,i #aafth ,,congress #b;d ,session ,h4 ,r4 #hbjj ,,in ,,the ,,house ,,of ,,representatives ,september #aa1 #bjbj ,ms4 ,kelly of ,illinois 7for herself1 ,ms4 ,bass1 ,mr4 ,castro of ,texas1 ,ms4 ,judy ,chu of ,california1 ,mr4 ,garca of ,illinois1 ,ms4 ,haaland1 ,ms4 ,lee of ,california1 ,mr4 ,soto1 ,ms4 ,sewell of ,alabama1 ,mr4 ,butterfield1 ,mr4 ,sablan1 ,ms4 ,barragn1 ,ms4 ,clarke of ,new ,york1 ,mr4 ,crdenas1 ,mr4 ,sarbanes1 ,ms4 ,pressley1 ,mr4 ,thompson of ,mississippi1 ,ms4 ,escobar1 ,mr4 ,brendan ,f4 ,boyle of ,pennsylvania1 ,mr4 ,carson of ,indiana1 ,mr4 ,clay1 ,mrs4 ,beatty1 ,mr4 ,khanna1 ,ms4 ,garcia of ,texas1 ,mr4 ,san ,nicolas1 ,mr4 ,espaillat1 ,ms4 ,jayapal1 ,mrs4 ,demings1 ,mr4 ,hastings1 ,mrs4 ,watson ,coleman1 ,ms4 ,johnson of ,texas1 ,mr4 ,grijalva1 ,ms4 ,bonamici1 and ,mr4 ,lynch7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means1 the ,judiciary1 ,transportation and ,infrastructure1 ,education and ,labor1 ,agriculture1 ,natural ,resources1 ,house ,administration1 ,oversight and ,reform1 the ,budget1 and ,small ,business1 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 individuals during the ,,covid-#ai pandemic1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,ending ,health ,disparities ,during ,,covid-#ai ,act of #bjbj or the ,,ehdc ,act of #bjbj4 #b4 ,table of contents ,sec4 #a4 ,short title4 ,sec4 #b4 ,table of contents4 ,title ,i--,racial and ,ethnicity ,data ,collection ,subtitle ,a--,collection and ,reporting ,sec4 #aja4 ,equitable data collection and disclosure on ,,covid-#ai ,act4 ,sec4 #ajb4 ,,covid-#ai reporting portal4 ,sec4 #ajc4 ,regular ,,cdc reporting on demographic data4 ,sec4 #ajd4 ,amendment to the ,public ,health ,service ,act4 ,sec4 #aje4 ,elimination of prerequisite of direct appropriations for data collection and analysis4 ,sec4 #ajf4 ,collection of data for the ,medicare program4 ,sec4 #ajg4 ,revision of ,,hipaa claims standards4 ,sec4 #ajh4 ,disparities data collected by the ,federal ,government4 ,sec4 #aji4 ,standards for measuring sexual orientation1 gender identity1 and socioeconomic status in collection of health data4 ,sec4 #aaj4 ,improving health data regarding ,native ,hawaiians and other ,pacific ,islanders4 ,subtitle ,b--,improvements and ,modernization ,sec4 #aba4 ,federal modernization for health inequities data4 ,sec4 #abb4 ,modernization of ,state and local health inequities data4 ,sec4 #abc4 ,additional reporting to ,congress on the race and ethnicity rates of ,,covid-#ai testing1 hospitalizations1 and mortalities4 ,title ,,ii--,equitable ,testing and ,tracing ,subtitle ,a--,free ,testing for ,patients ,sec4 #bja4 ,sooner coverage of testing for ,,covid-#ai4 ,subtitle ,b--,national ,testing ,strategy ,sec4 #baa4 ,,covid-#ai testing strategy4 ,sec4 #bab4 ,coronavirus immigrant families protection4 ,sec4 #bac4 ,,ice detention4 ,subtitle ,c--,contact ,tracing ,sec4 #bba4 ,,covid-#ai ,testing1 reaching1 and contacting everyone4 ,sec4 #bbb4 ,national system for ,,covid-#ai testing1 contact tracing1 surveillance1 containment1 and mitigation4 ,sec4 #bbc4 ,grants4 ,sec4 #bbd4 ,grants to ,state and ,tribal workforce agencies4 ,title ,,iii--,free ,treatment for ,all ,americans ,sec4 #cja4 ,coverage at no cost sharing of ,,covid-#ai vaccine and treatment4 ,sec4 #cjb4 ,optional coverage at no cost sharing of ,,covid-#ai treatment and vaccines under ,medicaid for uninsured individuals4 ,sec4 #cjc4 ,coverage of treatments for ,,covid-#ai at no cost sharing under the ,medicare ,advantage program4 ,sec4 #cjd4 ,requiring coverage under ,medicare ,,pdps and ,,ma-,,pd plans1 without the imposition of cost sharing or utilization management requirements1 of drugs intended to treat ,,covid-#ai during certain emergencies4 ,sec4 #cje4 ,coverage of ,,covid-#ai related treatment at no cost sharing4 ,sec4 #cjf4 ,reimbursement for additional health services relating to coronavirus4 ,title ,,iv--,federal ,health ,equity ,oversight ,sec4 #dja4 ,,covid-#ai ,racial and ,ethnic ,disparities ,task ,force ,act of #bjbj4 ,sec4 #djb4 ,protection of the ,,hhs ,offices of ,minority ,health4 ,sec4 #djc4 ,establish an interagency counsel and grant programs on social determinants of health4 ,sec4 #djd4 ,accountability and transparency within the ,department of ,health and ,human ,services4 ,title ,v--,expanded ,insurance ,access ,sec4 #eja4 ,medicare special enrollment period for individuals residing in ,,covid-#ai emergency areas4 ,sec4 #ejb4 ,special enrollment period through exchanges2 ,federal exchange outreach and educational activities4 ,sec4 #ejc4 ,,momma's ,act4 ,sec4 #ejd4 ,allowing for medical assistance under ,medicaid for inmates during #cj-;day period preceding release4 ,sec4 #eje4 ,providing for immediate ,medicaid eligibility for former foster youth4 ,sec4 #ejf4 ,expanded coverage for former foster youth4 ,sec4 #ejg4 ,removing citizenship and immigration barriers to access to affordable health care under ,,aca4 ,sec4 #ejh4 ,medicaid in the territories4 ,sec4 #eji4 ,removing ,medicare barrier to health care4 ,sec4 #eaj4 ,removing barriers to health care and nutrition assistance for children1 pregnant persons1 and lawfully present individuals4 ,sec4 #eaa4 ,repeal of requirement for documentation evidencing citizenship or nationality under the ,medicaid program4 ,title ,,vi--,community ,based ,grants ,sec4 #fja4 ,grants for racial and ethnic approaches to community health4 ,sec4 #fjb4 ,grants to promote health for underserved communities4 ,sec4 #fjc4 ,addressing ,,covid-#ai health inequities and improving health equity4 ,sec4 #fjd4 ,improving social determinants of health4 ,sec4 #fje4 ,funding to ,states1 localities1 and community-based organizations for emergency aid and services4 ,sec4 #fjf4 ,supplemental nutrition assistance program4 ,title ,,vii--,culturally and ,linguistically ,competent ,care ,sec4 #gja4 ,ensuring standards for culturally and linguistically appropriate services in health care4 ,sec4 #gjb4 ,culturally and linguistically appropriate health care in the ,public ,health ,service ,act4 ,sec4 #gjc4 ,training tomorrow's doctors for culturally and linguistically appropriate care3 graduate medical education4 ,sec4 #gjd4 ,federal reimbursement for culturally and linguistically appropriate services under the ,medicare1 ,medicaid1 and ,state ,children's ,health ,insurance ,programs4 ,sec4 #gje4 ,requirements for health programs or activities receiving ,federal funds4 ,sec4 #gjf4 ,report on ,federal efforts to provide culturally and linguistically appropriate health care services4 ,sec4 #gjg4 ,health professions competencies to address racial and ethnic mental health disparities4 ,sec4 #gjh4 ,study on the uninsured4 ,title ,,viii--,aid to ,providers ,serving ,minority ,communities ,sec4 #hja4 ,temporary increase in ,medicaid ,,dsh allotments4 ,sec4 #hjb4 ,,covid-#ai-related temporary increase of ,medicaid ,,fmap4 ,sec4 #hjc4 ,appropriation for primary health care4 ,sec4 #hjd4 ,amendment to the ,public ,health ,service ,act4 ,sec4 #hje4 ,pandemic premium pay for essential workers4 ,sec4 #hjf4 ,,covid-#ai ,heroes ,fund grants4 ,sec4 #hjg4 ,enforcement and outreach4 ,title ,,ix--,health ,,it and ,bridging the ,digital ,divide in ,health ,care ,sec4 #ija4 ,,hrsa assistance to health centers for promotion of ,health ,,it4 ,sec4 #ijb4 ,assessment of impact of ,health ,,it on racial and ethnic minority communities2 outreach and adoption of ,health ,,it in such communities4 ,sec4 #ijc4 ,extending funding to strengthen the ,health ,,it infrastructure in racial and ethnic minority communities4 ,sec4 #ijd4 ,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 #ije4 ,authorization of appropriations4 ,sec4 #ijf4 ,data collection and assessments conducted in coordination with minority-serving institutions4 ,sec4 #ijg4 ,study of health information technology in medically underserved communities4 ,sec4 #ijh4 ,study on the effects of changes to telehealth under the ,medicare and ,medicaid programs during the ,,covid-#ai emergency4 ,sec4 #iji4 ,,covid-#ai designation of immediate special authority of spectrum for ,tribes' emergency response in ,indian ,country4 ,sec4 #iaj4 ,facilitating the provision of telehealth services across ,state lines4 ,title ,x--,public ,awareness ,sec4 #ajja4 ,awareness campaigns4 ,sec4 #ajjb4 ,increasing understanding of and improving health literacy4 ,sec4 #ajjc4 ,english for speakers of other languages4 ,sec4 #ajjd4 ,influenza1 ,,covid-#ai1 and pneumonia vaccination campaign4 ,title ,,xi--,research ,sec4 #aaja4 ,research and development4 ,sec4 #aajb4 ,,cdc field studies pertaining to specific health inequities4 ,sec4 #aajc4 ,expanding capacity for health outcomes4 ,sec4 #aajd4 ,data collection and analysis grants to minority-serving institutions4 ,sec4 #aaje4 ,safety and effectiveness of drugs with respect to racial and ethnic background4 ,sec4 #aajf4 ,,gao and ,,nih reports4 ,sec4 #aajg4 ,health impact assessments4 ,sec4 #aajh4 ,tribal funding to research health inequities including ,,covid-#ai4 ,sec4 #aaji4 ,research endowments at both current and former centers of excellence4 ,title ,,xii--,education ,sec4 #abja4 ,grants for schools of medicine in diverse and underserved areas4 ,sec4 #abjb4 ,amendment to the ,public ,health ,service ,act4 ,sec4 #abjc4 ,hispanic-serving institutions1 ,historically ,black ,colleges and ,universities1 ,asian ,american and ,native ,american ,pacific ,islander-serving institutions1 ,tribal colleges1 regional community-based organizations1 and national minority medical associations4 ,sec4 #abjd4 ,loan repayment program of ,centers for ,disease ,control and ,prevention4 ,sec4 #abje4 ,study and report on strategies for increasing diversity4 ,sec4 #abjf4 ,amendments to the ,pandemic ,,ebt ,act4 ,title ,,xiii--,public ,health ,assistance to ,tribes ,sec4 #acja4 ,appropriations for the ,indian ,health ,service4 ,sec4 #acjb4 ,improving ,state1 local1 and ,tribal public health security4 ,sec4 #acjc4 ,provision of items to ,indian programs and facilities4 ,sec4 #acjd4 ,health care access for urban native veterans4 ,sec4 #acje4 ,proper and reimbursed care for native veterans4 ,i ,racial and ,ethnicity ,data ,collection ,a ,collection and ,reporting #aja4 ,equitable data collection and disclosure on ,,covid-#ai ,act 7a7 ,findings ,congress makes the following findings3 7#a7 ,the ,world ,health ,organization 7,,who7 declared ,,covid-#ai a ,public ,health ,emergency of ,international ,concern on ,january #cj1 #bjbj4 ,by late ,march #bjbj1 there have been over #dgj1jjj confirmed cases of1 and #bj1jjj deaths associated with1 ,,covid-#ai worldwide4 7#b7 ,in the ,united ,states1 cases of ,,covid-#ai have quickly surpassed those across the world1 and as of ,april #ab1 #bjbj1 over #ejj1jjj cases and #bj1jjj deaths have been reported in the ,united ,states alone4 7#c7 ,early reporting on racial inequities in ,,covid-#ai testing and treatment have renewed calls for the ,centers for ,disease ,control and ,prevention and other relevant subagencies within the ,department of ,health and ,human ,services to publicly release racial and demographic information to better inform the pandemic response1 specifically in communities of color and in ,limited ,english ,proficient 7,,lep7 communities4 7#d7 ,the burden of morbidity and mortality in the ,united ,states has historically fallen disproportionately on marginalized communities 7those who suffer the most from great public health needs and are the most medically underserved74 7#e7 ,historically1 structures and systems1 such as racism1 ableism and class oppression1 have rendered affected individuals more vulnerable to inequities and have prevented people from achieving their optimal health even when there is not a crisis of pandemic proportions4 7#f7 ,significant differences in access to health care1 specifically to primary health care providers1 health care information1 and greater perceived discrimination in health care place communities of color1 individuals with disabilities1 and ,,lep individuals at greater risk of receiving delayed1 and perhaps poorer1 health care4 7#g7 ,stark racial inequities across the ,united ,states1 including unequal access to stable housing1 quality education1 and decent employment significantly impact the ability of individuals to take care of their most basic health needs4 ,communities of color are more likely to experience homelessness and struggle with low-paying jobs or unemployment4 ,to date1 experts have cited that #b in #e ,latino residents in ,new ,york ,city1 the current epicenter of the ,,covid-#ai pandemic1 are recently unemployed as a direct consequence of ,,covid-#ai4 ,and at a time when sheltering in place will save lives1 less than #a in #e ,black workers and roughly #a in #f ,latino workers are able to work from home4 7#h7 ,communities of color experience higher rates of chronic disease and disabilities1 such as diabetes1 hypertension1 and asthma1 than non-,hispanic ,white communities1 which predisposes them to greater risk of complications and mortality should they contract ,,covid-#ai4 7#i7 ,such communities are made even more vulnerable to the uncertainty of the preparation1 response1 and events surrounding the pandemic public health crisis1 ,,covid-#ai4 ,for instance1 in the recent past1 multiple epidemiologic studies and reviews have reported higher rates of hospitalization due to the #bjji ,h#a,n#a pandemic among the poor1 individuals with disabilities and preexisting conditions1 those living in impoverished neighborhoods1 and individuals of color and ethnic backgrounds in the ,united ,states4 ,these findings highlight the urgency to adapt the ,,covid-#ai response to monitor and act on these inequities via data collection and research by race and ethnicity4 7#aj7 ,research experts recognize that there are underlying differences in illness and death when each of these factors are examined through socioeconomic and racial or ethnic lenses4 ,these socially determinant factors of health accelerate disease and degradation4 7#aa7 ,language barriers are highly correlated with medication noncompliance and inconsistent engagement with health systems4 ,without language accessibility data and research around ,,covid-#ai1 these communities are less likely to receive critical testing and preventive health services4 ,yet1 to date1 the ,centers for ,disease ,control and ,prevention do not disseminate ,,covid-#ai messaging in critical languages1 including ,mandarin ,chinese1 ,spanish1 and ,korean within the same timeframe as information in ,english despite requirements to ensure limited ,english proficient populations are not discriminated against under title ,,vi of the ,civil ,rights ,act of #aifd and subsequent laws and ,federal policies4 7#ab7 ,further1 it is critical to disaggregate data further by ancestry to address disparities among ,asian ,american1 ,native ,hawaiian1 and ,pacific ,islander groups4 ,according to the ,national ,equity ,atlas1 while #ac percent of the ,asian population overall lived in poverty in #bjae1 #ci percent of ,burmese people1 #bi percent of ,hmong people1 and #ba percent of ,pacific ,islanders lived in poverty4 7#ac7 ,utilizing disaggregation of enrollment in ,affordable ,care ,act-sponsored health insurance1 the ,asian and ,pacific ,islander ,american ,health ,forum found that prior to the passage of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 ,korean ,americans had a high uninsured rate of #bc percent1 compared to just #ab percent for all ,asian ,americans4 ,developing targeted outreach efforts assisted #a1jjj1jjj people and resulted in a #ef-percent decrease in the uninsured among the ,asian1 ,native ,hawaiian1 and ,pacific ,islander population4 ,such efforts show that disaggregated data is essential to public health mobilizations efforts4 7#ad7 ,without clear understanding of how ,,covid-#ai impacts marginalized racial and ethnic communities1 there will be exacerbated risk of endangering the most historically vulnerable of our ,nation4 7#ae7 ,the consequences of misunderstanding the racial and ethnic impact of ,,covid-#ai expound beyond communities of color such that it would impact all4 7#af7 ,race and ethnicity are valuable research and practice variables when used and interpreted appropriately4 ,health data collected on patients by race and ethnicity will boost and more efficiently direct critical resources and inform risk communication development in languages and at appropriate health literacy levels1 which resonate with historically vulnerable communities of color4 7#ag7 ,to date1 there is no public standardized and comprehensive race and ethnicity data repository of ,,covid-#ai testing1 hospitalizations1 or mortality4 ,the inconsistency of data collection by ,federal1 ,state1 and local health authorities1 and the inability to access data by public research institutions and academic organizations1 poses a threat to analysis and synthesis of the pandemic impact on communities of color4 ,however1 research and medical experts of ,historically ,black ,colleges and ,universities1 academic health care institutions which are historically and geographically embedded in minoritized and marginalized communities1 generally also possess rapport with the communities they serve4 ,they are well-positioned1 as trusted thought leaders and health care service providers1 to collect data and conduct research toward creating holistic solutions to remedy the inequitable impact of this and future public health crises4 7#ah7 ,well-designed1 ethically sound research aligns with the goals of medicine1 addresses questions relevant to the population among whom the study will be carried out1 balances the potential for benefit against the potential for harm1 employs study designs that will yield scientifically valid and significant data1 and generates useful knowledge4 7#ai7 ,the dearth of racially and ethnically disaggregated data reflecting the health of communities of color underlies the challenges of a fully informed public health response4 7#bj7 ,without collecting race and ethnicity data associated with ,,covid-#ai testing1 hospitalizations1 morbidities1 and mortalities1 as well as publicly disclosing it1 communities of color will remain at greater risk of disease and death4 7b7 ,emergency funding for ,federal data collection on the racial1 ethnic1 and other demographic disparities of ,,covid-#ai ,to conduct or support data collection on the racial1 ethnic1 and other demographic implications of ,,covid-#ai in the ,united ,states and its territories1 including support to assist in the capacity building for ,state and local public health departments to collect and transmit racial1 ethnic1 and other demographic data to the relevant ,department of ,health and ,human ,services agencies1 there is authorized to be appropriated-- 7#a7 to the ,centers for ,disease ,control and ,prevention1 #ab1jjj1jjj2 7#b7 to ,state1 territorial1 and ,tribal public health agencies1 distributed proportionally based on the total population of their residents who are enrolled in ,medicaid or who have no health insurance1 #ae1jjj1jjj2 7#c7 to the ,indian ,health ,service1 ,indian ,tribes and ,tribal organizations 7as defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act71 and urban ,indian organizations 7as defined in section #d of the ,indian ,health ,care ,improvement ,act71 #c1jjj1jjj2 7#d7 to the ,centers for ,medicare ,medicaid ,services1 #e1jjj1jjj2 7#e7 to the ,food and ,drug ,administration1 #e1jjj1jjj2 7#f7 to the ,agency for ,healthcare ,research and ,quality1 #e1jjj1jjj2 and 7#g7 to the ,office of the ,national ,coordinator for ,health ,information ,technology1 #e1jjj1jjj4 7c7 ,,covid-#ai data collection and disclosure 7#a7 ,data collection ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 acting through the ,director of the ,centers for ,disease ,control and ,prevention and the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall make publicly available on the website of the ,centers for ,disease ,control and ,prevention data collected across all surveillance systems relating to ,,covid-#ai1 disaggregated by race1 ethnicity1 sex1 age1 primary language1 socioeconomic status1 disability status1 and county1 including the following3 7,a7 ,data related to all ,,covid-#ai testing1 including the number of individuals tested and the number of tests that were positive4 7,b7 ,data related to treatment for ,,covid-#ai1 including hospitalizations and intensive care unit admissions4 7,c7 ,data related to ,,covid-#ai outcomes1 including total fatalities and case fatality rates 7expressed as the proportion of individuals who were infected with ,,covid-#ai and died from the virus74 7#b7 ,application of standards ,to the extent practicable1 data collection under this subsection shall follow standards developed by the ,department of ,health and ,human ,services ,office of ,minority ,health and be collected1 analyzed1 and reported in accordance with the standards promulgated by the ,assistant ,secretary for ,planning and ,evaluation under title ,,xxxi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjkk et seq474 7#c7 ,timeline ,the data made available under this subsection shall be updated on a daily basis throughout the public health emergency4 7#d7 ,privacy ,in publishing data under this subsection1 the ,secretary shall take all necessary steps to protect the privacy of individuals whose information is included in such data1 including-- 7,a7 complying with privacy protections provided under the regulations promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif2 and 7,b7 protections from all inappropriate internal use by an 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 inappropriate uses4 7#e7 ,consultation with ,tribes ,the ,indian ,health ,service shall consult with ,indian ,tribes and confer with urban ,indian organizations on data collection and reporting4 7#f7 ,report ,not later than #fj days after the date on which the ,secretary certifies that the public health emergency related to ,,covid-#ai has ended1 the ,secretary shall make publicly available a summary of the final statistics related to ,,covid-#ai4 7#g7 ,report ,not later than #fj days after the date on which the ,secretary certifies that the public health emergency related to ,,covid-#ai has ended1 the ,department of ,health and ,human ,services shall compile and submit 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 a preliminary report-- 7,a7 describing the testing1 hospitalization1 mortality rates1 and preferred language of patients associated with ,,covid-#ai by race and ethnicity2 and 7,b7 proposing evidenced-based response strategies to safeguard the health of these communities in future pandemics4 7d7 ,commission on ,ensuring ,health ,equity ,during the ,,covid-#ai ,public ,health ,emergency 7#a7 ,in general ,not later than #cj days after the date of enactment of this ,act1 the ,secretary shall establish a commission1 to be known as the ,commission on ,ensuring ,health ,equity ,during the ,,covid-#ai ,public ,health ,emergency 7referred to in this subsection as the ,commission7 to provide clear and robust guidance on how to improve the collection1 analysis1 and use of demographic data in responding to future waves of the coronavirus4 7#b7 ,membership and chairperson 7,a7 ,membership ,the ,commission shall be composed of-- 7i7 the ,director of the ,centers for ,disease ,control and ,prevention2 7ii7 the ,director of the ,national ,institutes of ,health2 7iii7 the ,commissioner of ,food and ,drugs2 7iv7 the ,administrator of the ,federal ,emergency ,management ,agency2 7v7 the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities2 7vi7 the ,director of the ,indian ,health ,service2 7vii7 the ,administrator of the ,centers for ,medicare ,medicaid ,services2 7viii7 the ,director of the ,agency for ,healthcare ,research and ,quality2 7ix7 the ,surgeon ,general2 7x7 the ,administrator of the ,health ,resources and ,services ,administration2 7xi7 the ,director of the ,office of ,minority ,health2 7xii7 the ,director of the ,office of ,women's ,health2 7xiii7 the ,chairperson of the ,national ,council on ,disability2 7xiv7 at least #d ,state1 local1 territorial1 and ,tribal public health officials representing departments of public health1 who shall represent jurisdictions from different regions of the ,united ,states with relatively high concentrations of historically marginalized populations1 to be appointed by the ,secretary2 and 7xv7 racially and ethnically diverse representation from at least #c independent experts with knowledge or field experience with racial and ethnic disparities in public health appointed by the ,secretary4 7,b7 ,chairperson ,the ,president of the ,national ,academies of ,sciences1 ,engineering1 and ,medicine1 or designee1 shall serve as the chairperson of the ,commission4 7#c7 ,duties ,the ,commission shall-- 7,a7 examine barriers to collecting1 analyzing1 and using demographic data2 7,b7 determine how to best use such data to promote health equity across the ,united ,states and reduce racial1 ,tribal1 and other demographic disparities in ,,covid-#ai prevalence and outcomes2 7,c7 gather available data related to ,,covid-#ai treatment of individuals with disabilities1 including denial of treatment for pre-existing conditions1 removal or denial of disability related equipment 7including ventilators and ,,cpap71 and data on completion of ,,dnr orders1 and identify barriers to obtaining accurate and timely data related to ,,covid-#ai treatment of such individuals2 7,d7 solicit input from public health officials1 community-connected organizations1 health care providers1 ,state and local agency officials1 and other experts on barriers to1 and best practices for1 collecting demographic data2 and 7,e7 recommend policy changes that the data indicates are necessary to reduce disparities4 7#d7 ,report ,not later than #fj days after the date of enactment of this ,act1 and every #ahj days thereafter until the ,secretary certifies that the public health emergency related to ,,covid-#ai has ended1 the ,commission shall submit a written report of its findings and recommendations to ,congress and post such report on a website of the ,department of ,health and ,human ,services4 ,such reports shall contain information concerning-- 7,a7 how to enhance ,state1 local1 territorial1 and ,tribal capacity to conduct public health research on ,,covid-#ai1 with a focus on expanded capacity to analyze data on disparities correlated with race1 ethnicity1 income1 sex1 age1 disability status1 specific geographic areas1 and other relevant demographic characteristics1 and an analysis of what demographic data is currently being collected about ,,covid-#ai1 the accuracy of that data and any gaps1 how this data is currently being used to inform efforts to combat ,,covid-#ai1 and what resources are needed to supplement existing public health data collection2 7,b7 how to collect1 process1 and disclose to the public the data described in subparagraph 7,a7 in a way that maintains individual privacy while helping direct the ,state and local response to the virus2 7,c7 how to improve demographic data collection related to ,,covid-#ai in the short- and long-term1 including how to continue to grow and value the ,tribal sovereignty of data and information concerning ,tribal communities2 7,d7 to the extent possible1 a preliminary analysis of racial and other demographic disparities in ,,covid-#ai mortality1 including an analysis of comorbidities and case fatality rates2 7,e7 to the extent possible1 a preliminary analysis of sex1 gender1 sexual orientation1 and gender identity disparities in ,,covid-#ai treatment and mortality2 7,f7 an analysis of ,,covid-#ai treatment of individuals with disabilities1 including equity of access to treatment and equipment and intersections of disability status with other demographic factors1 including race1 and recommendations for how to improve transparency and equity of treatment for such individuals during the ,,covid-#ai public health emergency and future emergencies2 7,g7 how to support ,state1 local1 and ,tribal capacity to eliminate barriers to ,,covid-#ai testing and treatment2 and 7,h7 to the extent possible1 a preliminary analysis of ,federal ,government policies that disparately exacerbate the ,,covid-#ai impact1 and recommendations to improve racial and other demographic disparities in health outcomes4 7#e7 ,authorization of appropriations ,there is authorized to be appropriated such sums as may be necessary to carry out this subsection4 #ajb4 ,,covid-#ai reporting portal 7a7 ,in general ,not later than #ae days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall establish and maintain an online portal for use by eligible health care entities to track and transmit data regarding their personal protective equipment and medical supply inventory and capacity related to ,,covid-#ai4 7b7 ,eligible health care entities ,in this section1 the term eligible health care entity means a licensed acute care hospital1 hospital system1 or long-term care facility with confirmed cases of ,,covid-#ai4 7c7 ,submission ,an eligible health care entity shall report using the portal under this section on a biweekly basis in order to assist the ,secretary in tracking usage and need of ,,covid-related supplies and personnel in a regular and real-time manner4 7d7 ,included information ,the ,secretary shall design the portal under this section to include information on personal protective equipment and medical supply inventory and capacity related to ,,covid-#ai1 including with respect to the following3 7#a7 ,personal protective equipment ,total personal protective equipment inventory1 including1 in units1 the numbers of ,n#ie masks and authorized equivalent respirator masks1 surgical masks1 exam gloves1 face shields1 isolation gowns1 and coveralls4 7#b7 ,medical supply 7,a7 ,total ventilator inventory1 including1 in units1 the number of universal1 adult1 pediatric1 and infant ventilators4 7,b7 ,total diagnostic and serological test inventory1 including1 in units1 the number of test platforms1 tests1 test kits1 reagents1 transport media1 swabs1 and other materials or supplies determined necessary by the ,secretary4 7#c7 ,capacity 7,a7 ,case count measurements1 including confirmed positive cases and persons under investigation4 7,b7 ,total number of staffed beds1 including medical surgical beds1 intensive care beds1 and critical care beds4 7,c7 ,available beds1 including medical surgical beds1 intensive care beds1 and critical care beds4 7,d7 ,total number of ,,covid-#ai patients currently utilizing a ventilator4 7,e7 ,average number of days a ,,covid-#ai patient is utilizing a ventilator4 7,f7 ,total number of additionally needed professionals in each of the following categories3 intensivists1 critical care physicians1 respiratory therapists1 registered nurses1 certified registered nurse anesthetists1 and laboratory personnel4 7,g7 ,total number of hospital personnel currently not working due to self-isolation following a known or presumed ,,covid-#ai exposure4 7e7 ,access to information related to inventory and capacity ,the ,secretary shall ensure that relevant agencies and officials1 including the ,centers for ,disease ,control and ,prevention1 the ,assistant ,secretary for ,preparedness and ,response1 and the ,federal ,emergency ,management ,agency1 have access to information related to inventory and capacity submitted under this section4 7f7 ,weekly report to ,congress ,on a weekly basis1 the ,secretary shall transmit information related to inventory and capacity submitted under this section to the appropriate committees of the ,house and ,senate4 #ajc4 ,regular ,,cdc reporting on demographic data ,not later than #ad days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services1 in coordination with the ,director of the ,centers for ,disease ,control and ,prevention1 shall amend the reporting under the heading ,department of ,health and ,human ,services--,office of the ,secretary--,public ,health and ,social ,service ,emergency ,fund in title ,i of division ,b of the ,paycheck ,protection ,program and ,health ,care ,enhancement ,act 7,public ,law #aaf-aci2 #acd ,stat4 #fbj1 #fbf7 on the demographic characteristics1 including race1 ethnicity 7including breakdowns of major ethnic groups and ,tribal affiliations within minority populations71 age1 sex1 gender1 geographic region1 primary written and spoken language1 disability status1 sexual orientation1 socioeconomic status1 occupation1 and other relevant factors of individuals tested for or diagnosed with ,,covid-#ai1 to include-- 7#a7 providing technical assistance to ,state1 local1 ,tribal1 and territorial health departments to improve the collection and reporting of such demographic data2 7#b7 if such data is not so collected or reported1 the reason why the ,state1 local1 ,tribal1 or territorial department of health has not been able to collect or provide such information2 and 7#c7 making a copy of such report available publicly on the website of the ,centers for ,disease ,control and ,prevention4 #ajd4 ,amendment to the ,public ,health ,service ,act 7a7 ,purpose ,it is the purpose of the amendment made by this section to promote data collection1 analysis1 and reporting by race1 ethnicity1 sex1 primary language1 sexual orientation1 disability status1 gender identity1 age1 and socioeconomic status among federally supported health programs4 7b7 ,amendment ,the ,public ,health ,service ,act is amended by adding at the end the following3 ,,xxxiv ,strengthening data collection1 improving data analysis1 and expanding data reporting #cdjj4 ,health disparity data 7a7 ,requirements 7#a7 ,in general ,each health-related program 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 age1 and socioeconomic status of each applicant for and recipient of health-related assistance under such program1 including-- 7i7 using1 at a minimum1 standards for data collection on race1 ethnicity1 sex1 primary language1 sexual orientation1 gender identity1 age1 socioeconomic status1 and disability status as each are 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 standards developed under section #caja2 7iii7 using1 where practicable1 the standards developed by the ,health and ,medicine ,division of the ,national ,academies of ,sciences1 ,engineering1 and ,medicine 7formerly known as the ,institute of ,medicine7 in the #bjji publication1 entitled ,race1 ,ethnicity1 and ,language ,data3 ,standardization for ,health ,care ,quality ,improvement2 and 7iv7 where practicable1 collecting such data 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 age1 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 age1 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 any requirements1 including such requirements in effect on or after the date of enactment of this section1 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 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 and linguistically appropriate manner1 to improve the collection1 analysis1 and reporting of racial1 ethnic1 sex1 primary language1 sexual orientation1 disability status1 gender identity1 age1 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 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 knowledge among ,federal agencies1 ,states1 territories1 ,indian ,tribes1 counties1 municipalities1 health providers1 health plans1 and the general public that data collection1 analysis1 and reporting by race1 ethnicity1 sex1 primary language1 sexual orientation1 gender identity1 age1 socioeconomic status1 and disability 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 follow ,federal standards promulgated under the ,health ,information ,technology for ,economic and ,clinical ,health ,act for the collection and meaningful use of electronic health data on race1 ethnicity1 sex1 primary language1 sexual orientation1 gender identity1 age1 socioeconomic status1 and disability status2 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 ,states1 counties1 and municipalities for racial and ethnic groups that comprise a significant proportion of the population of the ,state1 county1 or municipality2 7#e7 provide researchers with greater access to racial1 ethnic1 primary language1 sex1 sexual orientation1 gender identity1 age1 socioeconomic status data1 and disability status data1 subject to all applicable privacy and confidentiality requirements1 including ,,hipaa privacy and security law as defined in section #cjji2 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 standards developed under section #caja4 7e7 ,analysis of health disparity data ,the ,secretary1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality and in coordination with the ,assistant ,secretary for ,planning and ,evaluation1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 the ,director of the ,national ,center for ,health ,statistics1 and the ,director of the ,national ,institutes of ,health1 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 racial1 ethnic1 and other disparities in health and health care in programs conducted or supported by such agencies 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 7f7 ,definitions ,in this section-- 7#a7 the term health-related program means a program that is operated by the ,secretary1 or that receives funding or reimbursement1 in whole or in part1 either directly or indirectly from the ,secretary-- 7,a7 for activities under the ,social ,security ,act for health care services2 or 7,b7 for providing ,federal financial assistance for health care1 biomedical research1 or health services research or for otherwise improving the health of the public2 7#b7 the term primary language data includes spoken and written primary language data2 and 7#c7 the term primary language data collection activities includes identifying1 collecting1 storing1 tracking1 and analyzing primary language data and information on the methods used to meet the language access needs of individuals with limited ,english proficiency4 7g7 ,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 #bjba through #bjbe4 #cdja4 ,establishing grants for data collection improvement activities 7a7 ,in general ,the ,secretary1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality and in consultation with the ,deputy ,assistant ,secretary for ,minority ,health1 the ,director of the ,national ,institutes of ,health1 the ,assistant ,secretary for ,planning and ,evaluation1 and the ,director of the ,national ,center for ,health ,statistics1 shall establish a technical assistance program under which the ,secretary provides grants to eligible entities to assist such entities in complying with section #cdca4 7b7 ,types of assistance ,a grant provided under this section may be used to-- 7#a7 enhance or upgrade computer technology that will facilitate collection1 analysis1 and reporting of racial1 ethnic1 primary language1 sexual orientation1 sex1 gender identity1 socioeconomic status1 and disability status data2 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 standards developed under section #caja2 7#c7 develop mechanisms for submitting collected data subject to any applicable privacy and confidentiality regulations2 and 7#d7 develop educational programs to inform health plans1 health providers1 health-related agencies1 and the general public that data collection and reporting by race1 ethnicity1 primary language1 sexual orientation1 sex1 gender identity1 disability status1 and socioeconomic status are legal and essential for eliminating health and health care disparities4 7c7 ,eligible entity ,to be eligible for grants under this section1 an entity shall be a ,state1 territory1 ,indian ,tribe1 municipality1 county1 health provider1 health care organization1 or health plan making a demonstrated effort to bring data collections into compliance with section #cdca4 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 #bjba through #bjbe4 #cdjb4 ,oversampling of underrepresented groups in ,federal health surveys 7a7 ,national strategy 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,national ,center for ,health ,statistics 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 underrepresented populations within the categories of race1 ethnicity1 sex1 primary language1 sexual orientation1 disability status1 gender identity1 and socioeconomic status as determined appropriate by the ,secretary in ,federal health surveys and program data collections4 ,such national strategy shall include a strategy for oversampling of ,native ,americans1 ,asian ,americans1 ,native ,hawaiians1 and ,pacific ,islanders4 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 this section1 the ,secretary shall-- 7,a7 consult with representatives of community groups1 nonprofit organizations1 nongovernmental organizations1 and government agencies working with underrepresented populations2 7,b7 solicit the participation of representatives from other ,federal departments and agencies1 including subagencies of the ,department of ,health and ,human ,services2 and 7,c7 consult on1 and use as models1 the #bjad ,national ,health ,interview ,survey oversample of ,native ,hawaiian and ,pacific ,islander populations and the #bjag ,behavioral ,risk ,factor ,surveillance ,system oversample of ,american ,indian and ,alaska ,native communities4 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 #bjba through #bjbe4 4 #aje4 ,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 #ajf4 ,collection of data for the ,medicare program ,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 data for the ,medicare program 7a7 ,requirement 7#a7 ,in general ,the ,commissioner of ,social ,security1 in consultation with the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall collect data on the race1 ethnicity1 sex1 primary language1 sexual orientation1 gender identity1 socioeconomic status1 and disability status of all applicants for ,social ,security benefits under title ,,ii or ,medicare benefits under title ,,xviii4 7#b7 ,data collection standards ,in collecting data under paragraph 7#a71 the ,commissioner of ,social ,security shall at least use the standards for data collection developed under section #caja of the ,public ,health ,service ,act or the standards developed by the ,office of ,management and ,budget1 whichever is more disaggregated4 ,in the event there are no standards for the demographic groups listed under paragraph 7#a71 the ,commissioner shall consult with stakeholder groups representing the various identities as well as with the ,office of ,minority ,health within the ,centers for ,medicare ,medicaid ,services to develop appropriate standards4 7#c7 ,data for additional population groups ,where practicable1 the information collected by the ,commissioner of ,social ,security under paragraph 7#a7 shall include data for additional population groups if such groups can be aggregated into the race and ethnicity categories outlined by the data collection standards described in paragraph 7#b74 7#d7 ,collection of data for minors and legally incapacitated individuals ,with respect to the collection of the data described in paragraph 7#a7 of applicants who are under #ah years of age or otherwise legally incapacitated1 the ,commissioner of ,social ,security shall 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 used in collecting the data4 7#e7 ,quality of data ,the ,commissioner of ,social ,security shall periodically review the quality and completeness of the data collected under paragraph 7#a7 and make adjustments as necessary to improve both4 7#f7 ,transmission of data ,upon enrollment in ,medicare benefits under title ,,xviii1 the ,commissioner of ,social ,security shall transmit an individual's demographic data as collected under paragraph 7#a7 to the ,centers for ,medicare and ,medicaid ,services4 7#g7 ,analysis and reporting of data ,with respect to data transmitted under paragraph 7#e71 the ,administrator of the ,centers for ,medicare and ,medicaid ,services1 in consultation with the ,commissioner of ,social ,security shall-- 7,a7 require that such data be uniformly analyzed and that such analysis be reported at least annually to ,congress2 7,b7 incorporate such data in other analysis and reporting on health disparities as appropriate2 7,c7 make such data available to researchers1 under the protections outlined in paragraph 7#g72 7,d7 provide opportunities to individuals enrolled in ,medicare to submit updated data2 and 7,e7 ensure that the provision of assistance or benefits to an applicant is not denied or otherwise adversely affected because of the failure of the applicant to provide any of the data collected under paragraph 7#a74 7#h7 ,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 is 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 7relating to the privacy of individually identifiable health information and other protections72 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 7b7 ,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 7c7 ,technical assistance ,the ,secretary may1 either directly or by grant or contract1 provide technical assistance to enable any entity to comply with the requirements of this section or with regulations implementing this section4 7d7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #ejj million for #bjbj and #ajj million for each fiscal year thereafter4 4 #ajg4 ,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 standards for data collection on race1 ethnicity1 primary language1 disability1 sex1 sexual orientation1 gender identity1 and socioeconomic status developed under section #caja of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjkk72 and 7#b7 in consultation with the ,office of the ,national ,coordinator for ,health ,information ,technology1 the designation of the appropriate racial1 ethnic1 primary language1 disability1 sex1 and other 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 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 entities comply with the new standards developed under subsection 7a7 not later than #b years after the final promulgation of such standards4 #ajh4 ,disparities data collected by the ,federal ,government 7a7 ,repository of ,government data ,the ,secretary of ,health and ,human ,services1 in coordination with the departments1 agencies1 or offices described in subsection 7b71 shall establish a centralized electronic repository of ,government data on factors related to the health and well-being of the population of the ,united ,states4 7b7 ,collection2 submission ,not later than #ahj 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 data on race1 ethnicity1 sex1 primary language1 sexual orientation1 disability status1 gender identity1 age1 or socioeconomic status during the preceding calendar year shall submit such data to the repository of ,government data established under subsection 7a74 7c7 ,analysis2 public availability2 reporting ,not later than ,april #cj1 #bjba1 and ,april #cj of each year thereafter1 the ,secretary of ,health and ,human ,services1 acting through the ,assistant ,secretary for ,planning and ,evaluation1 the ,assistant ,secretary for ,health1 the ,director of the ,agency for ,healthcare ,research and ,quality1 the ,director of the ,national ,center for ,health ,statistics1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities1 and the ,deputy ,assistant ,secretary for ,minority ,health1 shall-- 7#a7 prepare and make available datasets for public use that relate to disparities in health status1 health care access1 health care quality1 health outcomes1 public health1 and other areas of health and well-being by factors that include race1 ethnicity1 sex1 primary language1 sexual orientation1 disability status1 gender identity1 and socioeconomic status2 7#b7 ensure that these datasets are publicly identified on the repository established under subsection 7a7 as disparities data2 and 7#c7 submit a report to the ,congress on the availability and use of such data by public stakeholders4 #aji4 ,standards for measuring sexual orientation1 gender identity1 and socioeconomic status 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 socioeconomic status1 before and disability status2 7#b7 in paragraph 7#a77;,c71 by inserting sexual orientation1 gender identity1 socioeconomic status1 before and disability status2 and 7#c7 in paragraph 7#b77;,b71 by inserting sexual orientation1 gender identity1 socioeconomic status1 before and disability status4 #aaj4 ,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,u 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 of ,,nhopi populations ,the term government representatives of ,,nhopi populations 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 ,ending ,health ,disparities ,during ,,covid-#ai ,act of #bjbj1 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 ,ending ,health ,disparities ,during ,,covid-#ai ,act of #bjbj4 7d7 ,progress report ,not later than #b years after the date of enactment of the ,ending ,health ,disparities ,during ,,covid-#ai ,act of #bjbj1 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 ,health and ,medicine ,division 7#a7 ,in general ,the ,secretary shall enter into an agreement with the ,health and ,medicine ,division of the ,national ,academies of ,sciences1 ,engineering1 and ,medicine to conduct a study1 with input from stakeholders in insular areas1 on each of 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 determines appropriate4 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 that are set forth in the #aiih report entitled ,pacific ,partnerships for ,health3 ,charting a ,new ,course4 7#b7 ,report ,an agreement described in paragraph 7#a7 shall require the ,health and ,medicine ,division to submit to the ,secretary and to ,congress1 not later than #b years after the date of the enactment of the ,ending ,health ,disparities ,during ,,covid-#ai ,act of #bjbj1 a report containing a description of the results of the study conducted under paragraph 7#a71 including the conclusions and recommendations of the ,health and ,medicine ,division 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 #bjba through #bjbe4 4 ,b ,improvements and ,modernization #aba4 ,federal modernization for health inequities data 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall work with covered agencies to support the modernization of data collection methods and infrastructure at such agencies for the purpose of increasing data collection related to health inequities1 such as racial1 ethnic 7including breakdowns of major ethnic groups and ,tribal affiliations within minority populations71 socioeconomic1 sex1 gender1 age1 geographic region1 primary written and spoken language1 sexual orientation1 occupation1 and disability status disparities4 7b7 ,covered agency defined ,in this section1 the term covered agency means each of the following ,federal agencies3 7#a7 ,the ,agency for ,healthcare ,research and ,quality4 7#b7 ,the ,centers for ,disease ,control and ,prevention4 7#c7 ,the ,centers for ,medicare ,medicaid ,services4 7#d7 ,the ,food and ,drug ,administration4 7#e7 ,the ,office of the ,national ,coordinator for ,health ,information ,technology4 7#f7 ,the ,national ,institutes of ,health4 7c7 ,authorization of appropriations ,there is authorized to be appropriated to each covered agency to carry out this section #d1jjj1jjj1 to remain available until expended4 #abb4 ,modernization of ,state and local health inequities data 7a7 ,in general ,not later than #f months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall award grants to ,state1 local1 ,tribal1 and territorial health departments in order to support the modernization of data collection methods and infrastructure for the purposes of increasing data related to health inequities1 such as racial1 ethnic 7including breakdowns of major ethnic groups and ,tribal affiliations within minority populations71 socioeconomic1 sex1 gender1 age1 geographic region1 primary written and spoken language1 sexual orientation1 occupation1 and disability status disparities4 ,the ,secretary shall-- 7#a7 provide guidance1 technical assistance1 and information to grantees under this section on best practices regarding culturally competent1 accurate1 and increased data collection and transmission2 and 7#b7 track performance of grantees under this section to help improve their health inequities data collection by identifying gaps and taking effective steps to support ,states1 localities1 and territories in addressing the gaps4 7b7 ,report ,not later than #a year after the date on which the first grant is awarded under this section1 the ,secretary 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 an initial report detailing-- 7#a7 nationwide best practices for ensuring ,states and localities collect and transmit health inequities data2 7#b7 nationwide trends which hinder the collection and transmission of health inequities data2 7#c7 ,federal best practices for working with ,states and localities to ensure culturally competent1 accurate1 and increased data collection and transmission2 and 7#d7 any recommended changes to legislative or regulatory authority to help improve and increase health inequities data collection4 7c7 ,final report ,not later than ,december #ca1 #bjbc1 the ,secretary shall-- 7#a7 update and finalize the initial report under subsection 7b72 and 7#b7 submit such final report to the committees specified in such subsection4 7d7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #ajj1jjj1jjj1 to remain available until expended4 #abc4 ,additional reporting to ,congress on the race and ethnicity rates of ,,covid-#ai testing1 hospitalizations1 and mortalities 7a7 ,in general ,not later than ,august #a1 #bjbj1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall submit to the ,committee on ,appropriations and the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,appropriations and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate an initial report-- 7#a7 describing the testing1 positive diagnoses1 hospitalization1 intensive care admissions1 and mortality rates associated with ,,covid-#ai1 disaggregated by race1 ethnicity 7including breakdowns of major ethnic groups and ,tribal affiliations within minority populations71 age1 sex1 gender1 geographic region1 primary written and spoken language1 disability status1 sexual orientation1 socioeconomic status1 occupation1 and other relevant factors as determined by the ,secretary2 7#b7 including an analysis of any variances of testing1 positive diagnoses1 hospitalizations1 and deaths by demographic characteristics2 and 7#c7 including proposals for evidenced-based response strategies to reduce disparities related to ,,covid-#ai4 7b7 ,final report ,not later than ,december #ca1 #bjbd1 the ,secretary shall-- 7#a7 update and finalize the initial report under subsection 7a72 and 7#b7 submit such final report to the committees specified in such subsection4 7c7 ,coordination ,in preparing the report submitted under this section1 the ,secretary shall take into account and otherwise coordinate such report with reporting required under section #ajc and under the heading ,department of ,health and ,human ,services--,office of the ,secretary--,public ,health and ,social ,service ,emergency ,fund in title ,i of division ,b of the ,paycheck ,protection ,program and ,health ,care ,enhancement ,act 7,public ,law #aaf-aci2 #acd ,stat4 #fbj1 #fbf74 ,,ii ,equitable ,testing and ,tracing ,a ,free ,testing for ,patients #bja4 ,sooner coverage of testing for ,,covid-#ai ,section #fjja7;a7 of division ,f of the ,families ,first ,coronavirus ,response ,act 7#db ,u4,s4,c4 #acbj;b-#e note7 is amended by striking beginning on or after and inserting beginning before1 on1 or after4 ,b ,national ,testing ,strategy #baa4 ,,covid-#ai testing strategy 7a7 ,strategy ,not later than ,june #ae1 #bjbj1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall update the ,,covid-#ai strategic testing plan under the heading ,department of ,health and ,human ,services--,office of the ,secretary--,public ,health and ,social ,service ,emergency ,fund in title ,i of division ,b of the ,paycheck ,protection ,program and ,health ,care ,enhancement ,act 7,public ,law #aaf-aci1 #acd ,stat4 #fbj1 #fbf-fbg7 and submit to the appropriate congressional committees such updated national plan identifying-- 7#a7 what level of1 types of1 and approaches to testing 7including predicted numbers of tests1 populations to be tested1 and frequency of testing and the appropriate setting whether a health care setting 7such as hospital-based1 high-complexity laboratory1 point-of-care1 mobile testing units1 pharmacies or community health centers7 or non-health care setting 7such as workplaces1 schools1 or child care centers77 are necessary-- 7,a7 to sufficiently monitor and contribute to the control of the transmission of ,,sars-,co,v-#b in the ,united ,states2 7,b7 to ensure that any reduction in social distancing efforts1 when determined appropriate by public health officials1 can be undertaken in a manner that optimizes the health and safety of the people of the ,united ,states1 and reduces disparities 7including disparities related to race1 ethnicity1 sex1 age1 disability status1 socioeconomic status1 primary written and spoken language1 occupation1 and geographic location7 in the prevalence of1 incidence of1 and health outcomes with respect to1 ,,covid-#ai2 and 7,c7 to provide for ongoing surveillance sufficient to support contact tracing1 case identification1 quarantine1 and isolation to prevent future outbreaks of ,,covid-#ai2 7#b7 specific plans and benchmarks1 each with clear timelines1 to ensure-- 7,a7 such level of1 types of1 and approaches to testing as are described in paragraph 7#a71 with respect to optimizing health and safety2 7,b7 sufficient availability of all necessary testing materials and supplies1 including extraction and testing kits1 reagents1 transport media1 swabs1 instruments1 analysis equipment1 personal protective equipment if necessary for testing 7including point-of-care testing71 and other equipment2 7,c7 allocation of testing materials and supplies in a manner that optimizes public health1 including by considering the variable impact of ,,sars-,co,v-#b on specific ,states1 territories1 ,indian ,tribes1 ,tribal organizations1 urban ,indian organizations1 communities1 industries1 and professions2 7,d7 sufficient evidence of validation for tests that are deployed as a part of such strategy2 7,e7 sufficient laboratory and analytical capacity1 including target turnaround time for test results2 7,f7 sufficient personnel1 including personnel to collect testing samples1 conduct and analyze results1 and conduct testing follow-up1 including contact tracing1 as appropriate2 and 7,g7 enforcement of the ,families ,first ,coronavirus ,response ,act 7,public ,law #aaf-abg7 to ensure patients who are tested are not subject to cost sharing2 7#c7 specific plans to ensure adequate testing in rural areas1 frontier areas1 health professional shortage areas1 and medically underserved areas 7as defined in section #ccj;,i7a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c-#ad7;a7771 and for underserved populations1 ,native ,americans 7including ,indian ,tribes1 ,tribal organizations1 and urban ,indian organizations71 and populations at increased risk related to ,,covid-#ai2 7#d7 specific plans to ensure accessibility of testing to people with disabilities1 older individuals1 individuals with limited ,english proficiency1 and individuals with underlying health conditions or weakened immune systems2 and 7#e7 specific plans for broadly developing and implementing testing for potential immunity in the ,united ,states1 as appropriate1 in a manner sufficient-- 7,a7 to monitor and contribute to the control of ,,sars-,co,v-#b in the ,united ,states2 7,b7 to ensure that any reduction in social distancing efforts1 when determined appropriate by public health officials1 can be undertaken in a manner that optimizes the health and safety of the people of the ,united ,states2 and 7,c7 to reduce disparities 7including disparities related to race1 ethnicity1 sex1 age1 disability status1 socioeconomic status1 primary written and spoken language1 occupation1 and geographic location7 in the prevalence of1 incidence of1 and health outcomes with respect to1 ,,covid-#ai4 7b7 ,coordination ,the ,secretary shall carry out this section-- 7#a7 in coordination with the ,administrator of the ,federal ,emergency ,management ,agency2 7#b7 in collaboration with other agencies and departments1 as appropriate2 and 7#c7 taking into consideration the ,state plans for ,,covid-#ai testing prepared as required under the heading ,department of ,health and ,human ,services--,office of the ,secretary--,public ,health and ,social ,service ,emergency ,fund in title ,i of division ,b of the ,paycheck ,protection ,program and ,health ,care ,enhancement ,act 7,public ,law #aaf-aci2 #acd ,stat4 #fbj1 #fbd74 7c7 ,updates 7#a7 ,frequency ,the updated national plan under subsection 7a7 shall be updated every #cj days until the end of the public health emergency first declared by the ,secretary under section #cai of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;d7 on ,january #ca1 #bjbj1 with respect to ,,covid-#ai4 7#b7 ,relation to other law ,paragraph 7#a7 applies in lieu of the requirement 7for updates every #ij days until funds are expended7 in the second to last proviso under the heading ,department of ,health and ,human ,services--,office of the ,secretary--,public ,health and ,social ,service ,emergency ,fund in title ,i of division ,b of the ,paycheck ,protection ,program and ,health ,care ,enhancement ,act 7,public ,law #aaf-aci2 #acd ,stat4 #fbj1 #fbg74 7d7 ,appropriate congressional committees ,in this section1 the term appropriate congressional committees means-- 7#a7 the ,committee on ,appropriations and the ,committee on ,energy and ,commerce of the ,house of ,representatives2 and 7#b7 the ,committee on ,appropriations and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate4 #bab4 ,coronavirus immigrant families protection 7a7 ,definitions ,in this section3 7#a7 ,coronavirus public health emergency ,the term coronavirus public health emergency means-- 7,a7 an emergency involving ,federal primary responsibility determined to exist by the ,president under section #eja7;b7 of the ,robert ,t4 ,stafford ,disaster ,relief and ,emergency ,assistance ,act 7#db ,u4,s4,c4 #eaia7;b77 with respect to ,,covid-#ai or any other coronavirus with pandemic potential2 7,b7 an emergency declared by a ,federal official with respect to coronavirus 7as defined in section #ejf of the ,coronavirus ,preparedness and ,response ,supplemental ,appropriations ,act1 #bjbj 7,public ,law #aaf-abc772 7,c7 a national emergency declared by the ,president under the ,national ,emergencies ,act 7#ej ,u4,s4,c4 #afja et seq47 with respect to ,,covid-#ai or any other coronavirus with pandemic potential2 and 7,d7 a public health emergency declared by the ,secretary of ,health and ,human ,services pursuant to section #cai of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg7;d77 with respect to ,,covid-#ai or any other coronavirus with pandemic potential4 7#b7 ,coronavirus response law ,the term coronavirus response law means-- 7,a7 the ,coronavirus ,preparedness and ,response ,supplemental ,appropriations ,act1 #bjbj 7,public ,law #aaf-abc72 7,b7 the ,families ,first ,coronavirus ,response ,act 7,public ,law #aaf-abg72 7,c7 the ,coronavirus ,aid1 ,relief1 and ,economic ,security ,act 7,public ,law #aaf-acf72 and 7,d7 any subsequent law enacted as a response to a coronavirus public health emergency4 7#c7 ,,covid-#ai ,the term ,,covid-#ai means the ,coronavirus ,disease #bjai4 7#d7 ,enforcement action ,the term enforcement action means an apprehension1 an arrest1 a search1 an interview1 a request for identification1 or surveillance for the purposes of immigration enforcement4 7#e7 ,sensitive location ,the term sensitive location means all physical space located within #a1jjj feet of-- 7,a7 a medical treatment or health care facility1 including a hospital1 an office of a health care practitioner1 an accredited health clinic1 an alcohol or drug treatment center1 an emergent or urgent care facility1 and a community health center2 7,b7 a location at which emergency service providers distribute food or provide shelter2 7,c7 an organization that provides-- 7i7 disaster or emergency social services and assistance2 7ii7 services for individuals experiencing homelessness1 including food banks and shelters2 or 7iii7 assistance for children1 pregnant women1 victims of crime or abuse1 or individuals with significant mental or physical disabilities2 7,d7 a public assistance office1 including any ,federal1 ,state1 or municipal location at which individuals may apply for or receive unemployment compensation or report violations of labor and employment laws2 7,e7 a ,federal1 ,state1 or local courthouse1 including the office of the legal counsel or representative of an individual2 7,f7 a domestic violence shelter1 rape crisis center1 supervised visitation center1 family justice center1 or victim services provider2 7,g7 an office of the ,social ,security ,administration2 7,h7 a childcare facility or a school1 including a preschool1 primary school1 secondary school1 post-secondary school up to and including a college or university1 and any other institution of learning such as a vocational or trade school2 7,i7 a church1 synagogue1 mosque or any other institution of worship1 such as a building rented for the purpose of a religious service2 7,j7 the site of a funeral1 wedding1 or any other public religious ceremony2 7,k7 in the case of a jurisdiction in which a shelter-in-place order is in effect during a coronavirus public health emergency1 any business location considered to provide an essential service1 such as a pharmacy or a grocery store2 and 7,l7 any other location specified by the ,secretary of ,homeland ,security4 7b7 ,suspension of adverse immigration actions that deter immigrant communities from seeking health services in a public health emergency 7#a7 ,in general ,beginning on the date on which a coronavirus public health emergency is declared and ending on the date that is #fj days after the date on which the coronavirus public health emergency expires-- 7,a7 the ,secretary of ,homeland ,security1 the ,secretary of ,state1 and the ,attorney ,general shall not-- 7i7 implement the final rule of the ,department of ,homeland ,security entitled ,inadmissibility on ,public ,charge ,grounds 7#hd ,fed4 ,reg4 #dabib 7,august #ad1 #bjai772 7ii7 implement the interim final rule of the ,department of ,state entitled ,visas3 ,ineligibility ,based on ,public ,charge ,grounds 7#hd ,fed4 ,reg4 #ediif 7,october #aa1 #bjai772 7iii7 implement the proposed rule of the ,department of ,justice entitled ,inadmissibility on ,public ,charge ,grounds published in the ,fall #bjah ,uniform ,regulatory ,agenda2 7iv7 conduct any enforcement action against an individual at1 or in transit to or from1 a sensitive location unless the enforcement action is conducted pursuant to a valid judicial warrant2 7v7 detain or remove-- 7,i7 a survivor of domestic violence1 sexual assault1 or human trafficking1 or any other individual1 who has a pending application under section #aja7;a77#ae77,t71 #aja7;a77#ae77,u71 #ajf1 #bdj;,a7b77#b7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaja7;a77#ae77,t71 #aaja7;a77#ae77,u71 #aaje;a1 #abbi;b7b77#b77 or section #bdd7;a77#c7 of that ,act 7as in effect on ,march #ca1 #aiig72 or 7,,ii7 a ,,vawa self-petitioner described in section #aja7;a77#ea7 of that ,act 7#h ,u4,s4,c4 #aaja7;a77#ea77 who has a pending application for relief under-- 7aa7 a provision referred to in any of subparagraphs 7,a7 through 7,g7 of that section2 or 7bb7 section #aja7;a77#bg77;,j7 of that ,act 7#h ,u4,s4,c4 #aaja7;a77#bg77;,j772 and 7vi7 require an individual subject to supervision by ,u4,s4 ,immigration and ,customs ,enforcement to report in person4 7,b7 ,the ,attorney ,general shall conduct fully telephonic bond hearings and allow supporting documents to be faxed and emailed to the appropriate clerk4 7,c7 ,the ,secretary of ,homeland ,security1 to the extent practicable1 shall stipulate to bond determinations on written motions4 7#b7 ,use of benefits funded by coronavirus response law ,the ,secretary of ,homeland ,security1 the ,secretary of ,state1 and the ,attorney ,general shall not consider in any determination affecting the current or future immigration status of any individual the use of any benefit of any program or activity funded in whole or in part by amounts made available under a coronavirus response law4 7c7 ,access to ,,covid-#ai testing and treatment for all communities 7#a7 ,clarification regarding emergency services for certain individuals ,section #aijc7v77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7v77#b77 is amended by adding at the end the following flush sentence3 ,for purposes of subparagraph 7,a71 care and services described in such subparagraph include any in vitro diagnostic product described in section #aije7;a77#c77;,b7 that is administered during any portion of the emergency period described in such section beginning on or after the date of the enactment of this sentence 7and the administration of such product71 any ,,covid-#ai vaccine that is administered during any such portion 7and the administration of such vaccine71 any item or service that is furnished during any such portion for the treatment of ,,covid-#ai or a condition that may complicate the treatment of ,,covid-#ai1 and any services described in section #aiaf7;a77#b77;,g74 4 7#b7 ,emergency medicaid for individuals with suspected ,,covid-#ai infections ,section #aijc7v77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7v77#c77 is amended by striking means a and inserting means any concern that the individual may have contracted ,,covid-#ai or another44 7#c7 ,treatment of assistance and services provided ,for any period during which a coronavirus public health emergency is in effect-- 7,a7 the value of assistance or services provided to any person under a program with respect to which a coronavirus response law establishes or expands eligibility or benefits shall not be considered income or resources2 and 7,b7 7i7 any medical coverage or services shall be considered treatment for an emergency medical condition 7as defined in section #aijc7v77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7v77#c777 for any purpose under any ,federal1 ,state1 or local law1 including law relating to taxation1 welfare1 and public assistance programs2 7ii7 a participating ,state or political subdivision of a ,state shall not decrease any assistance otherwise provided to an individual because of the receipt of benefits under the ,social ,security ,act 7#db ,u4,s4,c4 #cja et seq472 and 7iii7 assistance and services described in this subparagraph shall be considered noncash disaster assistance1 notwithstanding the form in which the assistance and services are provided1 except that cash received by an individual or a household may be treated as income by any public benefit program under the rules applicable before the date of the enactment of this ,act4 7#d7 ,nondiscrimination ,no person shall be1 on the basis of actual or perceived immigration status1 excluded from participation in1 denied the benefits of1 or subject to discrimination under1 any program or activity funded in whole or in part by amounts made available under a coronavirus response law4 7d7 ,language access and public outreach for public health 7#a7 ,grants and cooperative agreements 7,a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention 7referred to in this subsection as the ,director7 shall provide grants to1 or enter into cooperative agreements with1 community-based organizations for the purpose of supporting culturally and linguistically appropriate preparedness1 response1 and recovery activities1 such as the development of educational programs and materials to promote screening1 testing1 treatment1 and public health practices4 7,b7 ,definition of community-based organization ,in this paragraph1 the term community-based organization means an entity that has established relationships with hard-to-reach populations1 including racial and ethnic minorities1 individuals with limited ,english proficiency1 and individuals with disabilities4 7#b7 ,translation 7,a7 ,in general ,the ,director shall provide for the translation of materials on awareness1 screening1 testing1 and treatment for ,,covid-#ai into the languages described in the language access plan of the ,federal ,emergency ,management ,agency dated ,october #a1 #bjaf1 as the languages most frequently encountered4 7,b7 ,public availability ,not later than #g days after the date on which the materials described in subparagraph 7,a7 are made available to the public in ,english1 the ,director shall ensure that the translations required by that subparagraph are made available to the public4 7#c7 ,hotline ,the ,director shall establish an informational hotline line that provides1 in the languages referred to in paragraph 7#b77;,a71 information to the public directly on ,,covid-#ai4 7#d7 ,interagency coordination ,with respect to individuals with limited ,english proficiency1 the ,director shall facilitate interagency coordination among agencies activated through the ,national ,response ,framework based on the language access standards established under the language access plans of the ,federal ,emergency ,management ,agency and the ,department of ,health and ,human ,services4 7#e7 ,authorization of appropriations 7,a7 ,in general ,there is authorized to be appropriated to carry out this subsection #ajj1jjj1jjj for fiscal year #bjbj1 to be available until expended4 7,b7 ,grants and cooperative agreements ,of the amount authorized to be appropriated under subparagraph 7,a71 not less than #ej1jjj1jjj shall be made available to carry out paragraph 7#a74 7e7 ,access ,to support measures for vulnerable communities 7#a7 ,disaster supplemental nutrition assistance program benefits ,the ,robert ,t4 ,stafford ,disaster ,relief and ,emergency ,assistance ,act 7#db ,u4,s4,c4 #eaba et seq47 is amended-- 7,a7 in section #ajb7a7 7#db ,u4,s4,c4 #eabb7a771 by inserting or pandemic after catastrophe2 7,b7 in section #cja 7#db ,u4,s4,c4 #eada71 by inserting or an emergency due to a pandemic after major disaster each place the term appears2 7,c7 in section #dab 7#db ,u4,s4,c4 #eagi7-- 7i7 by inserting or an emergency due to a pandemic after major disaster each place the term appears2 7ii7 in subsection 7a71 by inserting without regard to regular allotments before and to make surplus2 and 7iii7 by adding at the end the following3 7d7 ,assistance during a pandemic ,in the case of an emergency due to a pandemic1 for purposes of providing benefits under this section1 the ,secretary of ,agriculture shall remove or delay the requirement of an in-person interview1 and if an interview occurs1 provide an alternative to the in-person interview requirement for all applicants4 ,assistance shall be provided based on need and not lost provisions4 7e7 ,authorization of appropriations ,there are authorized to be appropriated such sums as are necessary to carry out this section1 only if such sums are designated by ,congress as being for an emergency requirement pursuant to section #bea7;b77#b77;,a77i7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe 7#b ,u4,s4,c4 #ija7;b77#b77;,a77i774 2 and 7,d7 in section #ejb7;a7 7#db ,u4,s4,c4 #eaib7;a77-- 7i7 in paragraph 7#g71 by striking and at the end2 7ii7 in paragraph 7#h77;,b71 by striking the period at the end and inserting a semicolon2 and 7iii7 by adding at the end the following3 7#i7 provide assistance in accordance with section #dab4 4 7#b7 ,access to benefits using individual taxpayer identification number ,subsection 7g77#b77;,a7 of section #fdbh of the ,internal ,revenue ,code of #aihf1 as added by section #bbja of the ,coronavirus ,aid1 ,relief1 and ,economic ,security ,act 7,public ,law #aaf-acf71 is amended by inserting before the period at the end or a taxpayer identification number4 7#c7 ,extension of immigration status and employment authorization 7,a7 ,in general ,notwithstanding any other provision of law1 including the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaja et seq471 the ,secretary of ,homeland ,security shall automatically extend the immigration status and employment authorization1 as applicable1 of an alien described in subparagraph 7,b7 for the same period for which the status and employment authorization was initially granted4 7,b7 ,alien described ,an alien described in this subparagraph is an alien 7as defined in section #aja7;a7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaja7;a777 whose immigration status1 including permanent1 temporary1 and deferred status1 or whose employment authorization-- 7i7 expired during the #cj-;day period preceding the date of the enactment of this ,act2 or 7ii7 will expire not later than-- 7,i7 one year after such date of enactment2 or 7,,ii7 #ij days after the date on which the national emergency declared by the ,president under the ,national ,emergencies ,act 7#ej ,u4,s4,c4 #afja et seq47 with respect to the ,coronavirus ,disease #bjai 7,,covid-#ai7 is rescinded4 7#d7 ,language access ,any agency receiving funding under a coronavirus response law shall ensure that all programs and opportunities made available to the general public provide translated materials describing the programs and opportunities into the languages described in the language access plan of the ,federal ,emergency ,management ,agency dated ,october #a1 #bjaf1 as the languages most frequently encountered4 #bac4 ,,ice detention 7a7 ,reviewing ,,ice detention ,during the public health emergency declared by the ,secretary of ,health and ,human ,services under section #cai of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;d7 with respect to ,,covid-#ai1 the ,secretary of ,homeland ,security shall review the immigration files of all individuals in the custody of ,u4,s4 ,immigration and ,customs ,enforcement to assess the need for continued detention4 ,the ,secretary of ,homeland ,security shall prioritize for release on recognizance or alternatives to detention individuals who are not subject to mandatory detention laws1 unless the individual is a threat to public safety or national security4 7b7 ,access to electronic communications and hygiene products ,during the period described in subsection 7c71 the ,secretary of ,homeland ,security shall ensure that-- 7#a7 all individuals in the custody of ,u4,s4 ,immigration and ,customs ,enforcement-- 7,a7 have access to telephonic or video communication at no cost to the detained individual2 7,b7 have access to free1 unmonitored telephone calls1 at any time1 to contact attorneys or legal service providers in a sufficiently private space to protect confidentiality2 7,c7 are permitted to receive legal correspondence by fax or email rather than postal mail2 and 7,d7 are provided sufficient soap1 hand sanitizer1 and other hygiene products2 and 7#b7 nonprofit organizations providing legal orientation programming or know-your-rights programming to individuals in the custody of ,u4,s4 ,immigration and ,customs ,enforcement are permitted broad and flexible access to such individuals-- 7,a7 to provide group presentations using remote videoconferencing2 and 7,b7 to schedule and provide individual orientations using free telephone calls or remote videoconferencing4 7c7 ,period described ,the period described in this subsection-- 7#a7 begins on the first day of the public health emergency declared by the ,secretary of ,health and ,human ,services under section #cai of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;d7 with respect to ,,covid-#ai2 and 7#b7 ends #ij days after the date on which such public health emergency terminates4 ,c ,contact ,tracing #bba4 ,,covid-#ai ,testing1 reaching1 and contacting everyone 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 may award grants to eligible entities to conduct diagnostic testing for ,,covid-#ai1 to trace and monitor the contacts of infected individuals1 and to support the quarantine of such contacts1 through-- 7#a7 mobile health units2 and 7#b7 as necessary1 testing individuals and providing individuals with services related to testing and quarantine at their residences4 7b7 ,permissible uses of funds ,a grant recipient under this section may use the grant funds1 in support of the activities described in subsection 7a7-- 7#a7 to hire1 train1 compensate1 and pay the expenses of individuals2 and 7#b7 to purchase personal protective equipment and other supplies4 7c7 ,priority ,in selecting grant recipients under this section1 the ,secretary shall give priority to-- 7#a7 applicants proposing to conduct activities funded under this section in hot spots and medically underserved communities2 and 7#b7 applicants that agree1 in hiring individuals to carry out activities funded under this section1 to hire residents of the area or community where the activities will primarily occur1 with higher priority among applicants described in this paragraph given based on the percentage of individuals to be hired from such area or community4 7d7 ,distribution ,in selecting grant recipients under this section1 the ,secretary shall ensure that grants are distributed across urban and rural areas4 7e7 ,federal privacy requirements ,nothing in this section shall be construed to supersede any ,federal privacy or confidentiality requirement1 including 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 and section #edc of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;dd-#b74 7f7 ,definitions ,in this section3 7#a7 ,the term eligible entity means-- 7,a7 a ,federally qualified health center 7as defined in section #ahfa7;aa7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa7772 7,b7 a school-based health clinic2 7,c7 a disproportionate share hospital 7as defined under the applicable ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 pursuant to section #aibc7;a77#a77;,a7 of such ,act 7#db ,u4,s4,c4 #acifr-#d772 7,d7 an academic medical center2 7,e7 a nonprofit organization 7including any such faith-based organization72 7,f7 an institution of higher education 7as defined in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja772 7,g7 a high school 7as defined in section #haja of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja772 7,h7 any ,tribal organization including the ,indian ,health ,service and ,native ,american servicing facilities2 or 7,i7 any other type of entity that is determined by the ,secretary to be an eligible entity for purposes of this section4 7#b7 ,the term emergency period has the meaning given to that term in section #aace7;g77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#e7;g77#a77;,b774 7#c7 ,the term hot spot means a geographic area where the rate of infection with the virus that causes ,,covid-#ai exceeds the national average4 7#d7 ,the term medically underserved community 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 7g7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated-- 7#a7 #ajj1jjj1jjj1jjj for fiscal year #bjbj2 and 7#b7 such sums as may be necessary for each of fiscal year #bjba and any subsequent fiscal year during which the emergency period continues4 #bbb4 ,national system for ,,covid-#ai testing1 contact tracing1 surveillance1 containment1 and mitigation 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 and in coordination with ,state1 local1 ,tribal1 and territorial health departments1 shall establish and implement a nationwide evidence-based system for-- 7#a7 testing1 contact tracing1 surveillance1 containment1 and mitigation with respect to ,,covid-#ai2 7#b7 offering guidance on voluntary isolation and quarantine of individuals infected with1 or exposed to individuals infected with1 the virus that causes ,,covid-#ai2 and 7#c7 public reporting on testing1 contact tracing1 surveillance1 and voluntary isolation and quarantine activities with respect to ,,covid-#ai4 7b7 ,coordination2 technical assistance ,in carrying out the national system under this section1 the ,secretary shall-- 7#a7 coordinate ,state1 local1 ,tribal1 and territorial activities related to testing1 contact tracing1 surveillance1 containment1 and mitigation with respect to ,,covid-#ai1 as appropriate2 and 7#b7 provide technical assistance for such activities1 as appropriate4 7c7 ,consideration ,in establishing and implementing the national system under this section1 the ,secretary shall take into consideration-- 7#a7 the ,state plans referred to in the heading ,public ,health and ,social ,services ,emergency ,fund in title ,i of division ,b of the ,paycheck ,protection ,program and ,health ,care ,enhancement ,act 7,public ,law #aaf-aci72 and 7#b7 the testing strategy submitted under section #baa4 7d7 ,reporting ,the ,secretary shall-- 7#a7 not later than ,december #ca1 #bjbj1 submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions a preliminary report on the effectiveness of the activities carried out pursuant to this subtitle2 and 7#b7 not later than ,december #ba1 #bjba1 submit to such committees a final report on such effectiveness4 #bbc4 ,grants 7a7 ,in general ,to implement the national system under section #bbb1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall1 subject to the availability of appropriations1 award grants to ,state1 local1 ,tribal1 and territorial health departments that seek grants under this section to carry out coordinated testing1 contact tracing1 surveillance1 containment1 and mitigation with respect to ,,covid-#ai1 including-- 7#a7 diagnostic and surveillance testing and reporting2 7#b7 community-based contact tracing efforts2 and 7#c7 policies related to voluntary isolation and quarantine of individuals infected with1 or exposed to individuals infected with1 the virus that causes ,,covid-#ai4 7b7 ,flexibility ,the ,secretary shall ensure that-- 7#a7 the grants under subsection 7a7 provide flexibility for ,state1 local1 ,tribal1 and territorial health departments to modify1 establish1 or maintain evidence-based systems2 and 7#b7 local health departments receive funding from ,state health departments or directly from the ,centers for ,disease ,control and ,prevention to contribute to such systems1 as appropriate4 7c7 ,allocations 7#a7 ,formula ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall allocate amounts made available pursuant to subsection 7a7 in accordance with a formula to be established by the ,secretary that provides a minimum level of funding to each ,state1 local1 ,tribal1 and territorial health department that seeks a grant under this section and allocates additional funding based on the following prioritization3 7,a7 ,the ,secretary shall give highest priority to applicants proposing to serve populations in one or more geographic regions with a high burden of ,,covid-#ai based on data provided by the ,centers for ,disease ,control and ,prevention1 or other sources as determined by the ,secretary4 7,b7 ,the ,secretary shall give second highest priority to applicants preparing for1 or currently working to mitigate1 a ,,covid-#ai surge in a geographic region that does not yet have a high number of reported cases of ,,covid-#ai based on data provided by the ,centers for ,disease ,control and ,prevention1 or other sources as determined by the ,secretary4 7,c7 ,the ,secretary shall give third highest priority to applicants proposing to serve high numbers of low-income and uninsured populations1 including medically underserved populations 7as defined in section #ccj7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c7771 health professional shortage areas 7as defined under section #ccb7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7a7771 racial and ethnic minorities1 or geographically diverse areas1 as determined by the ,secretary4 7#b7 ,notification ,not later than the date that is one week before first awarding grants under this section1 the ,secretary 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 notification detailing the formula established under paragraph 7#a7 for allocating amounts made available pursuant to subsection 7a74 7d7 ,use of funds ,a ,state1 local1 ,tribal1 and territorial health department receiving a grant under this section shall1 to the extent possible1 use the grant funds for the following activities1 or other activities deemed appropriate by the ,director of the ,centers for ,disease ,control and ,prevention3 7#a7 ,testing ,to implement a coordinated testing system that-- 7,a7 leverages or modernizes existing testing infrastructure and capacity2 7,b7 is consistent with the updated testing strategy required under section #baa2 7,c7 is coordinated with the ,state plan for ,,covid-#ai testing prepared as required under the heading ,department of ,health and ,human ,services--,office of the ,secretary--,public ,health and ,social ,service ,emergency ,fund in title ,i of division ,b of the ,paycheck ,protection ,program and ,health ,care ,enhancement ,act 7,public ,law #aaf-aci2 #acd ,stat4 #fbj1 #fbd72 7,d7 is informed by contact tracing and surveillance activities under this subtitle2 7,e7 is informed by guidelines established by the ,centers for ,disease ,control and ,prevention for which populations should be tested2 7,f7 identifies how diagnostic and serological tests in such system shall be validated prior to use2 7,g7 identifies how diagnostic and serological tests and testing supplies will be distributed to implement such system2 7,h7 identifies specific strategies for ensuring testing capabilities and accessibility in medically underserved populations 7as defined in section #ccj7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c7771 health professional shortage areas 7as defined under section #ccb7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7a7771 racial and ethnic minority populations1 and geographically diverse areas1 as determined by the ,secretary2 7,i7 identifies how testing may be used1 and results may be reported1 in both health care settings 7such as hospitals1 laboratories for moderate or high-complexity testing1 pharmacies1 mobile testing units1 and community health centers7 and non-health care settings 7such as workplaces1 schools1 childcare centers1 or drive-throughs72 7,j7 allows for testing in sentinel surveillance programs1 as appropriate2 and 7,k7 supports the procurement and distribution of diagnostic and serological tests and testing supplies to meet the goals of the system4 7#b7 ,contact tracing ,to implement a coordinated contact tracing system that-- 7,a7 leverages or modernizes existing contact tracing systems and capabilities1 including community health workers1 health departments1 and ,federally qualified health centers2 7,b7 is able to investigate cases of ,,covid-#ai1 and help to identify other potential cases of ,,covid-#ai1 through tracing contacts of individuals with positive diagnoses2 7,c7 establishes culturally competent and multilingual strategies for contact tracing1 which may include consultation with and support for cultural or civic organizations with established ties to the community2 7,d7 provides individuals identified under the contact tracing program with information and support for containment or mitigation2 7,e7 enables ,state1 local1 ,tribal1 and territorial health departments to work with a nongovernmental1 community partner or partners and ,state and local workforce development systems 7as defined in section #c7fg7 of ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cajb7fg777 receiving grants under section #bbd7;b7 of this ,act to hire and compensate a locally sourced contact tracing workforce1 if necessary1 to supplement the public health workforce1 to-- 7i7 identify the number of contact tracers needed for the respective ,state1 locality1 territorial1 or ,tribal health department to identify all cases of ,,covid-#ai currently in the jurisdiction and those anticipated to emerge over the next #ah months in such jurisdiction2 7ii7 outline qualifications necessary for contact tracers2 7iii7 train the existing and newly hired public health workforce on best practices related to tracing close contacts of individuals diagnosed with ,,covid-#ai1 including the protection of individual privacy and cybersecurity protection2 and 7iv7 equip the public health workforce with tools and resources to enable a rapid response to new cases2 7,f7 identifies the level of contact tracing needed within the ,state1 locality1 territory1 or ,tribal area to contain and mitigate the transmission of ,,covid-#ai2 7,g7 establishes statewide mechanisms to integrate regular evaluation to the ,centers for ,disease ,control and ,prevention regarding contact tracing efforts1 makes such evaluation publicly available1 and to the extent possible provides for such evaluation at the county level2 and 7,h7 identifies specific strategies for ensuring contact tracing activities in medically underserved populations 7as defined in section #ccj7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c7771 health professional shortage areas 7as defined under section #ccb7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7a7771 racial and ethnic minority populations1 and geographically diverse areas1 as determined by the ,secretary4 7#c7 ,surveillance ,to strengthen the existing public health surveillance system that-- 7,a7 leverages or modernizes existing surveillance systems within the respective ,state1 local1 ,tribal1 or territorial health department and national surveillance systems2 7,b7 detects and identifies trends in ,,covid-#ai at the county level2 7,c7 evaluates ,state1 local1 ,tribal1 and territorial health departments in achieving surveillance capabilities with respect to ,,covid-#ai2 7,d7 integrates and improves disease surveillance and immunization tracking2 and 7,e7 identifies specific strategies for ensuring disease surveillance in medically underserved populations 7as defined in section #ccj7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c7771 health professional shortage areas 7as defined under section #ccb7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7a7771 racial and ethnic minority populations1 and geographically diverse areas1 as determined by the ,secretary4 7#d7 ,containment and mitigation ,to implement a coordinated containment and mitigation system that-- 7,a7 leverages or modernizes existing containment and mitigation strategies within the respective ,state1 local1 ,tribal1 or territorial governments and national containment and mitigation strategies2 7,b7 may provide for1 connect to1 and leverage existing social services and support for individuals who have been infected with or exposed to ,,covid-#ai and who are isolated or quarantined in their homes1 such as through-- 7i7 food assistance programs2 7ii7 guidance for household infection control2 7iii7 information and assistance with childcare services2 and 7iv7 information and assistance pertaining to support available under the ,,cares ,act 7,public ,law #aaf-acf7 and this ,act2 7,c7 provides guidance on the establishment of safe1 high-quality1 facilities for the voluntary isolation of individuals infected with1 or quarantine of the contacts of individuals exposed to ,,covid-#ai1 where hospitalization is not required1 which facilities should-- 7i7 be prohibited from making inquiries relating to the citizenship status of an individual isolated or quarantined2 and 7ii7 be operated by a non-,federal1 community partner or partners that-- 7,i7 have previously established relationships in localities2 7,,ii7 work with local places of worship1 community centers1 medical facilities1 and schools to recruit local staff for such facilities2 and 7,,iii7 are fully integrated into ,state1 local1 ,tribal1 or territorial containment and mitigation efforts2 and 7,d7 identifies specific strategies for ensuring containment and mitigation activities in medically underserved populations 7as defined in section #ccj7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c7771 health professional shortage areas 7as defined under section #ccb7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7a7771 racial and ethnic minority populations1 and geographically diverse areas1 as determined by the ,secretary4 7e7 ,reporting ,the ,secretary shall facilitate mechanisms for timely1 standardized reporting by grantees under this section regarding implementation of the systems established under this section and coordinated processes with the reporting as required and under the heading ,department of ,health and ,human ,services--,office of the ,secretary--,public ,health and ,social ,service ,emergency ,fund in title ,i of division ,b of the ,paycheck ,protection ,program and ,health ,care ,enhancement ,act 7,public ,law #aaf-aci1 #acd ,stat4 #fbj71 including-- 7#a7 a summary of county or local health department level information from the ,states receiving funding1 and information from directly funded localities1 territories1 and ,tribal entities1 about the activities that will be undertaken using funding awarded under this section1 including subgrants2 7#b7 any anticipated shortages of required materials for testing for ,,covid-#ai under subsection 7a72 and 7#c7 other barriers in the prevention1 mitigation1 or treatment of ,,covid-#ai under this section4 7f7 ,public listing of awards ,the ,secretary shall-- 7#a7 not later than #g days after first awarding grants under this section1 post in a searchable1 electronic format a list of all awards made by the ,secretary under this section1 including the recipients and amounts of such awards2 and 7#b7 update such list not less than every #g days until all funds made available to carry out this section are expended4 #bbd4 ,grants to ,state and ,tribal workforce agencies 7a7 ,definitions ,in this section3 7#a7 ,in general ,except as otherwise provided1 the terms in this section have the meanings given the terms in section #c of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cajb74 7#b7 ,apprenticeship2 apprenticeship program ,the term apprenticeship or apprenticeship program means an apprenticeship program registered under the ,act of ,august #af1 #aicg 7commonly known as the ,national ,apprenticeship ,act7 7#ej ,stat4 #ffd1 chapter #ffc2 #bi ,u4,s4,c4 #ej et seq471 including any requirement1 standard1 or rule promulgated under such ,act1 as such requirement1 standard1 or rule was in effect on ,december #cj1 #bjai4 7#c7 ,contact tracing and related positions ,the term contact tracing and related positions means employment related to contact tracing1 surveillance1 containment1 and mitigation activities as described in paragraphs 7#b71 7#c71 and 7#d7 of section #bbc7;d74 7#d7 ,eligible entity ,the term eligible entity means-- 7,a7 a ,state or territory1 including the ,district of ,columbia and ,puerto ,rico2 7,b7 an ,indian ,tribe1 ,tribal organization1 ,alaska ,native entity1 ,indian-controlled organizations serving ,indians1 or ,native ,hawaiian organizations2 7,c7 an outlying area2 or 7,d7 a local board1 if an eligible entity under subparagraphs 7,a7 through 7,c7 has not applied with respect to the area over which the local board has jurisdiction as of the date on which the local board submits an application under subsection 7c74 7#e7 ,eligible individual ,notwithstanding section #agj7;b77#b7 of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cbbe7;b77#b771 the term eligible individual means an individual seeking or securing employment in contact tracing and related positions and served by an eligible entity or community-based organization receiving funding under this section4 7#f7 ,secretary ,the term ,secretary means the ,secretary of ,labor4 7b7 ,grants 7#a7 ,in general ,subject to the availability of appropriations under subsection 7g71 the ,secretary shall award national dislocated worker grants under section #agj7;b77#a77;,b7 of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cbbe7;b77#a77;,b77 to each eligible entity that seeks a grant to assist local boards and community-based organizations in carrying out activities under subsections 7f7 and 7d71 respectively1 for the following purposes3 7,a7 ,to support the recruitment1 placement1 and training1 as applicable1 of eligible individuals seeking employment in contact tracing and related positions in accordance with the national system for ,,covid-#ai testing1 contact tracing1 surveillance1 containment1 and mitigation established under section #bbb4 7,b7 ,to assist with the employment transition to new employment or education and training of individuals employed under this section in preparation for and upon termination of such employment4 7#b7 ,timeline ,the ,secretary of ,labor shall-- 7,a7 issue application requirements under subsection 7c7 not later than #aj days after the date of enactment of this section2 and 7,b7 award grants to an eligible entity under paragraph 7#a7 not later than #aj days after the date on which the ,secretary receives an application from such entity4 7c7 ,grant application ,an eligible entity applying for a grant under this section shall submit an application to the ,secretary1 at such time and in such form and manner as the ,secretary may reasonably require1 which shall include a description of-- 7#a7 how the eligible entity will support the recruitment1 placement1 and training1 as applicable1 of eligible individuals seeking employment in contact tracing and related positions by partnering with-- 7,a7 a ,state1 local1 ,tribal1 or territorial health department2 or 7,b7 one or more nonprofit or community-based organizations partnering with such health departments2 7#b7 how the activities described in paragraph 7#a7 will support ,state efforts to address the demand for contact tracing and related positions with respect to-- 7,a7 the ,state plans referred to in the heading ,public ,health and ,social ,services ,emergency ,fund in title ,i of division ,b of the ,paycheck ,protection ,program and ,health ,care ,enhancement ,act 7,public ,law #aaf-aci72 7,b7 the testing strategy submitted under section #baa2 and 7,c7 the number of eligible individuals that the ,state plans to recruit and train under the plans and strategies described in subparagraphs 7,a7 and 7,b72 7#c7 the specific strategies for recruiting and placement of eligible individuals from or residing within the communities in which they will work1 including-- 7,a7 plans for the recruitment of eligible individuals to serve as contact tracers and related positions1 including dislocated workers1 individuals with barriers to employment1 veterans1 new entrants in the workforce1 or underemployed or furloughed workers1 who are from or reside in or near the local area in which they will serve1 and who1 to the extent practicable-- 7i7 have experience or a background in industry-sectors and occupations such as public health1 social services1 customer service1 case management1 or occupations that require related qualifications1 skills1 or competencies1 such as strong interpersonal and communication skills1 needed for contact tracing and related positions1 as described in section #bbc7;d77#b77;,e77ii72 or 7ii7 seek to transition to public health and public health related occupations upon the conclusion of employment in contact tracing and related positions2 and 7,b7 how such strategies will take into account the diversity of such community1 including racial1 ethnic1 socioeconomic1 linguistic1 or geographic diversity2 7#d7 the amount1 timing1 and mechanisms for distribution of funds provided to local boards or through subgrants as described in subsection 7d72 7#e7 for eligible entities described in subparagraphs 7,a7 through 7,c7 of subsection 7a77#d71 a description of how the eligible entity will ensure the equitable distribution of funds with respect to-- 7,a7 geography 7such as urban and rural distribution72 7,b7 medically underserved populations 7as defined in section #cc7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b7772 7,c7 health professional shortage areas 7as defined under section #ccb7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7a7772 and 7,d7 the racial and ethnic diversity of the area2 and 7#f7 for eligible entities who are local boards1 a description of how a grant to such eligible entity would serve the equitable distribution of funds as described in paragraph 7#e74 7d7 ,subgrant authorization and application process 7#a7 ,in general ,an eligible entity may award a subgrant to one or more community-based organizations for the purposes of partnering with a ,state or local board to conduct outreach and education activities to inform potentially eligible individuals about employment opportunities in contact tracing and related positions4 7#b7 ,application ,a community-based organization shall submit an application at such time and in such manner as the eligible entity may reasonably require1 including-- 7,a7 a demonstration of the community-based organization's established expertise and effectiveness in community outreach in the local area that such organization plans to serve2 7,b7 a demonstration of the community-based organization's expertise in providing employment or public health information to the local areas in which such organization plans to serve2 and 7,c7 a description of the expertise of the community-based organization in utilizing culturally competent and multilingual strategies in the provision of services4 7e7 ,grant distribution 7#a7 ,federal distribution 7,a7 ,use of funds ,the ,secretary of ,labor shall use the funds appropriated to carry out this section as follows3 7i7 ,subject to clause 7ii71 the ,secretary shall distribute funds among eligible entities in accordance with a formula to be established by the ,secretary that provides a minimum level of funding to each eligible entity that seeks a grant under this section and allocates additional funding as follows3 7,i7 ,the formula shall give first priority based on the number and proportion of contact tracing and related positions that the ,state plans to recruit1 place1 and train individuals as a part of the ,state strategy described in subsection 7c77#b77;,a74 7,,ii7 ,subject to subclause 7,i71 the formula shall give priority in accordance with section #bbc7;c74 7ii7 ,not more than #b percent of the funding for administration of the grants and for providing technical assistance to recipients of funds under this section4 7,b7 ,equitable distribution ,if the geographic region served by one or more eligible entities overlaps1 the ,secretary shall distribute funds among such entities in such a manner that ensures equitable distribution with respect to the factors under subsection 7c77#e74 7#b7 ,eligible entity use of funds ,an eligible entity described in subparagraphs 7,a7 through 7,c7 of subsection 7a77#d7-- 7,a7 shall1 not later than #cj days after the date on which the entity receives grant funds under this section1 provide not less than #gj percent of grant funds to local boards for the purpose of carrying out activities in subsection 7f72 7,b7 may use up to #bj percent of such funds to make subgrants to community-based organizations in the service area to conduct outreach1 to potential eligible individuals1 as described in subsection 7d72 7,c7 in providing funds to local boards and awarding subgrants under this subsection shall ensure the equitable distribution with respect to the factors described in subsection 7c77#e72 and 7,d7 may use not more than #aj percent of the funds awarded under this section for the administrative costs of carrying out the grant and for providing technical assistance to local boards and community-based organizations4 7#c7 ,local board use of funds ,a local board1 or an eligible entity that is a local board1 shall use-- 7,a7 not less than #fj percent of the funds for recruitment and training for ,,covid-#ai testing1 contact tracing1 surveillance1 containment1 and mitigation established under section #bbb2 7,b7 not less than #cj percent of the funds to support the transition of individuals hired as contact tracers and related positions into an education or training program1 or unsubsidized employment upon completion of such positions2 and 7,c7 not more than #aj percent of the funds for administrative costs4 7f7 ,eligible activities ,the ,state or local boards shall use funds awarded under this section to support the recruitment and placement of eligible individuals1 training and employment transition as related to contact tracing and related positions1 and for the following activities3 7#a7 ,establishing or expanding partnerships with-- 7,a7 ,state1 local1 ,tribal1 and territorial public health departments2 7,b7 community-based health providers1 including community health centers and rural health clinics2 7,c7 labor organizations or joint labor management organizations2 7,d7 two-year and four-year institutions of higher education 7as defined in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja771 including institutions eligible to receive funds under section #cga7;a7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajfgq7a772 and 7,e7 community action agencies or other community-based organizations serving local areas in which there is a demand for contact tracing and related positions4 7#b7 ,providing training for contact tracing and related positions in coordination with ,state1 local1 ,tribal1 or territorial health departments that is consistent with the ,state or territorial testing and contact tracing strategy1 and ensuring that eligible individuals receive compensation while participating in such training4 7#c7 ,providing eligible individuals with-- 7,a7 adequate and safe equipment1 environments1 and facilities for training and supervision1 as applicable2 7,b7 information regarding the wages and benefits related to contact tracing and related positions1 as compared to ,state1 local1 and national averages2 7,c7 supplies and equipment needed by the eligible individuals to support placement of an individual in contact tracing and related positions1 as applicable2 7,d7 an individualized employment plan for each eligible individual1 as applicable-- 7i7 in coordination with the entity employing the eligible individual in a contact tracing and related positions2 and 7ii7 which shall include providing a case manager to work with each eligible individual to develop the plan1 which may include-- 7,i7 identifying employment and career goals1 and setting appropriate achievement objectives to attain such goals2 and 7,,ii7 exploring career pathways that lead to in-demand industries and sectors1 including in public health and related occupations2 and 7,e7 services for the period during which the eligible individual is employed in a contact tracing and related position to ensure job retention1 which may include-- 7i7 supportive services throughout the term of employment2 7ii7 a continuation of skills training as related to employment in contact tracing and related positions1 that is conducted in collaboration with the employers of such individuals2 7iii7 mentorship services and job retention support for eligible individuals2 or 7iv7 targeted training for managers and workers working with eligible individuals 7such as mentors71 and human resource representatives4 7#d7 ,supporting the transition and placement in unsubsidized employment for eligible individuals serving in contact tracing and related positions after such positions are no longer necessary in the ,state or local area1 including-- 7,a7 any additional training and employment activities as described in section #agj7;d77#d7 of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cbbe7;d77#d772 7,b7 developing the appropriate combination of services to enable the eligible individual to achieve the employment and career goals identified under paragraph 7#c77;,d77ii77,i72 and 7,c7 services to assist eligible individuals in maintaining employment for not less than #ab months after the completion of employment in contact tracing and related positions1 as appropriate4 7#e7 ,any other activities as described in subsections 7a77#c7 and 7b7 of section #acd of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cagd74 7g7 ,limitation ,notwithstanding section #agj7;d77#c77;,a7 of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cbbe7;d77#c77;,a771 a person may be employed in a contact tracing and related positions using funds under this section for a period not greater than #b years4 7h7 ,reporting by the ,department of ,labor 7#a7 ,in general ,not later than #abj days of the enactment of this ,act1 and once grant funds have been expended under this section1 the ,secretary shall report to the ,committee on ,education and ,labor of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate1 and make publicly available a report containing a description of-- 7,a7 the number of eligible individuals recruited1 hired1 and trained in contact tracing and related positions2 7,b7 the number of individuals successfully transitioned to unsubsidized employment or training at the completion of employment in contact tracing and related positions using funds under this subtitle2 7,c7 the number of such individuals who were unemployed prior to being hired1 trained1 or deployed as described in paragraph 7#a72 7,d7 the performance of each program supported by funds under this subtitle with respect to the indicators of performance under section #aaf of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cada71 as applicable2 7,e7 the number of individuals in unsubsidized employment within six months and #a year1 respectively1 of the conclusion of employment in contact tracing and related positions and1 of those1 the number of individuals within a ,state1 territorial1 or local public health department in an occupation related to public health2 7,f7 any information on how eligible entities1 local boards1 or community-based organizations that received funding under this subsection were able to support the goals of the national system for ,,covid-#ai testing1 contact tracing1 surveillance1 containment1 and mitigation established under section #bbb of this ,act2 and 7,g7 best practices for improving and increasing the transition of individuals employed in contract tracing and related positions to unsubsidized employment4 7#b7 ,disaggregation ,all data reported under paragraph 7#a7 shall be disaggregated by race1 ethnicity1 sex1 age1 and1 with respect to individuals with barriers to employment1 subpopulation of such individuals1 except for when the number of participants in a category is insufficient to yield statistically reliable information or when the results would reveal personally identifiable information about an individual participant4 7i7 ,special rule ,any funds used for programs under this section that are used to fund an apprenticeship or apprenticeship program shall only be used for1 or provided to1 an apprenticeship or apprenticeship program that meets the definition of such term subsection 7a7 of this section1 including any funds awarded for the purposes of grants1 contracts1 or cooperative agreements1 or the development1 implementation1 or administration1 of an apprenticeship or an apprenticeship program4 7j7 ,information sharing requirement for ,,hhs ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall provide the ,secretary of ,labor1 acting through the ,assistant ,secretary of the ,employment and ,training ,administration1 with information on grants under section #bbc1 including-- 7#a7 the formula used to award such grants to ,state1 local1 ,tribal1 and territorial health departments2 7#b7 the dollar amounts of and scope of the work funded under such grants2 7#c7 the geographic areas served by eligible entities that receive such grants2 and 7#d7 the number of contact tracers and related positions to be hired using such grants4 7k7 ,authorization of appropriations ,of the amounts appropriated to carry out this subtitle1 #ejj1jjj1jjj shall be used by the ,secretary of ,labor to carry out subsections 7a7 through 7h7 of this section4 ,,iii ,free ,treatment for ,all ,americans #cja4 ,coverage at no cost sharing of ,,covid-#ai vaccine and treatment 7a7 ,medicaid 7#a7 ,in general ,section #aije7;a77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77#d77 is amended-- 7,a7 by striking and 7,d7 and inserting 7,d72 and 7,b7 by striking the semicolon at the end and inserting 2 7,e7 during the portion of the emergency period described in paragraph 7#a77;,b7 of section #aace7;g7 beginning on the date of the enactment of ,the ,heroes ,act1 a ,,covid-#ai vaccine licensed under section #cea of the ,public ,health ,service ,act1 or approved or authorized under sections #eje or #efd of the ,federal ,food1 ,drug1 and ,cosmetic ,act1 and administration of the vaccine2 and 7,f7 during such portion of the emergency period described in paragraph 7#a77;,b7 of section #aace7;g71 items or services for the prevention or treatment of ,,covid-#ai1 including drugs approved or authorized under such section #eje or such section #efd or1 without regard to the requirements of section #aijb7;a77#aj77;,b7 7relating to comparability71 in the case of an individual who is diagnosed with or presumed to have ,,covid-#ai1 during such portion of such emergency period during which such individual is infected 7or presumed infected7 with ,,covid-#ai1 the treatment of a condition that may complicate the treatment of ,,covid-#ai24 7#b7 ,prohibition of cost sharing 7,a7 ,in general ,subsections 7a77#b7 and 7b77#b7 of section #aiaf of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo7 are each amended-- 7i7 in subparagraph 7,f71 by striking or at the end2 7ii7 in subparagraph 7,g71 by striking 2 and and inserting 22 and 7iii7 by adding at the end the following subparagraphs3 7,h7 during the portion of the emergency period described in paragraph 7#a77;,b7 of section #aace7;g7 beginning on the date of the enactment of this subparagraph1 a ,,covid-#ai vaccine licensed under section #cea of the ,public ,health ,service ,act1 or approved or authorized under section #eje or #efd of the ,federal ,food1 ,drug1 and ,cosmetic ,act1 and the administration of such vaccine2 or 7,i7 during such portion of the emergency period described in paragraph 7#a77;,b7 of section #aace7;g71 any item or service furnished for the treatment of ,,covid-#ai1 including drugs approved or authorized under such section #eje or such section #efd or1 in the case of an individual who is diagnosed with or presumed to have ,,covid-#ai1 during the portion of such emergency period during which such individual is infected 7or presumed infected7 with ,,covid-#ai1 the treatment of a condition that may complicate the treatment of ,,covid-#ai2 and 4 7,b7 ,application to alternative cost sharing ,section #aiaf;,a7b77#c77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo-#a7;b77#c77;,b77 is amended-- 7i7 in clause 7xi71 by striking any visit and inserting any service2 and 7ii7 by adding at the end the following clauses3 7xii7 ,during the portion of the emergency period described in paragraph 7#a77;,b7 of section #aace7;g7 beginning on the date of the enactment of this clause1 a ,,covid-#ai vaccine licensed under section #cea of the ,public ,health ,service ,act1 or approved or authorized under section #eje or #efd of the ,federal ,food1 ,drug1 and ,cosmetic ,act1 and the administration of such vaccine4 7xiii7 ,during such portion of the emergency period described in paragraph 7#a77;,b7 of section #aace7;g71 an item or service furnished for the treatment of ,,covid-#ai1 including drugs approved or authorized under such section #eje or such section #efd or1 in the case of an individual who is diagnosed with or presumed to have ,,covid-#ai1 during such portion of such emergency period during which such individual is infected 7or presumed infected7 with ,,covid-#ai1 the treatment of a condition that may complicate the treatment of ,,covid-#ai4 4 7,c7 ,clarification ,the amendments made by this subsection shall apply with respect to a ,state plan of a territory in the same manner as a ,state plan of one of the #ej ,states4 7b7 ,state pediatric vaccine distribution program ,section #aibh of the ,social ,security ,act 7#db ,u4,s4,c4 #acifs7 is amended-- 7#a7 in subsection 7a77#a7-- 7,a7 in subparagraph 7,a71 by striking 2 and and inserting a semicolon2 7,b7 in subparagraph 7,b71 by striking the period and inserting 2 and2 and 7,c7 by adding at the end the following subparagraph3 7,c7 during the portion of the emergency period described in paragraph 7#a77;,b7 of section #aace7;g7 beginning on the date of the enactment of this subparagraph1 each vaccine-eligible child 7as defined in subsection 7b77 is entitled to receive a ,,covid-#ai vaccine from a program-registered provider 7as defined in subsection 7h77#g77 without charge for-- 7i7 the cost of such vaccine2 or 7ii7 the administration of such vaccine4 2 7#b7 in subsection 7c77#b7-- 7,a7 in subparagraph 7,c77ii71 by inserting 1 but1 during the portion of the emergency period described in paragraph 7#a77;,b7 of section #aace7;g7 beginning on the date of the enactment of ,the ,heroes ,act1 may not impose a fee for the administration of a ,,covid-#ai vaccine before the period2 and 7,b7 by adding at the end the following subparagraph3 7,d7 ,the provider will provide and administer an approved ,,covid-#ai vaccine to a vaccine-eligible child in accordance with the same requirements as apply under the preceding subparagraphs to the provision and administration of a qualified pediatric vaccine to such a child4 2 and 7#c7 in subsection 7d77#a71 in the first sentence1 by inserting 1 including1 during the portion of the emergency period described in paragraph 7#a77;,b7 of section #aace7;g7 beginning on the date of the enactment of ,the ,heroes ,act1 with respect to a ,,covid-#ai vaccine licensed under section #cea of the ,public ,health ,service ,act1 or approved or authorized under section #eje or #efd of the ,federal ,food1 ,drug1 and ,cosmetic ,act before the period4 7c7 ,,chip 7#a7 ,in general ,section #bajc7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7c77 is amended by adding at the end the following paragraph3 7#aa7 ,coverage of ,,covid-#ai vaccines and treatment ,regardless of the type of coverage elected by a ,state under subsection 7a71 child health assistance provided under such coverage for targeted low-income children and1 in the case that the ,state elects to provide pregnancy-related assistance under such coverage pursuant to section #baab1 such pregnancy-related assistance for targeted low-income pregnant women 7as defined in section #baab7;d77 shall include coverage1 during the portion of the emergency period described in paragraph 7#a77;,b7 of section #aace7;g7 beginning on the date of the enactment of this paragraph1 of-- 7,a7 a ,,covid-#ai vaccine licensed under section #cea of the ,public ,health ,service ,act1 or approved or authorized under section #eje or #efd of the ,federal ,food1 ,drug1 and ,cosmetic ,act1 and the administration of such vaccine2 and 7,b7 any item or service furnished for the treatment of ,,covid-#ai1 including drugs approved or authorized under such section #eje or such section #efd1 or1 in the case of an individual who is diagnosed with or presumed to have ,,covid-#ai1 during the portion of such emergency period during which such individual is infected 7or presumed infected7 with ,,covid-#ai1 the treatment of a condition that may complicate the treatment of ,,covid-#ai4 4 7#b7 ,prohibition of cost sharing ,section #bajc7;e77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7e77#b771 as amended by section #fjjd7;b77#c7 of the ,families ,first ,coronavirus ,response ,act1 is amended-- 7,a7 in the paragraph header1 by inserting a ,,covid-#ai vaccine1 ,,covid-#ai treatment1 before or pregnancy-related assistance2 and 7,b7 by striking visits described in section #aiaf7;a77#b77;,g71 or and inserting services described in section #aiaf7;a77#b77;,g71 vaccines described in section #aiaf7;a77#b77;,h7 administered during the portion of the emergency period described in paragraph 7#a77;,b7 of section #aace7;g7 beginning on the date of the enactment of ,the ,heroes ,act1 items or services described in section #aiaf7;a77#b77;,i7 furnished during such emergency period1 or4 7d7 ,conforming amendments ,section #aicg of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#g7 is amended-- 7#a7 in subsection 7a77#a77;,b71 by inserting 1 under subclause 7,,xxiii7 of section #aijb7;a77#aj77;,a77ii71 after section #aijb7;a77#aj77;,a77i72 and 7#b7 in subsection 7b77#e71 by adding before the period the following3 1 and1 effective on the date of the enactment of ,the ,heroes ,act1 must comply with subparagraphs 7,f7 through 7,i7 of subsections 7a77#b7 and 7b77#b7 of section #aiaf and subsection 7b77#c77;,b7 of section #aiaf;,a4 7e7 ,effective date ,the amendments made by this section shall take effect on the date of enactment of this ,act and shall apply with respect to a ,,covid-#ai vaccine beginning on the date that such vaccine is licensed under section #cea of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bfb71 or approved or authorized under section #eje or #efd of the ,federal ,food1 ,drug1 and ,cosmetic ,act4 #cjb4 ,optional coverage at no cost sharing of ,,covid-#ai treatment and vaccines under ,medicaid for uninsured individuals 7a7 ,in general ,section #aijb7;a77#aj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77 is amended1 in the matter following subparagraph 7,g71 by striking and any visit described in section #aiaf7;a77#b77;,g7 and inserting the following3 1 any ,,covid-#ai vaccine that is administered during any such portion 7and the administration of such vaccine71 any item or service that is furnished during any such portion for the treatment of ,,covid-#ai1 including drugs approved or authorized under section #eje or #efd of the ,federal ,food1 ,drug1 and ,cosmetic ,act1 or1 in the case of an individual who is diagnosed with or presumed to have ,,covid-#ai1 during the period such individual is infected 7or presumed infected7 with ,,covid-#ai1 the treatment of a condition that may complicate the treatment of ,,covid-#ai1 and any services described in section #aiaf7;a77#b77;,g74 7b7 ,definition of uninsured individual 7#a7 ,in general ,subsection 7ss7 of section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended to read as follows3 7ss7 ,uninsured individual defined ,for purposes of this section1 the term uninsured individual means1 notwithstanding any other provision of this title1 any individual who is not covered by minimum essential coverage 7as defined in section #ejjj;,a7f77#a7 of the ,internal ,revenue ,code of #aihf74 4 7#b7 ,effective date ,the amendment made by paragraph 7#a7 shall take effect and apply as if included in the enactment of the ,families ,first ,coronavirus ,response ,act 7,public ,law #aaf-abg74 7c7 ,clarification regarding emergency services for certain individuals ,section #aijc7v77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7v77#b77 is amended by adding at the end the following flush sentence3 ,for purposes of subparagraph 7,a71 care and services described in such subparagraph include any in vitro diagnostic product described in section #aije7;a77#c77;,b7 7and the administration of such product71 any ,,covid-#ai vaccine 7and the administration of such vaccine71 any item or service that is furnished for the treatment of ,,covid-#ai1 including drugs approved or authorized under section #eje or #efd of the ,federal ,food1 ,drug1 and ,cosmetic ,act1 or a condition that may complicate the treatment of ,,covid-#ai1 and any services described in section #aiaf7;a77#b77;,g74 4 7d7 ,inclusion of ,,covid-#ai concern as an emergency condition ,section #aijc7v77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7v77#c77 is amended by adding at the end the following flush sentence3 ,such term includes any indication that an alien described in paragraph 7#a7 may have contracted ,,covid-#ai4 4 #cjc4 ,coverage of treatments for ,,covid-#ai at no cost sharing under the ,medicare ,advantage program 7a7 ,in general ,section #aheb7;a77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;a77#a77;,b77 is amended by adding at the end the following new clause3 7vii7 ,special coverage rules for specified ,,covid-#ai treatment services ,notwithstanding clause 7i71 in the case of a specified ,,covid-#ai treatment service 7as defined in section #cjbja7;b7 of ,the ,heroes ,act7 that is furnished during a plan year occurring during any portion of the emergency period defined in section #aace7;g77#a77;,b7 beginning on or after the date of the enactment of this clause1 a ,medicare ,advantage plan may not1 with respect to such service1 impose-- 7,i7 any cost-sharing requirement 7including a deductible1 copayment1 or coinsurance requirement72 and 7,,ii7 in the case such service is a critical specified ,,covid-#ai treatment service 7including ventilator services and intensive care unit services71 any prior authorization or other utilization management requirement4 ,a ,medicare ,advantage plan may not take the application of this clause into account for purposes of a bid amount submitted by such plan under section #ahed7;a77#f74 4 7b7 ,implementation ,notwithstanding any other provision of law1 the ,secretary of ,health and ,human ,services may implement the amendments made by this section by program instruction or otherwise4 #cjd4 ,requiring coverage under ,medicare ,,pdps and ,,ma-,,pd plans1 without the imposition of cost sharing or utilization management requirements1 of drugs intended to treat ,,covid-#ai during certain emergencies 7a7 ,coverage requirement ,section #ahfj;,d-#d7;b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;b77#c77 is amended by adding at the end the following new subparagraph3 7,i7 ,required inclusion of drugs intended to treat ,,covid-#ai 7i7 ,in general ,notwithstanding any other provision of law1 a ,,pdp sponsor offering a prescription drug plan shall1 with respect to a plan year1 any portion of which occurs during the period described in clause 7ii71 be required to-- 7,i7 include in any formulary-- 7aa7 all covered part ,d drugs with a medically accepted indication 7as defined in section #ahfj;,d-#b7;e77#d77 to treat ,,covid-#ai that are marketed in the ,united ,states2 and 7bb7 all drugs authorized under section #efd or #efd;,a of the ,federal ,food1 ,drug1 and ,cosmetic ,act to treat ,,covid-#ai2 and 7,,ii7 not impose any prior authorization or other utilization management requirement with respect to such drugs described in item 7aa7 or 7bb7 of subclause 7,i7 7other than such a requirement that limits the quantity of drugs due to safety74 7ii7 ,period described ,for purposes of clause 7i71 the period described in this clause is the period during which there exists the public health emergency declared by the ,secretary pursuant to section #cai of the ,public ,health ,service ,act on ,january #ca1 #bjbj1 entitled ,determination that a ,public ,health ,emergency ,exists ,nationwide as the ,result of the #bjai ,novel ,coronavirus 7including any renewal of such declaration pursuant to such section74 4 7b7 ,elimination of cost sharing 7#a7 ,elimination of cost sharing for drugs intended to treat ,,covid-#ai under standard and alternative prescription drug coverage ,section #ahfj;,d-#b of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7 is amended-- 7,a7 in subsection 7b7-- 7i7 in paragraph 7#a77;,a71 by striking ,the coverage and inserting ,subject to paragraph 7#h71 the coverage2 7ii7 in paragraph 7#b7-- 7,i7 in subparagraph 7,a71 by inserting after ,subject to subparagraphs 7,c7 and 7,d7 the following3 and paragraph 7#h72 7,,ii7 in subparagraph 7,c77i71 by striking paragraph 7#d7 and inserting paragraphs 7#d7 and 7#h72 and 7,,iii7 in subparagraph 7,d77i71 by striking paragraph 7#d7 and inserting paragraphs 7#d7 and 7#h72 7iii7 in paragraph 7#d77;,a77i71 by striking ,the coverage and inserting ,subject to paragraph 7#h71 the coverage2 and 7iv7 by adding at the end the following new paragraph3 7#h7 ,elimination of cost sharing for drugs intended to treat ,,covid-#ai ,the coverage does not impose any deductible1 copayment1 coinsurance1 or other cost-sharing requirement for drugs described in section #ahfj;,d-#d7;b77#c77;,i77i77,i7 with respect to a plan year1 any portion of which occurs during the period during which there exists the public health emergency declared by the ,secretary pursuant to section #cai of the ,public ,health ,service ,act on ,january #ca1 #bjbj1 entitled ,determination that a ,public ,health ,emergency ,exists ,nationwide as the ,result of the #bjai ,novel ,coronavirus 7including any renewal of such declaration pursuant to such section74 2 and 7,b7 in subsection 7c71 by adding at the end the following new paragraph3 7#d7 ,same elimination of cost sharing for drugs intended to treat ,,covid-#ai ,the coverage is in accordance with subsection 7b77#h74 4 7#b7 ,elimination of cost sharing for drugs intended to treat ,,covid-#ai dispensed to individuals who are subsidy eligible individuals ,section #ahfj;,d-#ad7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77 is amended-- 7,a7 in paragraph 7#a7-- 7i7 in subparagraph 7,d7-- 7,i7 in clause 7ii71 by striking ,in the case of and inserting ,subject to subparagraph 7,f71 in the case of2 and 7,,ii7 in clause 7iii71 by striking ,in the case of and inserting ,subject to subparagraph 7,f71 in the case of2 and 7ii7 by adding at the end the following new subparagraph3 7,f7 ,elimination of cost sharing for drugs intended to treat ,,covid-#ai ,coverage that is in accordance with section #ahfj;,d-#b7;b77#h74 2 and 7,b7 in paragraph 7#b7-- 7i7 in subparagraph 7,b71 by striking ,a reduction and inserting ,subject to subparagraph 7,f71 a reduction2 7ii7 in subparagraph 7,d71 by striking ,the substitution and inserting ,subject to subparagraph 7,f71 the substitution2 7iii7 in subparagraph 7,e71 by inserting after ,subject to the following3 subparagraph 7,f7 and2 and 7iv7 by adding at the end the following new subparagraph3 7,f7 ,elimination of cost sharing for drugs intended to treat ,,covid-#ai ,coverage that is in accordance with section #ahfj;,d-#b7;b77#h74 4 7c7 ,implementation ,notwithstanding any other provision of law1 the ,secretary of ,health and ,human ,services may implement the amendments made by this section by program instruction or otherwise4 #cje4 ,coverage of ,,covid-#ai related treatment at no cost sharing 7a7 ,in general ,a group health plan and a health insurance issuer offering group or individual health insurance coverage 7including a grandfathered health plan 7as defined in section #abea7;e7 of the ,patient ,protection and ,affordable ,care ,act77 shall provide coverage1 and shall not impose any cost sharing 7including deductibles1 copayments1 and coinsurance7 requirements1 for the following items and services furnished during any portion of the emergency period defined in paragraph 7#a77;,b7 of section #aace7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#e7;g77 beginning on or after the date of the enactment of this ,act3 7#a7 ,medically necessary items and services 7including in-person or telehealth visits in which such items and services are furnished7 that are furnished to an individual who has been diagnosed with 7or after provision of the items and services is diagnosed with7 ,,covid-#ai to treat or mitigate the effects of ,,covid-#ai4 7#b7 ,medically necessary items and services 7including in-person or telehealth visits in which such items and services are furnished7 that are furnished to an individual who is presumed to have ,,covid-#ai but is never diagnosed as such1 if the following conditions are met3 7,a7 ,such items and services are furnished to the individual to treat or mitigate the effects of ,,covid-#ai or to mitigate the impact of ,,covid-#ai on society4 7,b7 ,health care providers have taken appropriate steps under the circumstances to make a diagnosis1 or confirm whether a diagnosis was made1 with respect to such individual1 for ,,covid-#ai1 if possible4 7b7 ,items and services related to ,,covid-#ai ,for purposes of this section-- 7#a7 not later than one week after the date of the enactment of this section1 the ,secretary of ,health and ,human ,services1 ,secretary of ,labor1 and ,secretary of the ,treasury shall jointly issue guidance specifying applicable diagnoses and medically necessary items and services related to ,,covid-#ai2 and 7#b7 such items and services shall include all items or services that are relevant to the treatment or mitigation of ,,covid-#ai1 regardless of whether such items or services are ordinarily covered under the terms of a group health plan or group or individual health insurance coverage offered by a health insurance issuer4 7c7 ,enforcement 7#a7 ,application with respect to ,,phsa1 ,,erisa1 and ,,irc ,the provisions of this section shall be applied by the ,secretary of ,health and ,human ,services1 ,secretary of ,labor1 and ,secretary of the ,treasury to group health plans and health insurance issuers offering group or individual health insurance coverage as if included in the provisions of part ,a of title ,,xxvii of the ,public ,health ,service ,act1 part #g of the ,employee ,retirement ,income ,security ,act of #aigd1 and subchapter ,b of chapter #ajj of the ,internal ,revenue ,code of #aihf1 as applicable4 7#b7 ,private right of action ,an individual with respect to whom an action is taken by a group health plan or health insurance issuer offering group or individual health insurance coverage in violation of subsection 7a7 may commence a civil action against the plan or issuer for appropriate relief4 ,the previous sentence shall not be construed as limiting any enforcement mechanism otherwise applicable pursuant to paragraph 7#a74 7d7 ,implementation ,the ,secretary of ,health and ,human ,services1 ,secretary of ,labor1 and ,secretary of the ,treasury may implement the provisions of this section through sub-regulatory guidance1 program instruction or otherwise4 7e7 ,terms ,the terms group health plan1 health insurance issuer1 group health insurance coverage1 and individual health insurance coverage have the meanings given such terms in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia71 section #gcc of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaia;b71 and section #ihcb of the ,internal ,revenue ,code of #aihf1 as applicable4 #cjf4 ,reimbursement for additional health services relating to coronavirus ,title ,v of division ,a of the ,families ,first ,coronavirus ,response ,act 7,public ,law #aaf-abg7 is amended under the heading ,department of ,health and ,human ,services--,office of the ,secretary--,public ,health and ,social ,services ,emergency ,fund by inserting 1 or treatment related to ,,sars-,co,v-#b or ,,covid-#ai for uninsured individuals after or visits described in paragraph 7#b7 of such section for uninsured individuals4 ,,iv ,federal ,health ,equity ,oversight #dja4 ,,covid-#ai ,racial and ,ethnic ,disparities ,task ,force ,act of #bjbj 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall establish an interagency task force1 to be known as the ,,covid-#ai ,racial and ,ethnic ,disparities ,task ,force 7referred to in this section as the task force71 to gather data about disproportionately affected communities and provide recommendations to combat the racial and ethnic disparities in the ,,covid-#ai response throughout the ,united ,states and in response to future public health crises4 7b7 ,membership ,the task force shall be composed of the following3 7#a7 ,the ,secretary of ,health and ,human ,services4 7#b7 ,the ,assistant ,secretary for ,planning and ,evaluation of the ,department of ,health and ,human ,services4 7#c7 ,the ,assistant ,secretary for ,preparedness and ,response of the ,department of ,health and ,human ,services4 7#d7 ,the ,director of the ,centers for ,disease ,control and ,prevention4 7#e7 ,the ,director of the ,national ,institutes of ,health4 7#f7 ,the ,commissioner of ,food and ,drugs4 7#g7 ,the ,administrator of the ,federal ,emergency ,management ,agency4 7#h7 ,the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities4 7#i7 ,the ,director of the ,indian ,health ,service4 7#aj7 ,the ,administrator of the ,centers for ,medicare ,medicaid ,services4 7#aa7 ,the ,director of the ,agency for ,healthcare ,research and ,quality4 7#ab7 ,the ,surgeon ,general4 7#ac7 ,the ,administrator of the ,health ,resources and ,services ,administration4 7#ad7 ,the ,director of the ,office of ,minority ,health4 7#ae7 ,the ,secretary of ,housing and ,urban ,development4 7#af7 ,the ,secretary of ,education4 7#ag7 ,the ,secretary of ,labor4 7#ah7 ,the ,secretary of ,defense4 7#ai7 ,the ,secretary of ,transportation4 7#bj7 ,the ,secretary of the ,treasury4 7#ba7 ,the ,administrator of the ,small ,business ,administration4 7#bb7 ,the ,administrator of the ,environmental ,protection ,agency4 7#bc7 ,five health care professionals with expertise in addressing racial and ethnic disparities1 with at least one representative from a rural area1 to be appointed by the ,secretary4 7#bd7 ,five policy experts specializing in addressing racial and ethnic disparities in education or racial and ethnic economic inequality to be appointed by the ,secretary4 7#be7 ,six representatives from community-based organizations specializing in providing culturally competent care or services and addressing racial and ethnic disparities1 to be appointed by the ,secretary1 with at least one representative from an urban ,indian organization and one representative from a national organization that represents ,tribal governments with expertise in ,tribal public health4 7#bf7 ,six ,state1 local1 territorial1 or ,tribal public health officials representing departments of public health1 who shall represent jurisdictions from different regions of the ,united ,states with relatively high concentrations of historically marginalized populations1 to be appointed by the ,secretary1 with at least one territorial representative and one representative of a ,tribal public health department4 7c7 ,administrative provisions 7#a7 ,appointment of non-government members ,notwithstanding any other provision of law1 the ,secretary shall appoint all non-government members of the task force within #cj days of the date enactment of this section4 7#b7 ,chairperson ,the ,secretary shall serve as the chairperson of the task force4 ,the ,director of the ,office of ,minority ,health shall serve as the vice chairperson4 7#c7 ,staff ,the task force shall have #aj full-time staff members4 7#d7 ,meetings ,not later than #de days after the date of enactment of this section1 the full task force shall have its first meeting4 ,the task force shall convene at least once a month thereafter4 7#e7 ,subcommittees ,the chairperson and vice chairperson of the task force are authorized to establish subcommittees to consider specific issues related to the broader mission of addressing racial and ethnic disparities4 7d7 ,federal ,emergency ,management ,agency ,resource ,allocation ,reporting and ,recommendations 7#a7 ,weekly reports ,not later than #g days after the task force first meets1 and weekly thereafter1 the task force shall submit to ,congress and the ,federal ,emergency ,management ,agency a report that includes-- 7,a7 a description of ,,covid-#ai patient outcomes1 including cases1 hospitalizations1 patients on ventilation1 and mortality1 disaggregated by race and ethnicity 7where such data is missing1 the task force shall utilize appropriate authorities to improve data collection72 7,b7 the identification of communities that lack resources to combat the ,,covid-#ai pandemic1 including personal protective equipment1 ventilators1 hospital beds1 testing kits1 testing supplies1 vaccinations 7when available71 resources to conduct surveillance and contact tracing1 funding1 staffing1 and other resources the task force deems essential as needs arise2 7,c7 the identification of communities where racial and ethnic disparities in ,,covid-#ai infection1 hospitalization1 and death rates are out of proportion to the community's population by a certain threshold1 to be determined by the task force based on available public health data2 7,d7 recommendations about how to best allocate critical ,,covid-#ai resources to-- 7i7 communities with disproportionately high ,,covid-#ai infection1 hospitalization1 and death rates2 and 7ii7 communities identified in subparagraph 7,c72 7,e7 with respect to communities that are able to reduce racial and ethnic disparities effectively1 a description of best practices involved2 and 7,f7 an update with respect to the response of the ,federal ,emergency ,management ,agency to the task force's previous weeks' recommendations under this section4 7#b7 ,general consultation ,in submitting weekly reports and recommendations under this subsection1 the task force shall consult with and notify ,state1 local1 territorial1 and ,tribal officials and community-based organizations from communities identified as disproportionately impacted by ,,covid-#ai4 7#c7 ,consultation with indian tribes ,in submitting weekly reports and recommendations under this subsection1 the ,director of ,indian ,health ,service shall1 in coordination with the task force1 consult with ,indian ,tribes and ,tribal organizations that are disproportionately affected by ,,covid-#ai on a government to government basis to identify specific needs and recommendations4 7#d7 ,dissemination ,reports under this subsection shall be disseminated to all relevant stakeholders1 including ,state1 local1 territorial1 and ,tribal officials1 and public health departments4 7#e7 ,tribal data ,the task force1 in consultation with ,indian ,tribes and ,tribal organizations1 shall ensure that an ,indian ,tribe consents to any public reporting of health data4 7e7 ,,covid-#ai relief oversight and implementation reports ,not later than #ad days after the task force first meets1 and not later than every #ad days thereafter1 the task force shall submit to ,congress and the relevant ,federal agencies a report that includes-- 7#a7 an examination of funds distributed under ,,covid-#ai-related relief and stimulus laws 7enacted prior to and after the date of enactment of this ,act71 including the ,coronavirus ,preparedness and ,response ,emergency ,supplemental ,appropriations ,act1 #bjbj 7,public ,law #aaf-abc71 the ,families ,first ,coronavirus ,response ,act 7,public ,law #aaf-abg71 the ,coronavirus ,aid1 ,relief1 and ,economic ,security ,act 7,public ,law #aaf-acf71 and the ,paycheck ,protection ,program and ,health ,care ,enhancement ,act 7,public ,law #aaf-aci71 and how that distribution impacted racial and ethnic disparities with respect to the ,,covid-#ai pandemic2 and 7#b7 recommendations to relevant ,federal agencies about how to disburse any undisbursed funding from ,,covid-#ai-related relief and stimulus laws 7enacted prior to and after the date of enactment of this ,act71 including those laws described in paragraph 7#a71 to address racial and ethnic disparities with respect to the ,,covid-#ai pandemic1 including recommendations to-- 7,a7 the ,department of ,health and ,human ,services about disbursement of funds under the ,public ,health and ,social ,service ,emergency ,fund2 7,b7 the ,small ,business ,administration about disbursement of funds under the ,paycheck ,protection ,program and the ,economic ,injury ,disaster ,loan ,program2 and 7,c7 the ,department of ,education about disbursement of funds under the ,education ,stabilization ,fund4 7f7 ,final ,,covid-#ai reports ,not later than #ij days after the date on which the ,president declares the end of the ,,covid-#ai public health emergency first declared by the ,secretary on ,january #ca1 #bjbj1 the task force shall submit to ,congress a report that-- 7#a7 describes inequities within the health care system1 implicit bias1 structural racism1 and social determinants of health 7including housing1 nutrition1 education1 economic1 and environmental factors7 that contributed to racial and ethnic health disparities with respect to the ,,covid-#ai pandemic and how these factors contributed to such disparities2 7#b7 examines the initial ,federal response to the ,,covid-#ai pandemic and its impact on the racial and ethnic disparities in ,,covid-#ai infection1 hospitalization1 and death rates2 and 7#c7 contains recommendations to combat racial and ethnic disparities in future infectious disease responses1 including future ,,covid-#ai outbreaks4 7g7 ,sunset and successor task force 7#a7 ,sunset ,the task force shall terminate on the date that is #ij days after the date on which the ,president declares the end of the ,,covid-#ai public health emergency first declared by the ,secretary on ,january #ca1 #bjbj4 7#b7 ,successor ,upon the termination of the task force under paragraph 7#a71 the ,secretary shall establish a permanent ,infectious ,disease ,racial and ,ethnic ,disparities ,task ,force based on the membership1 convening1 and reporting requirements recommended by the task force in reports submitted under this section4 7h7 ,authorization of appropriations ,there is authorized to be appropriated1 such sums as may be necessary to carry out this section4 #djb4 ,protection of the ,,hhs ,offices of ,minority ,health 7a7 ,in general ,pursuant to section #agjg;,a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f;a71 the ,offices of ,minority ,health established within the ,centers for ,disease ,control and ,prevention1 the ,health ,resources and ,services ,administration1 the ,substance ,abuse and ,mental ,health ,services ,administration1 the ,agency for ,healthcare ,research and ,quality1 the ,food and ,drug ,administration1 and the ,centers for ,medicare ,medicaid ,services1 are offices that1 regardless of change in the structure of the ,department of ,health and ,human ,services1 shall report to the ,secretary of ,health and ,human ,services4 7b7 ,sense of ,congress ,it is the sense of the ,congress that any effort to eliminate or consolidate such ,offices of ,minority ,health undermines the progress achieved so far4 #djc4 ,establish an interagency counsel and grant programs on social determinants of health 7a7 ,short title ,this section may be cited as the ,social ,determinants ,accelerator ,act of #bjbj4 7b7 ,findings2 purposes 7#a7 ,findings ,congress finds the following3 7,a7 ,there is a significant body of evidence showing that economic and social conditions have a powerful impact on individual and population health outcomes1 including health disparities associated with public health emergencies1 and well-being1 as well as medical costs4 7,b7 ,state1 local1 and ,tribal governments and the service delivery partners of such governments face significant challenges in coordinating benefits and services delivered through the ,medicaid program and other social services programs because of the fragmented and complex nature of ,federal and ,state funding and administrative requirements4 7,c7 ,the ,federal ,government should prioritize and proactively assist ,state and local governments to strengthen the capacity of ,state and local governments to improve health and social outcomes for individuals1 thereby improving cost-effectiveness and return on investment4 7#b7 ,purposes ,the purposes of this ,act are as follows3 7,a7 ,to establish effective1 coordinated ,federal technical assistance to help ,state and local governments to improve outcomes and cost-effectiveness of1 and return on investment from1 health and social services programs4 7,b7 ,to build a pipeline of ,state and locally designed1 cross-sector interventions and strategies that generate rigorous evidence about how to improve health and social outcomes1 and increase the cost-effectiveness of1 and return on investment from1 ,federal1 ,state1 local1 and ,tribal health and social services programs4 7,c7 ,to enlist ,state and local governments and the service providers of such governments as partners in identifying ,federal statutory1 regulatory1 and administrative challenges in improving the health and social outcomes of1 cost-effectiveness of1 and return on investment from1 ,federal spending on individuals enrolled in ,medicaid4 7,d7 ,to develop strategies to improve health and social outcomes without denying services to1 or restricting the eligibility of1 vulnerable populations4 7c7 ,social determinants accelerator council 7#a7 ,establishment ,the ,secretary of ,health and ,human ,services 7referred to in this ,act as the ,secretary71 in coordination with the ,administrator of the ,centers for ,medicare ,medicaid ,services 7referred to in this ,act as the ,administrator71 shall establish an interagency council1 to be known as the ,social ,determinants ,accelerator ,interagency ,council 7referred to in this ,act as the ,council7 to achieve the purposes listed in subsection 7b77#a74 7#b7 ,membership 7,a7 ,federal composition ,the ,council shall be composed of at least one designee from each of the following ,federal agencies3 7i7 ,the ,office of ,management and ,budget4 7ii7 ,the ,department of ,agriculture4 7iii7 ,the ,department of ,education4 7iv7 ,the ,indian ,health ,service4 7v7 ,the ,department of ,housing and ,urban ,development4 7vi7 ,the ,department of ,labor4 7vii7 ,the ,department of ,transportation4 7viii7 ,any other ,federal agency the ,chair of the ,council determines necessary4 7,b7 ,designation 7i7 ,in general ,the head of each agency specified in subparagraph 7,a7 shall designate at least one employee to serve as a member of the ,council4 7ii7 ,responsibilities ,an employee described in this clause shall be a senior employee of the agency-- 7,i7 whose responsibilities relate to authorities1 policies1 and procedures with respect to the health and well-being of individuals receiving medical assistance under a ,state plan 7or a waiver of such plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq472 or 7,,ii7 who has authority to implement and evaluate transformative initiatives that harness data or conducts rigorous evaluation to improve the impact and cost-effectiveness of federally funded services and benefits4 7,c7 ,,hhs representation ,in addition to the designees under subparagraph 7,a71 the ,council shall include designees from at least three agencies within the ,department of ,health and ,human ,services1 including the ,centers for ,medicare ,medicaid ,services1 at least one of whom shall meet the criteria under this section4 7,d7 ,,omb role ,the ,director of the ,office of ,management and ,budget shall facilitate the timely resolution of ,governmentwide and multiagency issues to help the ,council achieve consensus recommendations described under this section4 7,e7 ,non-,federal composition ,the ,comptroller ,general of the ,united ,states may designate up to #f ,council designees-- 7i7 who have relevant subject matter expertise1 including expertise implementing and evaluating transformative initiatives that harness data and conduct evaluations to improve the impact and cost-effectiveness of ,federal ,government services2 and 7ii7 that each represent-- 7,i7 ,state1 local1 and ,tribal health and human services agencies2 7,,ii7 public housing authorities or ,state housing finance agencies2 7,,iii7 ,state and local government budget offices2 7,,iv7 ,state ,medicaid agencies2 or 7,v7 national consumer advocacy organizations4 7,f7 ,chair 7i7 ,in general ,the ,secretary shall select the ,chair of the ,council from among the members of the ,council4 7ii7 ,initiating guidance ,the ,chair1 on behalf of the ,council1 shall identify and invite individuals from diverse entities to provide the ,council with advice and information pertaining to addressing social determinants of health1 including-- 7,i7 individuals from ,state and local government health and human services agencies2 7,,ii7 individuals from ,state ,medicaid agencies2 7,,iii7 individuals from ,state and local government budget offices2 7,,iv7 individuals from public housing authorities or ,state housing finance agencies2 7,v7 individuals from nonprofit organizations1 small businesses1 and philanthropic organizations2 7,,vi7 advocates2 7,,vii7 researchers2 and 7,,viii7 any other individuals the ,chair determines to be appropriate4 7#c7 ,duties ,the duties of the ,council are-- 7,a7 to make recommendations to the ,secretary and the ,administrator regarding the criteria for making awards under this section2 7,b7 to identify ,federal authorities and opportunities for use by ,states or local governments to improve coordination of funding and administration of ,federal programs1 the beneficiaries of whom include individuals1 and which may be unknown or underutilized and to make information on such authorities and opportunities publicly available2 7,c7 to provide targeted technical assistance to ,states developing a social determinants accelerator plan under this section1 including identifying potential statutory or regulatory pathways for implementation of the plan and assisting in identifying potential sources of funding to implement the plan2 7,d7 to report to ,congress annually on the subjects set forth in this section2 7,e7 to develop and disseminate evaluation guidelines and standards that can be used to reliably assess the impact of an intervention or approach that may be implemented pursuant to this ,act on outcomes1 cost-effectiveness of1 and return on investment from ,federal1 ,state1 local1 and ,tribal governments1 and to facilitate technical assistance1 where needed1 to help to improve ,state and local evaluation designs and implementation2 7,f7 to seek feedback from ,state1 local1 and ,tribal governments1 including through an annual survey by an independent third party1 on how to improve the technical assistance the ,council provides to better equip ,state1 local1 and ,tribal governments to coordinate health and social service programs2 7,g7 to solicit applications for grants under this section2 and 7,h7 to coordinate with other cross-agency initiatives focused on improving the health and well-being of low-income and at-risk populations in order to prevent unnecessary duplication between agency initiatives4 7#d7 ,schedule ,not later than #fj days after the date of the enactment of this ,act1 the ,council shall convene to develop a schedule and plan for carrying out the duties described in this section1 including solicitation of applications for the grants under this section4 7#e7 ,report to ,congress ,the ,council shall submit an annual report to ,congress1 which shall include-- 7,a7 a list of the ,council members2 7,b7 activities and expenditures of the ,council2 7,c7 summaries of the interventions and approaches that will be supported by ,state1 local1 and ,tribal governments that received a grant under this section1 including-- 7i7 the best practices and evidence-based approaches such governments plan to employ to achieve the purposes listed in this section2 and 7ii7 a description of how the practices and approaches will impact the outcomes1 cost-effectiveness of1 and return on investment from1 ,federal1 ,state1 local1 and ,tribal governments with respect to such purposes2 7,d7 the feedback received from ,state and local governments on ways to improve the technical assistance of the ,council1 including findings from a third-party survey and actions the ,council plans to take in response to such feedback2 and 7,e7 the major statutory1 regulatory1 and administrative challenges identified by ,state1 local1 and ,tribal governments that received a grant under subsection 7d71 and the actions that ,federal agencies are taking to address such challenges4 7#f7 ,,faca applicability ,the ,federal ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 shall not apply to the ,council4 7#g7 ,council procedures ,the ,secretary1 in consultation with the ,comptroller ,general of the ,united ,states and the ,director of the ,office of ,management and ,budget1 shall establish procedures for the ,council to-- 7,a7 ensure that adequate resources are available to effectively execute the responsibilities of the ,council2 7,b7 effectively coordinate with other relevant advisory bodies and working groups to avoid unnecessary duplication2 7,c7 create transparency to the public and ,congress with regard to ,council membership1 costs1 and activities1 including through use of modern technology and social media to disseminate information2 and 7,d7 avoid conflicts of interest that would jeopardize the ability of the ,council to make decisions and provide recommendations4 7d7 ,social determinants accelerator grants to ,states or local governments 7#a7 ,grants to ,states1 local governments1 and tribes ,not later than #ahj days after the date of the enactment of this ,act1 the ,administrator1 in consultation with the ,secretary and the ,council1 shall award on a competitive basis not more than #be grants to eligible applicants described in this section1 for the development of social determinants accelerator plans1 as described in this section4 7#b7 ,eligible applicant ,an eligible applicant described in this section is a ,state1 local1 or ,tribal health or human services agency that-- 7,a7 demonstrates the support of relevant parties across relevant ,state1 local1 or ,tribal jurisdictions2 and 7,b7 in the case of an applicant that is a local government agency1 provides to the ,secretary a letter of support from the lead ,state health or human services agency for the ,state in which the local government is located4 7#c7 ,amount of grant ,the ,administrator1 in coordination with the ,council1 shall determine the total amount that the ,administrator will make available to each grantee under this section4 7#d7 ,application ,an eligible applicant seeking a grant under this section shall include in the application the following information3 7,a7 ,the target population 7or populations7 that would benefit from implementation of the social determinants accelerator plan proposed to be developed by the applicant4 7,b7 ,a description of the objective or objectives and outcome goals of such proposed plan1 which shall include at least one health outcome and at least one other important social outcome4 7,c7 ,the sources and scope of inefficiencies that1 if addressed by the plan1 could result in improved cost-effectiveness of or return on investment from ,federal1 ,state1 local1 and ,tribal governments4 7,d7 ,a description of potential interventions that could be designed or enabled using such proposed plan4 7,e7 ,the ,state1 local1 ,tribal1 academic1 nonprofit1 community-based organizations1 and other private sector partners that would participate in the development of the proposed plan and subsequent implementation of programs or initiatives included in such proposed plan4 7,f7 ,such other information as the ,administrator1 in consultation with the ,secretary and the ,council1 determines necessary to achieve the purposes of this ,act4 7#e7 ,use of funds ,a recipient of a grant under this section may use funds received through the grant for the following purposes3 7,a7 ,to convene and coordinate with relevant government entities and other stakeholders across sectors to assist in the development of a social determinant accelerator plan4 7,b7 ,to identify populations of individuals receiving medical assistance under a ,state plan 7or a waiver of such plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 who may benefit from the proposed approaches to improving the health and well-being of such individuals through the implementation of the proposed social determinants accelerator plan4 7,c7 ,to engage qualified research experts to advise on relevant research and to design a proposed evaluation plan1 in accordance with the standards and guidelines issued by the ,administrator4 7,d7 ,to collaborate with the ,council to support the development of social determinants accelerator plans4 7,e7 ,to prepare and submit a final social determinants accelerator plan to the ,council4 7#f7 ,contents of plans ,a social determinant accelerator plan developed under this section shall include the following3 7,a7 ,a description of the target population 7or populations7 that would benefit from implementation of the social determinants accelerator plan1 including an analysis describing the projected impact on the well-being of individuals described in paragraph 7#e77;,b74 7,b7 ,a description of the interventions or approaches designed under the social determinants accelerator plan and the evidence for selecting such interventions or approaches4 7,c7 ,the objectives and outcome goals of such interventions or approaches1 including at least one health outcome and at least one other important social outcome4 7,d7 ,a plan for accessing and linking relevant data to enable coordinated benefits and services for the jurisdictions described in this section and an evaluation of the proposed interventions and approaches4 7,e7 ,a description of the ,state1 local1 ,tribal1 academic1 nonprofit1 or community-based organizations1 or any other private sector organizations that would participate in implementing the proposed interventions or approaches1 and the role each would play to contribute to the success of the proposed interventions or approaches4 7,f7 ,the identification of the funding sources that would be used to finance the proposed interventions or approaches4 7,g7 ,a description of any financial incentives that may be provided1 including outcome-focused contracting approaches to encourage service providers and other partners to improve outcomes of1 cost-effectiveness of1 and return on investment from1 ,federal1 ,state1 local1 or ,tribal government spending4 7,h7 ,the identification of the applicable ,federal1 ,state1 local1 or ,tribal statutory and regulatory authorities1 including waiver authorities1 to be leveraged to implement the proposed interventions or approaches4 7,i7 ,a description of potential considerations that would enhance the impact1 scalability1 or sustainability of the proposed interventions or approaches and the actions the grant awardee would take to address such considerations4 7,j7 ,a proposed evaluation plan1 to be carried out by an independent evaluator1 to measure the impact of the proposed interventions or approaches on the outcomes of1 cost-effectiveness of1 and return on investment from1 ,federal1 ,state1 local1 and ,tribal governments4 7,k7 ,precautions for ensuring that vulnerable populations will not be denied access to ,medicaid or other essential services as a result of implementing the proposed plan4 7e7 ,funding 7#a7 ,in general ,out of any money in the ,treasury not otherwise appropriated1 there is appropriated to carry out this ,act #be1jjj1jjj1 of which up to #e1jjj1jjj may be used to carry out this ,act1 to remain available for obligation until the date that is #e years after the date of enactment of this ,act4 7#b7 ,reservation of funds 7,a7 ,in general ,of the funds made available under paragraph 7#a71 the ,secretary shall reserve not less than #bj percent to award grants to eligible applicants for the development of social determinants accelerator plans under this section intended to serve rural populations4 7,b7 ,exception ,in the case of a fiscal year for which the ,secretary determines that there are not sufficient eligible applicants to award up to #be grants under section #d that are intended to serve rural populations and the ,secretary cannot satisfy the #bj-percent requirement1 the ,secretary may reserve an amount that is less than #bj percent of amounts made available under paragraph 7#a7 to award grants for such purpose4 7#c7 ,rule of construction ,nothing in this ,act shall prevent ,federal agencies represented on the ,council from contributing additional funding from other sources to support activities to improve the effectiveness of the ,council4 #djd4 ,accountability and transparency within the ,department of ,health and ,human ,services ,title ,,xxxiv of the ,public ,health ,service ,act is amended by inserting after subtitle ,c the following3 ,d ,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 that receive ,federal financial assistance are in compliance with title ,,vi of the ,civil ,rights ,act1 including through the following activities3 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 ,national ,academy of ,sciences 7formerly known as the ,institute of ,medicine7 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 ,national ,academy of ,sciences4 ,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 ,such review shall include an assessment of health disparities in communities with a combination of these classes4 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 most recent version of the ,office of ,management and ,budget statistical policy directive entitled ,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 ,health4 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 #bjba1 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 #bjba through #bjbf4 #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 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 the applicable agency1 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 most recent version of the ,office of ,management and ,budget statistical policy directive entitled ,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 ,health4 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 of 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 agency described in subsection 7a71 subject to paragraph 7#b74 7#b7 ,department of ,justice ,the ,office for ,civil ,rights of the ,department of ,justice may1 as appropriate1 institute formal proceedings when a civil rights compliance office established under subsection 7a7 determines that a recipient of ,federal financial assistance is not in compliance with the disparity reduction standards of the applicable 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 ,v ,expanded ,insurance ,access #eja4 ,medicare special enrollment period for individuals residing in ,,covid-#ai emergency areas 7a7 ,in general ,section #ahcg7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciep7i77 is amended by adding at the end the following new paragraph3 7#e7 7,a7 ,in the case of an individual who-- 7i7 is eligible under section #ahcf to enroll in the medical insurance program established by this part1 7ii7 did not enroll 7or elected not to be deemed enrolled7 under this section during an enrollment period1 and 7iii7 during the emergency period 7as described in section #aace7;g77#a77;,b771 resided in an emergency area 7as described in such section71 there shall be a special enrollment period described in subparagraph 7,b74 7,b7 ,the special enrollment period referred to in subparagraph 7,a7 is the period that begins not later than ,july #a1 #bjbj1 and ends on the last day of the month in which the emergency period 7as described in section #aace7;g77#a77;,b77 ends4 4 7b7 ,coverage period for individuals transitioning from other coverage ,section #ahch7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieq7e77 is amended-- 7#a7 by striking pursuant to section #ahcg7;i77#c7 or #ahcg7;i77#d77;,b7-- and inserting the following3 pursuant to-- 7#a7 section #ahcg7;i77#c7 or #ahcg7;i77#d77;,b7-- 2 7#b7 by redesignating paragraphs 7#a7 and 7#b7 as subparagraphs 7,a7 and 7,b71 respectively1 and moving the indentation of each such subparagraph #b ems to the right2 7#c7 by striking the period at the end of the subparagraph 7,b71 as so redesignated1 and inserting 2 or2 and 7#d7 by adding at the end the following new paragraph3 7#b7 section #ahcg7;i77#e71 the coverage period shall begin on the first day of the month following the month in which the individual so enrolls4 4 7c7 ,funding ,the ,secretary of ,health and ,human ,services shall provide for the transfer from the ,federal ,hospital ,insurance ,trust ,fund 7as described in section #ahag of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i77 and the ,federal ,supplementary ,medical ,insurance ,trust ,fund 7as described in section #ahda of such ,act 7#db ,u4,s4,c4 #aciet771 in such proportions as determined appropriate by the ,secretary1 to the ,social ,security ,administration1 of #cj1jjj1jjj1 to remain available until expended1 for purposes of carrying out the amendments made by this section4 7d7 ,implementation ,notwithstanding any other provision of law1 the ,secretary of ,health and ,human ,services may implement the amendments made by this section by program instruction or otherwise4 #ejb4 ,special enrollment period through exchanges2 ,federal exchange outreach and educational activities 7a7 ,special enrollment period through ,exchanges ,section #acaa7;c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77 is amended-- 7#a7 in paragraph 7#f7-- 7,a7 in subparagraph 7,c71 by striking at the end and2 7,b7 in subparagraph 7,d71 by striking at the end the period and inserting 2 and2 and 7,c7 by adding at the end the following new subparagraph3 7,e7 subject to subparagraph 7,b7 of paragraph 7#h71 the special enrollment period described in subparagraph 7,a7 of such paragraph4 2 and 7#b7 by adding at the end the following new paragraph3 7#h7 ,special enrollment period for certain public health emergency 7,a7 ,in general ,the ,secretary shall1 subject to subparagraph 7,b71 require an ,exchange to provide-- 7i7 for a special enrollment period during the emergency period described in section #aace7;g77#a77;,b7 of the ,social ,security ,act-- 7,i7 which shall begin on the date that is one week after the date of the enactment of this paragraph and which1 in the case of an ,exchange established or operated by the ,secretary within a ,state pursuant to section #acba7;c71 shall be an #h-week period2 and 7,,ii7 during which any individual who is otherwise eligible to enroll in a qualified health plan through the ,exchange may enroll in such a qualified health plan2 and 7ii7 that1 in the case of an individual who enrolls in a qualified health plan through the ,exchange during such enrollment period1 the coverage period under such plan shall begin1 at the option of the individual1 on ,april #a1 #bjbj1 or on the first day of the month following the day the individual selects a plan through such special enrollment period4 7,b7 ,exception ,the requirement of subparagraph 7,a7 shall not apply to a ,state-operated or ,state-established ,exchange if such ,exchange1 prior to the date of the enactment of this paragraph1 established or otherwise provided for a special enrollment period to address access to coverage under qualified health plans offered through such ,exchange during the emergency period described in section #aace7;g77#a77;,b7 of the ,social ,security ,act4 4 7b7 ,federal ,exchange outreach and educational activities ,section #acba7;c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjda7;c77 is amended by adding at the end the following new paragraph3 7#c7 ,outreach and educational activities 7,a7 ,in general ,in the case of an ,exchange established or operated by the ,secretary within a ,state pursuant to this subsection1 the ,secretary shall carry out outreach and educational activities for purposes of informing potential enrollees in qualified health plans offered through the ,exchange of the availability of coverage under such plans and financial assistance for coverage under such plans4 ,such outreach and educational activities shall be provided in a manner that is culturally and linguistically appropriate to the needs of the populations being served by the ,exchange 7including hard-to-reach populations1 such as racial and sexual minorities1 limited ,english proficient populations1 and young adults74 7,b7 ,limitation on use of funds ,no funds appropriated under this paragraph shall be used for expenditures for promoting non-,,aca compliant health insurance coverage4 7,c7 ,non-,,aca compliant health insurance coverage ,for purposes of subparagraph 7,b73 7i7 ,the term non-,,aca compliant health insurance coverage means health insurance coverage1 or a group health plan1 that is not a qualified health plan4 7ii7 ,such term includes the following3 7,i7 ,an association health plan4 7,,ii7 ,short-term limited duration insurance4 7,d7 ,funding ,there are appropriated1 out of any funds in the ,treasury not otherwise appropriated1 #be1jjj1jjj1 to remain available until expended-- 7i7 to carry out this paragraph2 and 7ii7 at the discretion of the ,secretary1 to carry out section #acaa7;i71 with respect to an ,exchange established or operated by the ,secretary within a ,state pursuant to this subsection4 4 7c7 ,implementation ,the ,secretary of ,health and ,human ,services may implement the provisions of 7including amendments made by7 this section through subregulatory guidance1 program instruction1 or otherwise4 #ejc4 ,,momma's ,act 7a7 ,short title ,this section may be cited as the ,mothers and ,offspring ,mortality and ,morbidity ,awareness ,act or the ,,momma's ,act4 7b7 ,findings ,congress finds the following3 7#a7 ,every year1 across the ,united ,states1 #d1jjj1jjj women give birth1 about #gjj women suffer fatal complications during pregnancy1 while giving birth or during the postpartum period1 and #gj1jjj women suffer near-fatal1 partum-related complications4 7#b7 ,the maternal mortality rate is often used as a proxy to measure the overall health of a population4 ,while the infant mortality rate in the ,united ,states has reached its lowest point1 the risk of death for women in the ,united ,states during pregnancy1 childbirth1 or the postpartum period is higher than such risk in many other developed nations4 ,the estimated maternal mortality rate 7per #ajj1jjj live births7 for the #dh contiguous ,states and ,washington1 ,,dc increased from #ah4h percent in #bjjj to #bc4h percent in #bjad to #bf4f percent in #bjah4 ,this estimated rate is on par with such rate for underdeveloped nations such as ,iraq and ,afghanistan4 7#c7 ,international studies estimate the #bjae maternal mortality rate in the ,united ,states as #bf4d per #ajj1jjj live births1 which is almost twice the #bjae ,world ,health ,organization estimation of #ad per #ajj1jjj live births4 7#d7 ,it is estimated that more than #fj percent of maternal deaths in the ,united ,states are preventable4 7#e7 ,according to the ,centers for ,disease ,control and ,prevention1 the maternal mortality rate varies drastically for women by race and ethnicity4 ,there are #ab4g deaths per #ajj1jjj live births for ,white women1 #dc4e deaths per #ajj1jjj live births for ,african-,american women1 and #ad4d deaths per #ajj1jjj live births for women of other ethnicities4 ,while maternal mortality disparately impacts ,african-,american women1 this urgent public health crisis traverses race1 ethnicity1 socioeconomic status1 educational background1 and geography4 7#f7 ,african-,american women are #c to #d times more likely to die from causes related to pregnancy and childbirth compared to non-,hispanic ,white women4 7#g7 ,the findings described in paragraphs 7#a7 through 7#f7 are of major concern to researchers1 academics1 members of the business community1 and providers across the obstetrical continuum represented by organizations such as ,march of ,dimes2 the ,preeclampsia ,foundation2 the ,american ,college of ,obstetricians and ,gynecologists2 the ,society for ,maternal-,fetal ,medicine2 the ,association of ,women's ,health1 ,obstetric1 and ,neonatal ,nurses2 the ,california ,maternal ,quality ,care ,collaborative2 ,black ,women's ,health ,imperative2 the ,national ,birth ,equity ,collaborative2 ,black ,mamas ,matter ,alliance2 ,ever,thrive ,illinois2 the ,national ,association of ,certified ,professional ,midwives2 ,,pcos ,challenge3 ,the ,national ,polycystic ,ovary ,syndrome ,association2 and the ,american ,college of ,nurse ,midwives4 7#h7 ,hemorrhage1 cardiovascular and coronary conditions1 cardiomyopathy1 infection1 embolism1 mental health conditions1 preeclampsia and eclampsia1 polycystic ovary syndrome1 infection and sepsis1 and anesthesia complications are the predominant medical causes of maternal-related deaths and complications4 ,most of these conditions are largely preventable or manageable4 7#i7 ,oral health is an important part of perinatal health4 ,reducing bacteria in a woman's mouth during pregnancy can significantly reduce her risk of developing oral diseases and spreading decay-causing bacteria to her baby4 ,moreover1 some evidence suggests that women with periodontal disease during pregnancy could be at greater risk for poor birth outcomes1 such as preeclampsia1 pre-term birth1 and low-birth weight4 ,furthermore1 a woman's oral health during pregnancy is a good predictor of her newborn's oral health1 and since mothers can unintentionally spread oral bacteria to their babies1 putting their children at higher risk for tooth decay1 prevention efforts should happen even before children are born1 as a matter of pre-pregnancy health and prenatal care during pregnancy4 7#aj7 ,the ,united ,states has not been able to submit a formal maternal mortality rate to international data repositories since #bjjg4 ,thus1 no official maternal mortality rate exists for the ,united ,states4 ,there can be no maternal mortality rate without streamlining maternal mortality-related data from the ,state level and extrapolating such data to the ,federal level4 7#aa7 ,in the ,united ,states1 death reporting and analysis is a ,state function rather than a ,federal process4 ,states report all deaths--including maternal deaths--on a semi-voluntary basis1 without standardization across ,states4 ,while the ,centers for ,disease ,control and ,prevention has the capacity and system for collecting death-related data based on death certificates1 these data are not sufficiently reported by ,states in an organized and standard format across ,states such that the ,centers for ,disease ,control and ,prevention is able to identify causes of maternal death and best practices for the prevention of such death4 7#ab7 ,vital statistics systems often underestimate maternal mortality and are insufficient data sources from which to derive a full scope of medical and social determinant factors contributing to maternal deaths4 ,while the addition of pregnancy checkboxes on death certificates since #bjjc have likely improved ,states' abilities to identify pregnancy-related deaths1 they are not generally completed by obstetrical providers or persons trained to recognize pregnancy-related mortality4 ,thus1 these vital forms may be missing information or may capture inconsistent data4 ,due to varying maternal mortality-related analyses1 lack of reliability1 and granularity in data1 current maternal mortality informatics do not fully encapsulate the myriad medical and socially determinant factors that contribute to such high maternal mortality rates within the ,united ,states compared to other developed nations4 ,lack of standardization of data and data sharing across ,states and between ,federal entities1 health networks1 and research institutions keep the ,nation in the dark about ways to prevent maternal deaths4 7#ac7 ,having reliable and valid ,state data aggregated at the ,federal level are critical to the ,nation's ability to quell surges in maternal death and imperative for researchers to identify long-lasting interventions4 7#ad7 ,leaders in maternal wellness highly recommend that maternal deaths be investigated at the ,state level first1 and that standardized1 streamlined1 de-identified data regarding maternal deaths be sent annually to the ,centers for ,disease ,control and ,prevention4 ,such data standardization and collection would be similar in operation and effect to the ,national ,program of ,cancer ,registries of the ,centers for ,disease ,control and ,prevention and akin to the ,confidential ,enquiry in ,maternal ,deaths ,programme in the ,united ,kingdom4 ,such a maternal mortalities and morbidities registry and surveillance system would help providers1 academicians1 lawmakers1 and the public to address questions concerning the types of1 causes of1 and best practices to thwart1 pregnancy-related or pregnancy-associated mortality and morbidity4 7#ae7 ,the ,united ,nations' ,millennium ,development ,goal #e;a aimed to reduce by #ge percent1 between #aiij and #bjae1 the maternal mortality rate1 yet this metric has not been achieved4 ,in fact1 the maternal mortality rate in the ,united ,states has been estimated to have more than doubled between #bjjj and #bjad4 ,yet1 because national data are not fully available1 the ,united ,states does not have an official maternal mortality rate4 7#af7 ,many ,states have struggled to establish or maintain ,maternal ,mortality ,review ,committees 7referred to in this section as ,,mmrc74 ,on the ,state level1 ,m,m,r,cs have lagged because ,states have not had the resources to mount local reviews4 ,state-level reviews are necessary as only the ,state departments of health have the authority to request medical records1 autopsy reports1 and police reports critical to the function of the ,,mmrc4 7#ag7 ,the ,united ,kingdom regards maternal deaths as a health systems failure and a national committee of obstetrics experts review each maternal death or near-fatal childbirth complication4 ,such committee also establishes the predominant course of maternal-related deaths from conditions such as preeclampsia4 ,consequently1 the ,united ,kingdom has been able to reduce its incidence of preeclampsia to less than one in #aj1jjj women--its lowest rate since #aieb4 7#ah7 ,the ,united ,states has no comparable1 coordinated ,federal process by which to review cases of maternal mortality1 systems failures1 or best practices4 ,many ,states have active ,m,m,r,cs and leverage their work to impact maternal wellness4 ,for example1 the ,state of ,california has worked extensively with their ,state health departments1 health and hospital systems1 and research collaborative organizations1 including the ,california ,maternal ,quality ,care ,collaborative and the ,alliance for ,innovation on ,maternal ,health1 to establish ,m,m,r,cs1 wherein such ,state has determined the most prevalent causes of maternal mortality and recorded and shared data with providers and researchers1 who have developed and implemented safety bundles and care protocols related to preeclampsia1 maternal hemorrhage1 and the like4 ,in this way1 the ,state of ,california has been able to leverage its maternal mortality review board system1 generate data1 and apply those data to effect changes in maternal care-related protocol4 ,to date1 the ,state of ,california has reduced its maternal mortality rate1 which is now comparable to the low rates of the ,united ,kingdom4 7#ai7 ,hospitals and health systems across the ,united ,states lack standardization of emergency obstetrical protocols before1 during1 and after delivery4 ,consequently1 many providers are delayed in recognizing critical signs indicating maternal distress that quickly escalate into fatal or near-fatal incidences4 ,moreover1 any attempt to address an obstetrical emergency that does not consider both clinical and public health approaches falls woefully under the mark of excellent care delivery4 ,state-based maternal quality collaborative organizations1 such as the ,california ,maternal ,quality ,care ,collaborative or entities participating in the ,alliance for ,innovation on ,maternal ,health 7,,aim71 have formed obstetrical protocols1 tool kits1 and other resources to improve system care and response as they relate to maternal complications and warning signs for such conditions as maternal hemorrhage1 hypertension1 and preeclampsia4 7#bj7 ,the ,centers for ,disease ,control and ,prevention reports that nearly half of all maternal deaths occur in the immediate postpartum period--the #db days following a pregnancy--whereas more than one-third of pregnancy-related or pregnancy-associated deaths occur while a person is still pregnant4 ,yet1 for women eligible for the ,medicaid program on the basis of pregnancy1 such ,medicaid coverage lapses at the end of the month on which the #fjth postpartum day lands4 7#ba7 ,the experience of serious traumatic events1 such as being exposed to domestic violence1 substance use disorder1 or pervasive racism1 can over-activate the body's stress-response system4 ,known as toxic stress1 the repetition of high-doses of cortisol to the brain1 can harm healthy neurological development1 which can have cascading physical and mental health consequences1 as documented in the ,adverse ,childhood ,experiences study of the ,centers for ,disease ,control and ,prevention4 7#bb7 ,a growing body of evidence-based research has shown the correlation between the stress associated with one's race--the stress of racism--and one's birthing outcomes4 ,the stress of sex and race discrimination and institutional racism has been demonstrated to contribute to a higher risk of maternal mortality1 irrespective of one's gestational age1 maternal age1 socioeconomic status1 or individual-level health risk factors1 including poverty1 limited access to prenatal care1 and poor physical and mental health 7although these are not nominal factors74 ,african-,american women remain the most at risk for pregnancy-associated or pregnancy-related causes of death4 ,when it comes to preeclampsia1 for example1 which is related to obesity1 ,african-,american women of normal weight remain the most at risk of dying during the perinatal period compared to non-,african-,american obese women4 7#bc7 ,the rising maternal mortality rate in the ,united ,states is driven predominantly by the disproportionately high rates of ,african-,american maternal mortality4 7#bd7 ,african-,american women are #c to #d times more likely to die from pregnancy or maternal-related distress than are ,white women1 yielding one of the greatest and most disconcerting racial disparities in public health4 7#be7 ,compared to women from other racial and ethnic demographics1 ,african-,american women across the socioeconomic spectrum experience prolonged1 unrelenting stress related to racial and gender discrimination1 contributing to higher rates of maternal mortality1 giving birth to low-weight babies1 and experiencing pre-term birth4 ,racism is a risk-factor for these aforementioned experiences4 ,this cumulative stress often extends across the life course and is situated in everyday spaces where ,african-,american women establish livelihood4 ,structural barriers1 lack of access to care1 and genetic predispositions to health vulnerabilities exacerbate ,african-,american women's likelihood to experience poor or fatal birthing outcomes1 but do not fully account for the great disparity4 7#bf7 ,african-,american women are twice as likely to experience postpartum depression1 and disproportionately higher rates of preeclampsia compared to ,white women4 7#bg7 ,racism is deeply ingrained in ,united ,states systems1 including in health care delivery systems between patients and providers1 often resulting in disparate treatment for pain1 irreverence for cultural norms with respect to health1 and dismissiveness4 ,research has demonstrated that patients respond more warmly and adhere to medical treatment plans at a higher degree with providers of the same race or ethnicity or with providers with great ability to exercise empathy4 ,however1 the provider pool is not primed with many people of color1 nor are providers 7whether student-doctors in training or licensed practitioners7 consistently required to undergo implicit bias1 cultural competency1 or empathy training on a consistent1 on-going basis4 7c7 ,improving ,federal efforts with respect to prevention of maternal mortality 7#a7 ,technical assistance for ,states with respect to reporting maternal mortality ,not later than one year after the date of enactment of this ,act1 the ,director of the ,centers for ,disease ,control and ,prevention 7referred to in this section as the ,director71 in consultation with the ,administrator of the ,health ,resources and ,services ,administration1 shall provide technical assistance to ,states that elect to report comprehensive data on maternal mortality1 including oral1 mental1 and breastfeeding health information1 for the purpose of encouraging uniformity in the reporting of such data and to encourage the sharing of such data among the respective ,states4 7#b7 ,best practices relating to prevention of maternal mortality 7,a7 ,in general ,not later than one year after the date of enactment of this ,act-- 7i7 the ,director1 in consultation with relevant patient and provider groups1 shall issue best practices to ,state maternal mortality review committees on how best to identify and review maternal mortality cases1 taking into account any data made available by ,states relating to maternal mortality1 including data on oral1 mental1 and breastfeeding health1 and utilization of any emergency services2 and 7ii7 the ,director1 working in collaboration with the ,health ,resources and ,services ,administration1 shall issue best practices to hospitals1 ,state professional society groups1 and perinatal quality collaboratives on how best to prevent maternal mortality4 7,b7 ,authorization of appropriations ,for purposes of carrying out this subsection1 there is authorized to be appropriated #e1jjj1jjj for each of fiscal years #bjba through #bjbe4 7#c7 ,alliance for ,innovation on ,maternal ,health ,grant ,program 7,a7 ,in general ,not later than one year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this subsection as the ,secretary71 acting through the ,associate ,administrator of the ,maternal and ,child ,health ,bureau of the ,health ,resources and ,services ,administration1 shall establish a grant program to be known as the ,alliance for ,innovation on ,maternal ,health ,grant ,program 7referred to in this subsection as ,,aim7 under which the ,secretary shall award grants to eligible entities for the purpose of-- 7i7 directing widespread adoption and implementation of maternal safety bundles through collaborative ,state-based teams2 and 7ii7 collecting and analyzing process1 structure1 and outcome data to drive continuous improvement in the implementation of such safety bundles by such ,state-based teams with the ultimate goal of eliminating preventable maternal mortality and severe maternal morbidity in the ,united ,states4 7,b7 ,eligible entities ,in order to be eligible for a grant under paragraph 7#a71 an entity shall-- 7i7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require2 and 7ii7 demonstrate in such application that the entity is an interdisciplinary1 multi-stakeholder1 national organization with a national data-driven maternal safety and quality improvement initiative based on implementation approaches that have been proven to improve maternal safety and outcomes in the ,united ,states4 7,c7 ,use of funds ,an eligible entity that receives a grant under paragraph 7#a7 shall use such grant funds-- 7i7 to develop and implement1 through a robust1 multi-stakeholder process1 maternal safety bundles to assist ,states and health care systems in aligning national1 ,state1 and hospital-level quality improvement efforts to improve maternal health outcomes1 specifically the reduction of maternal mortality and severe maternal morbidity2 7ii7 to ensure1 in developing and implementing maternal safety bundles under subparagraph 7,a71 that such maternal safety bundles-- 7,i7 satisfy the quality improvement needs of a ,state or health care system by factoring in the results and findings of relevant data reviews1 such as reviews conducted by a ,state maternal mortality review committee2 and 7,,ii7 address topics such as-- 7aa7 obstetric hemorrhage2 7bb7 maternal mental health2 7cc7 the maternal venous system2 7dd7 obstetric care for women with substance use disorders1 including opioid use disorder2 7ee7 postpartum care basics for maternal safety2 7ff7 reduction of peripartum racial and ethnic disparities2 7gg7 reduction of primary caesarean birth2 7hh7 severe hypertension in pregnancy2 7ii7 severe maternal morbidity reviews2 7jj7 support after a severe maternal morbidity event2 7kk7 thromboembolism2 7ll7 optimization of support for breastfeeding2 and 7mm7 maternal oral health2 and 7iii7 to provide ongoing technical assistance at the national and ,state levels to support implementation of maternal safety bundles under subparagraph 7,a74 7,d7 ,maternal safety bundle defined ,for purposes of this subsection1 the term maternal safety bundle means standardized1 evidence-informed processes for maternal health care4 7,e7 ,authorization of appropriations ,for purposes of carrying out this subsection1 there is authorized to be appropriated #aj1jjj1jjj for each of fiscal years #bjba through #bjbe4 7#d7 ,funding for ,state-,based perinatal quality collaboratives development and sustainability 7,a7 ,in general ,not later than one year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this subsection as the ,secretary71 acting through the ,division of ,reproductive ,health of the ,centers for ,disease ,control and ,prevention1 shall establish a grant program to be known as the ,state-,based ,perinatal ,quality ,collaborative grant program under which the ,secretary awards grants to eligible entities for the purpose of development and sustainability of perinatal quality collaboratives in every ,state1 the ,district of ,columbia1 and eligible territories1 in order to measurably improve perinatal care and perinatal health outcomes for pregnant and postpartum women and their infants4 7,b7 ,grant amounts ,grants awarded under this subsection shall be in amounts not to exceed #bej1jjj per year1 for the duration of the grant period4 7,c7 ,state-based perinatal quality collaborative defined ,for purposes of this subsection1 the term ,state-based perinatal quality collaborative means a network of multidisciplinary teams that-- 7i7 work to improve measurable outcomes for maternal and infant health by advancing evidence-informed clinical practices using quality improvement principles2 7ii7 work with hospital-based or outpatient facility-based clinical teams1 experts1 and stakeholders1 including patients and families1 to spread best practices and optimize resources to improve perinatal care and outcomes2 7iii7 employ strategies that include the use of the collaborative learning model to provide opportunities for hospitals and clinical teams to collaborate on improvement strategies1 rapid-response data to provide timely feedback to hospital and other clinical teams to track progress1 and quality improvement science to provide support and coaching to hospital and clinical teams2 and 7iv7 have the goal of improving population-level outcomes in maternal and infant health4 7,d7 ,authorization of appropriations ,for purposes of carrying out this subsection1 there is authorized to be appropriated #ad1jjj1jjj per year for each of fiscal years #bjba through #bjbe4 7#e7 ,expansion of ,medicaid and ,,chip coverage for pregnant and postpartum women 7,a7 ,requiring coverage of oral health services for pregnant and postpartum women 7i7 ,medicaid ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7,i7 in subsection 7a77#d7-- 7aa7 by striking 2 and 7,d7 and inserting 2 7,d72 and 7bb7 by inserting 2 and 7,e7 oral health services for pregnant and postpartum women 7as defined in subsection 7ee77 after subsection 7bb772 and 7,,ii7 by adding at the end the following new subsection3 7ee7 ,oral health services for pregnant and postpartum women 7#a7 ,in general ,for purposes of this title1 the term oral health services for pregnant and postpartum women means dental services necessary to prevent disease and promote oral health1 restore oral structures to health and function1 and treat emergency conditions that are furnished to a woman during pregnancy 7or during the #a-year period beginning on the last day of the pregnancy74 7#b7 ,coverage requirements ,to satisfy the requirement to provide oral health services for pregnant and postpartum women1 a ,state shall1 at a minimum1 provide coverage for preventive1 diagnostic1 periodontal1 and restorative care consistent with recommendations for perinatal oral health care and dental care during pregnancy from the ,american ,academy of ,pediatric ,dentistry and the ,american ,college of ,obstetricians and ,gynecologists4 4 7ii7 ,,chip ,section #bajc7;c77#e77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7c77#e77;,a77 is amended by inserting or a targeted low-income pregnant woman after targeted low-income child4 7,b7 ,extending ,medicaid coverage for pregnant and postpartum women ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended-- 7i7 in subsection 7e7-- 7,i7 in paragraph 7#e7-- 7aa7 by inserting 7including oral health services for pregnant and postpartum women 7as defined in section #aije7;ee77 after postpartum medical assistance under the plan2 and 7bb7 by striking #fj-;day and inserting #a-year2 and 7,,ii7 in paragraph 7#f71 by striking #fj-;day and inserting #a-year2 and 7ii7 in subsection 7l77#a77;,a71 by striking #fj-;day and inserting #a-year4 7,c7 ,extending ,medicaid coverage for lawful residents ,section #aijc7v77#d77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7v77#d77;,a77 is amended by striking #fj-;day and inserting #a-year4 7,d7 ,extending ,,chip coverage for pregnant and postpartum women ,section #baab7;d77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acigll7d77#b77;,a77 is amended by striking #fj-;day and inserting #a-year4 7,e7 ,maintenance of effort 7i7 ,medicaid ,section #aijb7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7l77 is amended by adding at the end the following new paragraph3 7#e7 ,during the period that begins on the date of enactment of this paragraph and ends on the date that is five years after such date of enactment1 as a condition for receiving any ,federal payments under section #aijc7;a7 for calendar quarters occurring during such period1 a ,state shall not have in effect1 with respect to women who are eligible for medical assistance under the ,state plan or under a waiver of such plan on the basis of being pregnant or having been pregnant1 eligibility standards1 methodologies1 or procedures under the ,state plan or waiver that are more restrictive than the eligibility standards1 methodologies1 or procedures1 respectively1 under such plan or waiver that are in effect on the date of enactment of this paragraph4 4 7ii7 ,,chip ,section #baje7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7d77 is amended by adding at the end the following new paragraph3 7#d7 ,in eligibility standards for targeted low-income pregnant women ,during the period that begins on the date of enactment of this paragraph and ends on the date that is five years after such date of enactment1 as a condition of receiving payments under subsection 7a7 and section #aijc7;a71 a ,state that elects to provide assistance to women on the basis of being pregnant 7including pregnancy-related assistance provided to targeted low-income pregnant women 7as defined in section #baab7;d771 pregnancy-related assistance provided to women who are eligible for such assistance through application of section #aijb7v77#d77;,a77i7 under section #bajg7;e77#a71 or any other assistance under the ,state child health plan 7or a waiver of such plan7 which is provided to women on the basis of being pregnant7 shall not have in effect1 with respect to such women1 eligibility standards1 methodologies1 or procedures under such plan 7or waiver7 that are more restrictive than the eligibility standards1 methodologies1 or procedures1 respectively1 under such plan 7or waiver7 that are in effect on the date of enactment of this paragraph4 4 7,f7 ,information on benefits ,the ,secretary of ,health and ,human ,services shall make publicly available on the internet website of the ,department of ,health and ,human ,services1 information regarding benefits available to pregnant and postpartum women and under the ,medicaid program and the ,children's ,health ,insurance ,program1 including information on-- 7i7 benefits that ,states are required to provide to pregnant and postpartum women under such programs2 7ii7 optional benefits that ,states may provide to pregnant and postpartum women under such programs2 and 7iii7 the availability of different kinds of benefits for pregnant and postpartum women1 including oral health and mental health benefits1 under such programs4 7,g7 ,federal funding for cost of extended ,medicaid and ,,chip coverage for postpartum women 7i7 ,medicaid ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 as amended by paragraph 7#a71 is further amended-- 7,i7 in subsection 7b71 by striking and 7aa7 and inserting 7aa71 and 7ff72 and 7,,ii7 by adding at the end the following3 7ff7 ,increased ,,fmap for extended medical assistance for postpartum women ,notwithstanding subsection 7b71 the ,federal medical assistance percentage for a ,state1 with respect to amounts expended by such ,state for medical assistance for a woman who is eligible for such assistance on the basis of being pregnant or having been pregnant that is provided during the #cje-;day period that begins on the #fjth day after the last day of her pregnancy 7including any such assistance provided during the month in which such period ends71 shall be equal to-- 7#a7 #ajj percent for the first #bj calendar quarters during which this subsection is in effect2 and 7#b7 #ij percent for calendar quarters thereafter4 4 7ii7 ,,chip ,section #baje7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7c77 is amended by adding at the end the following new paragraph3 7#ab7 ,enhanced payment for extended assistance provided to pregnant women ,notwithstanding subsection 7b71 the enhanced ,,fmap1 with respect to payments under subsection 7a7 for expenditures under the ,state child health plan 7or a waiver of such plan7 for assistance provided under the plan 7or waiver7 to a woman who is eligible for such assistance on the basis of being pregnant 7including pregnancy-related assistance provided to a targeted low-income pregnant woman 7as defined in section #baab7;d771 pregnancy-related assistance provided to a woman who is eligible for such assistance through application of section #aijb7v77#d77;,a77i7 under section #bajg7;e77#a71 or any other assistance under the plan 7or waiver7 provided to a woman who is eligible for such assistance on the basis of being pregnant7 during the #cje-;day period that begins on the #fjth day after the last day of her pregnancy 7including any such assistance provided during the month in which such period ends71 shall be equal to-- 7,a7 #ajj percent for the first #bj calendar quarters during which this paragraph is in effect2 and 7,b7 #ij percent for calendar quarters thereafter4 4 7,h7 ,effective date 7i7 ,in general ,subject to subparagraph 7,b71 the amendments made by this subsection shall take effect on the first day of the first calendar quarter that begins on or after the date that is one year after the date of enactment of this ,act4 7ii7 ,exception for ,state legislation ,in the case of a ,state plan under title ,,xix of the ,social ,security ,act or a ,state child health plan under title ,,xxi of such ,act that the ,secretary of ,health and ,human ,services determines requires ,state legislation in order for the respective plan to meet any requirement imposed by amendments made by this subsection1 the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an 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 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 the session shall be considered to be a separate regular session of the ,state legislature4 7#f7 ,regional centers of excellence ,part ,p of title ,,iii of the ,public ,health ,service ,act is amended by adding at the end the following new section3 #cii,v-#g4 ,regional centers of excellence addressing implicit bias and cultural competency in patient-provider interactions education 7a7 ,in general ,not later than one year after the date of enactment of this section1 the ,secretary1 in consultation with such other agency heads as the ,secretary determines appropriate1 shall award cooperative agreements for the establishment or support of regional centers of excellence addressing implicit bias and cultural competency in patient-provider interactions education for the purpose of enhancing and improving how health care professionals are educated in implicit bias and delivering culturally competent health care4 7b7 ,eligibility ,to be eligible to receive a cooperative agreement under subsection 7a71 an entity shall-- 7#a7 be a public or other nonprofit entity specified by the ,secretary that provides educational and training opportunities for students and health care professionals1 which may be a health system1 teaching hospital1 community health center1 medical school1 school of public health1 dental school1 social work school1 school of professional psychology1 or any other health professional school or program at an institution of higher education 7as defined in section #aja of the ,higher ,education ,act of #aife7 focused on the prevention1 treatment1 or recovery of health conditions that contribute to maternal mortality and the prevention of maternal mortality and severe maternal morbidity2 7#b7 demonstrate community engagement and participation1 such as through partnerships with home visiting and case management programs2 and 7#c7 provide to the ,secretary such information1 at such time and in such manner1 as the ,secretary may require4 7c7 ,diversity ,in awarding a cooperative agreement under subsection 7a71 the ,secretary shall take into account any regional differences among eligible entities and make an effort to ensure geographic diversity among award recipients4 7d7 ,dissemination of information 7#a7 ,public availability ,the ,secretary shall make publicly available on the internet website of the ,department of ,health and ,human ,services information submitted to the ,secretary under subsection 7b77#c74 7#b7 ,evaluation ,the ,secretary shall evaluate each regional center of excellence established or supported pursuant to subsection 7a7 and disseminate the findings resulting from each such evaluation to the appropriate public and private entities4 7#c7 ,distribution ,the ,secretary shall share evaluations and overall findings with ,state departments of health and other relevant ,state level offices to inform ,state and local best practices4 7e7 ,maternal mortality defined ,in this section1 the term maternal mortality means death of a woman that occurs during pregnancy or within the one-year period following the end of such pregnancy4 7f7 ,authorization of appropriations ,for purposes of carrying out this section1 there is authorized to be appropriated #e1jjj1jjj for each of fiscal years #bjba through #bjbe4 4 7#g7 ,special supplemental nutrition program for women1 infants1 and children ,section #ag7;d77#c77;,a77ii7 of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aghf7;d77#c77;,a77ii77 is amended-- 7,a7 by striking the clause designation and heading and all that follows through ,a ,state and inserting the following3 7ii7 ,women 7,i7 ,breastfeeding women ,a ,state 2 7,b7 in subclause 7,i7 7as so designated71 by striking #a year and all that follows through earlier and inserting #b years postpartum2 and 7,c7 by adding at the end the following3 7,,ii7 ,postpartum women ,a ,state may elect to certify a postpartum woman for a period of #b years4 4 7#h7 ,definitions ,in this section3 7,a7 ,maternal mortality ,the term maternal mortality means death of a woman that occurs during pregnancy or within the one-year period following the end of such pregnancy4 7,b7 ,severe maternal morbidity ,the term severe maternal morbidity includes unexpected outcomes of labor and delivery that result in significant short-term or long-term consequences to a woman's health4 7d7 ,increasing excise taxes on cigarettes and establishing excise tax equity among all tobacco product tax rates 7#a7 ,tax parity for roll-,your-,own tobacco ,section #egja7;g7 of the ,internal ,revenue ,code of #aihf is amended by striking #bd4gh and inserting #di4ef4 7#b7 ,tax parity for pipe tobacco ,section #egja7;f7 of the ,internal ,revenue ,code of #aihf is amended by striking #b4hcaa cents and inserting #di4ef4 7#c7 ,tax parity for smokeless tobacco 7,a7 ,section #egja7;e7 of the ,internal ,revenue ,code of #aihf is amended-- 7i7 in paragraph 7#a71 by striking #a4ea and inserting #bf4hd2 7ii7 in paragraph 7#b71 by striking #ej4cc cents and inserting #aj4gd2 and 7iii7 by adding at the end the following3 7#c7 ,smokeless tobacco sold in discrete single-use units ,on discrete single-use units1 #ajj4ff per thousand4 4 7,b7 ,section #egjb7m7 of such ,code is amended-- 7i7 in paragraph 7#a71 by striking or chewing tobacco and inserting 1 chewing tobacco1 or discrete single-use unit2 7ii7 in paragraphs 7#b7 and 7#c71 by inserting that is not a discrete single-use unit before the period in each such paragraph2 and 7iii7 by adding at the end the following3 7#d7 ,discrete single-use unit ,the term discrete single-use unit means any product containing tobacco that-- 7,a7 is not intended to be smoked2 and 7,b7 is in the form of a lozenge1 tablet1 pill1 pouch1 dissolvable strip1 or other discrete single-use or single-dose unit4 4 7#d7 ,tax parity for small cigars ,paragraph 7#a7 of section #egja7;a7 of the ,internal ,revenue ,code of #aihf is amended by striking #ej4cc and inserting #ajj4ff4 7#e7 ,tax parity for large cigars 7,a7 ,in general ,paragraph 7#b7 of section #egja7;a7 of the ,internal ,revenue ,code of #aihf is amended by striking #eb4ge percent and all that follows through the period and inserting the following3 #di4ef per pound and a proportionate tax at the like rate on all fractional parts of a pound but not less than #aj4jff cents per cigar44 7,b7 ,guidance ,the ,secretary of the ,treasury1 or the ,secretary's delegate1 may issue guidance regarding the appropriate method for determining the weight of large cigars for purposes of calculating the applicable tax under section #egja7;a77#b7 of the ,internal ,revenue ,code of #aihf4 7#f7 ,tax parity for roll-,your-,own tobacco and certain processed tobacco ,subsection 7o7 of section #egjb of the ,internal ,revenue ,code of #aihf is amended by inserting 1 and includes processed tobacco that is removed for delivery or delivered to a person other than a person with a permit provided under section #egac1 but does not include removals of processed tobacco for exportation after wrappers thereof4 7#g7 ,clarifying tax rate for other tobacco products 7,a7 ,in general ,section #egja of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following new subsection3 7i7 ,other tobacco products ,any product not otherwise described under this section that has been determined to be a tobacco product by the ,food and ,drug ,administration through its authorities under the ,family ,smoking ,prevention and ,tobacco ,control ,act shall be taxed at a level of tax equivalent to the tax rate for cigarettes on an estimated per use basis as determined by the ,secretary4 4 7,b7 ,establishing per use basis ,for purposes of section #egja7;i7 of the ,internal ,revenue ,code of #aihf1 not later than #ab months after the later of the date of the enactment of this ,act or the date that a product has been determined to be a tobacco product by the ,food and ,drug ,administration1 the ,secretary of the ,treasury 7or the ,secretary of the ,treasury's delegate7 shall issue final regulations establishing the level of tax for such product that is equivalent to the tax rate for cigarettes on an estimated per use basis4 7#h7 ,clarifying definition of tobacco products 7,a7 ,in general ,subsection 7c7 of section #egjb of the ,internal ,revenue ,code of #aihf is amended to read as follows3 7c7 ,tobacco products ,the term tobacco products means-- 7#a7 cigars1 cigarettes1 smokeless tobacco1 pipe tobacco1 and roll-your-own tobacco1 and 7#b7 any other product subject to tax pursuant to section #egja7;i74 4 7,b7 ,conforming amendments ,subsection 7d7 of section #egjb of such ,code is amended by striking cigars1 cigarettes1 smokeless tobacco1 pipe tobacco1 or roll-your-own tobacco each place it appears and inserting tobacco products4 7#i7 ,increasing tax on cigarettes 7,a7 ,small cigarettes ,section #egja7;b77#a7 of such ,code is amended by striking #ej4cc and inserting #ajj4ff4 7,b7 ,large cigarettes ,section #egja7;b77#b7 of such ,code is amended by striking #aje4fi and inserting #baa4ch4 7#aj7 ,tax rates adjusted for inflation ,section #egja of such ,code1 as amended by subsection 7g71 is amended by adding at the end the following new subsection3 7j7 ,inflation adjustment 7#a7 ,in general ,in the case of any calendar year beginning after #bjba1 the dollar amounts provided under this chapter shall each be increased by an amount equal to-- 7,a7 such dollar amount1 multiplied by 7,b7 the cost-of-living adjustment determined under section #a7;f77#c7 for the calendar year1 determined by substituting #8calendar year #bjag' for #8calendar year #bjaf' in subparagraph 7,a77ii7 thereof4 7#b7 ,rounding ,if any amount as adjusted under paragraph 7#a7 is not a multiple of #j4ja1 such amount shall be rounded to the next highest multiple of #j4ja4 4 7#aa7 ,floor ,stocks ,taxes 7,a7 ,imposition of tax ,on tobacco products manufactured in or imported into the ,united ,states which are removed before any tax increase date and held on such date for sale by any person1 there is hereby imposed a tax in an amount equal to the excess of-- 7i7 the tax which would be imposed under section #egja of the ,internal ,revenue ,code of #aihf on the article if the article had been removed on such date1 over 7ii7 the prior tax 7if any7 imposed under section #egja of such ,code on such article4 7,b7 ,credit against tax ,each person shall be allowed as a credit against the taxes imposed by paragraph 7#a7 an amount equal to #ejj4 ,such credit shall not exceed the amount of taxes imposed by paragraph 7#a7 on such date for which such person is liable4 7,c7 ,liability for tax and method of payment 7i7 ,liability for tax ,a person holding tobacco products on any tax increase date to which any tax imposed by paragraph 7#a7 applies shall be liable for such tax4 7ii7 ,method of payment ,the tax imposed by paragraph 7#a7 shall be paid in such manner as the ,secretary shall prescribe by regulations4 7iii7 ,time for payment ,the tax imposed by paragraph 7#a7 shall be paid on or before the date that is #abj days after the effective date of the tax rate increase4 7,d7 ,articles in foreign trade zones ,notwithstanding the ,act of ,june #ah1 #aicd 7commonly known as the ,foreign ,trade ,zone ,act1 #dh ,stat4 #iih1 #ai ,u4,s4,c4 #ha;a et seq471 or any other provision of law1 any article which is located in a foreign trade zone on any tax increase date shall be subject to the tax imposed by paragraph 7#a7 if-- 7i7 internal revenue taxes have been determined1 or customs duties liquidated1 with respect to such article before such date pursuant to a request made under the #ast proviso of section #c7;a7 of such ,act2 or 7ii7 such article is held on such date under the supervision of an officer of the ,united ,states ,customs and ,border ,protection of the ,department of ,homeland ,security pursuant to the #b;d proviso of such section #c7;a74 7,e7 ,definitions ,for purposes of this subsection-- 7i7 ,in general ,any term used in this subsection which is also used in section #egjb of such ,code shall have the same meaning as such term has in such section4 7ii7 ,tax increase date ,the term tax increase date means the effective date of any increase in any tobacco product excise tax rate pursuant to the amendments made by this section 7other than subsection 7j7 thereof74 7iii7 ,secretary ,the term ,secretary means the ,secretary of the ,treasury or the ,secretary's delegate4 7,f7 ,controlled groups ,rules similar to the rules of section #ejfa7;e77#c7 of such ,code shall apply for purposes of this subsection4 7,g7 ,other laws applicable ,all provisions of law1 including penalties1 applicable with respect to the taxes imposed by section #egja of such ,code shall1 insofar as applicable and not inconsistent with the provisions of this subsection1 apply to the floor stocks taxes imposed by paragraph 7#a71 to the same extent as if such taxes were imposed by such section #egja4 ,the ,secretary may treat any person who bore the ultimate burden of the tax imposed by paragraph 7#a7 as the person to whom a credit or refund under such provisions may be allowed or made4 7#ab7 ,effective dates 7,a7 ,in general ,except as provided in paragraphs 7#b7 through 7#d71 the amendments made by this section shall apply to articles removed 7as defined in section #egjb7;j7 of the ,internal ,revenue ,code of #aihf7 after the last day of the month which includes the date of the enactment of this ,act4 7,b7 ,discrete single-use units and processed tobacco ,the amendments made by subsections 7c77#a77;,c71 7c77#b71 and 7f7 shall apply to articles removed 7as defined in section #egjb7;j7 of the ,internal ,revenue ,code of #aihf7 after the date that is #f months after the date of the enactment of this ,act4 7,c7 ,large cigars ,the amendments made by subsection 7e7 shall apply to articles removed after ,december #ca1 #bjba4 7,d7 ,other tobacco products ,the amendments made by subsection 7g77#a7 shall apply to products removed after the last day of the month which includes the date that the ,secretary of the ,treasury 7or the ,secretary of the ,treasury's delegate7 issues final regulations establishing the level of tax for such product4 #ejd4 ,allowing for medical assistance under ,medicaid for inmates during #cj-;day period preceding release 7a7 ,in general ,the subdivision 7,a7 following paragraph 7#cj7 of section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is amended by inserting and except during the #cj-;day period preceding the date of release of such individual from such public institution after medical institution4 7b7 ,report ,not later than ,june #cj1 #bjbb1 the ,medicaid and ,,chip ,payment and ,access ,commission shall submit a report to ,congress on the ,medicaid inmate exclusion under the subdivision 7,a7 following paragraph 7#cj7 of section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a774 ,such report may1 to the extent practicable1 include the following information3 7#a7 ,the number of incarcerated individuals who would otherwise be eligible to enroll for medical assistance under a ,state plan approved under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 7or a waiver of such a plan74 7#b7 ,access to health care for incarcerated individuals1 including a description of medical services generally available to incarcerated individuals4 7#c7 ,a description of current practices related to the discharge of incarcerated individuals1 including how prisons interact with ,state ,medicaid agencies to ensure that such individuals who are eligible to enroll for medical assistance under a ,state plan or waiver described in paragraph 7#a7 are so enrolled4 7#d7 ,if determined appropriate by the ,commission1 recommendations for ,congress1 the ,department of ,health and ,human ,services1 or ,states regarding the ,medicaid inmate exclusion4 7#e7 ,any other information that the ,commission determines would be useful to ,congress4 #eje4 ,providing for immediate ,medicaid eligibility for former foster youth ,section #ajjb7;a77#b7 of the ,,support for ,patients and ,communities ,act 7,public ,law #aae-bga7 is amended by striking ,january #a1 #bjbc and inserting the date of enactment of the ,ending ,health ,disparities ,during ,,covid-#ai ,act of #bjbj4 #ejf4 ,expanded coverage for former foster youth 7a7 ,coverage continuity for former foster care children up to age #bf 7#a7 ,in general ,section #ajjb7;a77#a77;,b7 of the ,,support for ,patients and ,communities ,act 7,public ,law #aae-bga7 is amended by striking all that follows after item 7cc71 and inserting the following3 by striking responsibility of the ,state and all that follows through #dge7h77;,b77iii72 and and inserting responsibility of a ,state on the date of attaining #ah years of age 7or such higher age as such ,state has elected under section #dge7h77;,b77iii771 or who were in such care at any age but subsequently left such care to enter into a legal guardianship with a kinship caregiver 7without regard to whether kinship guardianship payments are being made on behalf of the child under this part7 or were emancipated from such care prior to attaining age #ah24 7#b7 ,amendments to ,social ,security ,act 7,a7 ,in general ,section #aijb7;a77#aj77;,a77i77,,ix7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77i77,,ix771 as amended by section #ajjb7;a7 of the ,,support for ,patients and ,communities ,act 7,public ,law #aae-bga71 is amended-- 7i7 in item 7bb71 by striking the semicolon at the end and inserting 2 and2 and 7ii7 by striking item 7dd74 7,b7 ,effective date ,the amendments made by this paragraph shall take effect on ,january #a1 #bjbc4 7b7 ,outreach efforts for enrollment of former foster children ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77 is amended-- 7#a7 in paragraph 7#he71 by striking 2 and and inserting a semicolon2 7#b7 in paragraph 7#hf71 by striking the period at the end and inserting 2 and2 and 7#c7 by inserting after paragraph 7#hf7 the following new paragraph3 7#hg7 not later than ,january #a1 #bjbj1 establish an outreach and enrollment program1 in coordination with the ,state agency responsible for administering the ,state plan under part ,e of title ,,iv and any other appropriate or interested agencies1 designed to increase the enrollment of individuals who are eligible for medical assistance under the ,state plan under paragraph 7#aj77;,a77i77,,ix7 in accordance with best practices established by the ,secretary4 4 #ejg4 ,removing citizenship and immigration barriers to access to affordable health care under ,,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 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 ,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 ,states4 7#d7 ,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#e7 ,requirement to maintain minimum essential coverage ,section #ejjj;,a7d7 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 amendments 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 heading1 by striking 2 access limited to citizens and lawful residents2 and 7,b7 by striking paragraph 7#c74 #ejh4 ,medicaid in the territories 7a7 ,elimination of general ,medicaid funding limitations 7cap7 for territories 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,a71 by inserting and subsection 7h7 after paragraphs 7#c7 and 7#e72 and 7,c7 by adding at the end the following new subsection3 7h7 ,sunset of ,medicaid funding limitations for ,puerto ,rico1 the ,virgin ,islands of the ,united ,states1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa ,subsections 7f7 and 7g7 shall not apply to ,puerto ,rico1 the ,virgin ,islands of the ,united ,states1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa beginning with fiscal year #bjbj4 4 7#b7 ,conforming amendments 7,a7 ,section #aijb7;j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7j77 is amended by striking 1 the limitation in section #aajh7;f714 7,b7 ,section #aijc7u7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7u77 is amended by striking paragraph 7#d74 7,c7 ,section #acbc7;c77#a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjdc7;c77#a77 is amended by striking #bjai and inserting #bjah4 7#c7 ,effective date ,the amendments made by this section shall apply beginning with fiscal year #bjba4 7b7 ,elimination of specific ,federal medical assistance percentage 7,,fmap7 limitation for territories ,section #aije7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b77 is amended1 in clause 7#b71 by inserting for fiscal years before fiscal year #bjbj after ,american ,samoa4 7c7 ,application of ,medicaid waiver authority to all of the territories 7#a7 ,in general ,section #aijb7;j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7j77 is amended-- 7,a7 by striking ,american ,samoa and the ,northern ,mariana ,islands and inserting ,puerto ,rico1 the ,virgin ,islands of the ,united ,states1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa2 7,b7 by striking ,american ,samoa or the ,northern ,mariana ,islands and inserting ,puerto ,rico1 the ,virgin ,islands of the ,united ,states1 ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa2 7,c7 by inserting 7#a7 after 7j72 7,d7 by inserting except as otherwise provided in this subsection1 after ,notwithstanding any other requirement of this title2 and 7,e7 by adding at the end the following3 7#b7 ,the ,secretary may not waive under this subsection the requirement of subsection 7a77#aj77;,a77i77,,ix7 7relating to coverage of adults formerly under foster care7 with respect to any territory4 4 7#b7 ,effective date ,the amendments made by this section shall apply beginning ,october #a1 #bjba4 7d7 ,permitting ,medicaid ,,dsh allotments for territories ,section #aibc7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7 is amended-- 7#a7 in paragraph 7#f71 by adding at the end the following new subparagraph3 7,c7 ,territories 7i7 ,fiscal year #bjbj ,for fiscal year #bjbj1 the ,,dsh allotment for ,puerto ,rico1 the ,virgin ,islands of the ,united ,states1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa shall bear the same ratio to #cjj1jjj1jjj as the ratio of the number of individuals who are low-income or uninsured and residing in such respective territory 7as estimated from time to time by the ,secretary7 bears to the sums of the number of such individuals residing in all of the territories4 7ii7 ,subsequent fiscal year ,for each subsequent fiscal year1 the ,,dsh allotment for each such territory is subject to an increase in accordance with paragraph 7#b74 2 and 7#b7 in paragraph 7#i71 by inserting before the period at the end the following3 1 and includes1 beginning with fiscal year #bjba1 ,puerto ,rico1 the ,virgin ,islands of the ,united ,states1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa4 #eji4 ,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 an alien and all that follows through under this section and inserting 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 an alien and all that follows through under this part and inserting an individual who is lawfully present in the ,united ,states4 #eaj4 ,removing barriers to health care and nutrition assistance for children1 pregnant persons1 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 persons during pregnancy and during the #ab-month 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,n7 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,n7 ,paragraph 7#d7 of section #aijc7v7 7relating to coverage of categories of children1 pregnant persons1 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 #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 #eaa4 ,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 ,state payments for medical assistance ,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 ,payment to states ,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 ,repeal ,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 amendments made by this section shall take effect as if included in the enactment of the ,deficit ,reduction ,act of #bjje4 ,,vi ,community ,based ,grants #fja4 ,grants for racial and ethnic approaches to community health 7a7 ,purpose ,it is the purpose of this section to award 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 ,administration 7referred to in this section as the ,secretary71 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 ,indian tribes or tribal organizations 7as such terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd771 the ,indian ,health ,service1 or any other organization that serves ,alaska ,natives2 and 7,v7 interested public or private health care providers or organizations as determined 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 oral disease1 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 ,any funds provided to an eligible entity through a grant under this section shall-- 7#a7 supplement1 not supplant1 any other ,federal funds made available to the entity for the purposes of this section2 and 7#b7 not be used to duplicate the activities of any other health disparity grant program under this ,act1 including an amendment made by 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 eligible entities receiving grants under this section to share best practices1 evaluation results1 and reports with communities not affiliated with such entities1 by using the ,internet1 conferences1 and other pertinent information regarding the projects funded by this section1 including through using outreach efforts of the ,office of ,minority ,health 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 eligible entities receiving grants under this section4 7i7 ,authorization of appropriations ,there are authorized to be appropriated such sums as may be necessary to carry out this section4 #fjb4 ,grants to promote health for underserved communities ,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-#c4 ,grants to promote health for underserved communities 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-- 7#a7 to promote health for underserved communities1 with preference given to projects that benefit racial and ethnic minority women1 racial and ethnic minority children1 adolescents1 and lesbian1 gay1 bisexual1 transgender1 queer1 or questioning communities2 and 7#b7 to strengthen health outreach initiatives in medically underserved communities1 including linguistically isolated populations4 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 educate and provide outreach in a community setting regarding health problems prevalent among underserved communities1 and especially among racial and ethnic minority women1 racial and ethnic minority children1 adolescents1 and lesbian1 gay1 bisexual1 transgender1 queer1 or questioning communities2 7#c7 to educate and provide experiential learning opportunities and target risk factors and healthy behaviors that impede or contribute to achieving positive health outcomes1 including-- 7,a7 healthy nutrition2 7,b7 physical activity2 7,c7 overweight or obesity2 7,d7 tobacco use1 including the use of e-cigarettes and vaping2 7,e7 alcohol and substance use2 7,f7 injury and violence2 7,g7 sexual health2 7,h7 mental health2 7,i7 musculoskeletal health and arthritis2 7,j7 prenatal and postnatal care2 7,k7 dental and oral health2 7,l7 understanding informed consent2 7,m7 stigma2 and 7,n7 environmental hazards2 7#d7 to promote community wellness and awareness2 and 7#e7 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 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 or 7iii7 have a high number of households experiencing extreme poverty2 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 these programs 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 positive healthy 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 7k7 ,authorization of ,appropriations ,there are authorized to be appropriated to carry out this section #ae1jjj1jjj for each of fiscal years #bjba through #bjbe4 4 #fjc4 ,addressing ,,covid-#ai health inequities and improving health equity 7a7 ,in general ,not later than #fj days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall award grants to eligible entities to establish or expand programs to improve health equity regarding ,,covid-#ai and reduce or eliminate inequities1 including racial and ethnic inequities1 in the incidence1 prevalence1 and health outcomes of ,,covid-#ai4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an entity shall-- 7#a7 be a nongovernmental entity or consortium of entities that works to improve health and health equity in populations or communities disproportionately affected by adverse health outcomes1 including-- 7,a7 racial and ethnic minority communities2 7,b7 ,indian ,tribes1 ,tribal organizations1 and urban ,indian organizations2 7,c7 people with disabilities2 7,d7 ,english language learners2 7,e7 older adults2 7,f7 low-income communities2 7,g7 justice-involved communities2 7,h7 immigrant communities2 and 7,i7 communities on the basis of their sexual orientation or gender identity2 7#b7 have demonstrated experience in successfully working in and partnering with such communities1 and have an established record of accomplishment in improving health outcomes or preventing1 reducing or eliminating health inequities1 including racial and ethnic inequities1 in those communities2 7#c7 communicate with ,state1 local1 and ,tribal health departments to coordinate grant activities1 as appropriate2 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 ,an entity shall use amounts received under grant under this section to establish1 improve upon1 or expand programs to improve health equity regarding ,,covid-#ai and reduce or eliminate inequities1 including racial and ethnic inequities1 in the incidence1 prevalence1 and health outcomes of ,,covid-#ai4 ,such uses may include-- 7#a7 acquiring and distributing medical supplies1 such as personal protective equipment1 to communities that are at an increased risk of ,,covid-#ai2 7#b7 helping people enroll in a health insurance plan that meets minimum essential coverage2 7#c7 increasing the availability of ,,covid-#ai testing and any future ,,covid-#ai treatments or vaccines in communities that are at an increased risk of ,,covid-#ai2 7#d7 aiding communities and individuals in following guidelines and best practices in regards to ,,covid-#ai1 including physical distancing guidelines2 7#e7 helping communities and ,,covid-#ai survivors recover and cope with the long-term health impacts of ,,covid-#ai2 7#f7 addressing social determinants of health1 such as transportation1 nutrition1 housing1 discrimination1 health care access1 including mental health care and substance use disorder prevention1 treatment1 and recovery1 health literacy1 employment status1 and working conditions1 education1 income1 and stress1 that impact ,,covid-#ai incidence1 prevalence1 and health outcomes1 and facilitating or providing access to needed services2 7#g7 the provision of anti-racism and implicit and explicit bias training for health care providers and other relevant professionals2 7#h7 creating and disseminating culturally informed1 linguistically appropriate1 accessible1 and medically accurate outreach and education regarding ,,covid-#ai2 7#i7 acquiring1 retaining1 and training a diverse workforce2 and 7#aj7 improving the accessibility to health care1 including accessibility to health care providers1 mental health care1 and ,,covid-#ai testing for people with disabilities4 7d7 ,administration 7#a7 ,priority ,in awarding grants under this section1 the ,secretary shall give priority to eligible entities that are a community-based organization or have an established history of successfully working in and partnering with the community or with populations which the entity intends to provide services under the grant4 ,the ,secretary shall also utilize available demographic data to give priority to eligible entities working with populations or communities disproportionately affected by ,,covid-#ai4 7#b7 ,geographical diversity ,the ,secretary shall seek to ensure geographical diversity among grant recipients4 7#c7 ,reduction of burdens ,in administering the grant program under this section1 the ,secretary shall make every effort to minimize unnecessary administrative burdens on eligible entities receiving such grants4 7#d7 ,technical assistance ,the ,secretary shall provide technical assistance to eligible entities on best practices for applying grants under this section4 7e7 ,duration ,a grant awarded under this section shall be for a period of #c years4 7f7 ,reporting 7#a7 ,by grantee ,not later than #ahj days after the end of a grant period under this section1 the grantee shall submit to the ,secretary a report on the activities conducted under the grant1 including-- 7,a7 a description of the impact of grant activities1 including on-- 7i7 outreach and education related to ,,covid-#ai2 and 7ii7 improving public health activities related to ,,covid-#ai1 including physical distancing2 7,b7 the number of individuals reached by the activities under the grant and1 to the extent known1 the disaggregated demographic data of such individuals1 such as by race1 ethnicity1 sex 7including sexual orientation and gender identity71 income1 disability status1 or primary language2 and 7,c7 any other information the ,secretary determines is necessary4 7#b7 ,by ,secretary ,not later than #a year after the end of the grant program under this section1 the ,secretary shall submit to ,congress a report on the grant program1 including a summary of the information gathered under paragraph 7#a74 7g7 ,supplement1 not supplant ,grants awarded under this ,act shall be used to supplement and not supplant any other ,federal funds made available to carry out the activities described in this ,act4 7h7 ,funding ,out of funds in the ,treasury not otherwise appropriated1 there are appropriated to carry out this section1 #ejj1jjj1jjj for each of fiscal years #bjbj through #bjbb4 #fjd4 ,improving social determinants of health 7a7 ,findings ,congress finds the following3 7#a7 ,healthy ,people #bjbj defines social determinants of health as conditions in the environments in which people live1 learn1 work1 play1 worship1 and age that affect a wide range of health1 functioning1 and quality-of-life outcomes and risks4 7#b7 ,one of the overarching goals of ,healthy ,people #bjbj is to create social and physical environments that promote good health for all4 7#c7 ,healthy ,people #bjbj developed a place-based organizing framework1 reflecting five key areas of social determinants of health namely-- 7,a7 economic stability2 7,b7 education2 7,c7 social and community context2 7,d7 health and health care2 and 7,e7 neighborhood and built environment4 7#d7 ,it is estimated that medical care accounts for only #aj to #bj percent of the modifiable contributors to healthy outcomes for a population4 7#e7 ,the ,centers for ,medicare ,medicaid ,services has indicated the importance of the social determinants in its work stating that1 ,as we seek to foster innovation1 rethink rural health1 find solutions to the opioid epidemic1 and continue to put patients first1 we need to take into account social determinants of health and recognize their importance44 7#f7 ,the ,department of ,health and ,human ,services' ,public ,health #c4j initiative recognizes the role of public health in working across sectors on social determinants of health1 as well as the role of public health as chief health strategist in communities4 7#g7 ,through its ,health ,impact in #e ,years initiative1 the ,centers for ,disease ,control and ,prevention has highlighted nonclinical1 community-wide approaches that show positive health impacts1 results within five years1 and cost effectiveness or cost savings over the lifetime of the population or earlier4 7#h7 ,health departments and the ,centers for ,disease ,control and ,prevention are not funded for such cross-cutting work4 7#i7 ,providing grants to public health departments and other eligible entities to coordinate cross-sector collaboration will allow a community-wide1 evidence-based approach to address underlying social determinants of health4 7b7 ,social ,determinants of ,health ,program 7#a7 ,program ,to the extent and in the amounts made available in advance in appropriations ,acts1 the ,director of the ,centers for ,disease ,control and ,prevention 7in this section referred to as the ,director7 shall carry out a program1 to be known as the ,social ,determinants of ,health ,program 7in this section referred to as the ,program71 to achieve the following goals3 7,a7 ,improve health outcomes and reduce health inequities by coordinating social determinants of health activities across the ,centers for ,disease ,control and ,prevention4 7,b7 ,improve the capacity of public health agencies and community organizations to address social determinants of health in communities4 7#b7 ,activities ,to achieve the goals listed in paragraph 7#a71 the ,director shall carry out activities including the following3 7,a7 ,coordinating across the ,centers for ,disease ,control and ,prevention to ensure that relevant programs consider and incorporate social determinants of health in grant awards and other activities4 7,b7 ,awarding grants under subsection 7c7 to ,state1 local1 territorial1 and ,tribal health agencies and organizations1 and to other eligible entities1 to address social determinants of health in target communities4 7,c7 ,awarding grants under subsection 7d7 to nonprofit organizations and public or other nonprofit institutions of higher education-- 7i7 to conduct research on best practices to improve social determinants of health2 7ii7 to provide technical assistance1 training1 and evaluation assistance to grantees under subsection 7c72 and 7iii7 to disseminate best practices to grantees under subsection 7c74 7,d7 ,coordinating1 supporting1 and aligning activities of the ,centers for ,disease ,control and ,prevention related to social determinants of health with activities of other ,federal agencies related to social determinants of health1 including such activities of agencies in the ,department of ,health and ,human ,services such as the ,centers for ,medicare ,medicaid ,services4 7,e7 ,collecting and analyzing data related to the social determinants of health4 7c7 ,grants ,to address social determinants of health 7#a7 ,in general ,the ,director1 as part of the ,program1 shall award grants to eligible entities to address social determinants of health in their communities4 7#b7 ,eligibility ,to be eligible to apply for a grant under this subsection1 an entity shall be-- 7,a7 a ,state1 local1 territorial1 or ,tribal health agency or organization2 7,b7 a qualified nongovernmental entity1 as defined by the ,director2 or 7,c7 a consortium of entities that includes a ,state1 local1 territorial1 or ,tribal health agency or organization4 7#c7 ,use of funds 7,a7 ,in general ,a grant under this subsection shall be used to address social determinants of health in a target community by designing and implementing innovative1 evidence-based1 cross-sector strategies4 7,b7 ,target community ,for purposes of this subsection1 a target community shall be a ,state1 county1 city1 or other municipality4 7#d7 ,priority ,in awarding grants under this subsection1 the ,director shall prioritize applicants proposing to serve target communities with significant unmet health and social needs1 as defined by the ,director4 7#e7 ,application ,to seek a grant under this subsection1 an eligible entity shall-- 7,a7 submit an application at such time1 in such manner1 and containing such information as the ,director may require2 7,b7 propose a set of activities to address social determinants of health through evidence-based1 cross-sector strategies1 which activities may include-- 7i7 collecting quantifiable data from health care1 social services1 and other entities regarding the most significant gaps in health-promoting social1 economic1 and environmental needs2 7ii7 identifying evidence-based approaches to meeting the nonmedical1 social needs of populations identified by data collection described in clause 7i71 such as unstable housing or inadequate food2 7iii7 developing scalable methods to meet patients' social needs identified in clinical settings or other sites2 7iv7 convening entities such as local and ,state governmental and nongovernmental organizations1 health systems1 payors1 and community-based organizations to review1 plan1 and implement community-wide interventions and strategies to advance health-promoting social conditions2 7v7 monitoring and evaluating the impact of activities funded through the grant on the health and well-being of the residents of the target community and on the cost of health care2 and 7vi7 such other activities as may be specified by the ,director2 7,c7 demonstrate how the eligible entity will collaborate with-- 7i7 health systems2 7ii7 payors1 including1 as appropriate1 medicaid managed care organizations 7as defined in section #aijc7m77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7m77#a77;,a7771 ,medicare ,advantage plans under part ,c of title ,,xviii of such ,act 7#db ,u4,s4,c4 #aciew-#ba et seq471 and health insurance issuers and group health plans 7as such terms are defined in section #bgia of the ,public ,health ,service ,act72 7iii7 other relevant stakeholders and initiatives in areas of need1 such as the ,accountable ,health ,communities ,model of the ,centers for ,medicare ,medicaid ,services1 health homes under the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 community-based organizations1 and human services organizations2 7iv7 other non-health care sector organizations1 including organizations focusing on transportation1 housing1 or food access2 and 7v7 local employers2 and 7,d7 identify key health inequities in the target community and demonstrate how the proposed efforts of the eligible entity would address such inequities4 7#f7 ,monitoring and evaluation ,as a condition of receipt of a grant under this subsection1 a grantee shall agree to submit an annual report to the ,director describing the activities carried out through the grant and the outcomes of such activities4 7#g7 ,independent national evaluation 7,a7 ,in general ,not later than #e years after the first grants are awarded under this subsection1 the ,director shall provide for the commencement of an independent national evaluation of the ,program under this subsection4 7,b7 ,report to ,congress ,not later than #fj days after receiving the results of such independent national evaluation1 the ,director shall report such results to the ,congress4 7d7 ,research and training ,the ,director1 as part of the ,program-- 7#a7 shall award grants to nonprofit organizations and public or other nonprofit institutions of higher education-- 7,a7 to conduct research on best practices to improve social determinants of health2 7,b7 to provide technical assistance1 training1 and evaluation assistance to grantees under subsection 7c72 and 7,c7 to disseminate best practices to grantees under subsection 7c72 and 7#b7 may require a grantee under paragraph 7#a7 to provide technical assistance and capacity building to entities that are eligible entities under subsection 7c7 but not receiving funds through such subsection4 7e7 ,funding 7#a7 ,in general ,there is authorized to be appropriated to carry out this section1 #ej1jjj1jjj for each of fiscal years #bjba through #bjbf4 7#b7 ,allocation ,of the amount made available to carry out this section for a fiscal year1 not less than #ge percent shall be used for grants under subsections 7c7 and 7d74 #fje4 ,funding to ,states1 localities1 and community-based organizations for emergency aid and services 7a7 ,funding for ,states 7#a7 ,increase in funding for ,social ,services ,block ,grant ,program 7,a7 ,appropriation ,out of any money in the ,treasury of the ,united ,states not otherwise appropriated1 there are appropriated #i1fjj1jjj1jjj1 which shall be available for payments under section #bjjb of the ,social ,security ,act4 7,b7 ,deadline for distribution of funds ,within #de days after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall distribute the funds made available by this paragraph1 which shall be made available to ,states on an emergency basis for immediate obligation and expenditure4 7,c7 ,submission of ,revised ,pre-,expenditure ,report ,within #ij days after a ,state receives funds made available by this paragraph1 the ,state shall submit to the ,secretary a revised pre-expenditure report pursuant to title ,,xx of the ,social ,security ,act that describes how the ,state plans to administer the funds4 7,d7 ,obligation of funds by ,states ,a ,state to which funds made available by this paragraph are distributed shall obligate the funds not later than ,december #ca1 #bjbj4 7,e7 ,expenditure of funds by ,states ,a grantee to which a ,state 7or a subgrantee to which a grantee7 provides funds made available by this paragraph shall expend the funds not later than ,december #ca1 #bjba4 7#b7 ,rules governing use of additional funds ,a ,state to which funds made available by paragraph 7#a77;,b7 are distributed shall use the funds in accordance with the following3 7,a7 ,purpose 7i7 ,in general ,the ,state shall use the funds only to support the provision of emergency services to disadvantaged children1 families1 and households4 7ii7 ,disadvantaged defined ,in this paragraph1 the term disadvantaged means1 with respect to an entity1 that the entity-- 7,i7 is an individual1 or is located in a community1 that is experiencing material hardship2 7,,ii7 is a household in which there is a child 7as defined in section #ab7;d7 of the ,richard ,b4 ,russell ,national ,school ,lunch ,act7 or a child served under section #aa7;a77#a7 of such ,act1 who1 if not for the closure of the school attended by the child during a public health emergency designation and due to concerns about a ,,covid-#ai outbreak1 would receive free or reduced price school meals pursuant to such ,act2 7,,iii7 is an individual1 or is located in a community1 with barriers to employment2 or 7,,iv7 is located in a community that1 as of the date of the enactment of this ,act1 is not experiencing a #ef-;day downward trajectory of-- 7aa7 influenza-like illnesses2 7bb7 ,,covid-like syndromic cases2 7cc7 documented ,,covid-#ai cases2 or 7dd7 positive test results as a percentage of total ,,covid-#ai tests4 7,b7 ,pass-through to local entities 7i7 ,in the case of a ,state in which a county administers or contributes financially to the non-,federal share of the amounts expended in carrying out a ,state program funded under title ,,iv of the ,social ,security ,act1 the ,state may pass funds so made available through to-- 7,i7 the chief elected official of the city or urban county that administers the program2 or 7,,ii7 local government and community-based organizations4 7ii7 ,in the case of any other ,state1 the ,state shall-- 7,i7 pass the funds through to-- 7aa7 7,,aa7 local governments that will expend or distribute the funds in consultation with community-based organizations with experience serving disadvantaged families or individuals2 or 7,,bb7 community-based organizations with experience serving disadvantaged families and individuals2 and 7bb7 sub-,state areas in proportions based on the population of disadvantaged individuals living in the areas2 and 7,,ii7 report to the ,secretary on how the ,state determined the amounts passed through pursuant to this clause4 7,c7 ,methods 7i7 ,in general ,the ,state shall use the funds only for-- 7,i7 administering emergency services2 7,,ii7 providing short-term cash1 non-cash1 or in-kind emergency disaster relief2 7,,iii7 providing services with demonstrated need in accordance with objective criteria that are made available to the public2 7,,iv7 operational costs directly related to providing services described in subclauses 7,i71 7,,ii71 and 7,,iii72 7,v7 local government emergency social service operations2 and 7,,vi7 providing emergency social services to rural and frontier communities that may not have access to other emergency funding streams4 7ii7 ,administering emergency services defined ,in clause 7i71 the term administering emergency services means-- 7,i7 providing basic disaster relief1 economic1 and well-being necessities to ensure communities are able to safely observe shelter-in-place and social distancing orders2 7,,ii7 providing necessary supplies such as masks1 gloves1 and soap1 to protect the public against infectious disease2 and 7,,iii7 connecting individuals1 children1 and families to services or payments for which they may already be eligible4 7,d7 ,prohibitions 7i7 ,no individual eligibility determinations by grantees or subgrantees ,neither a grantee to which the ,state provides the funds nor any subgrantee of such a grantee may exercise individual eligibility determinations for the purpose of administering short-term1 non-cash1 in-kind emergency disaster relief to communities4 7ii7 ,applicability of certain social services block grant funds use limitations ,the ,state shall use the funds subject to the limitations in section #bjje of the ,social ,security ,act1 except that1 for purposes of this clause1 section #bjje7;a77#b7 and #bjje7;a77#h7 of such ,act shall not apply4 7iii7 ,no supplantation of certain ,state funds ,the ,state may use the funds to supplement1 not supplant1 ,state general revenue funds for social services4 7iv7 ,ban on use for certain costs reimbursable by ,,fema ,the ,state may not use the funds for costs that are reimbursable by the ,federal ,emergency ,management ,agency1 under a contract for insurance1 or by self-insurance4 7b7 ,funding for federally recognized ,indian ,tribes and ,tribal organizations 7#a7 ,grants 7,a7 ,in general ,within #ij days after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall make grants to federally recognized ,indian ,tribes and ,tribal organizations4 7,b7 ,amount of grant ,the amount of the grant for an ,indian ,tribe or ,tribal organization shall bear the same ratio to the amount appropriated by paragraph 7#c7 as the total amount of grants awarded to the ,indian ,tribe or ,tribal organization under the ,low-,income ,home ,energy ,assistance ,act of #aiha and the ,community ,service ,block ,grant for fiscal year #bjbj bears to the total amount of grants awarded to all ,indian ,tribes and ,tribal organizations under such ,act and such ,grant for the fiscal year4 7#b7 ,rules governing use of funds ,an entity to which a grant is made under paragraph 7#a7 shall obligate the funds not later than ,december #ca1 #bjbj1 and the funds shall be expended by grantees and subgrantees not later than ,december #ca1 #bjba1 and used in accordance with the following3 7,a7 ,purpose 7i7 ,in general ,the grantee shall use the funds only to support the provision of emergency services to disadvantaged households4 7ii7 ,disadvantaged defined ,in clause 7i71 the term disadvantaged means1 with respect to an entity1 that the entity-- 7,i7 is an individual1 or is located in a community1 that is experiencing material hardship2 7,,ii7 is a household in which there is a child 7as defined in section #ab7;d7 of the ,richard ,b4 ,russell ,national ,school ,lunch ,act7 or a child served under section #aa7;a77#a7 of such ,act1 who1 if not for the closure of the school attended by the child during a public health emergency designation and due to concerns about a ,,covid-#ai outbreak1 would receive free or reduced price school meals pursuant to such ,act2 7,,iii7 is an individual1 or is located in a community1 with barriers to employment2 or 7,,iv7 is located in a community that1 as of the date of the enactment of this ,act1 is not experiencing a #ef-;day downward trajectory of-- 7aa7 influenza-like illnesses2 7bb7 ,,covid-like syndromic cases2 7cc7 documented ,,covid-#ai cases2 or 7dd7 positive test results as a percentage of total ,,covid-#ai tests4 7,b7 ,methods 7i7 ,in general ,the grantee shall use the funds only for-- 7,i7 administering emergency services2 7,,ii7 providing short-term1 non-cash1 in-kind emergency disaster relief2 and 7,,iii7 tribal emergency social service operations4 7ii7 ,administering emergency services defined ,in clause 7i71 the term administering emergency services means-- 7,i7 providing basic economic and well-being necessities to ensure communities are able to safely observe shelter-in-place and social distancing orders2 7,,ii7 providing necessary supplies such as masks1 gloves1 and soap1 to protect the public against infectious disease2 and 7,,iii7 connecting individuals1 children1 and families to services or payments for which they may already be eligible4 7,c7 ,prohibitions 7i7 ,no individual eligibility determinations by grantees or subgrantees ,neither the grantee nor any subgrantee may exercise individual eligibility determinations for the purpose of administering short-term1 non-cash1 in-kind emergency disaster relief to communities4 7ii7 ,ban on use for certain costs reimbursable by ,,fema ,the grantee may not use the funds for costs that are reimbursable by the ,federal ,emergency ,management ,agency1 under a contract for insurance1 or by self-insurance4 7#c7 ,appropriation ,out of any money in the ,treasury of the ,united ,states not otherwise appropriated1 there are appropriated to the ,secretary of ,health and ,human ,services #djj1jjj1jjj to carry out this subsection4 #fjf4 ,supplemental nutrition assistance program 7a7 ,value of benefits ,notwithstanding any other provision of law1 beginning on ,june #a1 #bjbj1 and for each subsequent month through ,september #cj1 #bjba1 the value of benefits determined under section #h7;a7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjag7;a771 and consolidated block grants for ,puerto ,rico and ,american ,samoa determined under section #ai7;a7 of such ,act 7#g ,u4,s4,c4 #bjbh7;a771 shall be calculated using #aae percent of the ,june #bjai value of the thrifty food plan 7as defined in section #c of such ,act 7#g ,u4,s4,c4 #bjab77 if the value of the benefits and block grants would be greater under that calculation than in the absence of this subsection4 7b7 ,minimum amount 7#a7 ,in general ,the minimum value of benefits determined under section #h7;a7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjag7;a77 for a household of not more than #b members shall be #cj4 7#b7 ,effectiveness ,paragraph 7#a7 shall remain in effect until the date on which #h percent of the value of the thrifty food plan for a household containing #a member1 rounded to the nearest whole dollar increment1 is equal to or greater than #cj4 7c7 ,requirements for the ,secretary ,in carrying out this section1 the ,secretary shall-- 7#a7 consider the benefit increases described in each of subsections 7a7 and 7b7 to be a mass change2 7#b7 require a simple process for ,states to notify households of the increase in benefits2 7#c7 consider section #af7;c77#c77;,a7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjbe7;c77#c77;,a77 to apply to any errors in the implementation of this section1 without regard to the #abj-;day limit described in that section2 7#d7 disregard the additional amount of benefits that a household receives as a result of this section in determining the amount of overissuances under section #ac of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjbb72 and 7#e7 set the tolerance level for excluding small errors for the purposes of section #af7;c7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjbe7;c77 at #ej through ,september #cj1 #bjba4 7d7 ,provisions for impacted workers ,notwithstanding any other provision of law1 the requirements under subsections 7d77#a77;,a77ii7 and 7o7 of section #f of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjae7 shall not be in effect during the period beginning on ,june #a1 #bjbj1 and ending #b years after the date of enactment of this ,act4 7e7 ,administrative expenses 7#a7 ,in general ,for the costs of ,state administrative expenses associated with carrying out this section and administering the supplemental nutrition assistance program established under the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjaa et seq471 the ,secretary shall make available #aej1jjj1jjj for fiscal year #bjbj and #aej1jjj1jjj for fiscal year #bjba4 7#b7 ,timing for fiscal year #bjbj ,not later than #fj days after the date of the enactment of this ,act1 the ,secretary shall make available to ,states amounts for fiscal year #bjbj under paragraph 7#a74 7#c7 ,allocation of funds ,funds described in paragraph 7#a7 shall be made available as grants to ,state agencies for each fiscal year as follows3 7,a7 #ge percent of the amounts available for each fiscal year shall be allocated to ,states based on the share of each ,state of households that participate in the supplemental nutrition assistance program as reported to the ,department of ,agriculture for the most recent #ab-month period for which data are available1 adjusted by the ,secretary 7as of the date of the enactment of this ,act7 for participation in disaster programs under section #e7;h7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjad7;h772 and 7,b7 #be percent of the amounts available for each fiscal year shall be allocated to ,states based on the increase in the number of households that participate in the supplemental nutrition assistance program as reported to the ,department of ,agriculture over the most recent #ab-month period for which data are available1 adjusted by the ,secretary 7as of the date of the enactment of this ,act7 for participation in disaster programs under section #e7;h7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjad7;h774 7f7 ,,snap rules ,no funds 7including fees7 made available under this ,act or any other ,act for any fiscal year may be used to finalize1 implement1 administer1 enforce1 carry out1 or otherwise give effect to-- 7#a7 the final rule entitled ,supplemental ,nutrition ,assistance ,program3 ,requirements for ,able-,bodied ,adults ,without ,dependents published in the ,federal ,register on ,december #e1 #bjai 7#hd ,fed4 ,reg4 #ffghb72 7#b7 the proposed rule entitled ,revision of ,categorical ,eligibility in the ,supplemental ,nutrition ,assistance ,program 7,,snap7 published in the ,federal ,register on ,july #bd1 #bjai 7#hd ,fed4 ,reg4 #ceegj72 or 7#c7 the proposed rule entitled ,supplemental ,nutrition ,assistance ,program3 ,standardization of ,state ,heating and ,cooling ,standard ,utility ,allowances published in the ,federal ,register on ,october #c1 #bjai 7#hd ,fed4 ,reg4 #ebhji74 7g7 ,certain exclusions from ,,snap income ,a ,federal pandemic unemployment compensation payment made to an individual under section #bajd of the ,,cares ,act 7,public ,law #aaf-acf7 shall not be regarded as income and shall not be regarded as a resource for the month of receipt and the following #i months1 for the purpose of determining eligibility for such individual or any other individual for benefits or assistance1 or the amount of benefits or assistance1 under any programs authorized under the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjaa et seq474 7h7 ,public availability ,not later than #aj days after the date of the receipt or issuance of each document listed below1 the ,secretary shall make publicly available on the website of the ,department of ,agriculture the following documents3 7#a7 ,any ,state agency request to participate in the supplemental nutrition assistance program online program under section #g7k74 7#b7 ,any ,state agency request to waive1 adjust1 or modify statutory or regulatory requirements under the ,food and ,nutrition ,act of #bjjh related to the ,,covid-#ai outbreak4 7#c7 ,the ,secretary's approval or denial of each such request under paragraphs 7#a7 or 7#b74 7i7 ,funding ,there are hereby appropriated to the ,secretary1 out of any money not otherwise appropriated1 such sums as may be necessary to carry out this section4 ,,vii ,culturally and ,linguistically ,competent ,care #gja4 ,ensuring standards for culturally and linguistically appropriate services in health care 7a7 ,applicability ,this section shall apply 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 7#db ,u4,s4,c4 #ahjja et seq47 7or amendments made thereby74 7b7 ,standards ,each program or activity described in subsection 7a7-- 7#a7 shall 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 program or activity2 7#b7 shall educate and train governance1 leadership1 and workforce at all levels and across all disciplines of the program or activity in culturally and linguistically appropriate policies and practices on an ongoing basis at least yearly2 7#c7 shall offer and provide language assistance1 including trained and competent bilingual staff and interpreter services1 to individuals with limited ,english proficiency or who have other communication needs1 at no cost to the individual at all points of contact1 and during all hours of operation1 to facilitate timely access to health care services and health-care-related services2 7#d7 shall for each language group consisting of individuals with limited ,english proficiency 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 program or activity1 make available at a fifth grade reading level-- 7,a7 easily understood patient-related materials1 including print and multimedia materials1 in the language of such language group2 7,b7 information or notices about termination of benefits in such language2 7,c7 signage2 and 7,d7 any other documents or types of documents designated by the ,secretary2 7#e7 shall 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 planning and operations of the program or activity2 7#f7 shall 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 program or activity and develop ways to standardize the assessments1 and such assessments must occur at least yearly2 7#g7 shall 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-b note71 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 management information systems of the program or activity2 and 7,c7 periodically updated2 7#h7 shall maintain a current demographic1 cultural1 and epidemiological profile of the community1 conduct regular assessments of community health assets and needs1 and use the results of such assessments to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area of the program or activity2 7#i7 shall 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#aj7 shall ensure that conflict and grievance resolution processes are culturally and linguistically appropriate and capable of identifying1 preventing1 and resolving cross-cultural conflicts or complaints by patients2 7#aa7 shall 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#ab7 shall1 if requested1 regularly make available to the head of each ,federal entity from which ,federal funds are provided1 information about the progress and successful innovations of the program or activity in implementing the standards under this section as required by the head of such entity4 7c7 ,comments accepted through notice and comment rulemaking ,an agency carrying out a program described in subsection 7a7 shall ensure that comments with respect to such program that are accepted through notice and comment rulemaking be accepted in all languages1 may not require such comments to be submitted only in ,english1 and must ensure these comments are considered equally as comments submitted in ,english during the agency's review of comments submitted4 #gjb4 ,culturally and linguistically appropriate health care in the ,public ,health ,service ,act ,title ,,xxxiv of the ,public ,health ,service ,act1 as amended by section #ajd1 is further amended by adding at the end the following3 ,b ,,culturally ,,and ,,linguistically ,,appropriate ,,health ,,care #cdjc4 ,definitions 7a7 ,in general ,in this title3 7#a7 ,bilingual ,the term bilingual1 with respect to an individual1 means a person who has sufficient degree of proficiency in #b languages4 7#b7 ,cultural ,the term cultural means relating 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 queer1 and questioning individuals1 and individuals with physical and mental disabilities4 7#c7 ,culturally and linguistically appropriate ,the term culturally and linguistically appropriate means being respectful of and responsive to the cultural and linguistic needs of all individuals4 7#d7 ,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 speaking1 or learning impairment1 that enables access to1 understanding of1 and benefit from health care or health-care-related services1 and full participation in the development of their treatment plan4 7#e7 ,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#f7 ,health care group ,the term health care group means a group of physicians organized1 at least in part1 for the purposes of providing physician services under the ,medicaid program under title ,,xix of the ,social ,security ,act1 the ,state ,children's ,health ,insurance ,program under title ,,xxi of such ,act1 or the ,medicare program under title ,,xviii of such ,act and may include a hospital and any other individual or entity furnishing services covered under any such program that is affiliated with the health care group4 7#g7 ,health care services ,the term health care services means services that address physical as well as mental health conditions in all care settings4 7#h7 ,health-care-related services ,the term health-care-related services means human or social services programs or activities that provide access1 referrals1 or links to health care4 7#i7 ,health educator ,the term health educator includes a professional with a baccalaureate degree who is responsible for designing1 implementing1 and evaluating individual and population health promotion and chronic disease prevention programs4 7#aj7 ,indian2 indian tribe ,the terms ,indian and ,indian ,tribe have the meanings given such terms in section #d of the ,indian ,self-,determination and ,education ,assistance ,act4 7#aa7 ,individual with a disability ,the term individual with a disability means any individual who has a disability as defined for the purpose of section #ejd of the ,rehabilitation ,act of #aigc4 7#ab7 ,individual with limited ,english proficiency ,the term individual with limited ,english proficiency means an individual whose primary language for communication is not ,english and who has a limited ability to read1 write1 speak1 or understand ,english4 7#ac7 ,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 disorder1 and related disciplines to improve the health outcomes of an individual4 ,such providers may include hospitals1 health1 mental health1 or substance use disorder clinics and providers1 home health agencies1 ambulatory surgery centers1 skilled nursing facilities1 rehabilitation centers1 and employed1 independent1 or contracted physicians4 7#ad7 ,interpreting2 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#ae7 ,language access ,the term language access means the provision of language services to an individual with limited ,english proficiency or an individual with communication disabilities designed to enhance that individual's access to1 understanding of1 or benefit from health care services or health-care-related services4 7#af7 ,language assistance services ,the term language assistance services includes-- 7,a7 oral language assistance1 including interpretation in non-,english languages provided in-person or remotely by a qualified interpreter for an individual with limited ,english proficiency1 and the use of qualified bilingual or multilingual staff to communicate directly with individuals with limited ,english proficiency2 7,b7 written translation1 performed by a qualified and competent translator1 of written content in paper or electronic form into languages other than ,english2 and 7,c7 taglines4 7#ag7 ,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 groups1 members of sexual and gender minority groups1 and individuals with a disability4 7#ah7 ,minority group ,the term minority group has the meaning given the term racial and ethnic minority group4 7#ai7 ,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 services or health-care-related services and the recipient of such services who is limited in ,english proficiency or has a communication impairment such as an impairment in hearing1 vision1 or learning4 7#bj7 ,qualified individual with a disability ,the term qualified individual with a disability means1 with respect to a health program or activity1 an individual with a disability who1 with or without reasonable modifications to policies1 practices1 or procedures1 the removal of architectural1 communication1 or transportation barriers1 or the provision of auxiliary aids and services1 meets the essential eligibility requirements for the receipt of aids1 benefits1 or services offered or provided by the health program or activity4 7#ba7 ,qualified interpreter for an individual with a disability ,the term qualified interpreter for an individual with a disability1 for an individual with a disability-- 7,a7 means an interpreter who by means of a remote interpreting service or an on-site appearance2 7i7 adheres to generally accepted interpreter ethics principles1 including client confidentiality2 and 7ii7 is able to interpret effectively1 accurately1 and impartially1 both receptively and expressively1 using any necessary specialized vocabulary1 terminology1 and phraseology2 and 7,b7 may include sign language interpreters1 oral transliterators 7individuals who represent or spell in the characters of another alphabet71 and cued language transliterators 7individuals who represent or spell by using a small number of handshapes74 7#bb7 ,qualified interpreter for an individual with limited ,english proficiency ,the term qualified interpreter for an individual with limited ,english proficiency means an interpreter who via a remote interpreting service or an on-site appearance-- 7,a7 adheres to generally accepted interpreter ethics principles1 including client confidentiality2 7,b7 has demonstrated proficiency in speaking and understanding both spoken ,english and one or more other spoken languages2 and 7,c7 is able to interpret effectively1 accurately1 and impartially1 both receptively and expressly1 to and from such languages and ,english1 using any necessary specialized vocabulary1 terminology1 and phraseology4 7#bc7 ,qualified translator ,the term qualified translator means a translator who-- 7,a7 adheres to generally accepted translator ethics principles1 including client confidentiality2 7,b7 has demonstrated proficiency in writing and understanding both written ,english and one or more other written non-,english languages2 and 7,c7 is able to translate effectively1 accurately1 and impartially to and from such languages and ,english1 using any necessary specialized vocabulary1 terminology1 and phraseology4 7#bd7 ,racial and ethnic minority group ,the term racial and ethnic minority group means ,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#be7 ,sexual and gender minority group ,the term sexual and gender minority group encompasses lesbian1 gay1 bisexual1 and transgender populations1 as well as those whose sexual orientation1 gender identity and expression1 or reproductive development varies from traditional1 societal1 cultural1 or physiological norms4 7#bf7 ,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#bg7 ,state ,notwithstanding section #b1 the term ,state means each of the several ,states1 the ,district of ,columbia1 the ,commonwealth of ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 ,american ,samoa1 and the ,commonwealth of the ,northern ,mariana ,islands4 7#bh7 ,telephonic interpretation ,the term telephonic interpretation 7also known as over the phone interpretation or ,,opi7 means1 with respect to interpretation for an individual with limited ,english proficiency1 a method of interpretation in which the interpreter is not in the physical presence of the provider of health care services or health-care-related services and such individual receiving such services1 but the interpreter is connected via telephone4 7#bi7 ,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#cj7 ,video remote interpreting services ,the term video remote interpreting services means the provision1 in health care services or health-care-related services1 through a qualified interpreter for an individual with limited ,english proficiency1 of video remote interpreting services that are-- 7,a7 in real-time1 full-motion video1 and audio over a dedicated high-speed1 wide-bandwidth video connection or wireless connection that delivers high quality video images that do not produce lags1 choppy1 blurry1 or grainy images1 or irregular pauses in communication2 and 7,b7 in a sharply delineated image that is large enough to display4 7#ca7 ,vital document ,the term vital document includes 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 individuals with limited ,english proficiency with communication disabilities of the availability of free language services1 alternative formats1 and other outreach materials4 7b7 ,reference ,in any reference in this title to a regulatory provision applicable to a handicapped individual1 the term handicapped individual in such provision shall have the same meaning as the term individual with a disability as defined in subsection 7a74 #a ,resources and innovation for culturally and linguistically appropriate health care #cdjd4 ,robert ,t4 ,matsui ,center for ,culturally and ,linguistically ,appropriate ,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 ,culturally and ,linguistically ,appropriate ,health ,care 7referred to in this section as the ,center7 to carry out each of 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 ,vital documents ,the ,center shall provide1 directly or through contract1 vital documents from competent translation services for providers of health care services and health-care-related services at no cost to such providers4 ,such documents may be submitted by covered entities 7as defined in section #ib4d of title #db1 ,code of ,federal ,regulations1 as in effect on ,may #af1 #bjaf7 for translation into non-,english languages or alternative formats at a fifth-grade reading level4 ,such 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 ,forms ,for each form developed or revised by the ,secretary that will be used by individuals with limited ,english proficiency 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 shall be completed within #de calendar days of the ,secretary receiving final approval of the form from the ,office of ,management and ,budget4 ,the ,center shall post all translated forms on its website so that other entities may use the same translations4 7#c7 ,toll-free customer service telephone number ,the ,center shall provide1 through a toll-free number1 a customer service line for individuals with limited ,english proficiency-- 7,a7 to obtain information about federally conducted or funded health programs1 including the ,medicare program under title ,,xviii of the ,social ,security ,act1 the ,medicaid program under title ,,xix of such ,act1 and the ,state ,children's ,health ,insurance ,program under title ,,xxi of such ,act1 marketplace coverage available pursuant to title ,,xxvii of this ,act and the ,patient ,protection and ,affordable ,care ,act1 and other sources of free or reduced care including federally qualified health centers1 title ,x clinics1 and public health departments2 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 services and health-care-related services to reduce medical errors1 improve medical outcomes1 improve cultural competence1 reduce health care costs caused by miscommunication with individuals with limited ,english proficiency1 and reduce or eliminate the duplication of efforts to translate materials4 ,the clearinghouse shall include the information described in subparagraphs 7,b7 through 7,f7 and make such information available on the internet and in print4 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 templates for each of the following3 7i7 ,administrative and legal documents1 including-- 7,i7 intake forms2 7,,ii7 forms related to the ,medicare program under title ,,xviii of the ,social ,security ,act1 the ,medicaid program under title ,,xix of such ,act1 and the ,state ,children's ,health ,insurance ,program under title ,,xxi of such ,act1 including eligibility information for such programs2 7,,iii7 forms informing patients of the compliance and consent requirements pursuant to the regulations under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7#db ,u4,s4,c4 #acbj-b note72 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 and linguistically appropriate2 7ii7 allow public review of the documents before dissemination in order to ensure that the documents are understandable and culturally and linguistically 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 individuals with limited ,english proficiency1 including case studies using de-identified patient information1 program summaries1 and program evaluations4 7,e7 ,culturally and linguistically appropriate materials ,the ,center shall provide information relating to culturally and linguistically appropriate 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 appropriate care2 7ii7 culturally and linguistically appropriate self-assessment tools2 7iii7 culturally and linguistically appropriate training tools2 7iv7 strategic plans to increase cultural and linguistic appropriateness in different types of providers of health care services and health-care-related services1 including regional collaborations among health care organizations2 and 7v7 culturally and linguistically appropriate information for educators1 practitioners1 and researchers4 7,f7 ,translation ,glossaries ,the ,center shall-- 7i7 develop and publish on its website translation glossaries that provide standardized translations of commonly used terms and phrases utilized in documents translated by the ,center2 and 7ii7 make these glossaries available-- 7,i7 free of charge2 7,,ii7 in the #ae languages in which the ,center translates materials2 and 7,,iii7 in alternative formats in accordance with the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abaja et seq474 7,g7 ,information about progress ,the ,center shall regularly collect and make publicly available information about the progress of entities receiving grants under section #cdjb 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 individuals with limited ,english proficiency1 individuals with hearing or vision impairments1 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 and competent 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 ,there are authorized to be appropriated to carry out this section #e1jjj1jjj for each of fiscal years #bjba through #bjbe4 #cdje4 ,innovations in culturally and linguistically appropriate health care grants 7a7 ,in general 7#a7 ,grants ,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 culturally and linguistically appropriate access to health care services for individuals with limited ,english proficiency4 7#b7 ,coordination ,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 ,national ,institute 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 7a71 an entity shall-- 7#a7 be-- 7,a7 a city1 county1 ,indian ,tribe1 ,state1 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 disorder 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 any other entity designated by the ,secretary2 and 7#b7 prepare and submit to the ,secretary an application1 at such time1 in such manner1 and containing such additional information as the ,secretary may reasonably require4 7c7 ,use of funds ,an entity shall use funds received through 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 remote interpreting services2 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 entity2 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 the service area of the entity2 7#d7 develop a strategic plan to implement language services2 7#e7 develop participatory1 collaborative partnerships with communities encompassing the patient populations of individuals with limited ,english proficiency served by the grant to gain input in designing and implementing language services2 7#f7 develop and implement grievance resolution processes that are culturally and linguistically appropriate and capable of identifying1 preventing1 and resolving complaints by individuals with limited ,english proficiency2 7#g7 develop short-term medical and mental health interpretation training courses and incentives for bilingual health care staff who are asked to provide interpretation services 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 and linguistically appropriate providers2 7#i7 provide staff language training instruction1 which shall include information on the practical limitations of such instruction for nonnative 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 competence1 including cultural competence programs for community health workers2 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 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 care services 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 ,culturally and ,linguistically ,appropriate ,health ,care established under section #cdja4 ,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 #bjba through #bjbe4 #cdjf4 ,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 care services4 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 conduct such research4 7c7 ,use of funds ,research conducted 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 individuals with limited ,english proficiency4 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 individuals with limited ,english proficiency4 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 services 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 ,secretary can create or coordinate1 and subsidize or otherwise fund1 telephonic interpretation services 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 #e1jjj1jjj for each of fiscal years #bjba through #bjbe4 4 #gjc4 ,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 and linguistically appropriate 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 culturally and linguistically appropriate service delivery1 which shall include all diverse populations including people with disabilities and the ,lesbian1 gay1 bisexual1 transgender1 queer1 questioning1 questioning and intersex 7,,lgbtqia7 community1 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-- 7#a7 by redesignating the clause 7x7 added by section #eeje7;b7 of the ,patient ,protection and ,affordable ,care ,act as clause 7xi72 and 7#b7 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 #gjd4 ,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 ,innovation 7as referred to in section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a771 shall establish a demonstration program under which the ,secretary shall award grants to eligible ,medicare service providers to improve communication between such providers and ,medicare beneficiaries who are limited ,english proficient1 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 ,act 7#db ,u4,s4,c4 #acie;c et seq472 7ii7 a provider of services under part ,b of such title 7#db ,u4,s4,c4 #acie;j et seq472 7iii7 a ,medicare ,advantage organization offering a ,medicare ,advantage plan under part ,c of such title 7#db ,u4,s4,c4 #aciew-#ba et seq472 or 7iv7 a ,,pdp sponsor offering a prescription drug plan under part ,d of such title 7#db ,u4,s4,c4 #aciew-#aja et seq474 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 ,english learners1 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 sexual1 gender1 disability1 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 ,english learners4 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 ,practice and comply with the requirements of section #aeeg of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahaaf7 as published in the ,federal ,register on ,may #ah1 #bjaf2 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 an ,english learner 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 ,clause 7ii7 shall not be construed to exempt emergency rooms or similar entities that regularly provide health care services in medical emergencies to patients who are ,english learners 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 7#db ,u4,s4,c4 #aciew-#ba et seq47 or a ,,pdp sponsor offering a prescription drug plan under part ,d of such title 7#db ,u4,s4,c4 #aciew-#aja et seq471 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 ,english learners4 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 ,medicare beneficiaries who are ,english learners in a grantee's service area utilizing-- 7i7 data on the numbers of ,english learners 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 ,english learners 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 who is an ,english learner 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 ,medicare beneficiaries who are ,english learners 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 ,medicare beneficiaries who are ,english learners participating in the project as compared to such outcomes and costs for such ,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 section #aaae;,a7c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7c774 7,d7 ,recommendations1 if any1 regarding the extension of such project to the entire ,medicare ,program1 subject to the provisions of such section #aaae;,a7c74 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 7#ab7 ,english learner defined ,in this subsection1 the term ,english learner has the meaning given such term in section #haja7bj7 of the ,elementary and ,secondary ,education ,act of #aife1 except that subparagraphs 7,a71 7,b71 and 7,d7 of such section shall not apply4 7b7 ,language assistance 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 and at the end2 7ii7 by adding and at the end of subparagraph 7,c72 and 7iii7 by inserting after subparagraph 7,c7 the following new subparagraph3 7,d7 language assistance services as defined in subsection 7jjj77#a71 2 and 7,b7 by adding at the end the following new subsection3 7kkk7 ,language assistance services and related terms 7#a7 ,the term language assistance services means language access or language assistance services 7as those terms are defined in section #cdjj of the ,public ,health ,service ,act7 furnished by a qualified interpreter for an individual with limited ,english proficiency or a qualified translator 7as those terms are defined in such section #cdjj7 to an individual with limited ,english proficiency 7as defined in such section #cdjj7 or an ,english learner 7as defined in paragraph 7#b774 7#b7 ,the term ,english learner has the meaning given that term in section #haja7bj7 of the ,elementary and ,secondary ,education ,act of #aife1 except that subparagraphs 7,a71 7,b71 and 7,d7 of such section shall not apply4 4 7#b7 ,coverage ,section #ahcb7;a77#b7 of the ,social ,security ,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 the following new subparagraph3 7,k7 language assistance services 7as defined in section #ahfa7;jjj77#a774 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 striking the period at the end of paragraph 7#i7 and inserting 2 and2 and 7,c7 by inserting after paragraph 7#i7 the following new paragraph3 7#aj7 in the case of language assistance services 7as defined in section #ahfa7;jjj77#a771 #ajj percent of the reasonable charges for such services1 as determined in consultation with the ,medicare ,payment ,advisory ,commission4 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 assistance services 7as defined in section #ahfa7kkk77#a7 of such ,act74 7c7 ,medicare parts ,c and ,d 7#a7 ,in general ,medicare ,advantage plans under part ,c of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba et seq47 and prescription drug plans under part ,d of such title 7#db ,u4,s4,c4 #acieq-#aja7 shall comply with title ,,vi of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;d et seq47 and section #aeeg of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahaaf7 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 internal policies and procedures of the organization 7or sponsor7 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 ,ending ,health ,disparities ,during ,,covid-#ai ,act of #bjbj1 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 language services programs and services offered by the organization 7or sponsor7 with respect to the 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 enrollee population4 7,e7 ,the periodic provision of educational information to plan enrollees on the language services and programs offered by the organization 7or sponsor74 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;,e771 as amended by section #bjc7;g77#c71 is further amended by-- 7,a7 striking #ge and inserting #ie2 7,b7 striking translation or interpretation services and inserting language assistance 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#bi7 and inserting 7#bi71 and 7#cj74 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#bi71 by striking and at the end2 7,b7 by redesignating paragraph 7#cj7 as paragraph 7#ca72 and 7,c7 by inserting after paragraph 7#bi7 the following new paragraph3 7#cj7 language assistance services1 as such term is defined in section #ahfa7kkk77#a71 provided in a timely manner to individuals with limited ,english proficiency as defined in section #cdjj of the ,public ,health ,service ,act2 and 4 7#d7 ,use of deductions and cost sharing ,section #aiaf7;a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo7a77#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 assistance 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#aj72 and 7,b7 in subsection 7c71 by adding at the end the following new paragraph3 7#aj7 ,language assistance services ,the child health assistance provided to a targeted low-income child shall include coverage of language assistance services1 as such term is defined in section #ahfa7;jjj77#a71 provided in a timely manner to individuals with limited ,english proficiency 7as defined in section #cdjj of the ,public ,health ,service ,act74 2 and 7,c7 in subsection 7e77#b7-- 7i7 in the heading1 by striking preventive and inserting certain2 and 7ii7 by inserting or subsection 7c77#aj7 after subsection 7c77#a77;,d74 7#f7 ,definition of child health assistance ,section #baaj7;a77#bg7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;jj7a77#bg77 is amended by striking translation and inserting language assistance services as described in section #bajc7;c77#aj74 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 ,act 7#db ,u4,s4,c4 #acig;aa et seq472 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;ee7 is amended-- 7,a7 in subsection 7a77#a71 by striking #ge and inserting #ij2 and 7,b7 in subsection 7c77#b77;,a71 by inserting before the period at the end the following3 1 except that expenditures pursuant to clause 7iv7 of subparagraph 7,d7 of such paragraph shall not count towards this total4 7e7 ,funding language assistance 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 7referred to in this subsection as the ,secretary7 shall make payments 7on a quarterly basis7 directly to eligible entities to support the provision of language assistance services to ,english learners in an amount equal to an eligible entity's eligible costs for providing 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 #bjba through #bjbe4 7,c7 ,relation to ,medicaid ,,dsh ,payments under this subsection shall not offset or reduce payments under section #aibc of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d71 nor shall payments under such section be considered when determining uncompensated costs associated with the provision of language assistance services for the purposes of this section4 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 assistance 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 assistance 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 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 assistance services to ,english learners1 the product of-- 7i7 the average per person cost of language assistance services1 determined according to the methodology devised under paragraph 7#b72 and 7ii7 the number of ,english learners who are provided language assistance 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 not later than #f months after the date of the enactment of this ,act1 provides language assistance services to not less than #h percent of the entity's total number of patients2 and 7iii7 prepares and submits an application to the ,secretary1 at such time1 in such manner1 and accompanied by such information as the ,secretary may require1 to ascertain the entity's eligibility for funding under this subsection4 7,c7 ,english learner ,the term ,english learner has the meaning given such term in section #haja7bj7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja7bj771 except that subparagraphs 7,a71 7,b71 and 7,d7 of such section shall not apply4 7,d7 ,language assistance services ,the term language assistance services has the meaning given such term in section #ahfa7kkk77#a7 of the ,social ,security ,act1 as added by subsection 7b74 7f7 ,application of ,civil ,rights ,act of #aifd1 section #aeeg of the ,affordable ,care ,act1 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 #bjjj;d et seq471 section #aeeg of the ,affordable ,care ,act1 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 #bjba4 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 7#db ,u4,s4,c4 #acif et seq47 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 #gje4 ,requirements for health programs or activities receiving ,federal funds 7a7 ,covered entity2 covered program or activity ,in this section-- 7#a7 the term covered entity has the meaning given such term in section #ib4d of title #db1 ,code of ,federal ,regulations1 as in effect on ,may #af1 #bjaf2 and 7#b7 the term covered program or activity has the meaning given such term in section #ib4d of title #db1 ,code of ,federal ,regulations1 as in effect on ,may #af1 #bjaf4 7b7 ,requirements ,a covered entity1 in order to ensure the right of individuals with limited ,english proficiency to receive access to high-quality health care through the covered program or activity1 shall-- 7#a7 ensure that appropriate clinical and support staff receive ongoing education and training in culturally and linguistically appropriate service delivery2 7#b7 offer and provide appropriate language assistance services at no additional charge to each patient that is an individual 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 qualified interpreters for an individual with limited ,english proficiency or qualified translators1 except as provided in subsection 7c74 7c7 ,exemptions ,the requirements of subsection 7b77#d7 shall not apply as follows3 7#a7 ,when a patient requests the use of family1 friends1 or other persons untrained in interpretation or translation if each of the following conditions are met3 7,a7 ,the interpreter requested by the patient is over the age of #ah4 7,b7 ,the covered entity informs the patient in the primary language of the patient that he or she has the option of having the entity provide to the patient an interpreter and translation services without charge4 7,c7 ,the covered entity informs the patient that the entity may not require an individual with a limited ,english proficiency to use a family member or friend as an interpreter4 7,d7 ,the covered entity evaluates whether the person the patient wishes to use as an interpreter is competent4 ,if the covered entity has reason to believe that such person is not competent as an interpreter1 the entity provides its own interpreter to protect the covered entity from liability if the patient's interpreter is later found not competent4 7,e7 ,if the covered entity has reason to believe that there is a conflict of interest between the interpreter and patient1 the covered entity may not use the patient's interpreter4 7,f7 ,the covered entity 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 primary 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 7d7 ,rule of construction ,subsection 7c77#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 #gjf4 ,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 ,national ,academy 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 to health care services and health-care-related services that are culturally and linguistically appropriate4 ,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 services and health-care-related services for individuals with limited ,english proficiency1 including people with cognitive1 hearing1 vision1 or print impairments2 7#d7 recommend guidelines or standards for health literacy and plain language1 informed consent1 discharge instructions1 and written communications1 and for improvement of health care access2 7#e7 a description of the effect of providing language services on quality of health care and access to care2 and 7#f7 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 #bjba through #bjbe4 #gjg4 ,health professions competencies to address racial and ethnic mental health disparities 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,assistant ,secretary for ,mental ,health and ,substance ,use1 shall award grants to qualified national organizations for the purposes of-- 7#a7 developing1 and disseminating to health professional educational programs curricula or core competencies addressing mental health inequities among racial and ethnic minority groups for use in the training of students in the professions of social work1 psychology1 psychiatry1 marriage and family therapy1 mental health counseling1 peer support1 and substance abuse counseling2 and 7#b7 certifying community health workers and peer wellness specialists with respect to such curricula and core competencies and integrating and expanding the use of such workers and specialists into health care and community-based settings to address mental health disparities among racial and ethnic minority groups4 7b7 ,curricula2 core competencies ,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 competencies described in subsection 7a77#a73 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 input1 including input from communities of color with lived experience1 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 7#d7 ,establishing external stakeholder advisory boards to provide meaningful input into policy and program development and best practices to reduce mental health inequities among racial and ethnic groups1 including participation from communities of color with lived experience of the impacts of mental health disparities4 7c7 ,definitions ,in this section3 7#a7 ,qualified national organization ,the term qualified national organization means a national organization that focuses on the education of students in programs of social work1 occupational therapy1 psychology1 psychiatry1 and marriage and family therapy4 7#b7 ,racial and ethnic minority group ,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 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 #bjba through #bjbe4 #gjh4 ,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 coverage or oral health 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 any annual open enrollment or any special enrollment period or upon enactment and implementation of any legislative changes to the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 that affect the number of persons eligible for coverage4 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-- 7,a7 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 ,act1 including the amendments made by such title2 and 7,b7 not use such report to engage in or anticipate any deportation or immigration related enforcement action by any entity1 including the ,department of ,homeland ,security4 ,,viii ,aid to ,providers ,serving ,minority ,communities #hja4 ,temporary increase in ,medicaid ,,dsh allotments 7a7 ,in general ,section #aibc7;f77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;f77#c77 is amended-- 7#a7 in subparagraph 7,a71 by striking and subparagraph 7,e7 and inserting and subparagraphs 7,e7 and 7,f72 and 7#b7 by adding at the end the following new subparagraph3 7,f7 ,temporary increase in allotments during certain public health emergency ,the ,,dsh allotment for any ,state for each of fiscal years #bjbj and #bjba is equal to #ajb4e percent of the ,,dsh allotment that would be determined under this paragraph for the ,state for each respective fiscal year without application of this subparagraph1 notwithstanding subparagraphs 7,b7 and 7,c74 ,for each fiscal year after fiscal year #bjba1 the ,,dsh allotment for a ,state for such fiscal year is equal to the ,,dsh allotment that would have been determined under this paragraph for such fiscal year if this subparagraph had not been enacted4 4 7b7 ,,dsh allotment adjustment for ,tennessee ,section #aibc7;f77#f77;,a77vi7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;f77#f77;,a77vi77 is amended-- 7#a7 by striking ,notwithstanding any other provision of this subsection and inserting the following3 7,i7 ,in general ,notwithstanding any other provision of this subsection 7except as provided in subclause 7,,ii7 of this clause7 2 and 7#b7 by adding at the end the following3 7,,ii7 ,temporary increase in allotments ,the ,,dsh allotment for ,tennessee for each of fiscal years #bjbj and #bjba shall be equal to #ed1dbg1ejj4 4 7c7 ,sense of ,congress ,it is the sense of ,congress that a ,state should prioritize making payments under the ,state plan of the ,state under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 7or a waiver of such plan7 to disproportionate share hospitals that have a higher share of ,,covid-#ai patients relative to other such hospitals in the ,state4 #hjb4 ,,covid-#ai-related temporary increase of ,medicaid ,,fmap 7a7 ,in general ,section #fjjh of the ,families ,first ,coronavirus ,response ,act 7#db ,u4,s4,c4 #acif;d note7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by inserting 7or1 if later1 ,june #cj1 #bjba7 after last day of such emergency period occurs2 and 7,b7 by striking #f4b percentage points4 and inserting the percentage points specified in subsection 7e74 ,in no case may the application of this section result in the ,federal medical assistance percentage determined for a ,state being more than #ie percent42 and 7#b7 by adding at the end the following new subsections3 7e7 ,specified percentage points ,for purposes of subsection 7a71 the percentage points specified in this subsection are-- 7#a7 for each calendar quarter occurring during the period beginning on the first day of the emergency period described in paragraph 7#a77;,b7 of section #aace7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#e7;g77 and ending on ,june #cj1 #bjbj1 #f4b percentage points2 7#b7 for each calendar quarter occurring during the period beginning on ,july #a1 #bjbj1 and ending on ,june #cj1 #bjba1 #ad percentage points2 and 7#c7 for each calendar quarter1 if any1 occurring during the period beginning on ,july #a1 #bjba1 and ending on the last day of the calendar quarter in which the last day of such emergency period occurs1 #f4b percentage points4 7f7 ,clarifications 7#a7 ,in the case of a ,state that treats an individual described in subsection 7b77#c7 as eligible for the benefits described in such subsection1 for the period described in subsection 7a71 expenditures for medical assistance and administrative costs attributable to such individual that would not otherwise be included as expenditures under section #aijc of the ,social ,security ,act shall be regarded as expenditures under the ,state plan approved under title ,,xix of the ,social ,security ,act or for administration of such ,state plan4 7#b7 ,the limitations on payment under subsections 7f7 and 7g7 of section #aajh of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7 shall not apply to ,federal payments made under section #aijc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#a77 attributable to the increase in the ,federal medical assistance percentage under this section4 7#c7 ,expenditures attributable to the increased ,federal medical assistance percentage under this section shall not be counted for purposes of the limitations under section #bajd7;b77#d7 of such ,act 7#db ,u4,s4,c4 #acig;dd7b77#d774 7#d7 ,notwithstanding the first sentence of section #baje7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7b771 the application of the increase under this section may result in the enhanced ,,fmap of a ,state for a fiscal year under such section exceeding #he percent1 but in no case may the application of such increase before application of the second sentence of such section result in the enhanced ,,fmap of the ,state exceeding #ie percent4 7g7 ,scope of application ,an increase in the ,federal medical assistance percentage for a ,state under this section shall not be taken into account for purposes of payments under part ,d of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fea et seq474 4 7b7 ,effective date ,the amendments made by subsection 7a7 shall take effect and apply as if included in the enactment of section #fjjh of the ,families ,first ,coronavirus ,response ,act 7,public ,law #aaf-abg74 #hjc4 ,appropriation for primary health care ,for an additional amount for ,department of ,health and ,human ,services--,health ,resources and ,services ,administration--,primary ,health ,care1 #g1fjj1jjj1jjj1 to remain available until ,september #cj1 #bjbe1 for necessary expenses to prevent1 prepare for1 and respond to coronavirus1 for grants and cooperative agreements under the ,health ,centers ,program1 as defined by section #ccj of the ,public ,health ,service ,act1 and for grants to ,federally qualified health centers1 as defined in section #ahfa7;aa77#d77;,b7 of the ,social ,security ,act1 and for eligible entities under the ,native ,hawaiian ,health ,care ,improvement ,act1 including maintenance or expansion of health center and system capacity and staffing levels3 ,provided1 ,that sections #ccj7r77#b77;,b71 #ccj7;e77#f77;,a77iii71 and #ccj7;e77#f77;,b77iii7 shall not apply to funds provided under this heading in this section3 ,provided further1 ,that funds provided under this heading in this section may be used to 7#a7 purchase equipment and supplies to conduct mobile testing for ,,sars-,co,v-#b or ,,covid-#ai2 7#b7 purchase and maintain mobile vehicles and equipment to conduct such testing2 and 7#c7 hire and train laboratory personnel and other staff to conduct such mobile testing3 ,provided further1 ,that such amount is designated by the ,congress as being for an emergency requirement pursuant to section #bea7;b77#b77;,a77i7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 #hjd4 ,amendment to the ,public ,health ,service ,act ,title ,,xxxiv of the ,public ,health ,service ,act1 as amended by sections #ajd and #gjb1 is further amended by adding at the following3 ,c ,reconstruction and ,improvement ,grants for ,public ,health ,care ,facilities ,serving ,pacific ,islanders and the ,insular ,areas #cdjg4 ,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 clinic1 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 plan under title ,,xix of the ,social ,security ,act 7or under a waiver of such plan71 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 minority groups2 or 7ii7 that-- 7,i7 serves a disproportionate percentage of local patients that are from a racial and ethnic minority group1 or that has a patient population1 at least #ej percent of which is composed of individuals with limited ,english proficiency2 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 minority 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 7,d7 coping with end-of-life issues2 and 7,e7 shared decision making4 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 #bjba through #bjbf4 #cdjh4 ,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 #bjba through #bjbf4 #cdji4 ,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 title ,,xviii of the ,social ,security ,act1 or a ,state plan under title ,,xix of such ,act 7or under a waiver of such plan71 or who are members of a vulnerable population1 as determined by the ,secretary2 or 7,b7 serves a disproportionate percentage of local patients that are from a racial and ethnic minority group4 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 receiving direct financial assistance under subsection 7a72 7#b7 include all amounts of ,federal assistance received by each such entity in the preceding fiscal year2 7#c7 review the total unmet needs of health care facilities serving ,american ,samoa1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,united ,states ,virgin ,islands1 ,puerto ,rico1 and ,hawaii1 including needs for renovation and expansion of existing facilities2 7#d7 include a strategic plan for addressing the needs of each such population 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 #hje4 ,pandemic premium pay for essential workers 7a7 ,in general ,beginning #c days after an essential work employer receives a grant under section #hjf from the ,secretary of the ,treasury1 the essential work employer shall-- 7#a7 be required to comply with subsections 7b7 through 7h72 and 7#b7 be subject to the enforcement requirements of section #hjg4 7b7 ,pandemic premium pay 7#a7 ,in general ,an essential work employer receiving a grant under section #hjf shall1 in accordance with this subsection1 provide each essential worker of the essential work employer with premium pay at a rate equal to #ac for each hour of work performed by the essential worker for the employer from ,january #bg1 #bjbj1 until the date that is #fj days after the last day of the ,,covid-#ai ,public ,health ,emergency4 7#b7 ,maximum amounts ,the total amount of all premium pay under this subsection that an essential work employer is required to provide to an essential worker1 including through any retroactive payment under paragraph 7#c71 shall not exceed-- 7,a7 for an essential worker who is not a highly-compensated essential worker1 #aj1jjj reduced by employer payroll taxes with respect to such premium pay2 or 7,b7 for a highly-compensated essential worker1 #e1jjj reduced by employer payroll taxes with respect to such premium pay4 7#c7 ,retroactive payment ,for all work performed by an essential worker during the period from ,january #bg1 #bjbj1 through the date on which the essential work employer of the worker receives a grant under this title1 the essential work employer shall use a portion of the amount of such grant to provide such worker with premium pay under this subsection for such work at the rate provided under paragraph 7#a74 ,such amount shall be provided to the essential worker as a lump sum in the next paycheck 7or other payment form7 that immediately follows the receipt of the grant by the essential work employer4 ,in any case where it is impossible for the employer to arrange for payment of the amount due in such paycheck 7or other payment form71 such amounts shall be paid as soon as practicable1 but in no event later than the second paycheck 7or other payment form7 following the receipt of the grant by the essential work employer4 7#d7 ,no employer discretion ,an essential work employer receiving a grant under section #hjf shall not have any discretion to determine which portions of work performed by an essential worker qualify for premium pay under this subsection1 but shall pay such premium pay for any increment of time worked by the essential worker for the essential work employer up to the maximum amount applicable to the essential worker under paragraph 7#b74 7c7 ,prohibition on reducing compensation and displacement 7#a7 ,in general ,any payments made to an essential worker as premium pay under subsection 7b7 shall be in addition to all other compensation1 including all wages1 remuneration1 or other pay and benefits1 that the essential worker otherwise receives from the essential work employer4 7#b7 ,reduction of compensation ,an essential work employer receiving a grant under section #hjf shall not1 during the period beginning on the date of enactment of this ,act and ending on the date that is #fj days after the last day of the ,,covid-#ai ,public ,health ,emergency1 reduce or in any other way diminish1 any other compensation1 including the wages1 remuneration1 or other pay or benefits1 that the essential work employer provided to the essential worker on the day before the date of enactment of this ,act4 7#c7 ,displacement ,an essential work employer shall not take any action to displace an essential worker 7including partial displacement such as a reduction in hours1 wages1 or employment benefits7 for purposes of hiring an individual for an equivalent position at a rate of compensation that is less than is required to be provided to an essential worker under paragraph 7#b74 7d7 ,demarcation from other compensation ,the amount of any premium pay paid under subsection 7b7 shall be clearly demarcated as a separate line item in each paystub or other document provided to an essential worker that details the remuneration the essential worker received from the essential work employer for a particular period of time4 ,if any essential worker does not otherwise regularly receive any such paystub or other document from the employer1 the essential work employer shall provide such paystub or other document to the essential worker for the duration of the period in which the essential work employer provides premium pay under subsection 7b74 7e7 ,exclusion from wage-,based calculations ,any premium pay under subsection 7b7 paid to an essential worker under this section by an essential work employer receiving a grant under section #hjf shall be excluded from the amount of remuneration for work paid to the essential worker for purposes of-- 7#a7 calculating the essential worker's eligibility for any wage-based benefits offered by the essential work employer2 7#b7 computing the regular rate at which such essential worker is employed under section #g of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjg72 and 7#c7 determining whether such essential worker is exempt from application of such section #g under section #ac7;a77#a7 of such ,act 7#bi ,u4,s4,c4 #bac7;a77#a774 7f7 ,essential worker death 7#a7 ,in general ,in any case in which an essential worker of an essential work employer receiving a grant under section #hjf exhibits symptoms of ,,covid-#ai and dies1 the essential work employer shall pay as a lump sum to the next of kin of the essential worker for premium pay under subsection 7b7-- 7,a7 for an essential worker who is not a highly-compensated essential worker1 the amount determined under subsection 7b77#b77;,a7 minus the total amount of any premium pay the worker received under subsection 7b7 prior to the death2 or 7,b7 for a highly-compensated essential worker1 the amount determined under subsection 7b77#b77;,b7 minus the amount of any premium pay the worker received under subsection 7b7 prior to the death4 7#b7 ,treatment of lump sum payments 7,a7 ,treatment as premium pay ,for purposes of this title1 any payment made under this subsection shall be treated as a premium pay under subsection 7b74 7,b7 ,treatment for purposes of ,internal ,revenue ,code of #aihf ,for purposes of the ,internal ,revenue ,code of #aihf1 any payment made under this subsection shall be treated as a payment for work performed by the essential worker4 7g7 ,application to self-,directed care workers funded through ,medicaid or the ,veteran-,directed ,care ,program 7#a7 ,medicaid ,in the case of an essential work employer receiving a grant under section #hjf that is a covered employer described in paragraph 7#d7 who1 under a ,state ,medicaid plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 or under a waiver of such plan1 has opted to receive items or services using a self-directed service delivery model1 the preceding requirements of this section1 including the requirements to provide premium pay under subsection 7b7 7including a lump sum payment in the event of an essential worker death under subsection 7f77 and the requirements of sections #hjf and #hjg1 shall apply to the ,state ,medicaid agency responsible for the administration of such plan or waiver with respect to self-directed care workers employed by that employer4 ,in administering payments made under this title to such self-directed care workers on behalf of such employers1 a ,state ,medicaid agency shall-- 7,a7 exclude and disregard any payments made under this title to such self-directed workers from the individualized budget that applies to the items or services furnished to the individual client employer under the ,state ,medicaid plan or waiver2 7,b7 to the extent practicable1 administer and provide payments under this title directly to such self-directed workers through arrangements with entities that provide financial management services in connection with the self-directed service delivery models used under the ,state ,medicaid plan or waiver2 and 7,c7 ensure that individual client employers of such self-directed workers are provided notice of1 and comply with1 the prohibition under section #hjg7;b77#a77;,b74 7#b7 ,veteran-,directed ,care ,program ,in the case of an essential work employer that is a covered employer described in paragraph 7#d7 who is a veteran participating in the ,veteran ,directed ,care program administered by the ,,va ,office of ,geriatrics ,extended ,care of the ,veterans ,health ,administration1 the preceding requirements of this section and sections #hjf and #hjg1 shall apply to such ,,va ,office of ,geriatrics ,extended ,care with respect to self-directed care workers employed by that employer4 ,paragraph 7#a7 of this subsection shall apply to the administration by the ,,va ,office of ,geriatrics ,extended ,care of payments made under this title to such self-directed care workers on behalf of such employers in the same manner as such requirements apply to ,state ,medicaid agencies4 7#c7 ,penalty enforcement ,the ,secretary of ,labor shall consult with the ,secretary of ,health and ,human ,services and the ,secretary of ,veterans ,affairs regarding the enforcement of penalties imposed under section #hjg7;b77#b7 with respect to violations of subparagraph 7,a7 or 7,b7 of section #hjg7;b77#a7 that involve self-directed workers for which the requirements of this section and sections #hjf and #hjg are applied to a ,state ,medicaid agency under paragraph 7#a7 or the ,,va ,office of ,geriatrics ,extended ,care under paragraph 7#b74 7#d7 ,covered employer described ,for purposes of paragraphs 7#a7 and 7#b71 a covered employer described in this paragraph means-- 7,a7 an entity or person that contracts directly with a ,state1 locality1 ,tribal government1 or the ,federal ,government1 to provide care 7which may include items and services7 through employees of such entity or person to individuals under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 under a ,state ,medicaid plan under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq47 or under a waiver of such plan1 or under any other program established or administered by a ,state1 locality1 ,tribal government1 or the ,federal ,government2 7,b7 a subcontractor of an entity or person described in subparagraph 7,a72 7,c7 an individual client 7or a representative on behalf of an individual client71 an entity1 or a person1 that employs an individual to provide care 7which may include items and services7 to the individual client under a self-directed service delivery model through a program established or administered by a ,state1 locality1 ,tribal government1 or the ,federal ,government2 or 7,d7 an individual client 7or a representative on behalf of an individual client7 that1 on their own accord1 employs an individual to provide care 7which may include items and services7 to the individual client using the individual client's own finances4 7h7 ,interaction with ,stafford ,act ,nothing in this section shall nullify1 supersede1 or otherwise change a ,state's ability to seek reimbursement under section #djc of the ,robert ,t4 ,stafford ,disaster ,relief and ,emergency ,assistance ,act 7#db ,u4,s4,c4 #eagj;b7 for the costs of premium pay based on pre-disaster labor policies for eligible employees4 7i7 ,calculation of paid leave under ,,ffcra and ,,fmla 7#a7 ,families ,first ,coronavirus ,response ,act ,section #eaaj7e77;,b7 of the ,families ,first ,coronavirus ,response ,act 7#bi ,u4,s4,c4 #bfja note7 is amended by adding at the end the following3 7iii7 ,pandemic premium pay ,compensation received by an employee under section #hjg7;b7 of the ,,ehdc ,act of #bjbj shall be included as remuneration for employment paid to the employee for purposes of computing the regular rate at which such employee is employed4 4 7#b7 ,family and ,medical ,leave ,act of #aiic ,section #aaj7;b77#b77;,b7 of the ,family and ,medical ,leave ,act of #aiic 7#bi ,u4,s4,c4 #bfbj7;b77#b77;,b77 is amended by adding at the end the following3 7iii7 ,pandemic premium pay ,compensation received by an employee under section #hjg7;b7 of the ,,ehdc ,act of #bjbj shall be included as remuneration for employment paid to the employee for purposes of computing the regular rate at which such employee is employed4 4 #hjf4 ,,covid-#ai ,heroes ,fund grants 7a7 ,grants 7#a7 ,for pandemic premium pay ,the ,secretary of the ,treasury shall1 subject to the availability of amounts provided in this title1 award a grant to each essential work employer that applies for a grant1 in accordance with this section1 for the purpose of providing premium pay to essential workers under section #hje7;b71 including amounts paid under section #hje7;f74 7#b7 ,eligibility 7,a7 ,eligible employers generally ,any essential work employer shall be eligible for a grant under paragraph 7#a74 7,b7 ,self-directed care workers ,a self-directed care worker employed by an essential work employer other than an essential work employer described in section #hje7;g71 shall be eligible to apply for a grant under paragraph 7#a7 in the same manner as an essential work employer4 ,such a worker shall provide premium pay to himself or herself in accordance with this section1 including the recordkeeping and refund requirements of this section4 7b7 ,amount of grants 7#a7 ,in general ,the maximum amount available for making a grant under subsection 7a77#a7 to an essential work employer shall be equal to the sum of-- 7,a7 the amount obtained by multiplying #aj1jjj by the number of essential workers the employer certifies1 in the application submitted under subsection 7c77#a71 as employing1 or providing remuneration to for services or labor1 who are paid wages or remuneration by the employer at a rate that is less than the equivalent of #bjj1jjj per year2 and 7,b7 the amount obtained by multiplying #e1jjj by the number of highly-compensated essential workers the employer certifies1 in the application submitted under subsection 7c77#a71 as employing1 or providing remuneration to for services or labor1 who are paid wages or remuneration by the employer at a rate that is equal to or greater than the equivalent of #bjj1jjj per year4 7#b7 ,no partial grants ,the ,secretary of the ,treasury shall not award a grant under this section in an amount less than the maximum described in paragraph 7#a74 7c7 ,grant application and disbursal 7#a7 ,application ,any essential work employer seeking a grant under subsection 7a77#a7 shall submit an application to the ,secretary of the ,treasury at such time1 in such manner1 and complete with such information as the ,secretary may require4 7#b7 ,notice and certification 7,a7 ,in general ,the ,secretary of the ,treasury shall1 within #ae days after receiving a complete application from an essential work employer eligible for a grant under this section-- 7i7 notify the employer of the ,secretary's findings with respect to the requirements for the grant2 and 7ii7 7,i7 if the ,secretary finds that the essential work employer meets the requirements under this section for a grant under subsection 7a71 provide a certification to the employer-- 7aa7 that the employer has met such requirements2 7bb7 of the amount of the grant payment that the ,secretary has determined the employer shall receive based on the requirements under this section2 or 7,,ii7 if the ,secretary finds that the essential work employer does not meet the requirements under this section for a grant under subsection 7a71 provide a notice of denial stating the reasons for the denial and provide an opportunity for administrative review by not later than #aj days after the denial4 7,b7 ,transfer ,not later than #g days after making a certification under subparagraph 7,a77ii7 with respect to an essential work employer1 the ,secretary of the ,treasury shall make the appropriate transfer to the employer of the amount of the grant4 7d7 ,use of funds 7#a7 ,in general ,an essential work employer receiving a grant under this section shall use the amount of the grant solely for the following purposes3 7,a7 ,providing premium pay under section #hje7;b7 to essential workers in accordance with the requirements for such payments under such section1 including providing payments described in section #hje7;f7 to the next of kin of essential workers in accordance with the requirements for such payments under such section4 7,b7 ,paying employer payroll taxes with respect to premium pay amounts described in subparagraph 7,a71 including such payments described in section #hje7;f74 ,each dollar of a grant received by an essential work employer under this title shall be used as provided in subparagraph 7,a7 or 7,b7 or returned to the ,secretary of the ,treasury4 7#b7 ,no other uses authorized ,an essential work employer who uses any amount of a grant for a purpose not required under paragraph 7#a7 shall be-- 7,a7 considered to have misused funds in violation of section #hje2 and 7,b7 subject to the enforcement and remedies provided under section #hjg4 7#c7 ,refund 7,a7 ,in general ,if an essential work employer receives a grant under this section and1 for any reason1 does not provide every dollar of such grant to essential workers in accordance with the requirements of this title1 then the employer shall refund any such dollars to the ,secretary of the ,treasury not later than ,june #cj1 #bjba4 ,any amounts returned to the ,secretary shall be deposited into the ,fund and be available for any additional grants under this section4 7,b7 ,requirement for not reducing compensation ,an essential work employer who is required to refund any amount under this paragraph shall not reduce or otherwise diminish an eligible worker's compensation or benefits in response to or otherwise due to such refund4 7e7 ,recordkeeping ,an essential work employer that receives a grant under this section shall-- 7#a7 maintain records1 including payroll records1 demonstrating how each dollar of funds received through the grant were provided to essential workers2 and 7#b7 provide such records to the ,secretary of the ,treasury or the ,secretary of ,labor upon the request of either such ,secretary4 7f7 ,recoupment ,in addition to all other enforcement and remedies available under this title or any other law1 the ,secretary of the ,treasury shall establish a process under which the ,secretary shall recoup the amount of any grant awarded under subsection 7a77#a7 if the ,secretary determines that the essential work employer receiving the grant-- 7#a7 did not provide all of the dollars of such grant to the essential workers of the employer2 7#b7 did not1 in fact1 have the number of essential workers certified by the employer in accordance with subparagraphs 7,a7 and 7,b7 of subsection 7b77#a72 7#c7 did not pay the essential workers for the number of hours the employer claimed to have paid2 or 7#d7 otherwise misused funds or violated this title4 7g7 ,special rule for certain employees of ,tribal employers ,essential workers of ,tribal employers who receive funds under title ,,ii shall not be eligible to receive funds from grants under this section4 7h7 ,tax treatment 7#a7 ,exclusion from income ,for purposes of the ,internal ,revenue ,code of #aihf1 any grant received by an essential work employer under this section shall not be included in the gross income of such essential work employer4 7#b7 ,denial of double benefit 7,a7 ,in general ,in the case of an essential work employer that receives a grant under this section-- 7i7 amounts paid under subsections 7b7 or 7f7 of section #hje shall not be taken into account as wages for purposes of sections #da1 #de;,a1 #ea1 or #acif of the ,internal ,revenue ,code of #aihf or section #bcja of the ,,cares ,act 7,public ,law #aaf-acf72 and 7ii7 any deduction otherwise allowable under such ,code for applicable payments during any taxable year shall be reduced 7but not below zero7 by the excess 7if any7 of-- 7,i7 the aggregate amounts of grants received under this section2 over 7,,ii7 the sum of any amount refunded under subsection 7d7 plus the aggregate amount of applicable payments made for all preceding taxable years4 7,b7 ,applicable payments ,for purposes of this paragraph1 the term applicable payments means amounts paid as premium pay under subsections 7b7 or 7f7 of section #hje and amounts paid for employer payroll taxes with respect to such amounts4 7,c7 ,aggregation rule ,rules similar to the rules of subsections 7a7 and 7b7 of section #eb of the ,internal ,revenue ,code of #aihf shall apply for purposes of this section4 7#c7 ,information reporting ,the ,secretary of the ,treasury shall submit to the ,commissioner of ,internal ,revenue statements containing-- 7,a7 the name and tax identification number of each essential work employer receiving a grant under this section2 7,b7 the amount of such grant2 and 7,c7 any amounts refunded under subsection 7d77#c74 7i7 ,reports 7#a7 ,in general ,not later than #cj days after obligating the last dollar of the funds appropriated under this title1 the ,secretary of the ,treasury shall submit a report1 to the ,committees of ,congress described in paragraph 7#b71 that-- 7,a7 certifies that all funds appropriated under this title have been obligated2 and 7,b7 indicates the number of pending applications for grants under this section that will be rejected due to the lack of funds4 7#b7 ,committees of ,congress ,the ,committees of ,congress described in this paragraph are-- 7,a7 the ,committee on ,ways and ,means of the ,house of ,representatives2 7,b7 the ,committee on ,education and ,labor of the ,house of ,representatives2 7,c7 the ,committee on ,finance of the ,senate2 and 7,d7 the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate4 #hjg4 ,enforcement and outreach 7a7 ,duties of ,secretary of ,labor ,the ,secretary of ,labor shall-- 7#a7 have authority to enforce the requirements of section #hje1 in accordance with subsections 7b7 through 7e72 7#b7 conduct outreach as described in subsection 7f72 and 7#c7 coordinate with the ,secretary of the ,treasury as needed to carry out the ,secretary of ,labor's responsibilities under this section4 7b7 ,prohibited acts1 penalties1 and enforcement 7#a7 ,prohibited acts ,it shall be unlawful for a person to-- 7,a7 violate any provision of section #hje applicable to such person2 or 7,b7 discharge or in any other manner discriminate against any essential worker because such essential worker has filed any complaint or instituted or caused to be instituted any proceeding under or related to this title1 or has testified or is about to testify in any such proceeding4 7#b7 ,enforcement and penalties 7,a7 ,premium pay violations ,a violation described in paragraph 7#a77;,a7 shall be deemed a violation of section #g of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjg7 and unpaid amounts required under this section shall be treated as unpaid overtime compensation under such section #g for the purposes of sections #ae and #af of such ,act 7#bi ,u4,s4,c4 #bae and #baf74 7,b7 ,discharge or discrimination ,a violation of paragraph 7#a77;,b7 shall be deemed a violation of section #ae7;a77#c7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bae7;a77#c774 7c7 ,investigation 7#a7 ,in general ,to ensure compliance with the provisions of section #hje1 including any regulation or order issued under that section1 the ,secretary of ,labor shall have the investigative authority provided under section #aa7;a7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #baa7;a774 ,for the purposes of any investigation provided for in this subsection1 the ,secretary of ,labor shall have the subpoena authority provided for under section #i of such ,act 7#bi ,u4,s4,c4 #bji74 7#b7 ,state agencies ,the ,secretary of ,labor may1 for the purpose of carrying out the functions and duties under this section1 utilize the services of ,state and local agencies in accordance with section #aa7;b7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #baa7;b774 7d7 ,essential worker enforcement 7#a7 ,right of action ,an action alleging a violation of paragraph 7#a7 or 7#b7 of subsection 7b7 may be maintained against an essential work employer receiving a grant under section #hjf in any ,federal or ,state court of competent jurisdiction by one or more essential workers or their representative for and on behalf of the essential workers1 or the essential workers and others similarly situated1 in the same manner1 and subject to the same remedies 7including attorney's fees and costs of the action71 as an action brought by an employee alleging a violation of section #g or #ae7;a77#c71 respectively1 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjg1 #bae7;a77#c774 7#b7 ,no waiver ,in an action alleging a violation of paragraph 7#a7 or 7#b7 of subsection 7b7 brought by one or more essential workers or their representative for and on behalf of the persons as described in paragraph 7#a71 to enforce the rights in section #hje1 no court of competent jurisdiction may grant the motion of an essential work employer receiving a grant under section #hjf to compel arbitration1 under chapter #a of title #i1 ,united ,states ,code1 or any analogous ,state arbitration statute1 of the claims involved4 ,an essential worker's right to bring an action described in paragraph 7#a7 or subsection 7b77#b77;,a7 on behalf of similarly situated essential workers to enforce such rights may not be subject to any private agreement that purports to require the essential workers to pursue claims on an individual basis4 7e7 ,recordkeeping ,an essential work employer receiving a grant under section #hjf shall make1 keep1 and preserve records pertaining to compliance with section #hje in accordance with section #aa7;c7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #baa7;c77 and in accordance with regulations prescribed by the ,secretary of ,labor4 7f7 ,outreach and education ,out of amounts appropriated to the ,secretary of the ,treasury under section #hje for a fiscal year1 the ,secretary of the ,treasury shall transfer to the ,secretary of ,labor1 #c1jjj1jjj1 of which the ,secretary of ,labor shall use-- 7#a7 #b1ejj1jjj for outreach to essential work employers and essential workers regarding the premium pay under section #hje2 and 7#b7 #ejj1jjj to implement an advertising campaign encouraging large essential work employers to provide the same premium pay provided for by section #hje using the large essential work employers' own funds and without utilizing grants under this title4 7g7 ,clarification of enforcing official ,nothing in the ,government ,employee ,rights ,act of #aiia 7#db ,u4,s4,c4 #bjjj;e-#af;a et seq47 or section #c7;e77#b77;,c7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjc7;e77#b77;,c77 shall be construed to prevent the ,secretary of ,labor from carrying out the authority of the ,secretary under this section in the case of ,state employees described in section #cjd7;a7 of the ,government ,employee ,rights ,act of #aiia 7#db ,u4,s4,c4 #bjjj;e-#af;c7a774 ,,ix ,health ,,it and ,bridging the ,digital ,divide in ,health ,care #ija4 ,,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;b7a777 to adopt and meaningfully use certified ,,ehr technology for the management of chronic diseases and health conditions and reduction of health disparities4 #ijb4 ,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 ,not later than #ah months after the date of enactment of this ,act1 the ,national ,coordinator for ,health ,information ,technology 7referred to in this section as the ,national ,coordinator7 shall-- 7#a7 conduct an evaluation of the level of interoperability1 access1 use1 and accessibility of electronic health records in racial and ethnic minority communities1 focusing on whether patients in such communities have providers who use electronic health records1 and the degree to which patients in such communities can access1 exchange1 and use without special effort their health information in those electronic health records1 and indicating whether such providers-- 7,a7 are participating in the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 or a ,state plan under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq47 7or a waiver of such plan72 7,b7 have received incentive payments or incentive payment adjustments under ,medicare and ,medicaid ,electronic ,health ,records ,incentive ,programs 7as defined in subsection 7c77#b772 7,c7 are ,,mips eligible professionals1 as defined in paragraph 7#a77;,c7 of section #ahdh7q7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q771 for purposes of the ,merit-,based ,incentive ,payment ,system under such section2 or 7,d7 have been recruited by any of the ,health ,information ,technology ,regional ,extension ,centers established under section #cjab of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#cb72 7#b7 publish the results of such evaluation including the race and ethnicity of such providers and the populations served by such providers2 and 7#c7 not later than #ab months after the enactment of this ,act1 shall promulgate a certification criterion and module of certified ,,ehr technology that stratifies quality measures by disparity characteristics1 including race1 ethnicity1 language1 gender1 gender identity1 sexual orientation1 socioeconomic status1 and disability status1 as those characteristics are defined in certified ,,ehr technology2 and reports to ,centers for ,medicare ,medicaid ,services the quality measures stratified by race and at least two other disparity characteristics4 ,the term quality measures refers to the quality measures specified in ,,mips4 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 ,national ,center for ,health ,statistics data brief entitled ,adoption of ,certified ,electronic ,health ,record ,systems and ,electronic ,information ,sharing in ,physician ,offices3 ,united ,states1 #bjac and #bjad 7,,nchs ,data ,brief ,no4 #bcf74 7c7 ,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 ,medicare and ,medicaid ,electronic ,health ,records ,incentive ,programs 7as defined in paragraph 7#b77 or the ,merit-,based ,incentive ,payment ,system under section #ahdh7q7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q771 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 7d7 ,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 7#c7 by striking ,the ,national ,coordinator and inserting the following3 7i7 ,in general ,the ,national ,coordinator 2 and 7#d7 by adding at the end the following3 7ii7 ,criteria ,in any publication under clause 7i71 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 of #aigc to encourage patient involvement in patient health care4 ,the ,national ,coordinator shall-- 7,i7 not later than #f months after the submission of the report required under section #hbb of the ,ending ,health ,disparities ,during ,,covid-#ai ,act of #bjbj1 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 7,,ii7 not later than #a year after the submission of such report1 conduct and publish the results of an evaluation of such impact4 4 #ijc4 ,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 in the matter preceding paragraph 7#a71 by inserting 1 including with respect to communities with a high proportion of individuals from racial and ethnic minority groups 7as defined in section #agjg7;g77 before the colon2 and 7#b7 by adding at the end the following new subsection3 7e7 ,annual report on expenditures ,the ,national ,coordinator shall report annually to ,congress on activities and expenditures under this section4 4 #ijd4 ,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 amended1 in the matter preceding paragraph 7#a71 by inserting 1 including with respect to communities with a high proportion of individuals from racial and ethnic minority groups 7as defined in section #agjg7;g77 after health care provider to4 #ije4 ,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 #bjba through #bjbf4 #ijf4 ,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 or ,pacific ,islander-serving institution with an accredited public health1 health policy1 or health services research program4 4 #ijg4 ,study of health information technology in medically underserved communities 7a7 ,in general ,not later than #b years after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall-- 7#a7 enter into an agreement with the ,national ,academies of ,sciences1 ,engineering1 and ,medicine 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 survey a cross-section of individuals in medically underserved areas and report their opinions about the various topics of study2 7#c7 examine the degree of interoperability among health information technology and users of health information technology in medically underserved areas1 including patients1 providers1 and community services2 7#d7 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#e7 examine the impact of health information technology on improving health care-related decisions by both patients and providers in such areas2 7#f7 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#g7 assess the feasibility and costs associated with the use of health information technology in such areas2 7#h7 evaluate whether the adoption and use of qualified electronic health records 7as defined in section #cjjj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj77 is effective in reducing health disparities1 including analysis of clinical quality measures reported by providers who are participating in the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 or a ,state plan under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq47 7or a waiver of such plan71 pursuant to programs to encourage the adoption and use of certified ,,ehr technology2 7#i7 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#aj7 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;,b of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #biep72 or 7#d7 another area or population that-- 7,a7 experiences significant barriers to accessing quality health services2 and 7,b7 has a high prevalence of diseases or conditions described in title ,,vii1 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 #ijh4 ,study on the effects of changes to telehealth under the ,medicare and ,medicaid programs during the ,,covid-#ai emergency 7a7 ,in general ,not later than #a year after the end of the emergency period described in section #aace7;g77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#e7;g77#a77;,b771 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall conduct a study and submit to the ,committee on ,energy and ,commerce and the ,committee on ,ways and ,means of the ,house of ,representatives and the ,committee on ,finance of the ,senate an interim report on any changes made to the provision or availability of telehealth services under part ,a or ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 during such period4 ,such report shall include the following3 7#a7 ,a summary of utilization of all health care services furnished under such part ,a or ,b during such period1 including the number of-- 7,a7 in-person outpatient visits1 inpatient admissions1 and in-person emergency department visits2 and 7,b7 telehealth visits1 broken down by-- 7i7 the number of such visits furnished via audio-visual technology compared to the number of such visits furnished via audio-only technology2 7ii7 the number of such visits furnished by each type of provider of services or supplier 7as defined in section #ahfa of such ,act 7#db ,u4,s4,c4 #aciex7 and including a ,federally qualified health center or rural health clinic 7as so defined771 including a specification of the specialty of each such provider or supplier 7if applicable72 and 7iii7 the type of service provided1 including level of service and diagnoses associated with the telehealth visit4 7#b7 ,a description of any changes in utilization patterns for the care settings described in paragraph 7#a7 over the course of such period compared to such patterns prior to such period4 7#c7 ,an analysis of utilization of telehealth services under such part ,a or ,b during such period1 broken down by age1 sex 7including sexual orientation and gender identity where possible71 race and ethnicity1 disability status1 primary language1 geographic region 7including by rural health areas 7as defined by the ,health ,resources ,services ,administration71 non-rural health areas1 health professional shortage areas 7as defined in section #ccb7;a77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7a77#a7771 medically underserved communities 7as defined in section #gii;,b7#f7 of such ,act 7#db ,u4,s4,c4 #biep7#f7771 areas with medically underserved populations 7as defined in section #ccj7;b77#c7 of such ,act 7#db ,u4,s4,c4 #bed;b7b77#c7771 and by ,state71 and income level 7as measured directly or indirectly1 such as by patient's zip code tabulation area median income as publicly reported by the ,united ,states ,census ,bureau71 and of any trends in such utilization during such period1 so broken down4 ,such analysis shall include the number of telehealth visits performed by providers of services or suppliers licensed in a ,state different from the ,state where the individual receiving such telehealth services is located at the time such services are furnished4 ,such analysis may not include any individually identifiable information or protected health information4 7#d7 ,a description of expenditures and any savings under such part ,a or ,b attributable to use of such telehealth services during such period4 7#e7 ,a description of any instances of fraud identified by the ,secretary1 acting through the ,office of the ,inspector ,general or other relevant agencies and departments1 with respect to such telehealth services furnished under such part ,a or ,b during such period and a comparison of the number of such instances with the number of instances of fraud so identified with respect to in-person services so furnished during such period4 7#f7 ,a description of any privacy concerns with respect to the furnishing of such telehealth services 7such as cybersecurity or ransomware concerns71 including a description of any actions taken by the ,secretary1 acting through the ,health ,sector ,cybersecurity ,coordination ,center or other relevant agencies and departments1 during such period to assist health care providers secure telecommunications systems4 7#g7 ,an analysis of health care quality related to telehealth 7which may include patient health outcomes 7such as morbidity1 mortality1 healthcare utilization1 and disease-specific management metrics71 safety metrics1 quality measures1 health equity focused measures1 patient satisfaction1 provider satisfaction1 and other inputs and sources as determined by the ,secretary74 7#h7 ,an analysis of any other outcomes or metrics related to telehealth1 as determined appropriate by the ,secretary4 7b7 ,input ,in conducting the study and submitting the report under subsection 7a71 the ,secretary-- 7#a7 7,a7 consult with relevant stakeholders 7such as patients1 caregivers1 patient advocacy groups1 minority or tribal groups 7including ,urban ,indian ,organization 7,u,i,os771 health care professionals 7including behavioral health professionals71 hospitals1 ,state medical boards1 ,state nursing boards1 the ,federation of ,state ,medical ,boards1 ,national ,council of ,state ,boards of ,nursing1 medical professional employers 7such as hospitals1 medical groups1 staffing companies71 telehealth groups1 health professional liability providers1 public and private payers1 and ,state leaders72 and 7,b7 solicit public comments on such report before the submission of such report2 and 7#b7 shall endeavor to include as many racially1 ethnically1 geographically1 linguistically1 and professionally diverse perspectives as possible4 7c7 ,final report ,not later than ,december #ca1 #bjbd1 the ,secretary shall-- 7#a7 update and finalize the interim report under subsection 7a72 and 7#b7 submit such updated and finalized report to the committees specified in such subsection4 7d7 ,grants for ,medicaid reports 7#a7 ,in general ,not later than #b years after the end of the emergency period described in section #aace7;g77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#e7;g77#a77;,b771 the ,secretary shall award grants to ,states with a ,state plan 7or waiver of such plan7 in effect under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr7 that submit an application under this subsection for purposes of enabling such ,states to study and submit reports to the ,secretary on any changes made to the provision or availability of telehealth services under such plans 7or such waivers7 during such period4 7#b7 ,eligibility ,to be eligible to receive a grant under paragraph 7#a71 a ,state shall-- 7,a7 provide benefits for telehealth services under the ,state plan 7or waiver of such plan7 in effect under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr72 7,b7 be able to differentiate telehealth from in-person visits within claims data submitted under such plan 7or such waiver7 during such period2 and 7,c7 submit to the ,secretary an application at such time1 in such manner1 and containing such information 7including the amount of the grant requested7 as the ,secretary may require4 7#c7 ,use of funds ,an ,state shall use amounts received under a grant under this subsection to conduct a study and report findings regarding the effects of changes to telehealth services offered under the ,state plan 7or waiver of such plan7 of such ,state under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 during such period in accordance with paragraph 7#d74 7#d7 ,reports 7,a7 ,interim report ,not later #a year after the date a ,state receives a grant under this subsection1 the ,state shall submit to the ,secretary an interim report that-- 7i7 details any changes made to the provision or availability of telehealth benefits 7such as eligibility1 coverage1 or payment changes7 under the ,state plan 7or waiver of such plan7 of the ,state under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 during the emergency period described in paragraph 7#a72 and 7ii7 contains-- 7,i7 a summary and description of the type described in paragraphs 7#a7 and 7#b71 respectively1 of subsection 7a72 and 7,,ii7 to the extent practicable1 an analysis of the type described in paragraph 7#c7 of subsection 7a71 except that any reference in such subsection to such part ,a or ,b shall1 for purposes of subclauses 7,i7 and 7,,ii71 be treated as a reference to such ,state plan 7or waiver74 7,b7 ,final report ,not later than #c years after the date a ,state receives a grant under this subsection1 the ,state shall update and finalize the interim report and submit such final report to the ,secretary4 7,c7 ,report by ,secretary ,not later than the earlier of the date that is #a year after the submission of all final reports under subparagraph 7,b7 and ,december #ca1 #bjbh1 the ,secretary shall submit to ,congress a report on the grant program1 including a summary of the reports received from ,states under this paragraph4 7#e7 ,modification authority ,the ,secretary may modify any deadline described in paragraph 7#d7 or any information required to be included in a report made under this subsection to provide flexibility for ,states to modify the scope of the study and timeline for such reports4 7#f7 ,technical assistance ,the ,secretary shall provide such technical assistance as may be necessary to a ,state receiving a grant under this subsection in order to assist such state in conducting studies and submitting reports under this subsection4 7#g7 ,state ,for purposes of this subsection1 the term ,state means each of the several ,states1 the ,district of ,columbia1 and each territory of the ,united ,states4 7e7 ,authorization of appropriations 7#a7 ,medicare ,for the purpose of carrying out subsections 7a7 through 7c71 there are authorized to be appropriated such sums as may be necessary for each of the fiscal years #bjbj through #bjbd4 7#b7 ,medicaid ,for the purpose of carrying out subsection 7d71 there are authorized to be appropriated such sums as may be necessary for each of the fiscal years #bjbb through #bjbh4 #iji4 ,,covid-#ai designation of immediate special authority of spectrum for ,tribes' emergency response in ,indian ,country 7a7 ,findings ,congress finds the following3 7#a7 ,the immediate grant of emergency special temporary authority of available spectrum that will efficiently support temporary wireless broadband networks and allow ,indian ,tribes to provide ,tribal members with wireless broadband service over ,tribal lands or ,hawaiian ,home ,lands during the ,,covid-#ai crisis due to the increased demand for telecommunications and disproportionate impacts of the ,,covid-#ai pandemic in ,indian ,country is essential4 7#b7 ,reservations are the most digitally disconnected areas in the ,united ,states that lack basic access to broadband and wireless services at rates comparable to1 and in some cases lower than1 third-world countries4 7#c7 ,in #bjah1 the ,government ,accountability ,office and the ,federal ,communications ,commission reported that only #fe percent of ,american ,indian and ,alaska ,natives 7,,ai_/,a,ns7 living on ,tribal lands had access to fixed broadband services1 and only #fh percent of ,,ai_/,,an households on rural ,tribal lands had telephone services4 ,this is a stark comparison to only #h percent of the national average that lacks access to fixed broadband services4 7#d7 ,indian ,tribes have previously encountered substantial barriers to accessing broadband and other communications services on ,tribal lands to deploy telecommunication services for the safety and well-being of ,tribal members and to decrease the alarming rates of unnecessary loss of lives that ,,ai_/,a,ns disproportionately experience1 especially through the lack of access to health care services and emergency resources1 as demonstrated during the ,,covid-#ai pandemic that continues to disproportionately impact ,indian ,country4 7#e7 ,indian ,tribes' lack of access to broadband services on ,tribal lands and ,hawaiian ,home ,lands during the ,,covid-#ai pandemic further highlights the digital divide in ,indian ,country4 7#f7 ,the ,government ,accountability ,office found that health information technology systems at the ,indian ,health ,service rank as the ,federal ,government's third-highest need for agency system modernization1 since #ej percent of ,indian ,health ,service facilities depend on outdated circuit connections based on one or two ,,ti circuit lines 7#c ,mbps71 creating slower response times than any other health facility system in the ,united ,states4 7#g7 ,a #bjah ,tribal health reform comment filed with the ,federal ,communications ,commission has further stated that approximately #a4e million people living on ,tribal lands lack access to broadband and1 of the #ge percent of rural ,indian ,health ,service facilities1 many still lack reliable broadband networks for ,american ,indians and ,alaska ,natives 7,,ai_/,a,ns7 to access telehealth or clinical health care services1 which is a critical need in the most geographically isolated areas of the country with some of the highest poverty rates1 and lack of access to reliable transportation4 7#h7 ,the ,bureau of ,indian ,education has stated that recent estimates from #adb out of #agd schools have indicated that approximately #ae to #ie percent of students do not have access to internet services at home depending on ,bureau school location and limitations on data caps during the ,,covid-#ai crisis4 7b7 ,deployment of wireless broadband service on ,tribal lands and ,hawaiian ,home ,lands 7#a7 ,funding of grants for immediate deployment of wireless broadband service on ,tribal lands and ,hawaiian ,home ,lands ,in addition to any other amounts made available1 out of any money in the ,treasury of the ,united ,states not otherwise appropriated1 there are appropriated-- 7,a7 #big1ejj1jjj for grants under the community facilities grant program under section #cjf7;a77#ai7 of the ,consolidated ,farm and ,rural ,development ,act to ,indian ,tribes1 qualifying ,tribal entities1 and the ,director of the ,department of ,hawaiian ,home ,lands1 for the immediate deployment of wireless broadband service on ,tribal lands and ,hawaiian ,home ,lands1 respectively1 through the use of emergency special temporary authority granted under paragraph 7#b7 of this subsection1 including backhaul costs1 repairs to damaged infrastructure1 the cost of the repairs to which would be less expensive than the cost of new infrastructure and would support the emergency special temporary use1 and the ,federal share applicable to grants from such amount shall be #ajj percent1 which amount shall remain available for one year from the enactment of this ,act2 and 7,b7 #c1jjj1jjj for grants under the community facilities technical assistance and training grant program under section #cjf7;a77#bf7 of such ,act1 without regard to sections #cjf7;a77#bf77;,b7 and #cjf7;a77#bf77;,c7 of such ,act1 to assist ,indian ,tribes1 qualifying ,tribal entities1 and the ,director of the ,department of ,hawaiian ,home ,lands in preparing applications for the grants referred to in subparagraph 7,b7 of this paragraph1 which amount shall remain available for one year from the enactment of this ,act4 ,grants referred to under subparagraph 7,b7 shall be available to ,indian ,tribes1 qualifying ,tribal entities and shall also be available to inter-,tribal government organizations1 universities1 and colleges with ,tribal serving institutions for the purposes stated herein4 7#b7 ,emergency special temporary authority ,to use available and efficient spectrum on ,tribal lands and ,hawaiian ,home ,lands 7,a7 ,grant of authority ,not later than #aj days after receiving a request from an ,indian ,tribe1 a qualifying ,tribal entity1 or the ,director of the ,department of ,hawaiian ,home ,lands for emergency special temporary authority to use electromagnetic spectrum described in subparagraph 7,c7 for the provision of wireless broadband service over the ,tribal lands over which the ,indian ,tribe or qualifying ,tribal entity has jurisdiction or 7in the case of a request from the ,director of the ,department of ,hawaiian ,home ,lands7 over the ,hawaiian ,home ,lands1 allowing unlicensed radio transmitters to operate for such provision on such spectrum at locations on such ,tribal lands or ,hawaiian ,home ,lands where such spectrum is not being used1 the ,commission shall grant such request on a secondary non-interference basis4 7,b7 ,duration ,a grant of emergency special temporary authority under subparagraph 7,a7 shall be for a period of operation to begin not later than #f months after the date of the enactment of this ,act and to remain in operation for not longer than #f months1 absent extensions granted by the ,commission pursuant to the procedures of the ,commission relating to special temporary authority4 7,c7 ,electromagnetic spectrum described ,the electromagnetic spectrum described in this subparagraph for utilization on the temporary basis is any portion of the electromagnetic spectrum-- 7i7 that is-- 7,i7 between the frequencies of #bdif megahertz and #bfij megahertz1 inclusive2 7,,ii7 in the white spaces of the television broadcast spectrum between the frequencies of #dgj megahertz and #gij megahertz1 inclusive1 excluding those frequencies utilized for other purposes under subpart ,h of part #ae of title #dg1 ,code of ,federal ,regulations2 7,,iii7 between the frequencies of #eibe megahertz and #gabe megahertz1 inclusive2 or 7,,iv7 between frequencies of #ceej megahertz and #cgjj megahertz1 inclusive2 and 7ii7 with respect to the ,tribal lands or ,hawaiian ,home ,lands over which authority to use such spectrum is requested under subparagraph 7,a71 is not assigned to any licensee4 7#c7 ,definitions ,in this subsection3 7,a7 ,commission ,the term ,commission means the ,federal ,communications ,commission4 7,b7 ,hawaiian ,home ,lands ,the term ,hawaiian ,home ,lands means lands held in trust for ,native ,hawaiians by ,hawaii pursuant to the ,hawaiian ,homes ,commission ,act1 #aibj4 7,c7 ,indian ,tribe ,the term ,indian ,tribe means the governing body of any individually identified and federally recognized ,indian or ,alaska ,native ,tribe1 band1 nation1 pueblo1 village1 community1 affiliated tribal group1 or component reservation in the list published pursuant to section #ajd7;a7 of the ,federally ,recognized ,indian ,tribe ,list ,act of #aiid 7#be ,u4,s4,c4 #eaca7;a774 7,d7 ,qualifying ,tribal entity ,the term qualifying ,tribal entity means an entity designated by the ,indian ,tribe with jurisdiction over particular ,tribal lands for which the spectrum access is sought4 ,the following may be designated as a qualifying ,tribal entity3 7i7 ,indian ,tribes4 7ii7 ,tribal consortia which consists of two or more ,indian ,tribes1 or an ,indian ,tribe and an entity that is more than #ej percent owned and controlled by one or more ,indian ,tribes4 7iii7 ,federally chartered ,tribal corporations created under section #ag of the ,indian ,reorganization ,act 7#be ,u4,s4,c4 #eabd71 and created under section #d of the ,oklahoma ,indian ,welfare ,act 7#be ,u4,s4,c4 #ebjd74 7iv7 ,entities that are more than #ej percent owned and controlled by an ,indian ,tribe or ,indian ,tribes4 7,e7 ,entity that is more than #ej percent owned and controlled by one or more ,indian ,tribes ,the term entity that is more than #ej percent owned and controlled by one or more ,indian ,tribes means an entity over which one or more ,indian ,tribes have both de facto and de jure control of the entity4 ,de jure control of the entity is evidenced by ownership of greater than #ej percent of the voting stock of a corporation1 or in the case of a partnership1 general partnership interests4 ,de facto control of an entity is determined on a case-by-case basis4 ,an ,indian ,tribe or ,indian ,tribes must demonstrate indicia of control to establish that such ,indian ,tribe or ,indian ,tribes retain de facto control of the applicant seeking eligibility as a qualifying ,tribal entity1 including the following3 7i7 ,the ,indian ,tribe or ,indian ,tribes constitute or appoint more than #ej percent of the board of directors or management committee of the entity4 7ii7 ,the ,indian ,tribe or ,indian ,tribes have authority to appoint1 promote1 demote1 and fire senior executives who control the day-to-day activities of the entity4 7iii7 ,the ,indian ,tribe or ,indian ,tribes play an integral role in the management decisions of the entity4 7iv7 ,the ,indian ,tribe or ,indian ,tribes have the authority to make decisions or otherwise engage in practices or activities that determine or significantly influence-- 7,i7 the nature or types of services offered by such an entity2 7,,ii7 the terms upon which such services are offered2 or 7,,iii7 the prices charged for such services4 7,f7 ,tribal lands ,the term ,tribal lands has the meaning given that term in section #gc4gjjj of title #dg1 ,code of ,federal ,regulations1 as of ,april #af1 #bjbj1 and includes the definition ,indian ,country as defined in section #aaea of title #ah1 ,united ,states ,code1 and includes fee simple and restricted fee land held by an ,indian ,tribe4 7,g7 ,wireless broadband service ,the term wireless broadband service means wireless broadband internet access service that is delivered-- 7i7 with a download speed of not less than #be megabits per second and an upload speed of not less than #c megabits per second2 and 7ii7 through-- 7,i7 mobile service2 7,,ii7 fixed point-to-point multipoint service2 7,,iii7 fixed point-to-point service2 or 7,,iv7 broadcast service4 #iaj4 ,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 ,x ,public ,awareness #ajja4 ,awareness campaigns ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,centers for ,disease ,control and ,prevention and in coordination with other offices and agencies1 as appropriate1 shall award competitive grants or contracts to one or more public or private entities1 including faith-based organizations1 to carry out multilingual and culturally appropriate awareness campaigns4 ,such campaigns shall-- 7#a7 be based on available scientific evidence2 7#b7 increase awareness and knowledge of ,,covid-#ai1 including countering stigma associated with ,,covid-#ai2 7#c7 improve information on the availability of ,,covid-#ai diagnostic testing2 and 7#d7 promote cooperation with contact tracing efforts4 #ajjb4 ,increasing understanding of and improving health literacy 7a7 ,in general ,the ,secretary1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality with respect to grants under subsection 7c77#a7 and through the ,administrator of the ,health ,resources and ,services ,administration with respect to grants under subsection 7c77#b71 in consultation with the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities and the ,deputy ,assistant ,secretary for ,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 reasonably require4 7c7 ,use of funds 7#a7 ,agency for healthcare research and quality ,a grant awarded under subsection 7a7 through the ,director of 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 ,director4 7#b7 ,health resources and services administration ,a grant awarded under subsection 7a7 through the ,administrator of 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 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 7,f7 the conduct of educational campaigns concerning health directed specifically at patients with mental disabilities1 including those with cognitive and intellectual disabilities1 designed to reduce the incidence of low health literacy among these populations1 which shall have instructional materials in the plain language standards promulgated under the ,plain ,writing ,act of #bjaj 7#e ,u4,s4,c4 #cja note7 for ,federal agencies2 and 7,g7 other activities determined appropriate by the ,administrator4 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 #bjba through #bjbe4 #ajjc4 ,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 7in this section referred to ,,esl7 instruction and shall determine1 after consultation with appropriate stakeholders1 the mechanism for administering and distributing such grants4 7b7 ,eligible entity defined ,in this section1 the term eligible entity means a ,state or community-based organization that employs and serves minority populations4 7c7 ,application ,an eligible entity may apply for a grant under this section by submitting such information as the ,secretary of ,education 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 individuals 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 funds available under this section to supplement rather than supplant any funds expended for ,,esl instruction in the ,state as of ,january #a1 #bjbj4 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 for ,,esl instruction1 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 not later than #a year after 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 #bej1jjj1jjj for each of fiscal years #bjba through #bjbd to carry out this section4 #ajjd4 ,influenza1 ,,covid-#ai1 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 influenza1 pneumonia1 and ,,covid-#ai2 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 influenza1 pneumonia1 and ,,covid-#ai2 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 #bjba through #bjbe4 ,,xi ,research #aaja4 ,research and development ,the ,secretary of ,health and ,human ,services1 in coordination with the ,director of the ,centers for ,disease ,control and ,prevention and in collaboration with the ,director of the ,national ,institutes of ,health1 the ,director of the ,agency for ,healthcare ,research and ,quality1 the ,commissioner of ,food and ,drugs1 and the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall support research and development on more efficient and effective strategies-- 7#a7 for the surveillance of ,,sars-,co,v-#b and ,,covid-#ai2 7#b7 for the testing and identification of individuals infected with ,,covid-#ai2 and 7#c7 for the tracing of contacts of individuals infected with ,,covid-#ai4 #aajb4 ,,cdc field studies pertaining to specific health inequities 7a7 ,in general ,not later than #ij days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 acting through the ,centers for ,disease ,control and ,prevention1 in collaboration with ,state1 local1 ,tribal1 and territorial health departments1 shall complete 7by the reporting deadline in subsection 7b77 field studies to better understand health inequities that are not currently tracked by the ,secretary4 ,such studies shall include an analysis of-- 7#a7 the impact of socioeconomic status on health care access and disease outcomes1 including ,,covid-#ai outcomes2 7#b7 the impact of disability status on health care access and disease outcomes1 including ,,covid-#ai outcomes2 7#c7 the impact of language preference on health care access and disease outcomes1 including ,,covid-#ai outcomes2 7#d7 factors contributing to disparities in health outcomes for the ,,covid-#ai pandemic2 and 7#e7 other topics related to disparities in health outcomes for the ,,covid-#ai pandemic1 as determined by the ,secretary4 7b7 ,report ,not later than ,december #ca1 #bjba1 the ,secretary 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 an initial report on the results of the field studies under this section4 7c7 ,final report ,not later than ,december #ca1 #bjbc1 the ,secretary shall-- 7#a7 update and finalize the initial report under subsection 7b72 and 7#b7 submit such final report to the committees specified in such subsection4 7d7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #be1jjj1jjj1 to remain available until expended4 #aajc4 ,expanding capacity for health outcomes 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall award grants to eligible entities to develop and expand the use of technology-enabled collaborative learning and capacity building models to respond to ongoing and real-time learning1 health care information sharing1 and capacity building needs related to ,,covid-#ai4 7b7 ,eligible entities ,to be eligible to receive a grant under this section1 an entity shall have experience providing technology-enabled collaborative learning and capacity building health care services-- 7#a7 in rural areas1 frontier areas1 health professional shortage areas1 or medically underserved area2 or 7#b7 to medically underserved populations or ,indian ,tribes4 7c7 ,use of funds ,an eligible entity receiving a grant under this section shall use funds received through the grant-- 7#a7 to advance quality of care in response to ,,covid-#ai1 with particular emphasis on rural and underserved areas and populations2 7#b7 to protect medical personnel and first responders through sharing real-time learning through virtual communities of practice2 7#c7 to improve patient outcomes for conditions affected or exacerbated by ,,covid-#ai1 including improvement of care for patients with complex chronic conditions2 and 7#d7 to support rapid uptake by health care professionals of emerging best practices and treatment protocols around ,,covid-#ai4 7d7 ,optional additional uses of funds ,an eligible entity receiving a grant under this section may use funds received through the grant for-- 7#a7 equipment to support the use and expansion of technology-enabled collaborative learning and capacity building models1 including hardware and software that enables distance learning1 health care provider support1 and the secure exchange of electronic health information2 7#b7 the participation of multidisciplinary expert team members to facilitate and lead technology-enabled collaborative learning sessions1 and professionals and staff assisting in the development and execution of technology-enabled collaborative learning2 7#c7 the development of instructional programming and the training of health care providers and other professionals that provide or assist in the provision of services through technology-enabled collaborative learning and capacity building models2 and 7#d7 other activities consistent with achieving the objectives of the grants awarded under this section4 7e7 ,technology-,enabled collaborative learning and capacity building model defined ,in this section1 the term technology-enabled collaborative learning and capacity building model has the meaning given that term in section #b7g7 of the ,expanding ,capacity for ,health ,outcomes ,act 7,public ,law #aad-bgj2 #acj ,stat4 #acie74 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #bj1jjj1jjj1 to remain available until expended4 #aajd4 ,data collection and analysis grants to minority-serving institutions 7a7 ,authority ,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 award grants to eligible entities to access and analyze racial and ethnic data on disparities in health and health care1 and where possible other data on disparities in health and health care1 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 an entity that has an accredited public health1 health policy1 or health services research program and is any of the following3 7#a7 ,a part ,b institution1 as defined in section #cbb of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajfa74 7#b7 ,a ,hispanic-serving institution1 as defined in section #ejb of such ,act 7#bj ,u4,s4,c4 #aaja;a74 7#c7 ,a ,tribal ,college or ,university1 as defined in section #caf of such ,act 7#bj ,u4,s4,c4 #ajei;c74 7#d7 ,an ,asian ,american and ,native ,american ,pacific ,islander-serving institution1 as defined in section #cga7;c7 of such ,act 7#bj ,u4,s4,c4 #ajfgq7c774 7c7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjba through #bjbe4 #aaje4 ,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;,f the following3 #eje;,g4 ,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 or other demographic characteristics 7such as age1 sex1 gender7 as to the safety or effectiveness of a drug or biological product or if such product addresses a disease that disproportionately impacts certain racial or ethnic groups or other demographic characteristics 7such as age1 sex1 gender71 then-- 7#a7 7,a7 in the case of a drug1 the investigations required under section #eje7;b77#a77;,a7 shall include adequate and well-controlled investigations of the disparity2 or 7,b7 in the case of a biological product1 the evidence required under section #cea7;a7 of the ,public ,health ,service ,act for approval of a biologics license application for the biological product shall include adequate and well-controlled investigations of the disparity2 and 7#b7 if the investigations described in subparagraph 7,a7 or 7,b7 of paragraph 7#a7 confirm that there is such a disparity1 the labeling of the drug or biological product 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 or other demographic characteristics 7such as age1 sex1 gender7 as to the safety or effectiveness of a drug for which there is an approved application under section #eje of this ,act or of a biological product for which there is an approved 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 postmarket 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 or biological product shall include appropriate information about the disparity4 7#c7 ,study design ,the ,secretary may1 in an order under paragraph 7#a71 specify all aspects of the design of the postmarket studies required under such paragraph for a drug or biological product1 including the number of studies and study participants1 and the other demographic characteristics of the study participants4 7#d7 ,modifications of study design ,the ,secretary may1 by order and as necessary1 modify any aspect of the design of a postmarket study required in an order under paragraph 7#a7 after issuing such order4 7#e7 ,study results ,the results from a study required under paragraph 7#a7 shall be submitted to the ,secretary as a supplement to the drug application or biologics license application4 7c7 ,applications under section #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 or other demographic characteristics 7such as age1 sex1 gender7 as to the safety or effectiveness of the drug 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 section #eje7;j77#e77;,f74 7#b7 ,labeling ,notwithstanding paragraph 7#a71 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 7such as age1 sex1 gender7 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 7d7 ,definition ,the term evidence that there may be a disparity on the basis of racial or ethnic background or other demographic characteristics 7such as age1 sex1 gender7 as to the safety or effectiveness1 with respect to a drug or biological product1 includes-- 7#a7 evidence that there is a disparity on the basis of racial or ethnic background or other demographic characteristics 7such as age1 sex1 gender7 as to safety or effectiveness of a drug or biological product in the same chemical class as the drug or biological product2 7#b7 evidence that there is a disparity on the basis of racial or ethnic background or other demographic characteristics 7such as age1 sex1 gender7 in the way the drug or biological product is metabolized2 7#c7 other evidence as the ,secretary may determine appropriate2 and 7#d7 if such product addresses a disease_/condition that evidence shows disproportionately impacts certain racial or ethnic groups or other demographic characteristics 7such as age1 sex1 gender74 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 7ee7 ,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;,g4 4 7c7 ,drug fees ,section #gcf7;a77#a77;,a77ii7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cgi;h7a77#a77;,a77ii77 is amended by inserting after are not required the following3 1 including postmarket studies required under section #eje;,g4 #aajf4 ,,gao and ,,nih reports 7b7 ,,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 #bjji1 and ending ,december #ca1 #bjai4 7,b7 ,all recipients of such grants1 contracts1 and cooperative agreements during such period4 7,c7 ,all members of the peer review panels of such applicants and recipients1 respectively4 7#b7 ,report ,not later than #f 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 7c7 ,,gao report ,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 identifies-- 7#a7 the racial and ethnic diversity of community-based organizations that applied for ,federal funding provided pursuant to ,coronavirus ,preparedness and ,response ,supplemental ,appropriations ,act 7,public ,law #aaf-abc71 ,families ,first ,coronavirus ,response ,act 7,public ,law #aaf-abg71 ,coronavirus ,aid1 ,relief1 and ,economic ,security ,act 7,public ,law #aaf-acf71 and ,paycheck ,protection ,program and ,health ,care ,enhancement ,act 7,public ,law #aaf-aci72 7#b7 the percentage of such organizations that were awarded such funding2 and 7#c7 the impact of such community-based organizations' efforts on reducing health disparities within racial and ethnic minority groups4 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 such 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 #aajg4 ,health impact assessments 7a7 ,findings ,congress makes the following findings3 7#a7 ,health ,impact ,assessment is a tool to help planners1 health officials1 decision makers1 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 fosters community leadership1 ownership and participation in decision-making processes4 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 amended by section #gif;,a1 is further amended by adding at the end the following3 #cii,v-#ab4 ,health impact assessments 7a7 ,definitions ,in this section3 7#a7 ,administrator ,the term ,administrator means the ,administrator of the ,environmental ,protection ,agency4 7#b7 ,director ,the term ,director means the ,director of the ,centers for ,disease ,control and ,prevention4 7#c7 ,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#d7 ,health disparity ,the term health disparity means a particular type of health difference that is closely linked with social1 economic1 or environmental disadvantage and that adversely affects 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 citizenship status2 or other characteristics historically linked to discrimination or exclusion4 7b7 ,establishment ,the ,secretary1 acting through the ,director and in collaboration with the ,administrator1 shall-- 7#a7 in consultation with the ,director of the ,national ,center for ,chronic ,disease ,prevention and ,health ,promotion and relevant offices within the ,department of ,housing and ,urban ,development1 the ,department of ,transportation1 and the ,department of ,agriculture1 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 assessment that includes-- 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 grants2 7#b7 develop guidance and guidelines to conduct health impact assessments in accordance with subsection 7c72 and 7#c7 establish a grant program to allow ,states to fund eligible entities to conduct health impact assessments4 7c7 ,guidance 7#a7 ,in general ,not later than #a year after the date of enactment of the ,ending ,health ,disparities during ,,covid-#ai ,act of #bjbj1 the ,secretary1 acting through the ,director1 shall issue final guidance for conducting the health impact assessments4 ,in developing such guidance the ,secretary shall-- 7,a7 consult 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 ,agriculture2 and 7,b7 consider available international health impact assessment guidance1 ,north ,american health impact assessment practice standards1 and recommendations from the ,national ,academy of ,science4 7#b7 ,content ,the guidance under this subsection shall include-- 7,a7 background on national and international efforts to bridge urban planning1 climate forecasting1 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 assessment4 7d7 ,grant program 7#a7 ,in general ,the ,secretary1 acting through the ,director and in collaboration with the ,administrator1 shall-- 7,a7 award grants to ,states to fund eligible entities for capacity building or to prepare health impact assessments2 and 7,b7 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 institution of higher education1 or nonprofit health impact assessment experts to provide such technical assistance4 7#b7 ,applications 7,a7 ,in general ,to be eligible to receive a grant under this section1 an eligible entity shall-- 7i7 be a ,state1 ,indian tribe1 or tribal organization that includes individuals or populations the health of which are1 or will be1 affected by an activity or a proposed activity2 and 7ii7 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 7#c7 ,use of funds 7,a7 ,in general ,an entity receiving a grant under this section shall use such grant funds to conduct health impact assessment capacity building or to fund subgrantees in conducting 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-- 7i7 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 7ii7 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 7iii7 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 7iv7 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 7v7 to ensure that the disproportionate distribution of negative impacts among vulnerable populations is minimized as much as possible2 7vi7 to engage affected community members and ensure adequate opportunity for public comment on all stages of the health impact assessment2 7vii7 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 work2 and 7viii7 to inspect homes1 water systems1 and other elements that pose risks to lead exposure1 with an emphasis on areas that pose a higher risk to children4 7#d7 ,assessments ,health impact assessments carried out using grant funds under this section shall-- 7,a7 take appropriate health factors 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 7#e7 ,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 disease1 including ,,covid-#ai4 7,x7 ,health disparities4 7,,xi7 ,existing air quality1 ground or surface water quality or quantity1 or noise levels4 7,,xii7 ,lead exposure4 7,,xiii7 ,drinking water quality and accessibility4 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 emergency1 pandemic1 or other infectious or biochemical agent2 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#f7 ,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 decision makers4 7,e7 ,monitoring and evaluating ,tracking the decision and implementation effect on health determinants and health status4 7#g7 ,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 leaders1 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#h7 ,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#i7 ,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#aj7 ,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 decision-making process it evaluates4 7#aa7 ,methodology ,in preparing a health impact assessment under this subsection1 an eligible entity or partner shall follow the guidance published under subsection 7c74 7e7 ,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 7f7 ,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 7g7 ,report to ,congress ,not later than #a year after the date of enactment of the ,ending ,health ,disparities ,during ,,covid-#ai ,act of #bjbj1 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 7h7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary4 #cii,v-#ac4 ,implementation of research findings to improve health outcomes through the built environment 7a7 ,research grant program ,the ,secretary1 in collaboration with the ,administrator of the ,environmental ,protection ,agency 7referred to in this section as the ,administrator71 shall award grants to public agencies or private nonprofit institutions to implement evidence-based programming to improve human health through improvements to the built environment and subsequently human health1 by addressing-- 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 or transportation options2 7#aj7 ability to reduce the spread of infectious diseases 7such as ,,covid-#ai72 and 7#aa7 other factors1 as the ,secretary determines appropriate4 7b7 ,applications ,a public agency or private nonprofit institution desiring a grant under this section shall submit to the ,secretary an application at such time1 in such manner1 and containing such agreements1 assurances1 and information as the ,secretary1 in consultation with the ,administrator1 may require4 7c7 ,research ,the ,secretary1 in consultation with the ,administrator1 shall support1 through grants awarded under this section1 research that-- 7#a7 uses evidence-based research to improve the built environment and human health2 7#b7 examines-- 7,a7 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 7,b7 the distribution of such impacts by-- 7i7 location2 and 7ii7 population subgroup2 7#c7 is used to develop-- 7,a7 measures and indicators to address health impacts and the connection of health to the built environment2 7,b7 efforts to link the measures to transportation1 land use1 and health databases2 and 7,c7 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 7,a7 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 7,b7 in developing the intervention strategies under subparagraph 7,a71 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 7d7 ,surveys ,the ,secretary may allow recipients of grants under this section to use such grant funds 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 7e7 ,priority ,in awarding grants under this section1 the ,secretary and the ,administrator shall give priority to entities with programming 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 7f7 ,authorization of appropriations ,there are authorized to be appropriated such sums as may be necessary to carry out this section4 ,the ,secretary may allocate not more than #bj percent of the amount so appropriated for a fiscal year for purposes of conducting research under subsection 7c74 4 #aajh4 ,tribal funding to research health inequities including ,,covid-#ai 7a7 ,in general ,not later than #f months after the date of enactment of this ,act1 the ,director of the ,indian ,health ,service1 in coordination with ,tribal ,epidemiology ,centers and other ,federal agencies1 as appropriate1 shall conduct or support research and field studies for the purposes of improved understanding of ,tribal health inequities among ,american ,indians and ,alaska ,natives1 including with respect to-- 7#a7 disparities related to ,,covid-#ai2 7#b7 public health surveillance and infrastructure regarding unmet needs in ,indian country and ,urban ,indian communities2 7#c7 population-based health disparities2 7#d7 barriers to health care services2 7#e7 the impact of socioeconomic status2 and 7#f7 factors contributing to ,tribal health inequities4 7b7 ,consultation1 confer1 and coordination ,in carrying out this section1 the ,director of the ,indian ,health ,service shall-- 7#a7 consult with ,indian ,tribes and ,tribal organizations2 7#b7 confer with ,urban ,indian organizations2 7#c7 coordinate with the ,director of the ,centers for ,disease ,control and ,prevention and the ,director of the ,national ,institutes of ,health4 7c7 ,process ,not later than #fj days after the date of enactment of this ,act1 the ,director of the ,indian ,health ,service shall establish a nationally representative panel to establish processes and procedures for the research and field studies conducted or supported under subsection 7a74 ,the ,director shall ensure that1 at a minimum1 the panel consists of the following individuals3 7#a7 ,elected ,tribal leaders or their designees4 7#b7 ,tribal public health practitioners and experts from the national and regional levels4 7d7 ,duties ,the panel established under subsection 7c7 shall1 at a minimum-- 7#a7 advise the ,director of the ,indian ,health ,service on the processes and procedures regarding the design1 implementation1 and evaluation of1 and reporting on1 research and field studies conducted or supported under this section2 7#b7 develop and share resources on ,tribal public health data surveillance and reporting1 including best practices2 and 7#c7 carry out such other activities as may be appropriate to establish processes and procedures for the research and field studies conducted or supported under subsection 7a74 7e7 ,report ,not later than #a year after expending all funds made available to carry out this section1 the ,director of the ,indian ,health ,service1 in coordination with the panel established under subsection 7c71 shall submit an initial report on the results of the research and field studies under this section to-- 7#a7 the ,committee on ,energy and ,commerce and the ,committee on ,natural ,resources of the ,house of ,representatives2 and 7#b7 the ,committee on ,indian ,affairs and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate4 7f7 ,tribal data sovereignty ,the ,director of the ,indian ,health ,service shall ensure that all research and field studies conducted or supported under this section are tribally-directed and carried out in a manner which ensures ,tribal-direction of all data collected under this section-- 7#a7 according to ,tribal best practices regarding research design and implementation1 including by ensuring the consent of the ,tribes involved to public reporting of ,tribal data2 7#b7 according to all relevant and applicable ,tribal1 professional1 institutional1 and ,federal standards for conducting research and governing research ethics2 7#c7 with the prior and informed consent of any ,indian ,tribe participating in the research or sharing data for use under this section2 and 7#d7 in a manner that respects the inherent sovereignty of ,indian ,tribes1 including ,tribal governance of data and research4 7g7 ,final report ,not later than ,december #ca1 #bjbc1 the ,director of the ,indian ,health ,service shall-- 7#a7 update and finalize the initial report under subsection 7e72 and 7#b7 submit such final report to the committees specified in such subsection4 7h7 ,definitions ,in this section3 7#a7 ,the terms ,indian ,tribe and ,tribal organization have the meanings given to such terms in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 7#b7 ,the term ,urban ,indian organization has the meaning given to such term in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc74 7i7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #be1jjj1jjj1 to remain available until expended4 #aaji4 ,research endowments at both current and former centers of excellence ,paragraph 7#a7 of section #dfdz-#c7;h7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhet7h77 is amended to read as follows3 7#a7 ,in general ,the ,director of the ,institute may carry out a program to facilitate minority health disparities research and other health disparities research by providing for research endowments-- 7,a7 at current or former centers of excellence under section #gcf2 and 7,b7 at current or former centers of excellence under section #dfdz-#d4 4 ,,xii ,education #abja4 ,grants for schools of medicine in diverse and underserved areas ,subpart ,,ii of part ,c of title ,,vii of the ,public ,health ,service ,act is amended by inserting after section #gdi;,b of such ,act 7#db ,u4,s4,c4 #bicm7 the following3 #gdi;,c4 ,schools of medicine in underserved areas 7a7 ,grants ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 may award grants to institutions of higher education 7including multiple institutions of higher education applying jointly7 for the establishment1 improvement1 and expansion of an allopathic or osteopathic school of medicine1 or a branch campus of an allopathic or osteopathic school of medicine4 7b7 ,priority ,in selecting grant recipients under this section1 the ,secretary shall give priority to institutions of higher education that-- 7#a7 propose to use the grant for an allopathic or osteopathic school of medicine1 or a branch campus of an allopathic or osteopathic school of medicine1 in a combined statistical area with fewer than #bjj actively practicing physicians per #ajj1jjj residents according to the medical board 7or boards7 of the ,state 7or ,states7 involved2 7#b7 have a curriculum that emphasizes care for diverse and underserved populations2 or 7#c7 are minority-serving institutions described in the list in section #cga7;a7 of the ,higher ,education ,act of #aife4 7c7 ,use of funds ,the activities for which a grant under this section may be used include-- 7#a7 planning and constructing-- 7,a7 a new allopathic or osteopathic school of medicine in an area in which no other school is based2 or 7,b7 a branch campus of an allopathic or osteopathic school of medicine in an area in which no such school is based2 7#b7 accreditation and planning activities for an allopathic or osteopathic school of medicine or branch campus2 7#c7 hiring faculty and other staff to serve at an allopathic or osteopathic school of medicine or branch campus2 7#d7 recruitment and enrollment of students at an allopathic or osteopathic school of medicine or branch campus2 7#e7 supporting educational programs at an allopathic or osteopathic school of medicine or branch campus2 7#f7 modernizing infrastructure or curriculum at an existing allopathic or osteopathic school of medicine or branch campus thereof2 7#g7 expanding infrastructure or curriculum at existing an allopathic or osteopathic school of medicine or branch campus2 and 7#h7 other activities that the ,secretary determines further the development1 improvement1 and expansion of an allopathic or osteopathic school of medicine or branch campus thereof4 7d7 ,definitions ,in this section3 7#a7 ,the term branch campus means a geographically separate site at least #ajj miles from the main campus of a school of medicine where at least one student completes at least #fj percent of the student's training leading to a degree of doctor of medicine4 7#b7 ,the term institution of higher education has the meaning given to such term in section #aja7;a7 of the ,higher ,education ,act of #aife4 7e7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #a1jjj1jjj1jjj1 to remain available until expended4 4 #abjb4 ,amendment to the ,public ,health ,service ,act ,title ,,xxxiv of the ,public ,health ,service ,act1 as amended by as amended by sections #ajd1 #gjb1 and #hjf1 is amended by adding at the end the following3 ,d ,diversifying the ,health ,care ,workplace #cdaj4 ,national ,working ,group on ,workforce ,diversity 7a7 ,in general ,the ,secretary1 acting through the ,bureau of ,health ,workforce of 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 each 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 ,national ,institute on ,minority ,health and ,health ,disparities4 7,g7 ,the ,agency for ,healthcare ,research and ,quality4 7,h7 ,the ,institute of ,medicine ,study ,committee for the #bjjd workforce diversity report4 7,i7 ,the ,indian ,health ,service4 7,j7 ,the ,department of ,education4 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 7including nonprofit7 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#i74 7,s7 ,national community-based organizations that serve as a national intermediary to their urban affiliate members and have demonstrated capacity to train health care professionals4 7,t7 ,the ,veterans ,health ,administration4 7,u7 ,other entities determined appropriate by the ,secretary4 7#b7 ,the grantee shall ensure that1 in addition to the representatives under paragraph 7#a71 the working 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 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 workforce data collection or tracking system to identify where racial and ethnic minority health professionals practice4 7#i7 ,develop a strategy for the inclusion of community members on admissions committees for health profession schools4 7#aj7 ,help with monitoring and implementation of standards for diversity1 equity1 and inclusion4 7#aa7 ,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 #bjba through #bjbe4 #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 ,administration and 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 clearinghouses related to health workforce diversity4 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 #bjba through #bjbe4 #cdac4 ,support for ,institutions committed to workforce diversity1 equity1 and inclusion 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 part ,b institutions1 as defined in section #cbb of the ,higher ,education ,act of #aife2 7,b7 ,hispanic-serving health professions schools2 7,c7 ,hispanic-serving institutions1 as defined in section #ejb of such ,act2 7,d7 ,tribal colleges or universities1 as defined in section #caf of such ,act2 7,e7 ,asian ,american and ,native ,american ,pacific ,islander-serving institutions1 as defined in section #cga7;c7 of such ,act2 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 institutions1 including national and regional community-based organizations with demonstrated commitment to a diversified workforce-- 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 supporting workforce diversity in 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 ,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 #bjba through #bjbe4 #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 agency listed in subsection 7a7 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 agency listed in subsection 7a7 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 #bjba through #bjbe4 #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 ,assistant ,secretary for ,mental ,health and ,substance ,use1 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 #bjba through #bjbe4 #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 #bjba through #bjbe4 #cdag4 ,health disparities education program 7a7 ,establishment ,the ,secretary1 acting through the ,office of ,minority ,health1 in collaboration with the ,national ,institute on ,minority ,health and ,health ,disparities1 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 individuals 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 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 resources2 and 7#g7 design and implement specific educational initiatives to educate the health care workforce relating to unconscious bias4 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 #bjba through #bjbe4 4 #abjc4 ,hispanic-serving institutions1 ,historically ,black ,colleges and ,universities1 ,asian ,american and ,native ,american ,pacific ,islander-serving institutions1 ,tribal colleges1 regional community-based organizations1 and national minority medical associations ,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 institutions1 ,historically ,black ,colleges and ,universities1 ,asian ,american and ,native ,american ,pacific ,islander-serving institutions1 and ,tribal colleges 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration and in consultation with the ,secretary of ,education1 shall award grants to ,hispanic-serving institutions1 ,historically ,black ,colleges and ,universities1 ,asian ,american and ,native ,american ,pacific ,islander-serving institutions1 ,tribal ,colleges or ,universities1 regional community-based organizations1 and national minority medical associations1 for counseling1 mentoring and providing information on financial assistance to prepare underrepresented minority individuals to enroll in and graduate from health professional schools and to increase services for underrepresented minority students including-- 7#a7 mentoring with underrepresented health professionals2 and 7#b7 providing financial assistance information for continued education and applications to health professional schools4 7b7 ,definitions ,in this section3 7#a7 ,asian ,american and ,native ,american ,pacific ,islander-serving institution ,the term ,asian ,american and ,native ,american ,pacific ,islander-serving institution has the meaning given such term in section #cbj7;b7 of the ,higher ,education ,act of #aife4 7#b7 ,hispanic-serving institution ,the term ,hispanic-serving institution means an entity that-- 7,a7 is a school or program for which there is a definition under #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 ,hispanic ,center of ,excellence in ,health ,professions ,education designated under section #gcf7;d77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bic7;d77#b774 7#c7 ,historically black colleges and university ,the term historically black college and university has the meaning given the term part ,b institution as defined in section #cbb of the ,higher ,education ,act of #aife4 7#d7 ,tribal college or university ,the term ,tribal ,college or ,university has the meaning given such term in section #caf7;b7 of the ,higher ,education ,act of #aife4 7c7 ,certain loan repayment programs ,in carrying out the ,national ,health ,service ,corps ,loan ,repayment ,program established under subpart ,,iii of part ,d of title ,,iii and the loan repayment program under section #cag;,f1 the ,secretary shall ensure1 notwithstanding such subpart or section1 that loan repayments of not less than #ej1jjj per year per person are awarded for repayment of loans incurred for enrollment or participation of underrepresented minority individuals in health professional schools and other health programs described in this section4 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 #bjba through #bjbf4 4 #abjd4 ,loan repayment program of ,centers for ,disease ,control and ,prevention ,section #cag;,f7c77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#g7;c77#a77 is amended-- 7#a7 by striking and after #aiid12 and 7#b7 by inserting before the period at the end the following3 1 #gej1jjj for fiscal year #bjbj1 and such sums as may be necessary for each of the fiscal years #bjba through #bjbe4 #abje4 ,study and report on strategies for increasing diversity 7a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study on strategies for increasing the diversity of the health professional workforce4 ,such study shall include an analysis of strategies for increasing the number of health professionals from rural1 lower income1 and underrepresented minority communities1 including which strategies are most effective for achieving such goal4 7b7 ,report ,not later than #b years after the date of enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report on the study conducted under subsection 7a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 #abjf4 ,amendments to the ,pandemic ,,ebt ,act ,section #aaja of the ,families ,first ,coronavirus ,response ,act 7,public ,law #aaf-abg7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by striking fiscal year #bjbj and inserting fiscal years #bjbj and #bjba2 7,b7 by striking during which the school would otherwise be in session2 and 7,c7 by inserting until the school reopens after assistance2 7#b7 in subsection 7b7-- 7,a7 by inserting and ,state agency plans for child care covered children in accordance with subsection 7i7 after with eligible children2 7,b7 by inserting 1 a plan to enroll children who become eligible children during a public health emergency designation before 1 and issuances2 7,c7 by striking in an amount not less than the value of meals at the free rate over the course of #e school days and inserting in accordance with subsection 7h77#a72 and 7,d7 by inserting and for each child care covered child in the household before the period at the end2 7#c7 in subsection 7c71 by inserting or child care center after school2 7#d7 by amending subsection 7e7 to read as follows3 7e7 ,release of information ,notwithstanding any other provision of law1 the ,secretary of ,agriculture may authorize-- 7#a7 ,state educational agencies and school food authorities administering a school lunch program under the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agea et seq47 to release to appropriate officials administering the supplemental nutrition assistance program such information as may be necessary to carry out this section with respect to eligible children2 and 7#b7 ,state agencies administering a child and adult care food program under section #ag of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agff7 to release to appropriate officials administering the supplemental nutrition assistance program such information as may be necessary to carry out this section with respect to child care covered children4 2 7#e7 by amending subsection 7g7 to read as follows3 7g7 ,availability of commodities 7#a7 ,in general ,subject to paragraph 7#b71 during fiscal year #bjbj1 the ,secretary of ,agriculture may purchase commodities for emergency distribution in any area of the ,united ,states during a public health emergency designation4 7#b7 ,purchases ,funds made available to carry out this subsection on or after the date of the enactment of the ,child ,nutrition and ,related ,programs ,recovery ,act may only be used to purchase commodities for emergency distribution-- 7,a7 under commodity distribution programs and child nutrition programs that were established and administered by the ,food and ,nutrition ,service on or before the day before the date of the enactment of the ,families ,first ,coronavirus ,response ,act 7,public ,law #aaf-abg72 7,b7 to ,tribal organizations 7as defined in section #c of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjab771 that are not administering the food distribution program established under section #d7;b7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjac7;b772 or 7,c7 to emergency feeding organizations that are eligible recipient agencies 7as such terms are defined in section #bja;,a of the ,emergency ,food ,assistance ,act of #aihc 7#g ,u4,s4,c4 #geja774 2 7#f7 by redesignating subsections 7h7 and 7i7 as subsections 7l7 and 7m72 7#g7 by inserting after subsection 7g7 the following3 7h7 ,amount of benefits 7#a7 ,in general ,a household shall receive benefits under this section in an amount equal to #a breakfast and #a lunch at the free rate for each eligible child or child care covered child in such household for each day4 7#b7 ,treatment of newly eligible children ,in the case of a child who becomes an eligible child during a public health emergency designation1 the ,secretary and ,state agency shall-- 7,a7 if such child becomes an eligible child during school year #bjai-bjbj1 treat such child as if such child was an eligible child as of the date the school in which the child is enrolled closed2 and 7,b7 if such child becomes an eligible child after school year #bjai-bjbj1 treat such child as an eligible child as of the first day of the month in which such child becomes so eligible4 7i7 ,child care covered child assistance 7#a7 ,in general ,during fiscal years #bjbj and #bjba1 in any case in which a child care center is closed for at least #e consecutive days during a public health emergency designation1 each household containing at least #a member who is a child care covered child attending the child care center shall be eligible until the schools in the ,state in which such child care center is located reopen1 as determined by the ,secretary1 to receive assistance pursuant to-- 7,a7 a ,state agency plan approved under subsection 7b7 that includes-- 7i7 an application by the ,state agency seeking to participate in the program under this subsection2 and 7ii7 a ,state agency plan for temporary emergency standards of eligibility and levels of benefits under the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjaa et seq47 for households with child care covered children2 or 7,b7 an addendum application described in paragraph 7#b74 7#b7 ,addendum application ,in the case of a ,state agency that submits a plan to the ,secretary of ,agriculture under subsection 7b7 that does not include an application or plan described in clauses 7i7 and 7ii7 of paragraph 7#a77;,a71 such ,state agency may apply to participate in the program under this subsection by submitting to the ,secretary of ,agriculture an addendum application for approval that includes a ,state agency plan described in such clause 7ii74 7#c7 ,requirements for participation ,a ,state agency may not participate in the program under this subsection if-- 7,a7 the ,state agency plan submitted by such ,state agency under subsection 7b7 with respect to eligible children is not approved by the ,secretary under such subsection2 or 7,b7 the ,state agency plan submitted by such ,state agency under subsection 7b7 or this subsection with respect to child care covered children is not approved by the ,secretary under either such subsection4 7#d7 ,automatic enrollment 7,a7 ,in general ,subject to subparagraph 7,b71 the ,secretary shall deem a child who is less than #f years of age to be a child care covered child eligible to receive assistance under this subsection if-- 7i7 the household with such child attests that such child is a child care covered child2 7ii7 such child resides in a household that includes an eligible child2 7iii7 such child receives cash assistance benefits under the temporary assistance for needy families program under part ,a of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq472 7iv7 such child receives assistance under the ,child ,care and ,development ,block ,grant ,act of #aiij 7#db ,u4,s4,c4 #iheg et seq472 7v7 such child is-- 7,i7 enrolled as a participant in a ,head ,start program authorized under the ,head ,start ,act 7#db ,u4,s4,c4 #ihca et seq472 7,,ii7 a foster child whose care and placement is the responsibility of an agency that administers a ,state plan under part ,b or ,e of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fba et seq472 7,,iii7 a foster child who a court has placed with a caretaker household2 or 7,,iv7 a homeless child or youth 7as defined in section #gbe7b7 of the ,mc,kinney-,vento ,homeless ,assistance ,act 7#db ,u4,s4,c4 #aadcd;a7#b7772 7vi7 such child participates in the special supplemental nutrition program for women1 infants1 and children under section #ag of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aghf72 7vii7 through the use of information obtained by the ,state agency for the purpose of participating in the supplemental nutrition assistance program under the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjaa et seq471 the ,state agency elects to treat as a child care covered child each child less than #f years of age who is a member of a household that receives supplemental nutrition assistance program benefits under such ,act2 or 7viii7 the ,state in which such child resides determines that such child is a child care covered child1 using ,state data approved by the ,secretary4 7,b7 ,acceptance of any form of automatic enrollment 7i7 ,one category ,for purposes of deeming a child to be a child care covered child under subparagraph 7,a71 a ,state agency may not be required to show that a child meets more than one requirement specified in clauses 7i7 through 7viii7 of such subparagraph4 7ii7 ,deeming requirement ,if a ,state agency submits to the ,secretary information that a child meets any one of the requirements specified in clauses 7i7 through 7viii7 of subparagraph 7,a71 the ,secretary shall deem such child a child care covered child under such subparagraph4 7j7 ,exclusions ,the provisions of section #af of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjbe7 relating to quality control shall not apply with respect to assistance provided under this section4 7k7 ,feasibility analysis 7#a7 ,in general ,not later than #cj days after the date of the enactment of the ,child ,nutrition and ,related ,programs ,recovery ,act1 the ,secretary shall submit to the ,education and ,labor ,committee and the ,agriculture ,committee of the ,house of ,representatives and the ,committee on ,agriculture1 ,nutrition1 and ,forestry of the ,senate a report on-- 7,a7 the feasibility of implementing the program for eligible children under this section using an ,,ebt system in ,puerto ,rico1 the ,commonwealth of the ,northern ,mariana ,islands1 and ,american ,samoa similar to the manner in which the supplemental nutrition assistance program under the ,food and ,nutrition ,act of #bjjh is operated in the ,states1 including an analysis of-- 7i7 the current nutrition assistance program issuance infrastructure2 7ii7 the availability of-- 7,i7 an ,,ebt system1 including the ability for authorized retailers to accept ,,ebt cards2 and 7,,ii7 ,,ebt cards2 7iii7 the ability to limit purchases using nutrition assistance program benefits to food for home consumption2 and 7iv7 the availability of reliable data necessary for the implementation of such program under this section for eligible children and child care covered children1 including the names of such children and the mailing addresses of their households2 and 7,b7 the feasibility of implementing the program for child care covered children under subsection 7i7 in ,puerto ,rico1 the ,commonwealth of the ,northern ,mariana ,islands1 and ,american ,samoa1 including with respect to such program each analysis specified in clauses 7i7 through 7iv7 of subparagraph 7,a74 7#b7 ,contingent availability of participation ,beginning #cj days after the date of the enactment of the ,child ,nutrition and ,related ,programs ,recovery ,act1 ,puerto ,rico1 the ,commonwealth of the ,northern ,mariana ,islands1 and ,american ,samoa may each-- 7,a7 submit a plan under subsection 7b71 unless the ,secretary makes a finding1 based on the analysis provided under paragraph 7#a77;,a71 that the implementation of the program for eligible children under this section is not feasible in such territories2 and 7,b7 submit a plan under subsection 7i71 unless the ,secretary makes a finding1 based on the analysis provided under paragraph 7#a77;,b71 that the implementation of the program for child care covered children under subsection 7i7 is not feasible in such territories4 7#c7 ,treatment of plans submitted by territories ,notwithstanding any other provision of law1 with respect to a plan submitted pursuant to this subsection by ,puerto ,rico1 the ,commonwealth of the ,northern ,mariana ,islands1 or ,american ,samoa under subsection 7b7 or subsection 7i71 the ,secretary shall treat such plan in the same manner as a plan submitted by a ,state agency under such subsection1 including with respect to the terms of funding provided under subsection 7m74 2 7#h7 in subsection 7l71 as redesigned by paragraph 7#g7-- 7,a7 by redesignating paragraph 7#a7 as paragraph 7#c72 7,b7 by redesignating paragraphs 7#b7 and 7#c7 as paragraphs 7#e7 and 7#f71 respectively2 7,c7 by inserting before paragraph 7#c7 7as so redesignated7 the following3 7#a7 ,the term child care center means an organization described in subparagraph 7,a7 or 7,b7 of section #ag7;a77#b7 of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agff7;a77#b77 and a family or group day care home4 7#b7 ,the term child care covered child means a child served under section #ag of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agff7 who1 if not for the closure of the child care center attended by the child during a public health emergency designation and due to concerns about a ,,covid-#ai outbreak1 would receive meals under such section at the child care center4 2 and 7,d7 by inserting after paragraph 7#c7 7as so redesignated7 the following3 7#d7 ,the term free rate means-- 7,a7 with respect to a breakfast1 the rate of a free breakfast under the school breakfast program under section #d of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aggc72 and 7,b7 with respect to a lunch1 the rate of a free lunch under the school lunch program under the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agga et seq474 2 and 7#i7 in subsection 7m71 as redesignated by paragraph 7#g71 by inserting 7including all administrative expenses7 after this section4 ,,xiii ,public ,health ,assistance to ,tribes #acja4 ,appropriations for the ,indian ,health ,service ,,heroes ,act ,division ,a1 ,title ,v--,department of ,health ,human ,services--,indian ,health ,service--,the #b4a billion in ,,covid-#ai response funding for the ,indian ,health ,service4 #acjb4 ,improving ,state1 local1 and ,tribal public health security ,section #cai;,c-#a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;d-#c;a7 is amended-- 7#a7 in the section heading1 by striking and local and inserting 1 local1 and ,tribal2 7#b7 in subsection 7b7-- 7,a7 in paragraph 7#a7-- 7i7 in subparagraph 7,b71 by striking or at the end2 7ii7 in subparagraph 7,c71 by striking and at the end and inserting or2 and 7iii7 by adding at the end the following3 7,d7 be an ,indian ,tribe1 ,tribal organization1 or a consortium of ,indian ,tribes or ,tribal organizations2 and 2 and 7,b7 in paragraph 7#b7-- 7i7 in the matter preceding subparagraph 7,a71 by inserting 1 as applicable after including2 7ii7 in subparagraph 7,a77viii7-- 7,i7 by inserting and ,tribal after with ,state2 7,,ii7 by striking 7as defined in section #haja of the ,elementary and ,secondary ,education ,act of #aife7 and inserting and ,tribal educational agencies 7as defined in sections #haja and #facb1 respectively1 of the ,elementary and ,secondary ,education ,act of #aife72 and 7,,iii7 by inserting and ,tribal after and ,state2 7iii7 in subparagraph 7,g71 by striking and tribal and inserting ,tribal1 and urban ,indian organization2 and 7iv7 in subparagraph 7,h71 by inserting 1 ,indian ,tribes1 and urban ,indian organizations after public health2 7#c7 in subsection 7e71 by inserting ,indian ,tribes1 ,tribal organizations1 urban ,indian organizations1 after local emergency plans12 7#d7 in subsection 7g77#a71 by striking tribal officials and inserting ,tribal officials2 7#e7 in subsection 7h7-- 7,a7 in paragraph 7#a77;,a7-- 7i7 by striking through #bjbc and inserting and #bjbj2 and 7ii7 by inserting before the period 2 and #fij1jjj1jjj for each of fiscal years #bjba through #bjbc for awards pursuant to paragraph 7#c7 7subject to the authority of the ,secretary to make awards pursuant to paragraphs 7#d7 and 7#e77 and paragraph 7#h71 of which not less than #e1jjj1jjj shall be reserved each fiscal year for awards under paragraph 7#h72 7,b7 in subsection 7h77#b77;,b71 by striking tribal public and inserting ,tribal public2 7,c7 in the heading of paragraph 7#c71 by inserting for ,states after amount2 and 7,d7 by adding at the end the following3 7#h7 ,tribal eligible entities 7,a7 ,determination of funding amount 7i7 ,in general ,the ,secretary shall award at least #aj cooperative agreements under this section1 in amounts not less than the minimum amount determined under clause 7ii71 to eligible entities described in subsection 7b77#a77;,d7 that submits to the ,secretary an application that meets the criteria of the ,secretary for the receipt of such an award and that meets other reasonable implementation conditions established by the ,secretary1 in consultation with ,indian ,tribes1 for such awards4 ,if the ,secretary receives more than #aj applications under this section from eligible entities described in subsection 7b77#a77;,d7 that meet the criteria and conditions described in the previous sentence1 the ,secretary1 in consultation with ,indian ,tribes1 may make additional awards under this section to such entities4 7ii7 ,minimum amount ,in determining the minimum amount of an award pursuant to clause 7i71 the ,secretary1 in consultation with ,indian ,tribes1 shall first determine an amount the ,secretary considers appropriate for the eligible entity4 7,b7 ,available until expended ,amounts provided to a ,tribal eligible entity under a cooperative agreement under this section for a fiscal year and remaining unobligated at the end of such year shall remain available to such entity during the entirety of the performance period1 for the purposes for which said funds were provided4 7,c7 ,no matching requirement ,subparagraphs 7,b71 7,c71 and 7,d7 of paragraph 7#a7 shall not apply with respect to cooperative agreements awarded under this section to eligible entities described in subsection 7b77#a77;,d74 2 and 7#f7 by adding at the end the following3 7l7 ,special rules related to ,tribal eligible entities 7#a7 ,modifications ,after consultation with ,indian ,tribes1 the ,secretary may make necessary and appropriate modifications to the program under this section to facilitate the use of the cooperative agreement program by eligible entities described in subsection 7b77#a77;,d74 7#b7 ,waivers 7,a7 ,in general ,except as provided in subparagraph 7,b71 the ,secretary may waive or specify alternative requirements for any provision of this section 7including regulations7 that the ,secretary administers in connection with this section if the ,secretary finds that the waiver or alternative requirement is necessary for the effective delivery and administration of this program with respect to eligible entities described in subsection 7b77#a77;,d74 7,b7 ,exception ,the ,secretary may not waive or specify alternative requirements under subparagraph 7,a7 relating to labor standards or the environment4 7#c7 ,consultation ,the ,secretary shall consult with ,indian ,tribes and ,tribal organizations on the design of this program with respect to such ,tribes and organizations to ensure the effectiveness of the program in enhancing the security of ,indian ,tribes with respect to public health emergencies4 7#d7 ,reporting 7,a7 ,in general ,not later than #b years after the date of enactment of this subsection1 and as an addendum to the biennial evaluations required under subsection 7k71 the ,secretary1 in coordination with the ,director of the ,indian ,health ,service1 shall-- 7i7 conduct a review of the implementation of this section with respect to eligible entities described in subsection 7b77#a77;,d71 including any factors that may have limited its success2 and 7ii7 submit a report describing the results of the review described in clause 7i7 to-- 7,i7 the ,committee on ,indian ,affairs1 the ,committee on ,health1 ,education1 ,labor1 and ,pensions1 and the ,committee on ,appropriations of the ,senate2 and 7,,ii7 the ,subcommittee for ,indigenous ,peoples of the ,united ,states of the ,committee on ,natural ,resources1 the ,committee on ,energy and ,commerce1 and the ,committee on ,appropriations of the ,house of ,representatives4 7,b7 ,analysis of ,tribal public health emergency infrastructure limitation ,the ,secretary shall include in the initial report submitted under subparagraph 7,a7 a description of any public health emergency infrastructure limitation encountered by eligible entities described in subsection 7b77#a77;,d74 4 #acjc4 ,provision of items to ,indian programs and facilities 7a7 ,strategic ,national ,stockpile ,section #cai;,f-#b7;a77#c77;,g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;d-#f;b7a77#c77;,g77 is amended by inserting 1 and1 in the case that the ,secretary deploys the stockpile under this subparagraph1 ensure1 in coordination with the applicable ,states and programs and facilities1 that appropriate drugs1 vaccines and other biological products1 medical devices1 and other supplies are deployed by the ,secretary directly to health programs or facilities operated by the ,indian ,health ,service1 an ,indian ,tribe1 a ,tribal organization 7as those terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd771 or an inter-,tribal consortium 7as defined in section #eja of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #echa77 or through an urban ,indian organization 7as defined in section #d of the ,indian ,health ,care ,improvement ,act71 while avoiding duplicative distributions to such programs or facilities before the semicolon4 7b7 ,distribution of qualified pandemic or epidemic products to ,,ihs facilities ,title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bda et seq47 is amended by inserting after section #cai;,f-#d the following3 #cai;,f-#e4 ,distribution of qualified pandemic or epidemic products to ,indian programs and facilities ,in the case that the ,secretary distributes qualified pandemic or epidemic products 7as defined in section #cai;,f-#c7;i77#g77 to ,states or other entities1 the ,secretary shall ensure1 in coordination with the applicable ,states and programs and facilities1 that1 as appropriate1 such products are distributed directly to health programs or facilities operated by the ,indian ,health ,service1 an ,indian ,tribe1 a ,tribal organization 7as those terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd771 or an inter-,tribal consortium 7as defined in section #eja of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #echa77 or through an urban ,indian organization 7as defined in section #d of the ,indian ,health ,care ,improvement ,act71 while avoiding duplicative distributions to such programs or facilities4 4 #acjd4 ,health care access for urban native veterans ,section #dje of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afde7 is amended-- 7#a7 in subsection 7a77#a71 by inserting urban ,indian organizations1 before and tribal organizations2 and 7#b7 in subsection 7c7-- 7,a7 by inserting urban ,indian organization1 before or tribal organization2 and 7,b7 by inserting an urban ,indian organization1 before or a tribal organization4 #acje4 ,proper and reimbursed care for native veterans ,section #dje7;c7 of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afde7;c77 is amended by inserting before the period at the end the following3 1 regardless of whether such services are provided directly by the ,service1 an ,indian tribe1 or tribal organization1 through contract health services1 or through a contract for travel described in section #bac7;b74