ,to be eligible to receive a grant under this paragraph1 an eligible entity is not required to have successfully completed a ,level #a ,cooperative ,agreement 7as described in paragraph 7#b774 7,b7 ,use of grant funds ,an eligible entity awarded a grant under this paragraph shall use the funds to further activities to carry out environmental health improvement activities1 including-- 7i7 addressing community environmental health priorities in accordance with paragraph 7#b77;,c77ii71 including-- 7,i7 geography2 7,,ii7 the built environment2 7,,iii7 air quality2 7,,iv7 water quality2 7,v7 land use2 7,,vi7 solid waste2 7,,vii7 housing2 7,,viii7 crime2 7,,ix7 socioeconomic status2 7,x7 ethnicity1 social construct and language preference2 7,,xi7 educational attainment2 7,,xii7 employment2 7,,xiii7 food safety2 7,,xiv7 nutrition2 7,,xv7 health care services2 and 7,,xvi7 injuries2 7ii7 building partnerships between planning1 public health1 and other sectors1 including child-serving institutions1 to address how the built environment impacts food availability and access and physical activity to promote healthy behaviors and lifestyles and reduce overweight and obesity1 musculoskeletal diseases1 respiratory conditions1 dental1 oral and mental health conditions1 poverty1 and related co-morbidities2 7iii7 establishing programs to address-- 7,i7 how environmental and social conditions of work and living choices influence physical activity and dietary intake2 or 7,,ii7 how those conditions influence the concerns and needs of people who have impaired mobility and use assistance devices1 including wheelchairs1 lower limb prostheses1 and hip1 knee1 and other joint replacements2 and 7iv7 convening intervention and demonstration programs that examine the role of the social environment in connection with the physical and chemical environment in-- 7,i7 determining access to nutritional food2 and 7,,ii7 improving physical activity to reduce overweight1 obesity1 and co-morbidities and increase quality of life4 7#d7 ,level #c cooperative agreements 7,a7 ,in general ,an eligible entity awarded a grant under this paragraph shall use the funds to identify and address racial and ethnic disparities in social determinants of health by creating demonstration programs that assess the feasibility of establishing a federally funded comprehensive program and describe key outcomes that address racial and ethnic disparities in social determinants of health4 7,b7 ,program ,design 7i7 ,evaluation ,no later than #a year after enactment of this ,act1 the ,director shall evaluate the best practices of existing programs from the private1 public1 community based1 and academically supported initiatives focused on reducing disparities in the social determinants of health for racial and ethnic populations4 7ii7 ,demonstration projects ,not later than two years after the date of enactment of this ,act1 the ,director shall implement at least ten demonstration projects including at least one project for each major racial and ethnic minority group1 each of which is unique to the cultural and linguistic needs of each of the following groups3 7,i7 ,native ,americans and ,alaska ,natives4 7,,ii7 ,asian-,americans4 7,,iii7 ,african-,americans_/,blacks4 7,,iv7 ,hispanic_/,latino-,americans4 7,v7 ,native ,hawaiians and ,pacific ,islanders4 7iii7 ,report to ,congress ,no later than #b years after the implementation of the initial demonstration projects1 the ,director shall submit to ,congress a report which includes-- 7,i7 a description of each demonstration project and design2 7,,ii7 an evaluation of the cost effectiveness of each project's prevention and treatment efforts2 7,,iii7 an evaluation of the cultural and linguistic appropriateness of each project by racial and ethnic group2 and 7,,iv7 an evaluation of the beneficiary's health status improvement under the demonstration project4 7iv7 ,any other information deemed appropriate by the ,director ,the ,director shall require any other information deemed appropriate to be shared by or developed by eligible entities awarded a grant under this paragraph1 including the following3 7,i7 ,developing models and evaluating methods that improve the cultural and linguistically appropriate services provided through the ,centers for ,disease ,control and ,prevention to target individuals impacted by health disparities based on their race1 ethnicity1 and gender4 7,,ii7 ,promoting the collaboration between primary and specialty care health care providers and patients1 to ensure patients impacted by health disparities based on race1 ethnicity1 and gender are receiving comprehensive and organized treatment and care4 7,,iii7 ,educating health care professionals on the causes and effects of disparities in the social determinants of health as it relates to minority and racial and ethnic communities and the need for culturally and linguistically appropriate care in the prevention and treatment of high-impact diseases4 7,,iv7 ,encouraging collaboration among community and patient-based organizations which work to address disparities in the social determinants of health as it relates to high-impact diseases in minority and racial and ethnic populations4 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section-- 7#a7 #be1jjj1jjj for fiscal year #bjae2 and 7#b7 such sums as may be necessary for fiscal years #bjaf through #bjah4 #ajjf4 ,additional research on the relationship between the built environment and the health of community residents 7a7 ,definition of eligible institution ,in this section1 the term eligible institution means a public or private nonprofit institution that submits to the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 and the ,administrator of the ,environmental ,protection ,agency 7in this section referred to as the ,administrator7 an application for a grant under the grant program authorized under subsection 7b77#b7 at such time1 in such manner1 and containing such agreements1 assurances1 and information as the ,secretary and ,administrator may require4 7b7 ,research grant program 7#a7 ,definition of health ,in this section1 the term health includes-- 7,a7 levels of physical activity2 7,b7 degree of mobility due to factors such as musculoskeletal diseases1 arthritis1 and obesity2 7,c7 consumption of nutritional foods2 7,d7 rates of crime2 7,e7 air1 water1 and soil quality2 7,f7 risk of injury2 7,g7 accessibility to health care services2 7,h7 levels of educational attainment2 and 7,i7 other indicators as determined appropriate by the ,secretary4 7#b7 ,grants ,the ,secretary1 in collaboration with the ,administrator1 shall provide grants to eligible institutions to conduct and coordinate research on the built environment and its influence on individual and population-based health4 7#c7 ,research ,the ,secretary shall support research that-- 7,a7 investigates and defines the causal links between all aspects of the built environment and the health of residents2 7,b7 examines-- 7i7 the extent of the impact of the built environment 7including the various characteristics of the built environment7 on the health of residents2 7ii7 the variance in the health of residents by-- 7,i7 location 7such as inner cities1 inner suburbs1 and outer suburbs72 and 7,,ii7 population subgroup 7including children1 the elderly1 the disadvantaged72 or 7iii7 the importance of the built environment to the total health of residents1 which is the primary variable of interest from a public health perspective2 7,c7 is used to develop-- 7i7 measures to address health and the connection of health to the built environment2 and 7ii7 efforts to link the measures to travel and health databases2 and 7,d7 distinguishes carefully between personal attitudes and choices and external influences on observed behavior to determine how much an observed association between the built environment and the health of residents1 versus the lifestyle preferences of the people that choose to live in the neighborhood1 reflects the physical characteristics of the neighborhood2 and 7,e7 7i7 identifies or develops effective intervention strategies to promote better health among residents with a focus on behavioral interventions and enhancements of the built environment that promote increased use by residents2 and 7ii7 in developing the intervention strategies under clause 7i71 ensures that the intervention strategies will reach out to high-risk populations1 including racial and ethnic minorities1 low-income urban and rural communities1 and children4 7#d7 ,priority ,in providing assistance under the grant program authorized under paragraph 7#b71 the ,secretary and the ,administrator shall give priority to research that incorporates-- 7,a7 minority-serving institutions as grantees2 7,b7 interdisciplinary approaches2 or 7,c7 the expertise of the public health1 physical activity1 nutrition and health care 7including child health71 urban planning1 and transportation research communities in the ,united ,states and abroad4 #ajjg4 ,environment and public health restoration 7a7 ,findings 7#a7 ,general findings ,the ,congress finds as follows3 7,a7 ,as human beings1 we share our environment with a wide variety of habitats and ecosystems that nurture and sustain a diversity of species4 7,b7 ,the abundance of natural resources in our environment forms the basis for our economy and has greatly contributed to human development throughout history4 7,c7 ,the accelerated pace of human development over the last several hundred years has significantly impacted our natural environment and its resources1 the health and diversity of plant and animal wildlife1 the availability of critical habitats1 the quality of our air and our water1 and our global climate4 7,d7 ,the intervention of the ,federal ,government is necessary to minimize and mitigate human impact on the environment for the benefit of public health1 to maintain air quality and water quality1 to sustain the diversity of plants and animals1 to combat global climate change1 and to protect the environment4 7,e7 ,laws and regulations in the ,united ,states have been created and promulgated to minimize and mitigate human impact on the environment for the benefit of public health1 to maintain air quality and water quality1 to sustain wildlife1 and to protect the environment4 7,f7 ,such laws include the ,antiquities ,act of #aijf 7#af ,u4,s4,c4 #dca et seq47 initiated by ,president ,theodore ,roosevelt to create the national park system1 the ,national ,environmental ,policy ,act of #aifi 7#db ,u4,s4,c4 #dcba et seq471 the ,clean ,air ,act 7#db ,u4,s4,c4 #gdja et seq471 the ,federal ,water ,pollution ,control ,act 7#cc ,u4,s4,c4 #abea et seq471 the ,comprehensive ,environmental ,response1 ,compensation1 and ,liability ,act of #aihj 7,public ,law #if-eaj71 the ,endangered ,species ,act of #aigc 7,public ,law #ic-bje71 and the ,national ,forest ,management ,act of #aigf 7,public ,law #id-ehh74 7,g7 ,attempts to repeal or weaken key environmental safeguards pose dangers to the public health1 air quality1 water quality1 wildlife1 and the environment4 7#b7 ,findings on changes and proposed changes in law ,the ,congress finds that1 since #bjja1 the following changes and proposed changes to existing law or regulations have negatively impacted or will negatively impact the environment and public health3 7,a7 ,clean water 7i7 ,on ,may #i1 #bjjb1 the ,environmental ,protection ,agency 7,,epa7 and the ,army ,corps of ,engineers put forth a final rule that reconciled regulations implementing section #djd of the ,federal ,water ,pollution ,control ,act by redefining the term fill material and amending the definition of the term discharge of fill material1 reversing a #be-year-old regulation4 ,the new rule fails to restrict the dumping of hardrock mining waste1 construction debris1 and other industrial wastes into rivers1 streams1 lakes1 and wetlands4 ,the rule further allows destructive mountaintop removal coal mining companies to dump waste into streams and lakes1 polluting the surrounding natural habitat and poisoning plants and animals that depend on those water sources4 7ii7 ,on ,february #ab1 #bjjc1 the ,environmental ,protection ,agency published the rule ,national ,pollutant ,discharge ,elimination ,system ,permit ,regulation and ,effluent ,limitation ,guidelines and ,standards for ,concentrated ,animal ,feeding ,operations1 new livestock waste regulations that aimed to control factory farm pollution but which would severely undermine existing protections under the ,federal ,water ,pollution ,control ,act4 ,this regulation allows large-scale animal factories to foul the ,nation's waters with animal waste1 allows livestock owners to draft their own pollution-management plans and avoid ground water monitoring1 legalizes the discharge of contaminated runoff water rich in nitrogen1 phosphorus1 bacteria1 and metals1 and ensures that large factory farms are not held liable for the environmental damage they cause4 ,in a #bjje ,federal court decision 7,waterkeeper ,alliance1 et al4 v4 ,enviromental ,protection ,agency1 #cii ,f4#c;d #dhf 7#bnd ,cir4 #bjje771 major parts of the rule were upheld1 others vacated1 and still others remanded back to the ,,epa4 ,on ,november #bj1 #bjjh1 the ,environmental ,protection ,agency published a revised final rule which undermines environmental protection provisions by removing mandatory permitting requirements and allowing large animal farms to self-certify the absence of pollutant discharge activity4 7iii7 ,on ,march #ai1 #bjjc1 the ,environmental ,protection ,agency published a new rule regarding the ,total ,maximum ,daily ,load program of the ,federal ,water ,pollution ,control ,act that regulates the maximum amount of a particular pollutant that can be present in a body of water and still meet water quality standards4 ,the new rule withdrew the existing regulation put forth on ,july #ac1 #bjjj1 and halted momentum in cleaning up polluted waterways throughout the ,nation4 ,by abandoning the existing rule1 the ,environmental ,protection ,agency is undermining the effectiveness of cleanup plans and is allowing ,states to avoid cleaning polluted waters entirely by dropping them from their cleanup lists4 ,waterways play a crucial role in the lives of the people of the ,united ,states and are critical to the livelihood of fish and wildlife4 ,the result of dropping the ,july #bjjj rule is that the restoration of polluted rivers1 shorelines1 and lakes will be delayed1 harming more fish and wildlife and worsening the quality of drinking water4 7iv7 ,on ,december #b1 #bjjh1 the ,environmental ,protection ,agency and the ,army ,corps of ,engineers jointly issued a guidance document in the form of a legal memorandum1 titled ,clean ,water ,act ,jurisdiction ,following the ,u4,s4 ,supreme ,court's ,decision in ,rapanos v4 ,united ,states ,carabell v4 ,united ,states4 ,this new guidance dictates enforcement actions under the ,federal ,water ,pollution ,control ,act and calls for a complicated case-by-case analysis to determine jurisdiction for waterways that do not flow all year4 ,such actions endanger small streams and wetlands that serve as important habitats for aquatic life1 which play a fundamental role in safeguarding sources of clean drinking water and mitigate the risks and effects of floods and droughts4 ,further1 the definition provided therein for waters of the ,united ,states is applicable to the ,federal ,water ,pollution ,control ,act as a whole1 potentially affecting programs that control industrial pollution and sewage levels1 prevent oil spills1 and set water quality standards for all waters in the ,united ,states protected under the ,federal ,water ,pollution ,control ,act4 7,b7 ,forests and land management 7i7 ,on ,december #c1 #bjjc1 the ,president signed into law the ,healthy ,forests ,restoration ,act of #bjjc 7,public ,law #ajh-adh2 #af ,u4,s4,c4 #feja et seq474 ,although the law attempts to reduce the risk of catastrophic forest fires1 it provides a boon to timber companies by accelerating the aggressive thinning of backcountry forests that are far from at-risk communities4 ,the law allows for increased logging of large1 fire-resistant trees that are not in close proximity of homes and communities2 it undermines critical protections for endangered species by exempting ,federal land management agencies from consulting with the ,united ,states ,fish and ,wildlife ,service before approving any action that could harm endangered plants or wildlife2 and it limits public participation by reducing the number of environmental project reviews4 7ii7 ,on ,april #ba1 #bjjh1 the ,department of ,agriculture issued a ,final ,planning ,rule and ,record of ,decision for ,national ,forest ,system ,land ,management ,planning4 ,similar to rules enacted by the ,administration on ,january #e1 #bjje1 later remanded back to the agency in ,federal district court for violating the ,national ,environmental ,policy ,act of #aifi1 the ,endangered ,species ,act of #aigc1 and the ,administrative ,procedure ,act 7,citizens for ,better ,forestry v4 ,united ,states ,department of ,agriculture1 #dha ,f4 ,supp4 #b;d #ajei 7,n4,d4 ,cal4 #bjjg771 this revised rule eliminates strict forest planning standards established in #aihb1 and opens millions of acres of public lands to damaging and invasive logging1 mining1 and drilling operations4 ,these regulations would reverse more than #bj years of protection for wildlife and national forests by removing the overall goal of ensuring ecological sustainability in managing the national forest system1 weakening the ,national ,forest ,management ,act of #aigf1 and effectively ending the review of forest management plans under the ,national ,environmental ,policy ,act of #aifi4 7iii7 ,on ,september #bj1 #bjjf1 the ,district ,court for the ,northern ,district of ,california vacated the ,protection of ,inventoried ,roadless ,areas rule1 enacted on ,may #ac1 #bjje1 which gave ,state ,governors #ah months to petition the ,federal ,government to either restore the previous rule for their ,states1 or submit a new management and development plan for national forest areas inventoried under the rule4 ,despite the enjoinment of the ,administration's #bjje rule1 and the subsequent restoration of the original ,roadless ,area ,conservation ,rule1 the ,united ,states ,forest ,service has continued to allow ,states to petition for a special rule under the authority of the ,administrative ,procedure ,act1 publishing a final special rule for ,idaho on ,october #af1 #bjjh4 ,as a result1 #eh4e million acres of wild national forests are still vulnerable to logging1 road building1 and other developments that may fragment natural habitats and negatively impact fish and wildlife4 7iv7 ,on ,november #ag1 #bjjh1 the ,department of the ,interior's ,bureau of ,land ,management 7,,blm7 signed the ,record of ,decision 7,,rod7 amending #ab resource management plans in ,colorado1 ,utah1 and ,wyoming1 opening #b1jjj1jjj acres of public lands to commercial tar sands and oil shale exploration and development4 ,on ,november #ah1 #bjjh1 the ,,blm published a final rule for ,oil ,shale ,management setting the policies and procedures for a commercial leasing program for the management of federally owned oil shale in those three ,states4 ,previously barred by a congressional moratorium on the commercial leasing regulations for oil shale until ,september #cj1 #bjjh1 the development of oil shale on public lands poses a serious threat to land conservation1 endangered and threatened species1 and critical habitat4 ,domestic shale oil production allowed by these regulations is highly water and energy intensive1 the impacts of which will intensify existing water scarcity in the arid ,western ,region and potentially degrade air and water quality for surrounding populations4 7,c7 ,scientific review ,on ,december #af1 #bjjh1 the ,united ,states ,fish and ,wildlife ,service of the ,department of the ,interior and the ,national ,oceanic and ,atmospheric ,administration of the ,department of ,commerce jointly issued a new rule amending regulations governing interagency cooperation under section #g of the ,endangered ,species ,act of #aigc 7,,esa74 ,this rule undermines the intention of the ,,esa to protect species and the ecosystems upon which they depend by allowing ,federal agencies to carry out1 permit1 or fund an action without proper environmental review and expert third-party consultation from ,federal wildlife experts4 ,under this new rule1 ,federal agencies can unilaterally circumvent the formal review process1 eliminating longstanding and scientifically grounded safeguards that serve to protect the biodiversity of our ,nation's ecosystems and avert harm to thousands of endangered and threatened species4 7b7 ,statement of policy ,it is the policy of the ,united ,states ,government to work in conjunction with ,states1 territories1 tribal governments1 international organizations1 and foreign governments in order to act as a steward of the environment for the benefit of public health1 to maintain air quality and water quality1 to sustain the diversity of plant and animal species1 to combat global climate change1 and to protect the environment for future generations to enjoy4 7c7 ,study and report on public health or environmental impact of revised rules1 regulations1 laws1 or proposed laws 7#a7 ,study ,not later than #cj days after the date of enactment of this ,act1 the ,president shall enter into an arrangement under which the ,national ,academy of ,sciences will conduct a study to determine the impact on public health1 air quality1 water quality1 wildlife1 and the environment of the following regulations1 laws1 and proposed laws3 7,a7 ,clean water 7i7 ,final revisions to the ,federal ,water ,pollution ,control ,act regulatory definitions of fill material and discharge of fill material1 finalized and published in the ,federal ,register on ,may #i1 #bjjb 7#fg ,fed4 ,reg4 #caabi71 amending part #bcb of title #dj1 ,code of ,federal ,regulations4 7ii7 ,revised ,national ,pollutant ,discharge ,elimination ,system ,permit ,regulation and ,effluent ,limitation ,guidelines and ,standards for ,concentrated ,animal ,feeding ,operations in response to the ,waterkeeper ,alliance1 et al4 v4 ,enviromental ,protection ,agency decision1 finalized and published in the ,federal ,register on ,november #bj1 #bjjh 7#gc ,fed4 ,reg4 #bbe71 amending parts #i1 #abb1 and #dab of title #dj1 ,code of ,federal ,regulations4 7iii7 ,a ,march #ai1 #bjjc1 rule published in the ,federal ,register 7#fh ,fed4 ,reg4 #acfjh7 withdrawing a ,july #ac1 #bjjj1 rule revising the ,total ,maximum ,daily ,load program of the ,federal ,water ,pollution ,control ,act 7#fe ,fed4 ,reg4 #dcehf71 amending parts #i1 #abb1 #abc1 #abd1 and #acj of title #dj1 ,code of ,federal ,regulations4 7iv7 ,official ,guidance ,document1 ,clean ,water ,act ,jurisdiction ,following the ,united ,states ,supreme ,court's ,decision in ,rapanos v4 ,united ,states ,carabell v4 ,united ,states1 issued on ,december #b1 #bjjh1 relating to jurisdiction under section #djd of the ,federal ,water ,pollution ,control ,act4 7,b7 ,forests and land management 7i7 ,healthy ,forests ,restoration ,act of #bjjc1 signed into law on ,december #c1 #bjjc 7,public ,law #ajh-adh2 #af ,u4,s4,c4 #feja et seq474 7ii7 ,national ,forest ,system ,land ,management ,planning ,rule1 finalized and published in the ,federal ,register on ,april #ba1 #bjjh 7#gc ,fed4 ,reg4 #badfh71 replacing the #bjje final rule 7#gj ,fed4 ,reg4 #ajbb1 ,jan4 #e1 #bjje71 as amended ,march #c1 #bjjf 7#ga ,fed4 ,reg4 #ajhcg7 and the #bjjj final rule adopted on ,november #i1 #bjjj 7#fe ,fed4 ,reg4 #fgead7 as amended on ,september #bi1 #bjjd 7#fi ,fed4 ,reg4 #ehjee71 amending title #cf1 ,code of ,federal ,regulations1 part #bai4 7iii7 ,the application of the ,administrative ,procedure ,act 7#e ,u4,s4,c4 #eea to #eei1 #gja to #gjf1 et seq471 such that ,states may petition for a special rule for the roadless areas in all or part of said ,state4 7iv7 ,record of ,decision1 ,oil ,shale and ,tar ,sands ,resources ,resource ,management ,plan ,amendments1 issued on ,november #ag1 #bjjh1 along with the ,final ,rule1 ,oil ,shale ,management-,general1 published in the ,federal ,register on ,november #ah1 #bjjh 7#gc ,fed4 ,reg4 #bbc71 amending title #dc1 ,code of ,federal ,regulations1 parts #cijj1 #ciaj1 #cibj1 and #cicj4 7,c7 ,scientific review ,final ,rule1 ,interagency ,cooperation ,under the ,endangered ,species ,act1 published in the ,federal ,register on ,december #af1 #bjjh1 amending title #ej1 ,code of ,federal ,regulations1 part #djb4 7#b7 ,method ,in conducting the study under paragraph 7#a71 the ,national ,academy of ,sciences may utilize and compare existing scientific studies regarding the regulations1 laws1 and proposed laws listed in paragraph 7#a74 7#c7 ,report ,under the arrangement entered into under paragraph 7#a71 not later than #bgj days after the date on which such arrangement is entered into1 the ,national ,academy of ,sciences shall make publicly available and shall submit to the ,congress and to the head of each department and agency of the ,federal ,government that issued1 implements1 or would implement a regulation1 law1 or proposed law listed in paragraph 7#a71 a report containing-- 7,a7 a description of the impact of all such regulations1 laws1 and proposed laws on public health1 air quality1 water quality1 wildlife1 and the environment1 compared to the impact of preexisting regulations1 or laws in effect1 including-- 7i7 any negative impacts to air quality or water quality2 7ii7 any negative impacts to wildlife2 7iii7 any delays in hazardous waste cleanup that are projected to be hazardous to public health2 and 7iv7 any other negative impact on public health or the environment2 and 7,b7 any recommendations that the ,national ,academy of ,sciences considers appropriate to maintain1 restore1 or improve in whole or in part protections for public health1 air quality1 water quality1 wildlife1 and the environment for each of the regulations1 laws1 and proposed laws listed in paragraph 7#a71 which may include recommendations for the adoption of any regulation or law in place or proposed prior to ,january #a1 #bjja4 7d7 ,department and agency revision of existing rules1 regulations1 or laws ,not later than #ahj days after the date on which the report is submitted pursuant to subsection 7c77#c71 the head of each department and agency that has issued or implemented a regulation or law listed in subsection 7c77#a7 shall submit to the ,congress a plan describing the steps such department or such agency will take1 or has taken1 to restore or improve protections for public health and the environment in whole or in part that were in existence prior to the issuance of such regulation or law4 #ajjh4 ,,gao report on health effects of ,deepwater ,horizon oil rig explosion in the ,gulf ,coast 7a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study on the type and scope of health care services administered through the ,department of ,health and ,human ,services addressing the provision of health care to racial and ethnic minorities 7whether residents1 cleanup workers1 or volunteers7 affected by the explosion of the mobile offshore drilling unit ,deepwater ,horizon that occurred on ,april #bj1 #bjaj4 7b7 ,specific components2 reporting ,in carrying out subsection 7a71 the ,comptroller ,general shall-- 7#a7 assess the type1 size1 and scope of programs administered by the ,department of ,health and ,human ,services that focus on provision of health care to communities in the ,gulf ,coast2 7#b7 identify the merits and disadvantages associated with each the programs2 7#c7 perform an analysis of the costs and benefits of the programs2 7#d7 determine whether there is any duplication of programs2 and 7#e7 not later than #ahj days after the date of the enactment of this ,act1 report findings and recommendations for improving access to health care for racial and ethnic minorities to the ,congress4