,i  #aaeth ,,congress  #ast ,session    
,h4 ,r4 #bjdh  ,,in ,,the ,,house ,,of  
,,representatives  ,april #f1 #bjag,mr4 
,ben ,ray ,lujn of ,new ,mexico         
introduced the following bill2 which was
 referred to the ,committee on ,energy  
and ,commerce  ,a ,,bill  ,to amend     
title ,,xix of the ,social ,security    
,act to incentivize the development of  
community-based interventions to reduce 
health disparities among certain        
populations1 and for other purposes4    
#a4 ,short title ,this ,act may be      
referred to as the ,eliminating ,health 
,disparities ,act of #bjag4  #b4 ,health
 ,disparities ,elimination ,state ,plan 
,option ,title ,,xix of the ,social     
,security ,act 7#db ,u4,s4,c4 #acif et  
seq47 is amended by adding at the end   
the following3  #aidg4 ,health          
,disparities ,elimination ,program      
,state ,plan ,option  7a7 ,in general   
,notwithstanding section #aijb7;a77#a7  
7relating to statewideness71 section    
#aijb7;a77#aj77;,b7 7relating to        

comparability71 and any other provision 
of this title that the ,secretary       
determines is necessary to waive in     
order to implement this section1        
beginning fiscal year #bjah1 a ,state1  
at its option as a ,state plan          
amendment1 may establish a ,health      
,disparities ,elimination ,program for  
purposes of reducing health disparities 
among targeted populations in           
communities served by qualified         
community health systems under which the
 ,state provides incentive payments to  
qualified community health systems for  
initiatives approved under subsection   
7c71 if the ,state meets the            
requirements specified in subsection    
7c74  7b7 ,state plan amendment ,each   
,state seeking a ,state plan amendment  
under this section shall submit such    
amendment to the ,secretary for         
approval4 ,the ,secretary shall approve 
any such amendment that meets the       
requirements of subsection 7c7 and      
includes--  7#a7 ,state goals for       

reducing health disparities through the 
,health ,disparities ,elimination       
,program to be established by the       
,state2  7#b7 any requirements for the  
development and approval of action plans
 described in subsection 7c77#a72  7#c7 
eligibility criteria for any qualified  
community health system seeking to      
establish a health disparities          
elimination initiative 7in this section 
referred to as an initiative7 pursuant  
to this section2  7#d7 the methodology  
for determining the amount of incentive 
payments to be made to a qualified      
community health system through an      
initiative1 based on the size of the    
target population to be served through  
the initiative and the potential of the 
initiative for reducing health          
disparities2 and  7#e7 the period during
 which initiatives may be implemented1  
in accordance with subsection 7c77#c74  
7c7 ,state requirements ,the            
requirements specified in this          
subsection with respect to a ,state are 

the following3  7#a7 ,health system     
action plan ,the ,state shall require   
that a qualified community health system
 submit an action plan for an initiative
 to the ,state agency with              
responsibility for administering the    
,state plan under this title for        
approval that identifies--  7,a7 the    
target population or populations to be  
served by the initiative2  7,b7         
specific1 evidence-based projects that  
the system will undertake through the   
initiative to reduce health disparities 
for such population or populations2     
7,c7 targets and benchmarks associated  
with such projects that must be met in  
order to receive incentive payments     
pursuant to this section2  7,d7 measures
 for evaluating the effectiveness of the
 initiative in reducing health          
disparities with respect to the goals   
established by the ,state pursuant to   
subsection 7b77#a72 and  7,e7 the amount
 of any proposed initial incentive      
payments to be made pursuant to this    

section to support startup costs of the 
initiative4  7#b7 ,priority in selection
 of health systems for participation ,in
 selecting qualified community health   
systems to establish an initiative under
 a ,state plan amendment approved under 
this section1 the ,state shall give     
priority to health systems--  7,a7 that 
have submitted action plans 7under      
paragraph 7#a77 that include the use of 
evidence-based interventions shown to   
reduce or eliminate health disparities2 
7,b7 that demonstrate the potential to  
have a high impact in the elimination of
 health disparities1 improved health    
care access1 improved health outcomes1  
or health care savings compared to the  
total incentive funding requested2  7,c7
 that have prior experience working on  
projects with the goal of reducing      
health disparities2  7,d7 that          
demonstrate long-term commitment to     
providing health services to the target 
population or populations2 and  7,e7    
with a demonstrated need for additional 

financial resources in order to         
strengthen and advance existing efforts 
of the health system to reduce health   
disparities4  7#c7 ,duration of action  
plan  7,a7 ,in general ,the ,state may  
not approve an action plan submitted    
under paragraph 7#a7 for a period       
exceeding #e years4  7,b7 ,report ,at   
the end of any such period1 the ,state  
shall require each participating        
qualified community health system to    
submit a report to the ,state describing
 the effectiveness of its initiative    
using the measures described in         
paragraph 7#a77;,d74  7,c7 ,extension ,a
 ,state may extend the initiative of    
such health system upon approval of a   
new action plan to extend1 improve1 or  
expand the initiative1 if the ,state    
determines that the initiative has      
proved effective1 taking into account   
the report submitted under subparagraph 
7,b74  7d7 ,state report and evaluation 
7#a7 ,in general ,a ,state with a ,state
 plan amendment approved under this     

section shall submit to the ,secretary1 
in a time and manner to be specified by 
the ,secretary--  7,a7 an annual report 
on the progress of the ,health          
,disparities ,elimination ,program of   
the ,state towards meeting the goals of 
the ,state described under subsection   
7b77#a72 and  7,b7 not less than once   
every #e years1 an evaluation of the    
effectiveness of the ,health            
,disparities ,elimination ,program of   
the ,state4  7#b7 ,contents ,the        
evaluation described in paragraph       
7#a77;,b7 shall include-- 7,a7 an       
assessment of the effectiveness of      
initiatives receiving incentive payments
 pursuant to this section during the    
period covered by the report in meeting 
the goals of the ,state described under 
subsection 7b77#a72 and  7,b7 a         
description of the activities of such   
initiatives4  7#c7 ,publication ,the    
,secretary shall publish on the public  
,web site of the ,centers for ,medicare 
,medicaid ,services each evaluation     

submitted under paragraph 7#a77;,b74    
7e7 ,funding  7#a7 ,state funding  7,a7 
,in general ,for the purpose of making  
allocations to ,states under            
subparagraph 7,c71 there is appropriated
 for fiscal year #bjah and each         
subsequent fiscal year1 out of any money
 in the ,treasury not otherwise         
appropriated1 an amount equal to one    
half of one percent of the total of the 
,federal share of expenditures with     
respect to all ,state plans under this  
title in the most recent fiscal year for
 which complete expenditure data is     
available4  7,b7 ,incentive payment fund
 ,the ,secretary shall deposit all funds
 appropriated under subparagraph 7,a7   
into an incentive payment fund4 ,such   
funds shall remain available until      
expended4  7,c7 ,allocation among       
,states ,of the total amount            
appropriated for this section for a     
fiscal year1 the ,secretary shall1      
except as provided in subparagraph 7,d71
 allocate for such fiscal year to each  

,state an amount in proportion to the   
ratio of--  7i7 the ,state's total      
expenditures under the ,state plan under
 this title in the most recent fiscal   
year for which complete expenditure data
 is available2 to  7ii7 the sum of all  
,states' total expenditures under all   
,state plans under this title in the    
fiscal year described in clause 7i74    
7,d7 ,funds not used by the ,state ,if  
the ,secretary determines1 on the basis 
of information available on the first   
day of a fiscal year1 that any          
allocation under subparagraph 7,c7 to a 
,state for such fiscal year will not be 
required because a ,state does not have 
a ,state plan amendment approved under  
subsection 7b7 for such fiscal year1    
then such ,state's allocation shall be  
treated as an unused allocation for such
 fiscal year and re-allocated in        
accordance with subparagraph 7,e77i74   
7,e7 ,qualifying ,states  7i7           
,re-allocation to qualifying ,states ,in
 addition to the allocation available to

 a ,state under subparagraph 7,c71 the  
,secretary shall allocate to each       
qualifying ,state for a fiscal year1 out
 of the sum of unused allocations1 as   
described in subparagraph 7,d71 for such
 fiscal year1 an amount in proportion to
 the ratio of--  7,i7 each such ,state's
 total expenditures under the ,state    
plan under this title in the most recent
 fiscal year for which complete         
expenditure data is available2 to       
7,,ii7 the sum of all such ,states'     
total expenditures under all ,state     
plans of such ,states under this title  
in the fiscal year described in         
subclause 7,i74  7ii7 ,availability of  
funds ,allocations made to a qualifying 
,state under clause 7i7 and subparagraph
 7,c7 shall remain available until      
expended4  7iii7 ,definitions ,in this  
section1 the term qualifying ,state     
means a ,state with a ,state plan       
amendment approved under this section   
that-- 7,i7 has in effect an agreement  
with one or more qualified community    

health system initiatives2 and  7,,ii7  
in any fiscal year other than the first 
fiscal year for which such ,state       
receives an allocation under            
subparagraph 7,c7 that is not           
re-allocated under subparagraph 7,d71   
has a ,health ,disparities ,elimination 
,program established under this section 
that1 as determined by the ,secretary1  
has made measurable progress towards    
meeting the ,state's goals1 as described
 under subsection 7b77#a71 based on     
reports and evaluations submitted under 
subsection 7d74  7#b7 ,payments  7,a7   
,in general ,subject to the provisions  
of this section1 the ,secretary shall   
pay to each ,state with a ,state plan   
amendment approved under this section1  
from its allocation under paragraph     
7#a77;,c7 and1 in the case of a         
qualifying ,state1 from its allocation  
under paragraph 7#a77;,e77i71 an amount 
for each quarter equal to #ij percent of
 the sum expended by the ,state in such 
quarter for incentive payments made to  

qualified community health systems for  
initiatives approved pursuant to this   
section4  7,b7 ,status of incentive     
payments ,incentive payments made under 
a ,state plan amendment approved under  
this section shall not be considered    
payment for health care items or        
services and shall not count towards any
 limit with respect to the maximum      
amount of payments that may be made to a
 provider under the ,state plan under   
this title 7or under a waiver of such   
plan74  7f7 ,definitions ,in this       
section3 7#a7 ,the term health disparity
 means a disparity in care provided to a
 health disparity population1 as defined
 in section #ijc7;d7 of the ,public     
,health ,service ,act 7#db ,u4,s4,c4    
#bii;a-#a7;d774  7#b7 ,the term         
qualified community health system       
means-- 7,a7 a hospital described in a  
report submitted under section          
#aijj7;b77#f77;,b77ii77,,iii72 or  7,b7 
an affiliated group of health care      
providers anchored by such hospital4    

7#c7 ,the term ,state means each of the 
several ,states and the ,district of    
,columbia4  7#d7 ,the term target       
population means a population of        
individuals that has empirically        
experienced disparities in health care  
access and quality and shall not be     
limited by source of coverage or lack   
thereof4  4