,,ii #aafth ,,congress #b;d ,session ,s4 #dhai ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,october #bj 7legislative day1 ,october #ai71 #bjbj,ms4 ,hirono 7for herself1 ,mrs4 ,gillibrand1 ,mr4 ,merkley1 ,ms4 ,duckworth1 ,mr4 ,blumenthal1 ,mr4 ,sanders1 ,mr4 ,booker1 ,mr4 ,cardin1 and ,mr4 ,kaine7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to improve the health of minority individuals1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,health ,equity and ,accountability ,act of #bjbj4 #b4 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title4,sec4 #b4 ,table of contents4,sec4 #c4 ,findings4,,title ,i--,data collection and reporting,sec4 #aja4 ,amendment to the ,public ,health ,service ,act4,sec4 #ajb4 ,elimination of prerequisite of direct appropriations for data collection and analysis4,sec4 #ajc4 ,collection of data for the ,medicare program4,sec4 #ajd4 ,revision of ,,hipaa claims standards4,sec4 #aje4 ,national ,center for ,health ,statistics4,sec4 #ajf4 ,disparities data collected by the ,federal ,government4,sec4 #ajg4 ,data collection and analysis grants to minority-serving institutions4,sec4 #ajh4 ,standards for measuring sexual orientation1 gender identity1 and socioeconomic status in collection of health data4,sec4 #aji4 ,safety and effectiveness of drugs with respect to racial and ethnic background4,sec4 #aaj4 ,improving health data regarding ,native ,hawaiians and other ,pacific ,islanders4,sec4 #aaa4 ,clarification of simplified administrative reporting requirement4,,title ,,ii--,culturally and linguistically appropriate health and health care,sec4 #bja4 ,definitions2 findings4,sec4 #bjb4 ,improving access to services for individuals with limited ,english proficiency4,sec4 #bjc4 ,ensuring standards for culturally and linguistically appropriate services in health care4,sec4 #bjd4 ,culturally and linguistically appropriate health care in the ,public ,health ,service ,act4,sec4 #bje4 ,pilot program for improvement and development of ,state medical interpreting services4,sec4 #bjf4 ,training tomorrow's doctors for culturally and linguistically appropriate care3 graduate medical education4,sec4 #bjg4 ,federal reimbursement for culturally and linguistically appropriate services under the ,medicare1 ,medicaid1 and ,state ,children's ,health ,insurance ,programs4,sec4 #bjh4 ,increasing understanding of and improving health literacy4,sec4 #bji4 ,requirements for health programs or activities receiving ,federal funds4,sec4 #baj4 ,report on ,federal efforts to provide culturally and linguistically appropriate health care services4,sec4 #baa4 ,english for speakers of other languages4,sec4 #bab4 ,implementation4,sec4 #bac4 ,language access services4,sec4 #bad4 ,medically underserved populations4,,title ,,iii--,health workforce diversity,sec4 #cja4 ,amendment to the ,public ,health ,service ,act4,sec4 #cjb4 ,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 #cjc4 ,loan repayment program of ,centers for ,disease ,control and ,prevention4,sec4 #cjd4 ,cooperative agreements for online degree programs at schools of public health and schools of allied health4,sec4 #cje4 ,sense of ,congress on the mission of the ,national ,health ,care ,workforce ,commission4,sec4 #cjf4 ,scholarship and fellowship programs4,sec4 #cjg4 ,mc,nair ,postbaccalaureate ,achievement ,program4,sec4 #cjh4 ,rules for determination of full-time equivalent residents for cost-reporting periods4,sec4 #cji4 ,developing and implementing strategies for local health equity4,sec4 #caj4 ,loan forgiveness for mental and behavioral health social workers4,sec4 #caa4 ,health ,professions ,workforce ,fund4,sec4 #cab4 ,findings2 sense of ,congress relating to graduate medical education4,sec4 #cac4 ,career support for skilled1 internationally educated health professionals4,sec4 #cad4 ,study and report on strategies for increasing diversity4,sec4 #cae4 ,conrad ,state #cj program2 physician retention4,,title ,,iv--,improving ,health ,care ,access and ,quality,subtitle ,a--,improvement of ,coverage,sec4 #dja4 ,repeal of requirement for documentation evidencing citizenship or nationality under the ,medicaid program4,sec4 #djb4 ,removing citizenship and immigration barriers to access to affordable health care under ,,aca4,sec4 #djc4 ,study on the uninsured4,sec4 #djd4 ,medicaid in the territories4,sec4 #dje4 ,extension of ,medicare secondary payer4,sec4 #djf4 ,indian defined in title ,i of the ,patient ,protection and ,affordable ,care ,act4,sec4 #djg4 ,removing ,medicare barrier to health care4,sec4 #djh4 #ajj percent ,,fmap for medical assistance provided by urban ,indian health centers4,sec4 #dji4 #ajj percent ,,fmap for medical assistance provided to a ,native ,hawaiian through a federally qualified health center or a ,native ,hawaiian health care system under the ,medicaid program4,sec4 #daj4 ,medicaid coverage for citizens of freely associated states4,subtitle ,b--,expansion of ,access ,sec4 #dab4 ,amendment to the ,public ,health ,service ,act4,sec4 #dac4 ,protecting sensitive locations4,sec4 #dad4 ,grants for racial and ethnic approaches to community health4,sec4 #dae4 ,border health grants4,sec4 #daf4 ,critical access hospital improvements4,sec4 #dag4 ,establishment of ,rural ,community ,hospital 7,,rch7 ,program4,sec4 #dah4 ,medicare remote monitoring pilot projects4,sec4 #dai4 ,rural ,health ,quality ,advisory ,commission and demonstration projects4,sec4 #dbj4 ,rural health care services4,sec4 #dba4 ,community health center collaborative access expansion4,sec4 #dbb4 ,facilitating the provision of telehealth services across ,state lines4,sec4 #dbc4 ,scoring of preventive health savings4,sec4 #dbd4 ,sense of ,congress on ,maintenance of ,effort ,provisions ,regarding ,children's ,health4,sec4 #dbe4 ,protection of the ,,hhs ,offices of ,minority ,health4,sec4 #dbf4 ,office of ,minority ,health in ,veterans ,health ,administration of ,department of ,veterans ,affairs4,sec4 #dbg4 ,study of ,,dsh payments to ensure hospital access for low-income patients4,sec4 #dbh4 ,assistant ,secretary of the ,indian ,health ,service4,sec4 #dbi4 ,reauthorization of the ,native ,hawaiian ,health ,care ,improvement ,act4,sec4 #dcj4 ,availability of non-,english language speaking providers4,sec4 #dca4 ,access to essential community providers4,sec4 #dcb4 ,provider network adequacy in communities of color4,sec4 #dcc4 ,improving access to dental care4,sec4 #dcd4 ,providing for a special enrollment period for pregnant individuals4,sec4 #dce4 ,coverage of maternity care for dependent children4,sec4 #dcf4 ,federal ,employee ,health ,benefit ,plans4,sec4 #dcg4 ,continuation of ,medicaid income eligibility standard for pregnant individuals and infants4,subtitle ,c--,advancing ,health ,equity ,through ,payment and ,delivery ,reform ,sec4 #dda4 ,sense of ,congress4,sec4 #ddb4 ,centers for ,medicare ,medicaid ,services reporting and value based programs4,sec4 #ddc4 ,development and testing of disparity reducing delivery and payment models4,sec4 #ddd4 ,diversity in ,centers for ,medicare and ,medicaid consultation4,sec4 #dde4 ,supporting safety net and community-based providers to compete in value-based payment systems4,subtitle ,d--,health ,empowerment ,zones ,sec4 #dea4 ,short title4,sec4 #deb4 ,findings4,sec4 #dec4 ,designation of health empowerment zones4,sec4 #ded4 ,assistance to those seeking designation4,sec4 #dee4 ,benefits of designation4,sec4 #def4 ,definition of ,secretary4,sec4 #deg4 ,authorization of appropriations4,,title ,v--,,improving ,,health ,,outcomes ,,for ,,women1 ,,children1 ,,and ,f,a,m,i,l,i,e,s,subtitle ,a--,in ,general,sec4 #eja4 ,grants to promote health for underserved communities4,sec4 #ejb4 ,removing barriers to health care and nutrition assistance for children1 pregnant persons1 and lawfully present individuals4,sec4 #ejc4 ,repeal of denial of ,,snap benefits4,sec4 #ejd4 ,birth defects prevention1 risk reduction1 and awareness4,sec4 #eje4 ,,momma's ,act4,sec4 #ejf4 ,rural maternal and obstetric modernization of services4,sec4 #ejg4 ,decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood4,sec4 #ejh4 ,reducing unintended teenage pregnancies4,sec4 #eji4 ,gestational diabetes4,sec4 #eaj4 ,emergency contraception education and information programs4,sec4 #eaa4 ,comprehensive sex education programs4,sec4 #eab4 ,compassionate assistance for rape emergencies4,sec4 #eac4 ,access to birth control duties of pharmacies to ensure provision of ,,fda-approved contraception4,sec4 #ead4 ,additional focus area for the ,office on ,women's ,health4,sec4 #eae4 ,interagency ,coordinating ,committee on the ,promotion of ,optimal ,maternity ,outcomes4,sec4 #eaf4 ,consumer education campaign4,sec4 #eag4 ,bibliographic database of systematic reviews for care of childbearing individuals and newborns4,sec4 #eah4 ,expansion of ,,cdc ,prevention ,research ,centers ,program to include ,centers on ,optimal ,maternity ,outcomes4,sec4 #eai4 ,expanding models allowed to be tested by ,center for ,medicare ,medicaid ,innovation to include maternity care models4,sec4 #ebj4 ,development of interprofessional maternity care educational models and tools4,sec4 #eba4 ,including services furnished by certain students1 interns1 and residents supervised by certified nurse midwives within inpatient hospital services under ,medicare4,sec4 #ebb4 ,grants to professional organizations to increase diversity in maternal1 reproductive1 and sexual health professionals4,sec4 #ebc4 ,interagency update to the quality family planning guidelines4,sec4 #ebd4 ,dissemination of the quality family planning guidelines4,subtitle ,b--,pregnancy ,screening,sec4 #eca4 ,pregnancy intention screening initiative demonstration program4,,title ,,vi--,mental health,sec4 #fja4 ,mental health findings4,sec4 #fjb4 ,coverage of marriage and family therapist services1 mental health counselor services1 substance abuse counselor services1 and peer support specialist services under part ,b of the ,medicare program4,sec4 #fjc4 ,integrated ,health ,care ,demonstration ,program4,sec4 #fjd4 ,addressing racial and ethnic mental health disparities research gaps4,sec4 #fje4 ,health professions competencies to address racial and ethnic mental health disparities4,sec4 #fjf4 ,geoaccess study4,sec4 #fjg4 ,asian ,american1 ,native ,hawaiian1 ,pacific ,islander1 and ,hispanic and ,latino behavioral and mental health outreach and education strategies4,sec4 #fjh4 ,mental health in schools4,sec4 #fji4 ,building an effective workforce in mental health4,sec4 #faj4 ,mental health at the border4,,title ,,vii--,addressing high impact minority diseases ,subtitle ,a--,cancer,sec4 #gja4 ,lung cancer mortality reduction4,sec4 #gjb4 ,expanding prostate cancer research1 outreach1 screening1 testing1 access1 and treatment effectiveness4,sec4 #gjc4 ,prostate research1 imaging1 and men's education 7,,prime74,sec4 #gjd4 ,prostate cancer detection research and education4,sec4 #gje4 ,national ,prostate ,cancer ,council4,sec4 #gjf4 ,improved ,medicaid coverage for certain breast and cervical cancer patients in the territories4,sec4 #gjg4 ,cancer prevention and treatment demonstration for ethnic and racial minorities4,sec4 #gjh4 ,reducing cancer disparities within ,medicare4,sec4 #gji4 ,cancer clinical trials4,subtitle ,b--,viral ,hepatitis and ,liver ,cancer ,control and ,prevention,sec4 #gaa4 ,viral hepatitis and liver cancer control and prevention4,subtitle ,c--,acquired ,bone ,marrow ,failure ,diseases,sec4 #gba4 ,acquired bone marrow failure diseases4,subtitle ,d--,cardiovascular ,disease1 ,chronic ,disease1 ,obesity1 and ,other ,disease ,issues,sec4 #gca4 ,guidelines for disease screening for minority patients4,sec4 #gcb4 ,,cdc ,wisewoman ,screening ,program4,sec4 #gcc4 ,report on cardiovascular care for women and minorities4,sec4 #gcd4 ,coverage of comprehensive tobacco cessation services in ,medicaid and private health insurance4,sec4 #gce4 ,clinical research funding for oral health4,sec4 #gcf4 ,participation by ,medicaid beneficiaries in approved clinical trials4,sec4 #gcg4 ,guide on evidence-based strategies for public health department obesity prevention programs4,subtitle ,e--,,hiv_/,a,i,d,s,sec4 #gda4 ,statement of policy4,sec4 #gdb4 ,findings4,sec4 #gdc4 ,additional funding for ,,aids drug assistance program treatments4,sec4 #gdd4 ,enhancing the national ,,hiv surveillance system4,sec4 #gde4 ,evidence-based strategies for improving linkage to and retention in appropriate care4,sec4 #gdf4 ,improving entry into and retention in care and antiretroviral adherence for persons with ,,hiv4,sec4 #gdg4 ,services to reduce ,,hiv_/,,aids in racial and ethnic minority communities4,sec4 #gdh4 ,minority ,,aids initiative4,sec4 #gdi4 ,health care professionals treating individuals with ,,hiv4,sec4 #gej4 ,,hiv_/,,aids provider loan repayment program4,sec4 #gea4 ,dental education loan repayment program4,sec4 #geb4 ,reducing new ,,hiv infections among injecting drug users4,sec4 #gec4 ,report on impact of ,,hiv_/,,aids in vulnerable populations4,sec4 #ged4 ,national ,,hiv_/,,aids observance days4,sec4 #gee4 ,review of all ,federal and ,state laws1 policies1 and regulations regarding the criminal prosecution of individuals for ,,hiv-related offenses4,sec4 #gef4 ,expanding support for condoms in prisons4,sec4 #geg4 ,automatic reinstatement or enrollment in ,medicaid for people who test positive for ,,hiv before reentering communities4,sec4 #geh4 ,stop ,,hiv in prison4,sec4 #gei4 ,support data system review and indicators for monitoring ,,hiv care4,sec4 #gfj4 ,transfer of funds for implementation of ending the ,,hiv epidemic3 a plan for ,america4,subtitle ,f--,diabetes,sec4 #gga4 ,research1 treatment1 and education4,sec4 #ggb4 ,research1 education1 and other activities4,sec4 #ggc4 ,programs to educate health providers on the causes and effects of diabetes in minority populations4,sec4 #ggd4 ,research1 education1 and other activities regarding diabetes in ,american ,indian populations4,sec4 #gge4 ,updated report on health disparities4,subtitle ,g--,lung ,disease ,sec4 #ggf4 ,expansion of the ,national ,asthma ,education and ,prevention ,program4,sec4 #ggg4 ,asthma-related activities of the ,centers for ,disease ,control and ,prevention4,sec4 #ggh4 ,influenza and pneumonia vaccination campaign4,sec4 #ggi4 ,chronic obstructive pulmonary disease action plan4,subtitle ,h--,tuberculosis,sec4 #gha4 ,elimination of all forms of tuberculosis4,sec4 #ghb4 ,additional funding for ,states in combating and eliminating tuberculosis4,sec4 #ghc4 ,strengthening clinical research funding for tuberculosis4,subtitle ,i--,osteoarthritis and ,musculoskeletal ,diseases,sec4 #ghe4 ,findings4,sec4 #ghf4 ,osteoarthritis and other musculoskeletal health-related activities of the ,centers for ,disease ,control and ,prevention4,sec4 #ghg4 ,grants for comprehensive osteoarthritis and musculoskeletal disease health education within health professions schools4,subtitle ,j--,sleep and ,circadian ,rhythm ,disorders,sec4 #gia4 ,short title2 findings4,sec4 #gib4 ,sleep and circadian rhythm disorders research activities of the ,national ,institutes of ,health4,sec4 #gic4 ,sleep and circadian rhythm health disparities-related activities of the ,centers for ,disease ,control and ,prevention4,sec4 #gid4 ,grants for comprehensive sleep and circadian health education within health professions schools4,sec4 #gie4 ,report on impact of sleep and circadian health disorders in vulnerable and racial_/ethnic populations4,subtitle ,k--,kidney ,disease ,research1 ,surveillance1 ,prevention1 and ,treatment,sec4 #gig4 ,kidney disease1 research1 surveillance1 prevention1 and treatment4,sec4 #gih4 ,kidney disease research in minority populations4,sec4 #gii4 ,kidney disease action plan4,sec4 #gii;,a4 ,home dialysis and increasing end-stage renal disease treatment modalities in minority communities action plan4,sec4 #gii;,b4 ,increasing kidney transplants in minority populations4,sec4 #gii;,c4 ,environmental and occupational health programs4,sec4 #gii;,d4 ,understanding the treatment patterns associated with providing care and treatment of kidney failure in minority populations4,sec4 #gii;,e4 ,improving access in underserved areas4,,title ,,viii--,health ,information ,technology,sec4 #hjj4 ,definitions4,subtitle ,a--,reducing ,health ,disparities ,through ,health ,i,t,sec4 #hja4 ,,hrsa assistance to health centers for promotion of ,health ,,it4,sec4 #hjb4 ,assessment of impact of ,health ,,it on racial and ethnic minority communities2 outreach and adoption of ,health ,,it in such communities4,sec4 #hjc4 ,nondiscrimination and health equity in health information technology4,sec4 #hjd4 ,language access in health information technology4,subtitle ,b--,modifications ,to ,achieve ,parity in ,existing ,programs,sec4 #haa4 ,extending funding to strengthen the ,health ,,it infrastructure in racial and ethnic minority communities4,sec4 #hab4 ,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 #hac4 ,authorization of appropriations4,subtitle ,c--,additional ,research and ,studies ,sec4 #hba4 ,data collection and assessments conducted in coordination with minority-serving institutions4,sec4 #hbb4 ,study of health information technology in medically underserved communities4,sec4 #hbc4 ,assessment of use and misuse of de-identified health data4,subtitle ,d--,closing ,gaps in ,funding ,to ,adopt ,certified ,e,h,rs,sec4 #hca4 ,extending ,medicaid ,,ehr incentive payments to rehabilitation facilities1 long-term care facilities1 and home health agencies4,sec4 #hcb4 ,extending physician assistant eligibility for ,medicaid electronic health record incentive payments4,,title ,,ix--,accountability and ,evaluation,sec4 #ija4 ,prohibition on discrimination in ,federal assisted health care services and research programs on the basis of sex 7including sex orientation1 gender identity1 and pregnancy1 including termination of pregnancy71 race1 color1 national origin1 marital status1 familial status1 sexual orientation1 gender identity1 or disability status4,sec4 #ijb4 ,treatment of ,medicare payments under title ,,vi of the ,civil ,rights ,act of #aifd4,sec4 #ijc4 ,accountability and transparency within the ,department of ,health and ,human ,services4,sec4 #ijd4 ,united ,states ,commission on ,civil ,rights4,sec4 #ije4 ,sense of ,congress concerning full funding of activities to eliminate racial and ethnic health disparities4,sec4 #ijf4 ,,gao and ,,nih reports4,,title ,x--,addressing ,social ,determinants and ,improving ,environmental ,justice,subtitle ,a--,in ,general,sec4 #ajja4 ,definitions4,sec4 #ajjb4 ,findings4,sec4 #ajjc4 ,health impact assessments4,sec4 #ajjd4 ,implementation of recommendations by ,environmental ,protection ,agency4,sec4 #ajje4 ,grant program to conduct environmental health improvement activities and to improve social determinants of health4,sec4 #ajjf4 ,additional research on the relationship between the built environment and the health of community residents4,sec4 #ajjg4 ,environment and public health restoration4,sec4 #ajjh4 ,,gao report on health effects of ,deepwater ,horizon oil rig explosion in the ,gulf ,coast4,sec4 #ajji4 ,establish an interagency counsel and grant programs on social determinants of health4,sec4 #ajaj4 ,correcting hurtful and alienating names in government expression 7,,change74,subtitle ,b--,gun ,violence,sec4 #ajaa4 ,findings4,sec4 #ajab4 ,reaffirming research authority of the ,centers for ,disease ,control and ,prevention4,sec4 #ajac4 ,national ,violent ,death ,reporting ,system4,sec4 #ajad4 ,report on effects of gun violence on public health4,sec4 #ajae4 ,report on effects of gun violence on mental health in minority communities4 #c4 ,findings ,the ,congress finds as follows3 7#a7 ,the population of racial and ethnic minorities is expected to increase over the next few decades1 yet racial and ethnic minorities have the poorest health status and face substantial cultural1 social1 and economic barriers to obtaining quality health care4 7#b7 ,health disparities are a function of not only access to health care1 but also the social determinants of health--including the environment1 the physical structure of communities1 nutrition and food options1 educational attainment1 employment1 race1 ethnicity1 sex1 geography1 language preference1 immigrant or citizenship status1 sexual orientation1 gender identity1 socioeconomic status1 or disability status--that directly and indirectly affect the health1 health care1 and wellness of individuals and communities4 7#c7 ,over the next few decades1 the ,united ,states will face a shortage of health care providers and allied health workers4 7#d7 ,all efforts to reduce health disparities and barriers to quality health services require better and more consistent data and better and more consistent collection of and access to data4 7#e7 ,a full range of culturally and linguistically appropriate health care and public health services must be available and accessible in every community4 7#f7 ,racial and ethnic minorities and underserved populations must be included early and equitably in health reform innovations4 7#g7 ,efforts to improve minority health have been limited by inadequate resources in funding1 staffing1 stewardship1 and accountability4 ,targeted investments that are focused on disparities elimination must be made in providing care and services that are community-based1 including prevention and policies addressing social determinants of health4 7#h7 ,in #bjaa1 the ,department of ,health and ,human ,services developed the ,,hhs ,action ,plan to ,reduce ,racial and ,ethnic ,health ,disparities and the ,national ,stakeholder ,strategy for ,achieving ,health ,equity1 which are #b strategic plans that represent the first coordinated roadmap in the ,united ,states to reducing health disparities4 ,these comprehensive plans1 along with the ,national ,prevention ,strategy issued by the ,national ,prevention ,council of the ,department of ,health and ,human ,services1 ,healthy ,people #bjcj1 and the ,national ,quality ,strategy of the ,agency for ,healthcare ,research and ,quality1 as well as critical resources such as the #bjab ,national ,healthcare ,quality and ,disparities ,reports1 will work to increase the number of people in the ,united ,states who are healthy at every stage of life4 7#i7 ,the ,secretary of ,health and ,human ,services has also reviewed and advanced updated clinical guidelines and developed other strategic planning documents to combat health disparities with a high impact on minority populations and to provide high-quality family planning services4 ,such guidelines and documents include the ,national ,,hiv_/,,aids ,strategy1 the ,action ,plan for the ,prevention1 ,care1 and ,treatment of ,viral ,hepatitis1 and recommendations of the ,centers for ,disease ,control and ,prevention and the ,office of ,population ,affairs4 7#aj7 ,the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 as amended by the ,health ,care and ,education ,reconciliation ,act 7,public ,law #aaa-aeb71 represents the biggest advancement for minority health in the #dj years immediately preceding the enactment of this ,act4 7#aa7 ,the ,health ,information ,technology for ,economic and ,clinical ,health ,act of #bjji1 part of the ,american ,recovery and ,reinvestment ,act of #bjji 7,public ,law #aaa-e71 provides that the nationwide health information exchange infrastructure be developed and used to reduce health disparities1 among other purposes4 ,i ,data collection and reporting #aja4 ,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 ,title ,,xxxiv of the ,public ,health ,service ,act1 as added by titles ,,ii and ,,iii of this ,act1 is further amended by inserting after subtitle ,b the following3 ,c ,strengthening data collection1 improving data analysis1 and expanding data reporting #cdca4 ,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 ,definition of health-,related program ,in this section1 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 public4 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 #cdcb4 ,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 #cdcc4 ,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 ,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 #ajb4 ,elimination of prerequisite of direct appropriations for data collection and analysis ,section #caja of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjkk7 is amended-- 7#a7 by striking subsection 7h72 and 7#b7 by redesignating subsection 7i7 as subsection 7h74 #ajc4 ,collection of 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 an individual's entitlement to1 or enrollment for1 benefits under title ,,xviii1 the ,commissioner of ,social ,security shall transmit the demographic data of the individual as collected under paragraph 7#a7 to the ,centers for ,medicare ,medicaid ,services4 7#g7 ,analysis and reporting of data ,with respect to data transmitted under paragraph 7#f71 the ,administrator of the ,centers for ,medicare ,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#h72 7,d7 provide opportunities to individuals entitled to1 or enrolled for1 benefits under title ,,xviii 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 this subsection 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 #ejj1jjj1jjj for fiscal year #bjba and #ajj1jjj1jjj for each fiscal year thereafter4 4 #ajd4 ,revision of ,,hipaa claims standards 7a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall revise the regulations promulgated under part ,c of title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;d et seq471 relating to the collection of data on race1 ethnicity1 and primary language in a health-related transaction1 to require-- 7#a7 the use1 at a minimum1 of 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 #aje4 ,national ,center for ,health ,statistics ,section #cjf7n7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdbk7n77 is amended-- 7#a7 in paragraph 7#a71 by striking #bjjc and inserting #bjbb2 7#b7 in paragraph 7#b71 in the first sentence1 by striking #bjjc and inserting #bjbb2 and 7#c7 in paragraph 7#c71 by striking #bjjb and inserting #bjbb4 #ajf4 ,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 #ajg4 ,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 #ajh4 ,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 #aji4 ,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;,g the following3 #eje;,h4 ,safety and effectiveness of drugs with respect to racial and ethnic background 7a7 ,preapproval studies ,if there is evidence that there may be a disparity on the basis of racial or ethnic background as to the safety or effectiveness of a drug or biological product1 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 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 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 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 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 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 in the way the drug or biological product is metabolized2 and 7#c7 other evidence as the ,secretary may determine appropriate4 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 7gg7 ,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;,h4 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;,h4 #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 the ,northern ,mariana ,islands1 ,american ,samoa1 the ,united ,states ,virgin ,islands1 the ,federated ,states of ,micronesia1 the ,republic of ,palau1 or the ,republic of the ,marshall ,islands4 7b7 ,national strategy 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,national ,center for ,health ,statistics 7referred to in this section as ,,nchs7 of the ,centers for ,disease ,control and ,prevention1 and other agencies within the ,department of ,health and ,human ,services as the ,secretary determines appropriate1 shall develop and implement an ongoing and sustainable national strategy for identifying and evaluating the health status and health care needs of ,,nhopi populations living in the continental ,united ,states1 ,hawaii1 ,american ,samoa1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,federated ,states of ,micronesia1 ,guam1 the ,republic of ,palau1 and the ,republic of the ,marshall ,islands4 7#b7 ,consultation ,in developing and implementing a national strategy1 as described in paragraph 7#a71 not later than #ahj days after the date of enactment of the ,health ,equity and ,accountability ,act of #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 ,health ,equity and ,accountability ,act of #bjbj4 7d7 ,progress report ,not later than #b years after the date of enactment of the ,health ,equity and ,accountability ,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 seek to 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 ,health ,equity and ,accountability ,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 #aaa4 ,clarification of simplified administrative reporting requirement ,section #aa7;a7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjbj7;a77 is amended by adding at the end the following3 7#e7 ,simplified administrative reporting requirement ,with respect to any obligation of a ,state agency carrying out the supplemental nutrition assistance program to comply with the notification requirement under paragraph 7#b7 of section #dba7;e7 of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afca7;e771 notwithstanding the requirement to include in that notification the names of the sponsor and the sponsored alien involved1 the ,state agency shall be considered to have complied with the notification requirement if the ,state agency submits to the ,attorney ,general a report that includes the aggregate number of exceptions granted by the ,state agency under paragraph 7#a7 of that section4 4 ,,ii ,culturally and linguistically appropriate health and health care #bja4 ,definitions2 findings 7a7 ,definitions ,in this title1 the definitions in section #cdjj of the ,public ,health ,service ,act1 as added by section #bjd1 shall apply4 7b7 ,findings ,congress finds the following3 7#a7 ,effective communication is essential to meaningful access to quality physical and mental health care4 7#b7 ,research indicates that the lack of appropriate language services creates language barriers that result in increased risk of misdiagnosis1 ineffective treatment plans1 and poor health outcomes for individuals with limited ,english proficiency and individuals with communication disabilities such as cognitive1 hearing1 vision1 or print impairments4 7#c7 ,the number of limited ,english-speaking residents in the ,united ,states who speak ,english less than very well and1 therefore1 cannot effectively communicate with health and social service providers continues to increase significantly4 7#d7 ,the responsibility to fund language services in the provision of health care and health-care-related services to individuals with limited ,english proficiency and individuals with communication disabilities such as cognitive hearing1 vision1 or print impairments is a societal one that cannot fairly be placed solely upon the health care1 public health1 or social services community4 7#e7 ,title ,,vi of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;d et seq47 prohibits discrimination based on the grounds of race1 color1 or national origin by any entity receiving ,federal financial assistance4 ,in order to avoid discrimination on the grounds of national origin1 all programs or activities administered by the ,federal ,government must take adequate steps to ensure that their policies and procedures do not deny or have the effect of denying individuals with limited ,english proficiency with equal access to benefits and services for which such persons qualify4 7#f7 ,both the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abaja et seq47 and the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gja et seq47 prohibit discrimination on the basis of disability and require the provision of appropriate auxiliary aids and services necessary to ensure effective communication with individuals with disabilities4 ,the type of auxiliary aid or service necessary to ensure effective communication will vary in accordance with the method of communication used by the individual2 the nature1 length1 and complexity of the communication involved2 and the context in which the communication is taking place4 ,a public accommodation should consult with individuals with disabilities whenever possible to determine what type of auxiliary aid is needed to ensure effective communication4 ,the public accommodation should use the individual's preferred method of communication whenever possible1 unless it would be an undue burden to the public accommodation and an alternative would provide an equally effective means of communication4 ,the ultimate decision as to what measures to take rests with the public accommodation1 provided that the method chosen results in effective communication4 7#g7 ,section #aeeg of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahaaf7 builds on title ,,vi of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;d et seq47 and section #ejd of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gid71 prohibits discrimination on the basis of race1 color1 national origin1 disability1 sex1 and age1 requires the provision of language services to ensure effective communication with individuals with limited ,english proficiency1 and requires the provision of appropriate auxiliary aids and services necessary to ensure effective communication with individuals with disabilities4 7#h7 ,linguistic diversity in the health care and health-care-related services workforce is important for providing all patients the environment most conducive to positive health outcomes4 7#i7 ,all members of the health care and health-care-related services community should continue to educate their staff and constituents about limited ,english-proficient and disability communication issues and help them identify resources to improve access to quality care for individuals with limited ,english proficiency and individuals with communication disabilities such as cognitive1 hearing1 vision1 or print impairments4 7#aj7 ,access to ,english as a second language1 foreign language1 and sign language interpreters1 translated and alternative format documents1 readers1 and other auxiliary aids and services1 are essential to ensure effective communication and eliminate the language barriers that impede access to health care4 7#aa7 ,competent language services in health care settings should be available as a matter of course4 #bjb4 ,improving access to services for individuals with limited ,english proficiency 7a7 ,purpose ,consistent with the goals provided in ,executive ,order #acaff 7#db ,u4,s4,c4 #bjjj;d-#a note2 relating to improving access to services for persons with limited ,english proficiency71 it is the purpose of this section-- 7#a7 to improve ,federal agency performance regarding access to federally conducted and federally assisted programs and activities for individuals with limited ,english proficiency2 7#b7 to require each ,federal agency to examine the services it provides and develop and implement a system by which individuals with limited ,english proficiency can obtain culturally competence services and meaningful access to those services consistent with1 and without substantially burdening1 the fundamental mission of the agency2 7#c7 to require each ,federal agency to ensure that recipients of ,federal financial assistance provide culturally competence services and meaningful access to applicants and beneficiaries that are individuals with limited ,english proficiency2 7#d7 to ensure that recipients of ,federal financial assistance take reasonable steps1 consistent with the guidelines set forth in the ,guidance to ,federal ,financial ,assistance ,recipients ,regarding ,title ,,vi ,prohibition ,against ,national ,origin ,discrimination ,affecting ,limited ,english ,proficient ,persons 7#fg ,fed4 ,reg4 #dadee 7,june #ah1 #bjjb771 to ensure culturally and linguistically appropriate access to their programs and activities by individuals with limited ,english proficiency2 and 7#e7 to ensure compliance 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 as published in the ,federal ,register on ,may #ah1 #bjaf1 that health care providers and organizations do not discriminate in the provision of services4 7b7 ,federally ,conducted programs and activities 7#a7 ,in general ,not later than #abj days after the date of enactment of this ,act1 each ,federal agency providing financial assistance to1 or administering1 a health program or activity described in section #bjc7;a7 shall prepare a plan or update a plan to improve culturally and linguistically appropriate access to such program or activity with respect to individuals with limited ,english proficiency4 ,not later than #a year after the date of enactment of this ,act1 each such ,federal agency shall ensure that such plan is fully implemented4 7#b7 ,plan requirement ,each plan under paragraph 7#a7 shall include-- 7,a7 the steps the agency will take to ensure that individuals with limited ,english proficiency have access to each health program or activity supported or administered by the agency2 7,b7 the policies and procedures for identifying1 assessing1 and meeting the culturally and linguistically appropriate language needs of its beneficiaries that are individuals with limited ,english proficiency served by such program or activity2 7,c7 the steps the agency will take for such program or activity to be culturally and linguistically appropriate by providing a range of language assistance options1 notice to individuals with limited ,english proficiency of the right to competent language services1 periodic training of staff1 monitoring and quality assessment of the language services and1 in appropriate circumstances1 the translation of written materials2 7,d7 the steps the agency will take for such program or activity to provide reasonable accommodations necessary for individuals with limited ,english proficiency1 including those individuals with a communication disability1 to understand communications from the agency2 7,e7 the steps the agency will take to ensure that applications1 forms1 and other relevant documents for such program or activity are competently translated into the primary language of a client that is an individual with limited ,english proficiency where such materials are needed to improve access of such client to such program or activity2 7,f7 the resources the agency will provide to improve cultural and linguistic appropriateness to assist recipients of ,federal funds to improve access to health care related programs and activities for individuals with limited ,english proficiency2 7,g7 the resources the agency will provide to ensure that competent language assistance is provided to patients that are individuals with limited ,english proficiency by interpreters or trained bilingual staff2 and 7,h7 the resources the agency will provide to ensure that family1 particularly minor children1 and friends are not used to provide interpretation services1 except as permitted under regulations implementing 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 #bjaf4 7#c7 ,submission of plan to ,,doj ,each agency that is required to prepare a plan under paragraph 7#a7 shall send a copy of such plan to the ,attorney ,general1 which shall serve as the central repository of all such plans4 #bjc4 ,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 annually2 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 ongoing1 at least annually1 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 assessments2 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-- 7#a7 shall ensure that comments with respect to such program that are accepted through notice and comment rulemaking are accepted in all languages2 7#b7 may not require such comments to be submitted only in ,english2 and 7#c7 shall ensure that any such comments that are not submitted in ,english are considered1 during the agency's review of such comments1 equally as such comments that are submitted in ,english4 #bjd4 ,culturally and linguistically appropriate health care in the ,public ,health ,service ,act ,the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bja et seq47 is amended by adding at the end the following3 ,,xxxiv ,,culturally ,,and ,,linguistically ,,appropriate ,,health ,,care #cdjj4 ,definitions 7a7 ,in general ,in this title3 7#a7 ,bilingual ,the term bilingual1 with respect to an individual1 means an individual 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 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 with respect to an individual with a disability-- 7,a7 means an interpreter for such individual who by means of a remote interpreting service or an onsite 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-- 7i7 sign language interpreters2 7ii7 oral transliterators1 which are individuals who represent or spell in the characters of another alphabet2 and 7iii7 cued language transliterators1 which are individuals who represent or spell by using a small number of handshapes4 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 by means of a remote interpreting service or an onsite 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 #cdja4 ,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 #de1 ,code of ,federal ,regulations1 as in effect on ,may #ah1 #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 and coverage available through an ,exchange established under title ,i of the ,patient ,protection and ,affordable ,care ,act1 and other sources of free or reduced care including through federally qualified health centers1 entities receiving assistance under title ,x1 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 each language in which the ,center translates forms under paragraph 7#b77;,b72 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 #cdjb4 ,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 #cdjc4 ,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 #bje4 ,pilot program for improvement and development of ,state medical interpreting services 7a7 ,grants authorized ,the ,secretary of ,health and ,human ,services shall award #a grant in accordance with this section to each of #c ,states 7to be selected by the ,secretary7 to assist each such ,state in designing1 implementing1 and evaluating a statewide program to provide onsite interpreter services under the ,state ,medicaid plan4 7b7 ,grant period ,a grant awarded under this section is authorized for the period of #c fiscal years beginning on ,october #a1 #bjba1 and ending on ,september #cj1 #bjbd4 7c7 ,preference ,in awarding a grant under this section1 the ,secretary shall give preference to a ,state-- 7#a7 that has a high proportion of qualified ,,lep enrollees1 as determined by the ,secretary2 7#b7 that has a large number of qualified ,,lep enrollees1 as determined by the ,secretary2 7#c7 that has a high growth rate of the population of individuals with limited ,english proficiency1 as determined by the ,secretary2 and 7#d7 that has a population of qualified ,,lep enrollees that is linguistically diverse1 requiring interpreter services in at least #bjj non-,english languages4 7d7 ,use of funds ,a ,state receiving a grant under this section shall use the grant funds to-- 7#a7 ensure that all health care providers in the ,state participating in the ,state ,medicaid plan have access to onsite interpreter services1 for the purpose of enabling effective communication between such providers and qualified ,,lep enrollees during the furnishing of items and services and administrative interactions2 7#b7 establish1 expand1 procure1 or contract for-- 7,a7 a statewide health care information technology system that is designed to achieve efficiencies and economies of scale with respect to onsite interpreter services provided to health care providers in the ,state participating in the ,state ,medicaid plan2 and 7,b7 an entity to administer such system1 the duties of which shall include-- 7i7 procuring and scheduling interpreter services for qualified ,,lep enrollees2 7ii7 procuring and scheduling interpreter services for individuals with limited ,english proficiency seeking to enroll in the ,state ,medicaid plan2 7iii7 ensuring that interpreters receive payment for interpreter services rendered under the system2 and 7iv7 consulting regularly with organizations representing consumers1 interpreters1 and health care providers2 and 7#c7 develop mechanisms to establish1 improve1 and strengthen the competency of the medical interpretation workforce that serves qualified ,,lep enrollees in the ,state1 including a national certification process that is valid1 credible1 and vendor-neutral4 7e7 ,application ,to receive a grant under this section1 a ,state shall submit an application at such time and containing such information as the ,secretary may require1 which shall include the following3 7#a7 ,a description of the language access needs of individuals in the ,state enrolled in the ,state ,medicaid plan4 7#b7 ,a description of the extent to which the program will-- 7,a7 use the grant funds for the purposes described in subsection 7d72 7,b7 meet the health care needs of rural populations of the ,state2 and 7,c7 collect information that accurately tracks the language services requested by consumers as compared to the language services provided by health care providers in the ,state participating in the ,state ,medicaid plan4 7#c7 ,a description of how the program will be evaluated1 including a proposal for collaboration with organizations representing interpreters1 consumers1 and individuals with limited ,english proficiency4 7f7 ,definitions ,in this section3 7#a7 ,qualified ,,lep enrollee ,the term qualified ,,lep enrollee means an individual-- 7,a7 who is limited ,english proficient2 and 7,b7 who is enrolled in a ,state ,medicaid plan4 7#b7 ,state ,the term ,state has the meaning given the term in section #aaja7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acja7;a77#a771 for purposes of title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq474 7#c7 ,state ,medicaid plan ,the term ,state ,medicaid plan means a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 or a waiver of such a plan4 7#d7 ,united ,states ,the term ,united ,states has the meaning given the term in section #aaja7;a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acja7;a77#b771 for purposes of title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq474 7g7 ,continuation past demonstration ,any ,state receiving a grant under this section must agree to directly pay for language services in ,medicaid for all ,medicaid providers by the end of the grant period4 7h7 ,funding 7#a7 ,authorization of appropriations ,there is authorized to be appropriated #e1jjj1jjj to carry out this section4 7#b7 ,availability of funds ,amounts appropriated pursuant to the authorization in paragraph 7#a7 are authorized to remain available without fiscal year limitation4 7#c7 ,increased ,federal financial participation ,section #aijc7;a77#b77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#b77;,e77 is amended by inserting 7or1 in the case of a ,state that was awarded a grant under section #bje of the ,health ,equity and ,accountability ,act of #bjbj1 #ajj percent for each quarter occurring during the grant period specified in subsection 7b7 of such section7 after #ge percent4 7i7 ,limitation ,no ,federal funds awarded under this section may be used to provide interpreter services from a location outside the ,united ,states4 #bjf4 ,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 7xi7 and moving the left margin of such clause and each subclause and item therein #b ems to the left2 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 #bjg4 ,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 7kkk77#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 #ahfa7kkk77#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 #ahfa7kkk77#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#f7 ,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 ,health ,equity and ,accountability ,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 #bje7;h77#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-- 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-- 7,a7 by striking or at the end of subparagraph 7,f72 7,b7 by striking 2 and at the end of subparagraph 7,g7 and inserting 1 or2 and 7,c7 by adding at the end the following new subparagraph3 7,h7 language assistance services described in section #aije7;a77#cj72 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 7#g7 and 7#h7 and inserting 7#g71 7#aj71 and 7#aa72 7,b7 in subsection 7c71 by adding at the end the following new paragraph3 7#aa7 ,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 #ahfa7kkk77#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 language assistance services described in subsection 7c77#aa71 before visits described in4 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#aa74 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#a7-- 7i7 in the matter preceding subparagraph 7,a71 by striking #ge and inserting #ie2 and 7ii7 in subparagraph 7,d77iv71 by striking translation or interpretation services and inserting language assistance services2 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 subsection 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 or a ,state plan for child health assistance under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig;aa 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 such ,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 #bjh4 ,increasing understanding of and improving health literacy 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 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 #bji4 ,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 #de1 ,code of ,federal ,regulations1 as in effect on ,may #ah1 #bjaf 7#ha ,fed4 ,reg4 #cadff 7,may #ah1 #bjaf772 and 7#b7 the term health program or activity has the meaning given such term in section #ib4d of title #de1 ,code of ,federal ,regulations1 as in effect on ,may #ah1 #bjaf 7#ha ,fed4 ,reg4 #cadff 7,may #ah1 #bjaf774 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 #baj4 ,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 #baa4 ,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 of individuals in the ,state and each participating locality2 7,f7 the effectiveness of the instruction in meeting the needs of individuals receiving instruction and individuals needing instruction2 7,g7 an 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 #bab4 ,implementation 7a7 ,general provisions 7#a7 ,immunity ,a ,state shall not be immune under the #aath ,amendment to the ,constitution of the ,united ,states from suit in ,federal court for a violation of this title 7including an amendment made by this title74 7#b7 ,remedies ,in a suit against a ,state for a violation of this title 7including an amendment made by this title71 remedies 7including remedies both at law and in equity7 are available for such a violation to the same extent as such remedies are available for such a violation in a suit against any public or private entity other than a ,state4 7b7 ,rule of construction ,nothing in this title shall be construed to limit otherwise existing obligations of recipients of ,federal financial assistance under title ,,vi of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;d et seq47 or any other ,federal statute4 #bac4 ,language access services 7a7 ,essential benefits ,section #acjb7;b77#a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;b77#a77 is amended by adding at the end the following3 7,k7 ,language access services1 including oral interpretation and written translations4 4 7b7 ,employer-,sponsored minimum essential coverage 7#a7 ,in general ,section #cf;,b7c77#b77;,c7 of the ,internal ,revenue ,code of #aihf is amended by redesignating clauses 7iii7 and 7iv7 as clauses 7iv7 and 7v71 respectively1 and by inserting after clause 7ii7 the following new clause3 7iii7 ,coverage must include language access and services ,except as provided in clause 7iv71 an employee shall not be treated as eligible for minimum essential coverage if such coverage consists of an eligible employer-sponsored plan 7as defined in section #ejjj;,a7f77#b77 and the plan does not provide coverage for language access services1 including oral interpretation and written translations4 4 7#b7 ,conforming amendments 7,a7 ,section #cf;,b7c77#b77;,c7 of such ,code is amended by striking clause 7iii7 each place it appears in clauses 7i7 and 7ii7 and inserting clause 7iv74 7,b7 ,section #cf;,b7c77#b77;,c77iv7 of such ,code1 as redesignated by this subsection1 is amended by striking 7i7 and 7ii7 and inserting 7i71 7ii71 and 7iii74 7c7 ,quality ,reporting ,section #bgag7;a77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ag7;a77#a77 is amended-- 7#a7 by striking and at the end of subparagraph 7,c72 7#b7 by striking the period at the end of subparagraph 7,d7 and inserting 2 and2 and 7#c7 by adding at the end the following new subparagraph3 7,e7 reduce health disparities through the provision of language access services1 including oral interpretation and written translations4 4 7d7 ,regulations regarding internal claims and appeals and external review processes for health plans and health insurance issuers ,the ,secretary of the ,treasury1 the ,secretary of ,labor1 and the ,secretary of ,health and ,human ,services shall amend the regulations in section #ed4ihae-bgai7;e7 of title #bf1 ,code of ,federal ,regulations1 section #beij4gae- #bgai7;e7 of title #bi1 ,code of ,federal ,regulations1 and section #adg4acf7;e7 of title #de1 ,code of ,federal ,regulations 7or a successor regulation71 respectively1 to require group health plans and health insurance issuers offering group or individual health insurance coverage to which such sections apply-- 7#a7 to provide oral interpretation services without any threshold requirements2 7#b7 to provide in the ,english versions of all notices a statement prominently displayed in not less than #ae non-,english languages clearly indicating how to access the language services provided by the plan or issuer2 and 7#c7 with respect to the requirements for providing relevant notices in a culturally and linguistically appropriate manner in the applicable non-,english languages1 to apply a threshold that #e percent of the population1 or not less than #ejj individuals1 in the county is literate only in the same non-,english language in order for the language to be considered an applicable non-,english language4 7e7 ,data collection and reporting ,the ,secretary of ,health and ,human ,services shall-- 7#a7 amend the single streamlined application form developed pursuant to section #adac of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjhc7 to collect the preferred spoken and written language for each household member applying for coverage under a qualified health plan through an ,exchange under title ,i of such ,act 7#db ,u4,s4,c4 #ahjja et seq472 7#b7 require navigators1 certified application counselors1 and other individuals assisting with enrollment to collect and report requests for language assistance2 and 7#c7 require the toll-free telephone hotlines established pursuant to section #acaa7;d77#d77;,b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;d77#d77;,b77 to submit an annual report documenting the number of language assistance requests1 the types of languages requested1 the range and average wait time for a consumer to speak with an interpreter1 and any steps the hotline1 and any entity contracting with the ,secretary to provide language services1 have taken to actively address some of the consumer complaints4 7f7 ,effective date ,the amendments made by this section shall not apply to plans beginning prior to the date of the enactment of this ,act4 #bad4 ,medically underserved populations ,section #ccj7;b77#c77;,a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c77;,a77 is amended to read as follows3 7,a7 ,in general ,the term medically underserved1 with respect to a population1 means-- 7i7 the population of an urban or rural area designated by the ,secretary as-- 7,i7 an area with a shortage of personal health services2 or 7,,ii7 a population group having a shortage of such services2 or 7ii7 a population of individuals1 not confined to a particular urban or rural area1 who are designated by the ,secretary as having a shortage of personal health services due to a specific demographic trait4 4 ,,iii ,health workforce diversity #cja4 ,amendment to the ,public ,health ,service ,act ,title ,,xxxiv of the ,public ,health ,service ,act1 as added by section #bjd1 is amended by adding at the end the following3 ,b ,diversifying the ,health ,care ,workplace #cdaa4 ,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 ,director of 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 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 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 #cjb4 ,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 7a7 ,in general ,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 mentoring1 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 section #gii;,b2 7,b7 has an enrollment of full-time equivalent students that is made up of at least #i percent ,hispanic students2 7,c7 has been effective in carrying out programs to recruit ,hispanic individuals to enroll in and graduate from the school2 7,d7 has been effective in recruiting and retaining ,hispanic faculty members2 7,e7 has a significant number of graduates who are providing health services to medically underserved populations or to individuals in health professional shortage areas2 and 7,f7 is a ,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 #cjc4 ,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 #bjba1 and such sums as may be necessary for each of the fiscal years #bjbb through #bjbf4 #cjd4 ,cooperative agreements for online degree programs at schools of public health and schools of allied health ,part ,b of title ,,vii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bic et seq471 as amended by section #cjb1 is further amended by adding at the end the following3 #gdc4 ,cooperative agreements for online degree programs 7a7 ,cooperative agreements ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 in consultation with the ,director of the ,centers for ,disease ,control and ,prevention1 the ,director of the ,agency for ,healthcare ,research and ,quality1 and the ,deputy ,assistant ,secretary for ,minority ,health1 shall enter into cooperative agreements with schools of public health and schools of allied health to design and implement online degree programs4 7b7 ,priority ,in entering into cooperative agreements under this section1 the ,secretary shall give priority to any school of public health or school of allied health that has an established track record of serving medically underserved communities4 7c7 ,requirements ,as a condition of entering into a cooperative agreement with the ,secretary under this section1 a school of public health or school of allied health shall agree to design and implement an online degree program that meets the following restrictions3 7#a7 ,enrollment of individuals who have obtained a secondary school diploma or its recognized equivalent4 7#b7 ,maintaining a significant enrollment of underrepresented minority or disadvantaged students4 7#c7 ,achieving a high completion rate of enrolled underrepresented minority or disadvantaged students4 7d7 ,period of cooperative agreements ,the period during which payments are made through a cooperative agreement entered into under this section may not exceed #c years4 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 #bjbe4 4 #cje4 ,sense of ,congress on the mission of the ,national ,health ,care ,workforce ,commission ,it is the sense of ,congress that the ,national ,health ,care ,workforce ,commission established by section #eaja of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #bidq7 should1 in carrying out its assigned duties under that section1 give attention to the needs of racial and ethnic minorities1 individuals with lower socioeconomic status1 individuals with mental1 developmental1 and physical disabilities1 lesbian1 gay1 bisexual1 transgender1 queer1 and questioning populations1 and individuals who are members of multiple minority or special population groups4 #cjf4 ,scholarship and fellowship programs ,subtitle ,b of title ,,xxxiv of the ,public ,health ,service ,act1 as added by section #cja1 is further amended by inserting after section #cdag the following3 #cdah4 ,david ,satcher ,public ,health and ,health ,services ,corps 7a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention1 in collaboration with the ,administrator of the ,health ,resources and ,services ,administration and the ,deputy ,assistant ,secretary for ,minority ,health1 shall award grants to eligible entities to increase awareness among secondary and postsecondary students of career opportunities in the health professions4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an entity shall-- 7#a7 be a clinical1 public health1 or health services organization1 community-based or nonprofit entity1 or other entity determined appropriate by the ,director of the ,centers for ,disease ,control and ,prevention2 7#b7 serve a health professional shortage area1 as determined by the ,secretary2 7#c7 work with students1 including those from racial and ethnic minority backgrounds1 that have expressed an interest in the health professions2 and 7#d7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,grant awards under subsection 7a7 shall be used to support internships that will increase awareness among students of non-research-based1 career opportunities in the following health professions3 7#a7 ,medicine4 7#b7 ,nursing4 7#c7 ,public health4 7#d7 ,pharmacy4 7#e7 ,health administration and management4 7#f7 ,health policy4 7#g7 ,psychology4 7#h7 ,dentistry4 7#i7 ,international health4 7#aj7 ,social work4 7#aa7 ,allied health4 7#ab7 ,psychiatry4 7#ac7 ,hospice care4 7#ad7 ,community health1 patient navigation1 and peer support4 7#ae7 ,other professions determined appropriate by the ,director of the ,centers for ,disease ,control and ,prevention4 7d7 ,priority ,in awarding grants under subsection 7a71 the ,director of the ,centers for ,disease ,control and ,prevention shall give priority to those entities that-- 7#a7 serve a high proportion of individuals from disadvantaged backgrounds2 7#b7 have experience in health disparity elimination programs2 7#c7 facilitate the entry of disadvantaged individuals into institutions of higher education2 and 7#d7 provide counseling or other services designed to assist disadvantaged individuals in successfully completing their education at the postsecondary level4 7e7 ,stipends 7#a7 ,in general ,subject to paragraph 7#b71 an entity receiving a grant under this section may use the funds made available through such grant to award stipends for educational and living expenses to students participating in the internship supported by the grant4 7#b7 ,limitations ,a stipend awarded under paragraph 7#a7 to an individual-- 7,a7 may not be provided for a period that exceeds #f months2 and 7,b7 may not exceed #bj per day for an individual 7notwithstanding any other provision of law regarding the amount of a stipend74 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjba through #bjbf4 #cdai4 ,louis ,stokes ,public ,health ,scholars ,program 7a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention1 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health1 shall award scholarships to eligible individuals under subsection 7b7 who seek a career in public health4 7b7 ,eligibility ,to be eligible to receive a scholarship under subsection 7a71 an individual shall-- 7#a7 have interest1 knowledge1 or skill in public health research or public health practice1 or other health professions as determined appropriate by the ,director of the ,centers for ,disease ,control and ,prevention2 7#b7 reside in a health professional shortage area as determined by the ,secretary2 7#c7 demonstrate promise for becoming a leader in public health2 7#d7 secure admission to a #d-year institution of higher education2 and 7#e7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,amounts received under an award under subsection 7a7 shall be used to support opportunities for students to become public health professionals4 7d7 ,priority ,in awarding grants under subsection 7a71 the ,director shall give priority to those students that-- 7#a7 are from disadvantaged backgrounds2 7#b7 have secured admissions to a minority-serving institution2 and 7#c7 have identified a health professional as a mentor at their school or institution and an academic advisor to assist in the completion of their baccalaureate degree4 7e7 ,scholarships ,the ,secretary may approve payment of scholarships under this section for such individuals for any period of education in student undergraduate tenure1 except that such a scholarship may not be provided to an individual for more than #d years1 and such a scholarship may not exceed #aj1jjj per academic year for an individual 7notwithstanding any other provision of law regarding the amount of a scholarship74 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjba through #bjbe4 #cdbj4 ,patsy ,mink ,health and ,gender ,research ,fellowship ,program 7a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention1 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health1 the ,assistant ,secretary for ,mental ,health and ,substance ,use1 and the ,director of the ,indian ,health ,services1 shall award research fellowships to eligible individuals under subsection 7b7 to conduct research that will examine gender and health disparities and to pursue a career in the health professions4 7b7 ,eligibility ,to be eligible to receive a fellowship under subsection 7a71 an individual shall-- 7#a7 have experience in health research or public health practice2 7#b7 reside in a health professional shortage area as designated by the ,secretary under section #ccb2 7#c7 have expressed an interest in the health professions2 7#d7 demonstrate promise for becoming a leader in the field of women's health2 7#e7 secure admission to a health professions school or graduate program with an emphasis in gender studies2 and 7#f7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,a fellowship awarded under subsection 7a7 to an eligible individual shall be used to support an opportunity for the individual to become a researcher and advance the research base on the intersection between gender and health4 7d7 ,priority ,in awarding fellowships under subsection 7a71 the ,director of the ,centers for ,disease ,control and ,prevention shall give priority to those applicants that-- 7#a7 are from disadvantaged backgrounds2 and 7#b7 have identified a mentor and academic advisor who will assist in the completion of their graduate or professional degree and have secured a research assistant position with a researcher working in the area of gender and health4 7e7 ,fellowships ,the ,director of the ,centers for ,disease ,control and ,prevention may approve fellowships for individuals under this section for any period of education in the student's graduate or health profession tenure1 except that such a fellowship may not be provided to an individual for more than #c years1 and such a fellowship may not exceed #ah1jjj per academic year for an individual 7notwithstanding any other provision of law regarding the amount of a fellowship74 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjba through #bjbe4 #cdba4 ,paul ,david ,wellstone ,international ,health ,fellowship ,program 7a7 ,in general ,the ,director of the ,agency for ,healthcare ,research and ,quality1 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health1 shall award research fellowships to eligible individuals under subsection 7b7 to advance their understanding of international health4 7b7 ,eligibility ,to be eligible to receive a fellowship under subsection 7a71 an individual shall-- 7#a7 have educational experience in the field of international health2 7#b7 reside in a health professional shortage area as determined by the ,secretary2 7#c7 demonstrate promise for becoming a leader in the field of international health2 7#d7 be a college senior or recent graduate of a #d-year institution of higher education2 and 7#e7 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 ,a fellowship awarded under subsection 7a7 to an eligible individual shall be used to support an opportunity for the individual to become a health professional and to advance the knowledge of the individual about international issues relating to health care access and quality4 7d7 ,priority ,in awarding fellowships under subsection 7a71 the ,director shall give priority to eligible individuals that-- 7#a7 are from a disadvantaged background2 and 7#b7 have identified a mentor at a health professions school or institution1 an academic advisor to assist in the completion of their graduate or professional degree1 and an advisor from an international health non-governmental organization1 private volunteer organization1 or other international institution or program that focuses on increasing health care access and quality for residents in developing countries4 7e7 ,fellowships ,a fellowship awarded under this section may not-- 7#a7 be provided to an eligible individual for more than a period of #f months2 7#b7 be awarded to a graduate of a #d-year institution of higher education that has not been enrolled in such institution for more than #a year2 and 7#c7 exceed #d1jjj per academic year 7notwithstanding any other provision of law regarding the amount of a fellowship74 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section1 such sums as may be necessary for each of fiscal years #bjba through #bjbe4 #cdbb4 ,edward ,r4 ,roybal ,health ,scholar ,program 7a7 ,in general ,the ,director of the ,agency for ,healthcare ,research and ,quality1 the ,director of the ,centers for ,medicare ,medicaid ,services1 and the ,administrator of the ,health ,resources and ,services ,administration1 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health1 shall award grants to eligible entities to expose entering graduate students to the health professions4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an entity shall-- 7#a7 be a clinical1 public health1 or health services organization1 community-based1 academic1 or nonprofit entity1 or other entity determined appropriate by the ,director of the ,agency for ,healthcare ,research and ,quality2 7#b7 serve in a health professional shortage area as designated by the ,secretary under section #ccb2 7#c7 work with students obtaining a degree in the health professions2 and 7#d7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,amounts received under a grant awarded under subsection 7a7 shall be used to support opportunities that expose students to non-research-based health professions1 including-- 7#a7 public health policy2 7#b7 health care and pharmaceutical policy2 7#c7 health care administration and management2 7#d7 health economics2 and 7#e7 other professions determined appropriate by the ,director of the ,agency for ,healthcare ,research and ,quality1 the ,director of the ,centers for ,medicare ,medicaid ,services1 or the ,administrator of the ,health ,resources and ,services ,administration4 7d7 ,priority ,in awarding grants under subsection 7a71 the ,director of the ,agency for ,healthcare ,research and ,quality1 the ,director of the ,centers for ,medicare ,medicaid ,services1 and the ,administrator of the ,health ,resources and ,services ,administration1 in collaboration with the ,deputy ,assistant for ,secretary for ,minority ,health1 shall give priority to those entities that-- 7#a7 have experience with health disparity elimination programs2 7#b7 facilitate training in the fields described in subsection 7c72 and 7#c7 provide counseling or other services designed to assist students in successfully completing their education at the postsecondary level4 7e7 ,stipends 7#a7 ,in general ,subject to paragraph 7#b71 an entity receiving a grant under this section may use the funds made available through such grant to award stipends for educational and living expenses to students participating in the opportunities supported by the grant4 7#b7 ,limitations ,a stipend awarded under paragraph 7#a7 to an individual-- 7,a7 may not be provided for a period that exceeds #b months2 and 7,b7 may not exceed #ajj per day 7notwithstanding any other provision of law regarding the amount of a stipend74 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 #bjbe4 #cdbc4 ,leadership fellowship programs 7a7 ,in general ,the ,secretary shall award grants to national minority medical or health professional associations to develop leadership fellowship programs for underrepresented health professionals in order to-- 7#a7 assist such professionals in becoming future leaders in public health and health care delivery institutions2 and 7#b7 increase diversity in decision-making positions that can improve the health of underserved communities4 7b7 ,use of funds ,a leadership fellowship program supported under this section shall-- 7#a7 focus on training mid-career physicians and health care executives who have documented leadership experience and a commitment to public health services in underserved communities2 and 7#b7 support ,federal public health policy and budget programs1 and priorities that impact health equity1 through activities such as didactic lectures and leader site visits4 7c7 ,period of grants ,the period during which payments are made under a grant awarded under subsection 7a7 may not exceed #c years4 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 #cjg4 ,mc,nair ,postbaccalaureate ,achievement ,program ,section #djb;,e of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajgj;a-#ae7 is amended by striking subsection 7g7 and inserting the following3 7g7 ,collaboration in health profession diversity training programs ,the ,secretary shall coordinate with the ,secretary of ,health and ,human ,services to ensure that there is collaboration between the goals of the program under this section and programs of the ,health ,resources and ,services ,administration that promote health workforce diversity4 ,the ,secretary of ,education shall take such measures as may be necessary to encourage students participating in projects assisted under this section to consider health profession careers4 7h7 ,funding ,from amounts appropriated pursuant to the authority of section #djb;,a7g71 the ,secretary shall1 to the extent practicable1 allocate funds for projects authorized by this section in an amount that is not less than #ca1jjj1jjj for each of the fiscal years #bjba through #bjbf4 4 #cjh4 ,rules for determination of full-time equivalent residents for cost-reporting periods 7a7 ,,dgme determinations ,section #ahhf7;h77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77#d771 as amended by section #bjf7;a71 is amended-- 7#a7 in subparagraph 7,e71 by striking ,subject to subparagraphs 7,j7 and 7,k71 such rules and inserting ,subject to subparagraphs 7,j71 7,k71 and 7,m71 such rules2 7#b7 in subparagraph 7,j71 by striking ,such rules and inserting ,subject to subparagraph 7,m71 such rules2 7#c7 in subparagraph 7,k71 by striking ,in determining and inserting ,subject to subparagraph 7,m71 in determining2 and 7#d7 by adding at the end the following new subparagraph3 7,m7 ,treatment of certain residents and interns ,for purposes of cost-reporting periods beginning on or after ,october #a1 #bjba1 in determining the hospital's number of full-time equivalent residents for purposes of this paragraph1 all the time spent by an intern or resident in an approved medical residency training program shall be counted toward the determination of full-time equivalency if the hospital-- 7i7 is recognized as a subsection 7d7 hospital2 7ii7 is recognized as a subsection 7d7 ,puerto ,rico hospital2 7iii7 is reimbursed under a reimbursement system authorized under section #ahad7;b77#c72 or 7iv7 is a provider-based hospital outpatient department4 4 7b7 ,,ime determinations ,section #ahhf7;d77#e77;,b77xi7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77xi771 as redesignated by section #bjf7;b71 is amended-- 7#a7 in subclause 7,,ii71 by striking ,in determining and inserting ,subject to subclause 7,,iv71 in determining2 7#b7 in subclause 7,,iii71 by striking ,in determining and inserting ,subject to subclause 7,,iv71 in determining2 and 7#c7 by inserting after subclause 7,,iii7 the following new subclause3 7,,iv7 ,for purposes of cost-reporting periods beginning on or after ,october #a1 #bjba1 the provisions of subparagraph 7,m7 of subsection 7h77#d7 shall apply under this subparagraph in the same manner as they apply under such subsection4 4 #cji4 ,developing and implementing strategies for local health equity 7a7 ,grants ,the ,secretary of ,health and ,human ,services1 acting jointly with the ,secretary of ,education and the ,secretary of ,labor1 shall make grants to institutions of higher education for the purposes of-- 7#a7 in accordance with subsection 7b71 developing capacity-- 7,a7 to build an evidence base for successful strategies for increasing local health equity2 and 7,b7 to serve as national models of driving local health equity2 7#b7 in accordance with subsection 7c71 developing a strategic partnership with the community in which the institution is located2 and 7#c7 collecting data on1 and periodically evaluating1 the effectiveness of the institution's programs funded through this section to enable the institution to adapt accordingly for maximum efficiency and success4 7b7 ,developing capacity for increasing local health equity ,as a condition on receipt of a grant under subsection 7a71 an institution of higher education shall agree to use the grant to build an evidence base for successful strategies for increasing local health equity1 and to serve as a national model of driving local health equity1 by supporting-- 7#a7 resources to strengthen institutional metrics and capacity to execute institution-wide health workforce goals that can serve as models for increasing health equity in communities across the ,united ,states2 7#b7 collaborations among a cohort of institutions in implementing systemic change1 partnership development1 and programmatic efforts supportive of health equity goals across disciplines and populations2 and 7#c7 enhanced or newly developed data systems and research infrastructure capable of informing current and future workforce efforts and building a foundation for a broader research agenda targeting urban health disparities4 7c7 ,strategic partnerships ,as a condition on receipt of a grant under subsection 7a71 an institution of higher education shall agree to use the grant to develop a strategic partnership with the community in which the institution is located for the purposes of-- 7#a7 strengthening connections between the institution and the community-- 7,a7 to improve evaluation of and address the community's health and health workforce needs2 and 7,b7 to engage the community in health workforce development2 7#b7 developing1 enhancing1 or accelerating innovative undergraduate and graduate programs in the biomedical sciences and health professions2 and 7#c7 strengthening pipeline programs in the biomedical sciences and health professions1 including by developing partnerships between institutions of higher education and elementary schools and secondary schools to recruit the next generation of health professionals earlier in the pipeline to a health care career4 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 #caj4 ,loan forgiveness for mental and behavioral health social workers ,section #dee of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajhg;e7 is amended by adding at the end the following3 7r7 ,repayment plan for mental and behavioral health social workers 7#a7 ,in general ,the ,secretary shall cancel the balance of interest and principal due1 in accordance with paragraph 7#b71 on any eligible ,federal ,direct ,loan not in default for a borrower who-- 7,a7 has made #abj monthly payments on the eligible ,federal ,direct ,loan after ,october #a1 #bjbj1 pursuant to any one or a combination of the following-- 7i7 payments under an income-based repayment plan under section #dic;,c2 7ii7 payments under a standard repayment plan under subsection 7d77#a77;,a71 based on a #aj-year repayment period2 7iii7 monthly payments under a repayment plan under subsection 7d77#a7 or 7g7 of not less than the monthly amount calculated under subsection 7d77#a77;,a71 based on a #aj-year repayment period2 or 7iv7 payments under an income contingent repayment plan under subsection 7d77#a77;,d72 and 7,b7 7i7 is employed as a mental health or behavioral health social worker1 as defined by the ,secretary by regulation1 at the time of such forgiveness2 and 7ii7 has been employed as such a mental health or behavioral health social worker during the period in which the borrower makes each of the #abj payments as described in subparagraph 7,a74 7#b7 ,loan cancellation amount ,after the conclusion of the employment period described in paragraph 7#a71 the ,secretary shall cancel the obligation to repay the balance of principal and interest due as of the time of such cancellation1 on the eligible ,federal ,direct ,loans made to the borrower under this part4 7#c7 ,ineligibility for double benefits ,no borrower may1 for the same employment as a mental health or behavioral health social worker1 receive a reduction of loan obligations under both this subsection and subsection 7m71 #dbh;,j1 #dbh,k1 #dbh,l1 or #dfj4 7#d7 ,definition of eligible ,federal ,direct ,loan ,in this subsection1 the term eligible ,federal ,direct ,loan means a ,federal ,direct ,stafford ,loan1 ,federal ,direct ,,plus ,loan1 ,federal ,direct ,unsubsidized ,stafford ,loan1 or a ,federal ,direct ,consolidation ,loan4 4 #caa4 ,health ,professions ,workforce ,fund 7a7 ,establishment ,there is established in the ,health ,resources and ,services ,administration of the ,department of ,health and ,human ,services a ,health ,professions ,workforce ,fund to provide for expanded and sustained national investment in the health professions and nursing workforce development programs under title ,,vii and title ,,viii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bib et seq42 #db ,u4,s4,c4 #bif et seq474 7b7 ,funding 7#a7 ,in general ,there is authorized to be appropriated1 and there is appropriated1 out of any monies in the ,treasury not otherwise appropriated1 to the ,health ,professions ,workforce ,fund-- 7,a7 #cee1jjj1jjj for fiscal year #bjba2 7,b7 #cge1jjj1jjj for fiscal year #bjbb2 7,c7 #cib1jjj1jjj for fiscal year #bjbc2 7,d7 #dab1jjj1jjj for fiscal year #bjbd2 7,e7 #dcb1jjj1jjj for fiscal year #bjbe2 7,f7 #ded1jjj1jjj for fiscal year #bjbf2 7,g7 #dgf1jjj1jjj for fiscal year #bjbg2 7,h7 #ejj1jjj1jjj for fiscal year #bjbh2 7,i7 #ebe1jjj1jjj for fiscal year #bjbi2 and 7,j7 #eeb1jjj1jjj for fiscal year #bjcj4 7#b7 ,health professions education programs ,for the purpose of carrying out health professions education programs authorized under title ,,vii of the ,public ,health ,service ,act1 in addition to any other amounts authorized to be appropriated for such purpose1 there is authorized to be appropriated out of any monies in the ,health ,professions ,workforce ,fund1 the following3 7,a7 #bdj1jjj1jjj for fiscal year #bjba4 7,b7 #bec1jjj1jjj for fiscal year #bjbb4 7,c7 #bfe1jjj1jjj for fiscal year #bjbc4 7,d7 #bgh1jjj1jjj for fiscal year #bjbd4 7,e7 #bib1jjj1jjj for fiscal year #bjbe4 7,f7 #cjg1jjj1jjj for fiscal year #bjbf4 7,g7 #cbb1jjj1jjj for fiscal year #bjbg4 7,h7 #cch1jjj1jjj for fiscal year #bjbh4 7,i7 #cee1jjj1jjj for fiscal year #bjbi4 7,j7 #cgc1jjj1jjj for fiscal year #bjcj4 7#c7 ,nursing workforce development programs ,for the purpose of carrying out nursing workforce development programs authorized under title ,,viii of the ,public ,health ,service ,act1 in addition to any other amounts authorized to be appropriated for such purpose1 there is authorized to be appropriated out of any monies in the ,health ,professions ,workforce ,fund1 the following3 7,a7 #aae1jjj1jjj for fiscal year #bjba4 7,b7 #abb1jjj1jjj for fiscal year #bjbb4 7,c7 #abg1jjj1jjj for fiscal year #bjbc4 7,d7 #acd1jjj1jjj for fiscal year #bjbd4 7,e7 #adj1jjj1jjj for fiscal year #bjbe4 7,f7 #adg1jjj1jjj for fiscal year #bjbf4 7,g7 #aed1jjj1jjj for fiscal year #bjbg4 7,h7 #afb1jjj1jjj for fiscal year #bjbh4 7,i7 #agj1jjj1jjj for fiscal year #bjbi4 7,j7 #agi1jjj1jjj for fiscal year #bjcj4 #cab4 ,findings2 sense of ,congress relating to graduate medical education 7a7 ,findings ,congress finds the following3 7#a7 ,projections by the ,association of ,american ,medical ,colleges and other expert entities1 such as the ,health ,resources and ,services ,administration1 have indicated a nationwide shortage of up to #aba1ijj physicians1 split evenly between primary care and specialists1 by #bjcb4 7#b7 ,primarily due to the growing and aging population1 over the next decade1 physician demand is expected to grow up to #ag percent4 7#c7 ,the ,united ,states ,census ,bureau estimates that the ,united ,states population will grow from #cba1jjj1jjj in #bjae to #cdg1jjj1jjj in #bjbe4 ,further1 the number of ,medicare beneficiaries is estimated to increase from #dg1hjj1jjj in #bjae to approximately #ff1jjj1jjj in #bjbe4 7#d7 ,approximately #cf percent of practicing physicians are over the age of #ee and are likely to retire within the next decade4 7#e7 ,a nationwide physician shortage will result in many people in the ,united ,states waiting longer and traveling farther for health care2 seeking nonemergent care in emergency departments2 and delaying treatment until their health care needs become more serious1 complex1 and costly4 7#f7 ,changing demographics 7such as an aging population71 new health care delivery models 7such as medical homes71 and other factors 7such as disaster preparedness7 are contributing to a shortage of both generalist and specialist physicians4 7#g7 ,these shortages will have the most severe impact on vulnerable and underserved populations1 including racial and ethnic minorities and the approximately #bj percent of people in the ,united ,states who live in rural or inner-city locations designated as health professional shortage areas4 7#h7 ,the health care utilization equity model of the ,association of ,american ,medical ,colleges estimates that if racial and ethnic minorities and individuals from rural areas utilized health care in a similar way to their ,caucasian counterparts living in metropolitan areas1 the physician shortage would require an additional #if1jjj physicians4 7#i7 ,to address the physician shortage in rural and medically underserved areas1 medical education and training need to be accessible to underrepresented minorities 7including individuals who are ,african ,american1 ,hispanic1 ,native ,american1 or ,native ,hawaiian71 and need to increase pathway programs for such underrepresented minorities who make up less than #ab percent of individuals enrolled in graduate medical education and for international students who make up #be percent of individuals enrolled in graduate medical education4 ,immigration pathways like student1 exchange-visitor1 and employment visas1 and programs like the ,national ,interest ,waiver and ,conrad #cj ,j-#a ,visa ,waiver1 help improve health access across the ,united ,states4 7#aj7 ,united ,states medical school enrollment was expected to grow by #cj percent from #bjah to #bjai to help reduce the shortage of quality physicians in the ,united ,states4 7#aa7 ,an increase in ,united ,states medical school graduates must be accompanied by an increase of #d1jjj graduate medical education training positions each year4 7#ab7 ,graduate medical education programs and teaching hospitals provide venues in which the next generation of physicians learns to work collaboratively with other physicians and health professionals1 adopt more efficient care delivery models 7such as care coordination and medical homes71 incorporate health information technology and electronic health records in every aspect of their work1 apply new methods of assuring quality and safety1 and participate in groundbreaking clinical and public health research4 7#ac7 ,the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 7having more beneficiaries than any other health care program7 supports its fair share of the costs associated with graduate medical education4 7#ad7 ,in general1 the level of support of graduate medical education by the ,medicare program has been capped since #aiig and has not been increased to support the expansion of graduate medical education programs needed to avert the projected physician shortage or to accommodate the increase in ,united ,states medical school graduates4 7b7 ,sense of ,congress ,it is the sense of ,congress that eliminating the limit of the number of residency positions that receive some level of ,medicare support under section #ahhf7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h771 also referred to as the ,medical graduate medical education cap1 is critical to-- 7#a7 ensuring an appropriate supply of physicians to meet the health care needs in the ,united ,states2 7#b7 facilitating equitable access for all who seek health care2 and 7#c7 mitigating disparities in health and health care4 #cac4 ,career support for skilled1 internationally educated health professionals 7a7 ,findings ,congress finds the following3 7#a7 ,according to a #bjah study1 the ,state and local public health workforce has shrunk by more than #ej1jjj individuals since the beginning of the #bjjh ,great ,recession and almost one quarter of individuals comprising the governmental public health workforce plan to leave or retire in the coming years4 7#b7 ,shortages are projected for other health professions1 including within the fields of nursing 7#ejj1jjj by #bjbe71 dentistry 7#ae1jjj by #bjbe71 pharmacy 7#ch1jjj by #bjcj71 mental and behavioral health1 primary care 7#df1jjj by #bjbe71 and community and allied health4 7#c7 ,a nationwide health workforce shortage will result in serious health threats and more severe and costly health care needs1 due to1 in part1 a delayed response to food-borne outbreaks1 emerging infectious diseases1 natural disasters1 fewer cancer screenings1 and delayed treatment4 7#d7 ,vulnerable and underserved populations and health professional shortage areas will be most severely impacted by the health workforce shortage4 7#e7 ,according to the ,migration ,policy ,institute1 more than #b1jjj1jjj college-educated immigrants in the ,united ,states today are unemployed or underemployed in low- or semi-skilled jobs that fail to draw on their education and expertise4 7#f7 ,approximately #b out of every #e internationally educated immigrants are unemployed or underemployed4 7#g7 ,according to the ,drexel ,university ,center for ,labor ,markets and ,policy1 underemployment for internationally educated immigrant women is #bh percent higher than for their male counterparts4 7#h7 ,according to the ,drexel ,university ,center for ,labor ,markets and ,policy1 the mean annual earnings of underemployed immigrants were #cb1jjj1 or #dc percent less than ,united ,states born college graduates employed in the college labor market4 7#i7 ,according to ,upwardly ,global and the ,welcome ,back ,initiative1 with proper guidance and support1 underemployed skilled immigrants typically increase their income by #bae percent to #ijj percent4 7#aj7 ,according to the ,brookings ,institution and the ,partnership for a ,new ,american ,economy1 immigrants working in the health workforce are1 on average1 better educated than ,united ,states-born workers in the health workforce4 7b7 ,grants to eligible entities 7#a7 ,authority to provide grants ,the ,secretary of ,health and ,human ,services1 acting through the ,bureau of ,health ,workforce within the ,health ,resources and ,services ,administration1 the ,national ,institute on ,minority ,health and ,health ,disparities1 or the ,office of ,minority ,health 7in this section referred to as the ,secretary71 may award grants to eligible entities to carry out activities described in subsection 7c74 7#b7 ,eligibility ,to be eligible to receive a grant under this section1 an entity shall-- 7,a7 be a clinical1 public health1 or health services organization1 a community-based or nonprofit entity1 an academic institution1 a faith-based organization1 a ,state1 county1 or local government1 an area health education center1 or another entity determined appropriate by the ,secretary2 and 7,b7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,authorized activities ,a grant awarded under this section shall be used-- 7#a7 to provide services to assist unemployed and underemployed skilled immigrants1 residing in the ,united ,states1 who have legal1 permanent work authorization and who are internationally educated health professionals1 enter into the health workforce of the ,united ,states with employment matching their health professional skills and education1 and advance in employment to positions that better match their health professional education and expertise2 7#b7 to provide training opportunities to reduce barriers to entry and advancement in the health workforce for skilled1 internationally educated immigrants2 7#c7 to educate employers regarding the abilities and capacities of internationally educated health professionals2 7#d7 to assist in the evaluation of foreign credentials2 7#e7 to support preceptorships for international medical graduates in hospital primary care training2 and 7#f7 to facilitate access to contextualized and accelerated courses on ,english as a second language4 #cad4 ,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 #cae4 ,conrad ,state #cj program2 physician retention 7a7 ,conrad ,state #cj program extension ,section #bbj7;c7 of the ,immigration and ,nationality ,technical ,corrections ,act of #aiid 7,public ,law #ajc-daf2 #h ,u4,s4,c4 #aahb note7 is amended by striking ,september #cj1 #bjae and inserting ,september #cj1 #bjba4 7b7 ,retaining physicians who have practiced in medically underserved communities ,section #bja7;b77#a7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaea7;b77#a77 is amended by adding at the end the following3 7,f7 7i7 ,alien physicians who have completed service requirements for a national interest waiver requested under section #bjc7;b77#b77;,b77ii71 including-- 7,i7 alien physicians who completed such service before the date of the enactment of the ,health ,equity and ,accountability ,act of #bjbj2 and 7,,ii7 the spouse or children of an alien physician described in subclause 7,i74 7ii7 ,nothing in this subparagraph may be construed-- 7,i7 to prevent the filing of a petition with the ,secretary of ,homeland ,security for classification under section #bjd7;a7 or the filing of an application for adjustment of status under section #bde by an alien physician described in clause 7i7 before the date on which such alien physician completes the service described in section #bad7l7 or worked full-time as a physician for an aggregate of #e years at the location identified in the waiver of the #b-year foreign residence requirement under section #bad7l7 or in an area or areas designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals2 or 7,,ii7 to permit the ,secretary of ,homeland ,security to grant a petition or application described in subclause 7,i7 until the alien has satisfied all of the requirements of the waiver received under section #bad7l74 4 7c7 ,employment protections for physicians 7#a7 ,exceptions to #b-year foreign residency requirement ,section #bad7l77#a7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahd7l77#a77 is amended-- 7,a7 in the matter preceding subparagraph 7,a71 by striking ,attorney ,general shall not and inserting ,secretary of ,homeland ,security may not2 7,b7 in subparagraph 7,a71 by striking ,director of the ,united ,states ,information ,agency and inserting ,secretary of ,state2 7,c7 in subparagraph 7,b71 by inserting 1 except as provided in paragraphs 7#g7 and 7#h7 before the semicolon at the end2 7,d7 in subparagraph 7,c71 by amending clauses 7i7 and 7ii7 to read as follows3 7i7 the alien demonstrates a bona fide offer of full-time employment at a health facility or health care organization1 which employment has been determined by the ,secretary of ,homeland ,security to be in the public interest2 and 7ii7 the alien-- 7,i7 has accepted employment with the health facility or health care organization in a geographic area or areas which are designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals2 7,,ii7 begins employment by the later of the date that is-- 7aa7 #abj days after receiving such waiver2 7bb7 #abj days after completing graduate medical education or training under a program approved pursuant to section #bab7;j77#a72 or 7cc7 #abj days after receiving nonimmigrant status or employment authorization1 if the alien or the alien's employer petitions for such nonimmigrant status or employment authorization not later than #abj days after the date on which the alien completes his or her graduate medical education or training under a program approved pursuant to section #bab7;j77#a72 and 7,,iii7 agrees to continue to work for a total of not less than #c years in the status authorized for such employment under this subsection1 except as provided in paragraph 7#h74 2 and 7,e7 in subparagraph 7,d71 in the matter preceding clause 7i71 by inserting subject to paragraph 7#h71 before in the case4 7#b7 ,allowable visa status for physicians fulfilling waiver requirements in medically underserved areas ,section #bad7l77#b77;,a7 of such ,act 7#h ,u4,s4,c4 #aahd7l77#b77;,a77 is amended to read as follows3 7,a7 ,upon the request of an interested ,federal agency or an interested ,state agency for recommendation of a waiver under this section by a physician who is maintaining valid nonimmigrant status under section #aja7;a77#ae77;,j7 and received a favorable recommendation by the ,secretary of ,state1 the ,secretary of ,homeland ,security may change the status of such physician to any status authorized for employment under this ,act4 ,the numerical limitations set forth in subsection 7g77#a77;,a7 shall not apply to any alien whose status is changed under this subparagraph4 4 7#c7 ,violation of agreements ,section #bad7l77#c77;,a7 of such ,act 7#h ,u4,s4,c4 #aahd7l77#c77;,a77 is amended by inserting substantial requirement of an before agreement entered into4 7#d7 ,physician employment in underserved areas ,section #bad7l7 of such ,act 7#h ,u4,s4,c4 #aahd7l771 as amended by this section1 is further amended by adding at the end the following3 7#d7 7,a7 ,if an interested ,state agency denies the application for a waiver under paragraph 7#a77;,b7 from a physician pursuing graduate medical education or training pursuant to section #aja7;a77#ae77;,j7 because the ,state has requested the maximum number of waivers permitted for that fiscal year1 the physician's nonimmigrant status shall be extended for up to #f months if the physician agrees to seek a waiver under this subsection 7except for paragraph 7#a77;,d77ii77 to work for an employer described in paragraph 7#a77;,c7 in a ,state that has not yet requested the maximum number of waivers4 7,b7 ,a physician described in subparagraph 7,a7 may only work for the employer referred to in subparagraph 7,a7 during the period beginning on the date on which a new waiver application is filed with such ,state and ending on the earlier of-- 7i7 the date on which the ,secretary of ,homeland ,security denies such waiver2 or 7ii7 the date on which the ,secretary approves an application for change of status under paragraph 7#b77;,a7 pursuant to the approval of such waiver4 4 7#e7 ,contract requirements ,section #bad7l7 of such ,act1 as amended by this section1 is further amended by adding at the end the following3 7#e7 ,an alien granted a waiver under paragraph 7#a77;,c7 shall enter into an employment agreement with the contracting health facility or health care organization that-- 7,a7 specifies the maximum number of on-call hours per week 7which may be a monthly average7 that the alien will be expected to be available and the compensation the alien will receive for on-call time2 7,b7 specifies-- 7i7 whether the contracting facility or organization will pay the alien's malpractice insurance premiums2 7ii7 whether the employer will provide malpractice insurance2 and 7iii7 the amount of such insurance that will be provided2 7,c7 describes all of the work locations that the alien will work1 including a statement that the contracting facility or organization will not add additional work locations without the approval of the ,federal agency or ,state agency that requested the waiver2 and 7,d7 does not include a non-compete provision4 7#f7 ,an alien granted a waiver under this subsection whose employment relationship with a health facility or health care organization terminates under paragraph 7#a77;,c77ii7 during the #c-year service period required under paragraph 7#a7 shall be considered to be maintaining lawful status in an authorized period of stay during the #abj-;day period referred to in items 7aa7 and 7bb7 of subclause 7,,iii7 of paragraph 7#a77;,c77ii7 or the #de-;day period referred to in subclause 7,,iii77cc7 of such paragraph4 4 7#f7 ,recapturing waiver slots lost to other states ,section #bad7l7 of such ,act1 as amended by this section1 is further amended by adding at the end the following3 7#g7 ,if a recipient of a waiver under this subsection terminates the recipient's employment with a health facility or health care organization pursuant to paragraph 7#a77;,c77ii71 including termination of employment because of circumstances described in paragraph 7#a77;,c77ii77,,iii71 and accepts new employment with such a facility or organization in a different ,state1 the ,state from which the alien is departing may be accorded an additional waiver by the ,secretary of ,state for use in the fiscal year in which the alien's employment was terminated4 4 7#g7 ,exception to #c-year work requirement ,section #bad7l7 of such ,act1 as amended by this section1 is further amended by adding at the end the following3 7#h7 ,the #c-year work requirement set forth in subparagraphs 7,c7 and 7,d7 of paragraph 7#a7 shall not apply if-- 7,a7 7i7 the ,secretary of ,homeland ,security determines that extenuating circumstances1 including violations by the employer of the employment agreement with the alien or of labor and employment laws1 exist that justify a lesser period of employment at such facility or organization2 and 7ii7 not later than #abj days after the employment termination date 7unless the ,secretary determines that extenuating circumstances would justify an extension71 the alien demonstrates another bona fide offer of employment at a health facility or health care organization in a geographic area or areas which are designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals1 for the remainder of such #c-year period2 7,b7 7i7 the interested ,state agency that requested the waiver attests that extenuating circumstances1 including violations by the employer of the employment agreement with the alien or of labor and employment laws1 exist that justify a lesser period of employment at such facility or organization2 and 7ii7 not later than #abj days after the employment termination date 7unless the ,secretary determines that extenuating circumstances would justify an extension71 the alien demonstrates another bona fide offer of employment at a health facility or health care organization in a geographic area or areas which are designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals1 for the remainder of such #c-year period2 or 7,c7 the alien-- 7i7 elects not to pursue a determination of extenuating circumstances pursuant to subclause 7,a7 or 7,b72 7ii7 terminates the alien's employment relationship with the health facility or health care organization at which the alien was employed2 7iii7 not later than #de days after the employment termination date1 demonstrates another bona fide offer of employment at a health facility or health care organization in a geographic area or areas1 in the ,state that requested the alien's waiver1 which are designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals2 and 7iv7 agrees to be employed for the remainder of such #c-year period1 and #a additional year for each termination under clause 7ii74 4 7d7 ,allotment of ,conrad #cj waivers 7#a7 ,in general ,section #bad7l7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahd7l771 as amended by subsection 7c71 is further amended by adding at the end the following3 7#i7 7,a7 7i7 ,all ,states shall be allotted #ce waivers under paragraph 7#a77;,b7 for each fiscal year if #ij percent of the waivers available to the ,states receiving at least #e waivers were used in the previous fiscal year4 7ii7 ,when an allotment occurs under clause 7i71 all ,states shall be allotted an additional #e waivers under paragraph 7#a77;,b7 for each subsequent fiscal year if #ij percent of the waivers available to the ,states receiving at least #e waivers were used in the previous fiscal year4 ,if the ,states are allotted #de or more waivers for a fiscal year1 the ,states will only receive an additional increase of #e waivers the following fiscal year if #ie percent of the waivers available to the ,states receiving at least #a waiver were used in the previous fiscal year4 7,b7 ,any increase in allotments under subparagraph 7,a7 shall be maintained indefinitely1 unless in a fiscal year1 the total number of such waivers granted is #e percent lower than in the last year in which there was an increase in the number of waivers allotted pursuant to this paragraph4 ,in such case-- 7i7 the number of waivers allotted beginning in the next fiscal year shall be decreased by #e for all ,states2 and 7ii7 each additional #e percent decrease in such waivers granted from the last year in which there was an increase in the allotment1 shall result in an additional decrease of #e waivers allotted for all ,states1 provided that the number of waivers allotted for all ,states shall not drop below #cj4 4 7#b7 ,academic medical centers ,section #bad7l77#a77;,d7 of such ,act1 as amended by subsection 7c77#a77;,e71 is further amended-- 7,a7 in clause 7ii71 by striking and at the end2 7,b7 in clause 7iii71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following3 7iv7 in the case of a request by an interested ,state agency-- 7,i7 the head of such agency determines that the alien is to practice medicine in1 or be on the faculty of a residency program at1 an academic medical center 7as defined in section #daa4cee7;e77#b7 of title #db1 ,code of ,federal ,regulations71 without regard to whether such facility is located within an area designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals2 and 7,,ii7 the head of such agency determines that-- 7aa7 the alien physician's work is in the public interest2 and 7bb7 subject to paragraph 7#f71 the grant of such waiver would not cause the number of the waivers granted on behalf of aliens for such ,state for a fiscal year to exceed #c1 within the limitation under subparagraph 7,b74 4 7e7 ,amendments to the procedures1 definitions1 and other provisions related to physician immigration 7#a7 ,dual intent for physicians seeking graduate medical training ,section #bad7;b7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahd7;b77 is amended by striking and other than a nonimmigrant described in any provision of section #aja7;a77#ae77;,h77i7 except subclause 7b#a7 of such section7 and inserting a nonimmigrant described in any provision of section #aja7;a77#ae77;,h77i7 7except subclause 7b#a7 of such section71 and an alien coming to the ,united ,states to receive graduate medical education or training as described in section #bab7;j7 or to take examinations required to receive graduate medical education or training as described in section #bab7;j774 7#b7 ,physician national interest waiver clarifications 7,a7 ,practice and geographic area ,section #bjc7;b77#b77;,b77ii77,i7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaec7;b77#b77;,b77ii77,i77 is amended by striking items 7aa7 and 7bb7 and inserting the following3 7aa7 the alien physician agrees to work on a full-time basis practicing primary care1 specialty medicine1 or a combination thereof1 in an area or areas designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals1 or at a health care facility under the jurisdiction of the ,secretary of ,veterans ,affairs2 or 7bb7 the alien physician is pursuing such waiver based upon service at a facility or facilities that serve patients who reside in a geographic area or areas designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals 7without regard to whether such facility or facilities are located within such an area7 and a ,federal agency1 or a local1 county1 regional1 or ,state department of public health determines the alien physician's work was or will be in the public interest4 4 7,b7 ,five-year service requirement ,section #bjc7;b77#b77;,b77ii7 of such ,act is amended-- 7i7 by moving subclauses 7,,ii71 7,,iii71 and 7,,iv7 #d ems to the left2 and 7ii7 in subclause 7,,ii7-- 7,i7 by inserting 7aa7 after 7,,ii72 and 7,,ii7 by adding at the end the following3 7bb7 ,the #e-year service requirement described in item 7aa7 shall begin on the date on which the alien physician begins work in the shortage area in any legal status and not on the date on which an immigrant visa petition is filed or approved4 ,such service shall be aggregated without regard to when such service began and without regard to whether such service began during or in conjunction with a course of graduate medical education4 7cc7 ,an alien physician shall not be required to submit an employment contract with a term exceeding the balance of the #e-year commitment yet to be served or an employment contract dated within a minimum time period before filing a visa petition under this subsection4 7dd7 ,an alien physician shall not be required to file additional immigrant visa petitions upon a change of work location from the location approved in the original national interest immigrant petition4 4 7#c7 ,technical clarification regarding advanced degree for physicians ,section #bjc7;b77#b77;,a7 of such ,act 7#h ,u4,s4,c4 #aaec7;b77#b77;,a77 is amended by adding at the end the following3 ,an alien physician holding a foreign medical degree that has been deemed sufficient for acceptance by an accredited ,united ,states medical residency or fellowship program shall be considered a member of the professions holding an advanced degree or its equivalent for purposes of this paragraph44 7#d7 ,short-,term work authorization for physicians completing their residencies 7,a7 ,in general ,a physician completing graduate medical education or training described in section #bab7;j7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahb7;j77 as a nonimmigrant described in section #aja7;a77#ae77;,h77i7 of such ,act 7#h ,u4,s4,c4 #aaja7;a77#ae77;,h77i77-- 7i7 shall have such nonimmigrant status automatically extended until ,october #a of the fiscal year for which a petition for a continuation of such nonimmigrant status has been submitted in a timely manner and the employment start date for the beneficiary of such petition is ,october #a of that fiscal year2 and 7ii7 shall be authorized to be employed incident to status during the period between the filing of such petition and ,october #a of such fiscal year4 7,b7 ,termination ,the status and employment authorization of a physician described in subparagraph 7,a7 shall terminate on the date that is #cj days after the date on which a petition described in clause 7i77,i7 is rejected1 denied or revoked4 7,c7 ,automatic extension ,the status and employment authorization of a physician described in subparagraph 7,a7 will automatically extend to ,october #a of the next fiscal year if all of the visas described in section #aja7;a77#ae77;,h77i7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaja7;a77#ae77;,h77i77 that were authorized to be issued for the fiscal year have been issued4 7#e7 ,applicability of section #bab7;e7 to spouses and children of ,j-#a exchange visitors ,a spouse or child of an exchange visitor described in section #aja7;a77#ae77;,j7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaja7;a77#ae77;,j77 shall not be subject to the requirements under section #bab7;e7 of such ,act 7#h ,u4,s4,c4 #aahb7;e774 ,,iv ,improving ,health ,care ,access and ,quality ,a ,improvement of ,coverage #dja4 ,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#bg7 as paragraphs 7#bb7 through 7#bf71 respectively2 and 7,b7 by redesignating subsections 7y71 7z71 and 7aa7 as subsections 7x71 7y71 and 7z71 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 on the date of enactment of this ,act4 #djb4 ,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 status2 and 7ii7 in clause 7ii71 by striking lawfully present in the ,united ,states1 but and inserting who2 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 #djc4 ,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 #djd4 ,medicaid in the territories 7a7 ,elimination of general ,medicaid funding limitations 7,cap7 for territories 7#a7 ,repeal of provisions related to cap after #bjai ,subsections 7a71 7b71 and 7d7 of section #bjb of subtitle ,b of title ,i of division ,n of the ,further ,consolidated ,appropriations ,act1 #bjbj 7,public ,law #aaf-id7 and section #fjji of the ,families ,first ,coronavirus ,response ,act 7,public ,law #aaf-abg7 are repealed and the provisions of law amended by such subsections and section are restored as if such subsections and section had not been enacted4 7#b7 ,sunset of ,medicaid funding limitations for territories ,section #aajh of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7 7as restored by paragraph 7#a77 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#c7 ,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#d7 ,effective date ,the amendments made by this subsection shall apply beginning with fiscal year #bjbj4 7b7 ,elimination of specific ,federal medical assistance percentage 7,,fmap7 limitation for territories ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7#a7 in clause 7#b7 of subsection 7b71 by inserting for fiscal years before fiscal year #bjbj after ,american ,samoa2 and 7#b7 in subsection 7ff7-- 7,a7 by striking 7z77#b7-- and all that follows through beginning ,october #a1 #bjai and inserting 7z77#b71 for the period beginning ,october #a1 #bjai2 7,b7 by striking #ajj percent2 and inserting #ajj percent42 and 7,c7 by striking paragraphs 7#b7 and 7#c74 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;a7j771 as amended by subsection 7a77#c77;,a71 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 subsection 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 #bjbj1 ,puerto ,rico1 the ,virgin ,islands of the ,united ,states1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa4 #dje4 ,extension of ,medicare secondary payer 7a7 ,in general ,section #ahfb7;b77#a77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7b77#a77;,c77 is amended-- 7#a7 in the last sentence1 by inserting 1 and before ,january #a1 #bjba after prior to such date72 and 7#b7 by adding at the end the following new sentence3 ,effective for items and services furnished on or after ,january #a1 #bjba 7with respect to periods beginning on or after the date that is #db months prior to such date71 clauses 7i7 and 7ii7 shall be applied by substituting #db-month for #ab-month each place it appears44 7b7 ,effective date ,the amendments made by this section shall take effect on the date of enactment of this ,act4 ,for purposes of determining an individual's status under section #ahfb7;b77#a77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7b77#a77;,c771 as amended by subsection 7a71 an individual who is within the coordinating period as of the date of enactment of this ,act shall have that period extended to the full #db months described in the last sentence of such section1 as added by the amendment made by subsection 7a77#b74 #djf4 ,indian defined in title ,i of the ,patient ,protection and ,affordable ,care ,act 7a7 ,definition of indian ,section #acjd of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbd7 is amended by adding at the end the following3 7f7 ,indian 7#a7 ,in general ,in this title1 the term ,indian means any individual-- 7,a7 described in paragraph 7#ac7 or 7#bh7 of section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc72 7,b7 who is eligible for health services provided by the ,indian ,health ,service under section #hji of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afgi72 7,c7 who is of ,indian descent and belongs to an ,indian community served by a local facility or program of the ,indian ,health ,service2 or 7,d7 who is otherwise described in paragraph 7#b74 7#b7 ,inclusions ,an individual is described in this paragraph if the individual is any of the following3 7,a7 ,a member of a federally recognized ,indian ,tribe4 7,b7 ,a resident of an urban center who meets any of the following criteria3 7i7 ,membership in a ,tribe1 band1 or other organized group of ,indians1 including those ,tribes1 bands1 or groups terminated since #aidj and those recognized as of the date of enactment of the ,health ,equity and ,accountability ,act of #bjah or later by the ,state in which they reside1 or being a descendant1 in the first or second degree1 of any such member4 7ii7 ,is an ,eskimo or ,aleut or other ,alaska ,native4 7iii7 ,is considered by the ,secretary of the ,interior to be an ,indian for any purpose4 7iv7 ,is determined to be an ,indian under regulations promulgated by the ,secretary4 7,c7 ,an individual who is considered by the ,secretary of the ,interior to be an ,indian for any purpose4 7,d7 ,an individual who is considered by the ,secretary to be an ,indian for purposes of eligibility for ,indian health care services1 including as a ,california ,indian1 ,eskimo1 ,aleut1 or other ,alaska ,native4 4 7b7 ,conforming amendments 7#a7 ,affordable choices health benefit plans ,section #acaa7;c77#f77;,d7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77#f77;,d77 is amended by striking 7as defined in section #d of the ,indian ,health ,care ,improvement ,act74 7#b7 ,reduced cost-sharing for individuals enrolling in qualified health plans ,section #adjb7;d7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7;d77 is amended-- 7,a7 in paragraph 7#a71 in the matter preceding subparagraph 7,a71 by striking 7as defined in section #d7;d7 of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej;b7d772 and 7,b7 in paragraph 7#b71 in the matter preceding subparagraph 7,a71 by striking 7as so defined74 7#c7 ,exemption from penalty for not maintaining minimum essential coverage ,section #ejjj;,a7e7 of the ,internal ,revenue ,code of #aihf is amended by striking paragraph 7#c7 and inserting the following3 7#c7 ,indians ,any applicable individual who is an ,indian 7as defined in section #acjd7;f7 of the ,patient ,protection and ,affordable ,care ,act74 4 #djg4 ,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 #djh4 #ajj percent ,,fmap for medical assistance provided by urban ,indian health centers 7a7 ,in general ,the third sentence of section #aije7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif7;b77 is amended by inserting or are received through a program operated by an urban ,indian organization through a grant or contract under title ,v of the ,indian ,health ,care ,improvement ,act after 7as defined in section #d of the ,indian ,health ,care ,improvement ,act74 7b7 ,effective date ,the amendment made by this section shall apply to medical assistance provided on or after the date of enactment of this ,act4 #dji4 #ajj percent ,,fmap for medical assistance provided to a ,native ,hawaiian through a federally qualified health center or a ,native ,hawaiian health care system under the ,medicaid program 7a7 ,in general ,the third sentence of section #aije7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b771 as amended by section #djh7;a71 is amended by inserting before the period the following3 1 and with respect to medical assistance provided to a ,native ,hawaiian 7as defined in section #ab7b7 of the ,native ,hawaiian ,health ,care ,improvement ,act7 through a federally qualified health center or a ,native ,hawaiian health care system 7as defined in section #ab7f7 of such ,act71 whether directly1 by referral1 or under contract or other arrangement between such federally qualified health center or ,native ,hawaiian health care system and another health care provider4 7b7 ,effective date ,the amendment made by this section shall apply to medical assistance provided on or after the date of enactment of this ,act4 #daj4 ,medicaid coverage for citizens of freely associated states 7a7 ,in general ,section #djb7;b77#b7 of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afab7;b77#b77 is amended by adding at the end the following new subparagraph3 7,g7 ,medicaid exception for citizens of freely associated states ,with respect to eligibility for benefits for the designated ,federal program described in paragraph 7#c77;,c71 section #dja7;a7 and paragraph 7#a7 shall not apply to any individual who lawfully resides in #a of the #ej ,states or the ,district of ,columbia in accordance with the ,compacts of ,free ,association between the ,government of the ,united ,states and the ,governments of the ,federated ,states of ,micronesia1 the ,republic of the ,marshall ,islands1 and the ,republic of ,palau and shall not apply1 at the option of the ,governors of ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa1 respectively1 as communicated to the ,secretary of ,health and ,human ,services in writing1 to any individual who lawfully resides in the respective territory in accordance with such ,compacts4 4 7b7 ,exception to #e-,year limited eligibility ,section #djc7;d7 of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afac7;d77 is amended-- 7#a7 in paragraph 7#a71 by striking or at the end2 7#b7 in paragraph 7#b71 by striking the period at the end and inserting 2 or2 and 7#c7 by adding at the end the following new paragraph3 7#c7 an individual described in section #djb7;b77#b77;,g71 but only with respect to the designated ,federal program described in section #djb7;b77#c77;,c74 4 7c7 ,definition of qualified alien ,section #dca7;b7 of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afda7;b77 is amended-- 7#a7 in paragraph 7#f71 by striking 2 or at the end and inserting a comma2 7#b7 in paragraph 7#g71 by striking the period at the end and inserting 1 or2 and 7#c7 by adding at the end the following new paragraph3 7#h7 an individual who lawfully resides in the ,united ,states in accordance with a ,compact of ,free ,association referred to in section #djb7;b77#b77;,g71 but only with respect to the designated ,federal program described in section #djb7;b77#c77;,c7 7relating to the ,medicaid program74 4 7d7 ,effective date ,the amendments made by this section take effect on ,october #a1 #bjba4 ,b ,expansion of ,access #dab4 ,amendment to the ,public ,health ,service ,act ,title ,,xxxiv of the ,public ,health ,service ,act1 as amended by titles ,i1 ,,ii1 ,,iii1 and ,,ix of this ,act1 is further amended by inserting after subtitle ,d the following3 ,e ,reconstruction and ,improvement ,grants for ,public ,health ,care ,facilities ,serving ,pacific ,islanders and the ,insular ,areas #cdea4 ,grant support for quality improvement initiatives 7a7 ,in general ,the ,secretary1 in collaboration with the ,administrator of the ,health ,resources and ,services ,administration1 the ,director of the ,agency for ,healthcare ,research and ,quality1 and the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall award grants to eligible entities for the conduct of demonstration projects to improve the quality of and access to health care4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an entity shall-- 7#a7 be a health center1 hospital1 health plan1 health system1 community 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 meeting the criteria under subsection 7b7 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 #cdeb4 ,centers of excellence 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall designate centers of excellence at public hospitals1 and other health systems serving large numbers of minority patients1 that-- 7#a7 meet the requirements of section #cdea7;b77#a72 7#b7 demonstrate excellence in providing care to minority populations2 and 7#c7 demonstrate excellence in reducing disparities in health and health care4 7b7 ,requirements ,a hospital or health system that serves as a center of excellence under subsection 7a7 shall-- 7#a7 design1 implement1 and evaluate programs and policies relating to the delivery of care in racially1 ethnically1 and linguistically diverse populations2 7#b7 provide training and technical assistance to other hospitals and health systems relating to the provision of quality health care to minority populations2 and 7#c7 develop activities for graduate or continuing medical education that institutionalize a focus on cultural competence training for health care providers4 7c7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section1 such sums as may be necessary for each of fiscal years #bjba through #bjbf4 #cdec4 ,reconstruction and improvement grants for public health care facilities serving pacific islanders and the insular areas 7a7 ,in general ,the ,secretary shall provide direct financial assistance to designated health care providers and community health centers in ,american ,samoa1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,united ,states ,virgin ,islands1 ,puerto ,rico1 and ,hawaii for the purposes of reconstructing and improving health care facilities and services in a culturally competent and sustainable manner4 7b7 ,eligibility ,to be eligible to receive direct financial assistance under subsection 7a71 an entity shall be a public health facility or community health center located in ,american ,samoa1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,united ,states ,virgin ,islands1 ,puerto ,rico1 or ,hawaii that-- 7#a7 is owned or operated by-- 7,a7 the ,government of ,american ,samoa1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,united ,states ,virgin ,islands1 ,puerto ,rico1 or ,hawaii or a unit of local government2 or 7,b7 a nonprofit organization2 and 7#b7 7,a7 provides care or treatment for a substantial number of patients who are uninsured1 receiving assistance under 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 #dac4 ,protecting sensitive locations ,section #bhg of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aceg7 is amended-- 7#a7 by striking ,service each place such term appears and inserting ,department of ,homeland ,security2 7#b7 by striking ,attorney ,general each place such term appears and inserting ,secretary of ,homeland ,security2 7#c7 in subsection 7f77#a71 by striking ,commissioner and inserting ,director of ,u4,s4 ,citizenship and ,immigration ,services2 7#d7 in subsection 7h7-- 7,a7 by striking of the ,immigration and ,nationality ,act2 and 7,b7 by striking of such ,act2 and 7#e7 by adding at the end the following3 7i7 7#a7 ,in this subsection3 7,a7 ,the term appropriate congressional committees means-- 7i7 the ,committee on ,homeland ,security and ,governmental ,affairs of the ,senate2 7ii7 the ,committee on the ,judiciary of the ,senate2 7iii7 the ,committee on ,homeland ,security of the ,house of ,representatives2 and 7iv7 the ,committee on the ,judiciary of the ,house of ,representatives4 7,b7 ,the term enforcement action-- 7i7 means an apprehension1 arrest1 interview1 request for identification1 search1 or surveillance for the purposes of immigration enforcement2 and 7ii7 includes an enforcement action at1 or focused on1 a sensitive location that is part of a joint case led by another law enforcement agency4 7,c7 ,the term exigent circumstances means a situation involving-- 7i7 the imminent risk of death1 violence1 or physical harm to any person or property1 including a situation implicating terrorism or the national security of the ,united ,states2 7ii7 the immediate arrest or pursuit of a dangerous felon1 terrorist suspect1 or other individual presenting an imminent danger2 or 7iii7 the imminent risk of destruction of evidence that is material to an ongoing criminal case4 7,d7 ,the term prior approval means-- 7i7 in the case of officers and agents of ,u4,s4 ,immigration and ,customs ,enforcement1 prior written approval to carry out an enforcement action involving a specific individual or individuals authorized by-- 7,i7 the ,assistant ,director of ,operations1 ,homeland ,security ,investigations2 7,,ii7 the ,executive ,associate ,director1 ,homeland ,security ,investigations2 7,,iii7 the ,assistant ,director for ,field ,operations1 ,enforcement and ,removal ,operations2 or 7,,iv7 the ,executive ,associate ,director for ,field ,operations1 ,enforcement and ,removal ,operations2 7ii7 in the case of officers and agents of ,u4,s4 ,customs and ,border ,protection1 prior written approval to carry out an enforcement action involving a specific individual or individuals authorized by-- 7,i7 a ,chief ,patrol ,agent2 7,,ii7 the ,director of ,field ,operations2 7,,iii7 the ,director of ,air and ,marine ,operations2 or 7,,iv7 the ,internal ,affairs ,special ,agent in ,charge2 and 7iii7 in the case of other ,federal1 ,state1 or local law enforcement officers1 to carry out an enforcement action involving a specific individual or individuals authorized by-- 7,i7 the head of the ,federal agency carrying out the enforcement action2 or 7,,ii7 the head of the ,state or local law enforcement agency carrying out the enforcement action4 7,e7 ,the term sensitive location includes all of the physical space located within #a1jjj feet of-- 7i7 any medical treatment or health care facility1 including any hospital1 doctor's office1 accredited health clinic1 alcohol or drug treatment center1 or emergent or urgent care facility2 7ii7 any public or private school1 including any known and licensed day care facility1 preschool1 other early learning program facility1 primary school1 secondary school1 postsecondary school 7including colleges and universities71 or other institution of learning 7including vocational or trade schools72 7iii7 any scholastic or education-related activity or event1 including field trips and interscholastic events2 7iv7 any school bus or school bus stop during periods when school children are present on the bus or at the stop2 7v7 any organization or subdivision of government that-- 7,i7 assists children1 pregnant women1 victims of crime or abuse1 or individuals with significant mental or physical disabilities2 or 7,,ii7 provides social services and assistance1 including emergency and disaster services or assistance with food and nutrition1 housing affordability and income or other services funded by ,state or local government1 charitable giving1 the ,special ,supplemental ,nutrition ,program for ,women1 ,infants1 and ,children 7,,wic71 ,supplemental ,nutrition ,assistance ,program 7,,snap71 ,temporary ,assistance for ,needy ,families 7,,tanf71 or the ,united ,states ,housing ,act2 7vi7 any church1 synagogue1 mosque1 or other place of worship1 including buildings rented for the purpose of religious services1 retreats1 counseling1 workshops1 instruction1 and education2 7vii7 any ,federal1 ,state1 or local courthouse1 including the office of an individual's legal counsel or representative1 and a probation1 parole1 or supervised release office2 7viii7 the site of a funeral1 wedding1 or other religious ceremony or observance2 7ix7 any public demonstration1 such as a march1 rally1 or parade2 7x7 any domestic violence shelter1 rape crisis center1 supervised visitation center1 family justice center1 or victim services provider2 or 7xi7 any other location specified by the ,secretary of ,homeland ,security for purposes of this subsection4 7#b7 7,a7 ,an enforcement action may not take place at1 or be focused on1 a sensitive location unless-- 7i7 the action involves exigent circumstances2 and 7ii7 prior approval for the enforcement action was obtained from the appropriate official4 7,b7 ,if an enforcement action is initiated pursuant to subparagraph 7,a7 and the exigent circumstances permitting the enforcement action cease1 the enforcement action shall be discontinued until such exigent circumstances reemerge4 7,c7 ,if an enforcement action is carried out in violation of this subsection-- 7i7 no information resulting from the enforcement action may be entered into the record or received into evidence in a removal proceeding resulting from the enforcement action2 and 7ii7 the alien who is the subject of such removal proceeding may file a motion for the immediate termination of the removal proceeding4 7#c7 7,a7 ,this subsection shall apply to any enforcement action by officers or agents of the ,department of ,homeland ,security1 including-- 7i7 officers or agents of ,u4,s4 ,immigration and ,customs ,enforcement2 7ii7 officers or agents of ,u4,s4 ,customs and ,border ,protection2 and 7iii7 any individual designated to perform immigration enforcement functions pursuant to subsection 7g74 7,b7 ,while carrying out an enforcement action at a sensitive location1 officers and agents referred to in subparagraph 7,a7 shall make every effort-- 7i7 to limit the time spent at the sensitive location2 7ii7 to limit the enforcement action at the sensitive location to the person or persons for whom prior approval was obtained2 and 7iii7 to conduct themselves discreetly4 7,c7 ,if1 while carrying out an enforcement action that is not initiated at or focused on a sensitive location1 officers or agents are led to a sensitive location1 and no exigent circumstance and prior approval with respect to the sensitive location exists1 such officers or agents shall-- 7i7 cease before taking any further enforcement action2 7ii7 conduct themselves in a discreet manner2 7iii7 maintain surveillance2 and 7iv7 immediately consult their supervisor in order to determine whether such enforcement action should be discontinued4 7,d7 ,the limitations under this paragraph shall not apply to the transportation of an individual apprehended at or near a land or sea border to a hospital or health care provider for the purpose of providing medical care to such individual4 7#d7 7,a7 ,each official specified in subparagraph 7,b7 shall ensure that the employees under his or her supervision receive annual training on compliance with-- 7i7 the requirements under this subsection in enforcement actions at or focused on sensitive locations and enforcement actions that lead officers or agents to a sensitive location2 and 7ii7 the requirements under section #bci of this ,act and section #chd of the ,illegal ,immigration ,reform and ,immigrant ,responsibility ,act of #aiif 7#h ,u4,s4,c4 #acfg74 7,b7 ,the officials specified in this subparagraph are-- 7i7 the ,chief ,counsel of ,u4,s4 ,immigration and ,customs ,enforcement2 7ii7 the ,field ,office ,directors of ,u4,s4 ,immigration and ,customs ,enforcement2 7iii7 each ,special ,agent in ,charge of ,u4,s4 ,immigration and ,customs ,enforcement2 7iv7 each ,chief ,patrol ,agent of ,u4,s4 ,customs and ,border ,protection2 7v7 the ,director of ,field ,operations of ,u4,s4 ,customs and ,border ,protection2 7vi7 the ,director of ,air and ,marine ,operations of ,u4,s4 ,customs and ,border ,protection2 7vii7 the ,internal ,affairs ,special ,agent in ,charge of ,u4,s4 ,customs and ,border ,protection2 and 7viii7 the chief law enforcement officer of each ,state or local law enforcement agency that enters into a written agreement with the ,department of ,homeland ,security pursuant to subsection 7g74 7#e7 ,the ,secretary of ,homeland ,security shall modify the ,notice to ,appear form 7,i-#hfb7-- 7,a7 to provide the subjects of an enforcement action with information1 written in plain language1 summarizing the restrictions against enforcement actions at sensitive locations set forth in this subsection and the remedies available to the alien if such action violates such restrictions2 7,b7 to ensure that the information described in subparagraph 7,a7 is accessible to individuals with limited ,english proficiency2 and 7,c7 to ensure that subjects of an enforcement action are not permitted to verify that the officers or agents that carried out such action complied with the restrictions set forth in this subsection4 7#f7 7,a7 ,the ,director of ,u4,s4 ,immigration and ,customs ,enforcement and the ,commissioner of ,u4,s4 ,customs and ,border ,protection shall each submit an annual report to the appropriate congressional committees that includes the information set forth in subparagraph 7,b7 with respect to the respective agency4 7,b7 ,each report submitted under subparagraph 7,a7 shall include1 with respect to the submitting agency during the reporting period-- 7i7 the number of enforcement actions that were carried out at1 or focused on1 a sensitive location2 7ii7 the number of enforcement actions in which officers or agents were subsequently led to a sensitive location2 and 7iii7 for each enforcement action described in clause 7i7 or 7ii7-- 7,i7 the date on which it occurred2 7,,ii7 the specific site1 city1 county1 and ,state in which it occurred2 7,,iii7 the components of the agency involved in the enforcement action2 7,,iv7 a description of the enforcement action1 including the nature of the criminal activity of its intended target2 7,v7 the number of individuals1 if any1 arrested or taken into custody2 7,,vi7 the number of collateral arrests1 if any1 and the reasons for each such arrest2 7,,vii7 a certification whether the location administrator was contacted before1 during1 or after the enforcement action2 and 7,,viii7 the percentage of all of the staff members and supervisors reporting to the officials listed in paragraph 7#d77;,b7 who completed the training required under paragraph 7#d77;,a74 7#g7 ,nothing in the subsection may be construed-- 7,a7 to affect the authority of ,federal1 ,state1 or local law enforcement agencies-- 7i7 to enforce generally applicable ,federal or ,state criminal laws unrelated to immigration2 or 7ii7 to protect residents from imminent threats to public safety2 or 7,b7 to limit or override the protections provided in-- 7i7 section #bci2 or 7ii7 section #chd of the ,illegal ,immigration ,reform and ,immigrant ,responsibility ,act of #aiif 7#h ,u4,s4,c4 #acfg74 4 #dad4 ,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 #dae4 ,border health grants 7a7 ,definitions ,in this section3 7#a7 ,border area ,the term border area means the ,united ,states-,mexico ,border ,area1 as defined in section #h of the ,united ,states-,mexico ,border ,health ,commission ,act 7#bb ,u4,s4,c4 #bijn-#f74 7#b7 ,eligible entity ,the term eligible entity means an entity that is located in the border area and is any of the following3 7,a7 ,a ,state1 local government1 or ,tribal government4 7,b7 ,a public institution of higher education4 7,c7 ,a nonprofit health organization4 7,d7 ,a community health center4 7,e7 ,a community clinic that is a health center receiving assistance under section #ccj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b74 7b7 ,authorization ,from funds appropriated under subsection 7f71 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary71 acting through the ,united ,states members of the ,united ,states-,mexico ,border ,health ,commission1 shall award grants to eligible entities to address priorities and recommendations to improve the health of border area residents that are established by-- 7#a7 the ,united ,states members of the ,united ,states-,mexico ,border ,health ,commission2 7#b7 the ,state border health offices2 and 7#c7 the ,secretary4 7c7 ,application ,an eligible entity that desires a grant under subsection 7b7 shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7d7 ,use of funds ,an eligible entity that receives a grant under subsection 7b7 shall use the grant funds for-- 7#a7 programs relating to-- 7,a7 maternal and child health2 7,b7 primary care and preventative health2 7,c7 public health and public health infrastructure2 7,d7 musculoskeletal health and obesity2 7,e7 health education and promotion2 7,f7 oral health2 7,g7 mental and behavioral health2 7,h7 substance use disorders2 7,i7 health conditions that have a high prevalence in the border area2 7,j7 medical and health services research2 7,k7 workforce training and development2 7,l7 community health workers1 patient navigators1 and promotores2 7,m7 health care infrastructure problems in the border area 7including planning and construction grants72 7,n7 health disparities in the border area2 7,o7 environmental health2 and 7,p7 outreach and enrollment services with respect to ,federal programs 7including programs authorized under titles ,,xix and ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq42 #db ,u4,s4,c4 #acig;aa et seq4772 and 7#b7 other programs determined appropriate by the ,secretary4 7e7 ,supplement1 not supplant ,amounts provided to an eligible entity awarded a grant under subsection 7b7 shall be used to supplement and not supplant other funds available to the eligible entity to carry out the activities described in subsection 7d74 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section1 #bjj1jjj1jjj for fiscal year #bjba1 and such sums as may be necessary for each succeeding fiscal year4 #daf4 ,critical access hospital improvements 7a7 ,elimination of isolation test for cost-,based ambulance reimbursement 7#a7 ,in general ,section #ahcd7l77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77#h77 is amended-- 7,a7 in subparagraph 7,b7-- 7i7 by striking owned and2 and 7ii7 by inserting 7including when such services are provided by the entity under an arrangement with the hospital7 after hospital2 and 7,b7 by striking the comma at the end of subparagraph 7,b7 and all that follows and inserting a period4 7#b7 ,effective date ,the amendments made by this subsection shall apply to services furnished on or after ,january #a1 #bjba4 7b7 ,provision of a more flexible alternative to the ,,cah designation #be inpatient bed limit requirement 7#a7 ,in general ,section #ahbj7;c77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#d7;c77#b77 is amended-- 7,a7 in subparagraph 7,b77iii71 by striking provides not more than and inserting subject to subparagraph 7,f71 provides not more than2 and 7,b7 by adding at the end the following new subparagraph3 7,f7 ,alternative to #be inpatient bed limit requirement 7i7 ,in general ,a ,state may elect to treat a facility1 with respect to the designation of the facility for a cost-reporting period1 as satisfying the requirement of subparagraph 7,b77iii7 relating to a maximum number of acute care inpatient beds if the facility elects1 in accordance with a method specified by the ,secretary and before the beginning of the cost reporting period1 to meet the requirement under clause 7ii74 7ii7 ,alternate requirement ,the requirement under this clause1 with respect to a facility and a cost-reporting period1 is that the total number of inpatient bed days described in subparagraph 7,b77iii7 during such period will not exceed #g1cjj4 ,for purposes of this subparagraph1 an individual who is an inpatient in a bed in the facility for a single day shall be counted as one inpatient bed day4 7iii7 ,withdrawal of election ,the option described in clause 7i7 shall not apply to a facility for a cost-reporting period if the facility 7for any two consecutive cost-reporting periods during the previous #e cost-reporting periods7 was treated under such option and had a total number of inpatient bed days for each of such two cost-reporting periods that exceeded the number specified in such clause4 4 7#b7 ,effective date ,the amendments made by paragraph 7#a7 shall apply to cost-reporting periods beginning on or after the date of the enactment of this ,act4 #dag4 ,establishment of ,rural ,community ,hospital 7,,rch7 ,program 7a7 ,in general ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 as amended by section #bjg7;b77#a71 is amended by adding at the end of the following new subsection3 7lll7 ,rural ,community ,hospital2 ,rural ,community ,hospital ,services 7#a7 ,the term rural community hospital means a hospital 7as defined in subsection 7e77 that-- 7,a7 is located in a rural area 7as defined in section #ahhf7;d77#b77;,d77 or treated as being so located pursuant to section #ahhf7;d77#h77;,e72 7,b7 subject to paragraph 7#b71 has less than #ea acute care inpatient beds1 as reported in its most recent cost report2 7,c7 makes available #bd-;hour emergency care services2 7,d7 subject to paragraph 7#c71 has a provider agreement in effect with the ,secretary and is open to the public as of ,january #a1 #bjaj2 and 7,e7 applies to the ,secretary for such designation4 7#b7 ,for purposes of paragraph 7#a77;,b71 beds in a psychiatric or rehabilitation unit of the hospital which is a distinct part of the hospital shall not be counted4 7#c7 ,paragraph 7#a77;,d7 shall not be construed to prohibit any of the following from qualifying as a rural community hospital3 7,a7 ,a replacement facility 7as defined by the ,secretary in regulations in effect on ,january #a1 #bjab7 with the same service area 7as defined by the ,secretary in regulations in effect on such date74 7,b7 ,a facility obtaining a new provider number pursuant to a change of ownership4 7,c7 ,a facility which has a binding written agreement with an outside1 unrelated party for the construction1 reconstruction1 lease1 rental1 or financing of a building as of ,january #a1 #bjab4 7#d7 ,nothing in this subsection shall be construed as prohibiting a critical access hospital from qualifying as a rural community hospital if the critical access hospital meets the conditions otherwise applicable to hospitals under subsection 7e7 and section #ahff4 7#e7 ,nothing in this subsection shall be construed as prohibiting a rural community hospital participating in the demonstration program under section #daj;,a of the ,medicare ,prescription ,drug1 ,improvement1 and ,modernization ,act of #bjjc 7,public ,law #ajh-agc2 #aag ,stat4 #bcac7 from qualifying as a rural community hospital if the rural community hospital meets the conditions otherwise applicable to hospitals under subsection 7e7 and section #ahff4 4 7b7 ,payment 7#a7 ,inpatient hospital services ,section #ahad of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7 is amended by adding at the end the following new subsection3 7m7 ,payment for ,inpatient ,services ,furnished in ,rural ,community ,hospitals ,the amount of payment under this part for inpatient hospital services furnished in a rural community hospital1 other than such services furnished in a psychiatric or rehabilitation unit of the hospital which is a distinct part1 is1 at the election of the hospital in the application referred to in section #ahfa7lll77#a77;,e7-- 7#a7 #aja percent of the reasonable costs of providing such services1 without regard to the amount of the customary or other charge1 or 7#b7 the amount of payment provided for under the prospective payment system for inpatient hospital services under section #ahhf7;d74 4 7#b7 ,outpatient services ,section #ahcd of such ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following new subsection3 7x7 ,payment for outpatient services furnished in rural community hospitals ,the amount of payment under this part for outpatient services furnished in a rural community hospital is1 at the election of the hospital in the application referred to in section #ahfa7lll77#a77;,e7-- 7#a7 #aja percent of the reasonable costs of providing such services1 without regard to the amount of the customary or other charge and any limitation under section #ahfa7v77#a77,u71 or 7#b7 the amount of payment provided for under the prospective payment system for covered ,,opd services under section #ahcc7t74 4 7#c7 ,exemption from #cj-percent reduction in reimbursement for bad debt ,section #ahfa7v77#a77,t7 of such ,act 7#db ,u4,s4,c4 #aciex7v77#a77,t77 is amended by inserting 7other than for a rural community hospital7 after ,in determining such reasonable costs for hospitals4 7c7 ,beneficiary cost-,sharing for outpatient services ,section #ahcd7x7 of such ,act 7as added by subsection 7b77#b77 is amended-- 7#a7 by redesignating paragraphs 7#a7 and 7#b7 as subparagraphs 7,a7 and 7,b71 respectively2 7#b7 by inserting 7#a7 after 7x72 and 7#c7 by adding at the end the following3 7#b7 ,the amounts of beneficiary cost-sharing for outpatient services furnished in a rural community hospital under this part shall be as follows3 7,a7 ,for items and services that would have been paid under section #ahcc7t7 if furnished by a hospital1 the amount of cost-sharing determined under paragraph 7#h7 of such section4 7,b7 ,for items and services that would have been paid under section #ahcc7;h7 if furnished by a provider of services or supplier1 no cost-sharing shall apply4 7,c7 ,for all other items and services1 the amount of cost-sharing that would apply to the item or service under the methodology that would be used to determine payment for such item or service if provided by a physician1 provider of services1 or supplier1 as the case may be4 4 7d7 ,conforming amendments 7#a7 ,part ,a payment ,section #ahad7;b7 of such ,act 7#db ,u4,s4,c4 #acie;f7b77 is amended in the matter preceding paragraph 7#a7 by inserting other than inpatient hospital services furnished by a rural community hospital1 after critical access hospital services14 7#b7 ,part ,b payment ,section #ahcc7;a7 of such ,act 7#db ,u4,s4,c4 #aciel7a771 as amended by section #bjg7;b77#c71 is amended-- 7,a7 by striking and at the end of paragraph 7#i72 7,b7 by striking the period at the end of paragraph 7#aj7 and inserting 2 and2 and 7,c7 by adding at the end the following3 7#aa7 in the case of outpatient services furnished by a rural community hospital1 the amounts described in section #ahcd7x74 4 7#c7 ,technical amendments 7,a7 ,consultation with ,state agencies ,section #ahfc of such ,act 7#db ,u4,s4,c4 #aciez7 is amended by striking and 7dd77#b7 and inserting 7dd77#b71 and 7lll77#a74 7,b7 ,provider agreements ,section #ahff7;a77#b77;,a7 of such ,act 7#db ,u4,s4,c4 #acie;cc7a77#b77;,a77 is amended by inserting section #ahcd7x77#b71 after section #ahcc7;b714 7e7 ,effective date ,the amendments made by this section shall apply to items and services furnished on or after ,october #a1 #bjba4 #dah4 ,medicare remote monitoring pilot projects 7a7 ,pilot projects 7#a7 ,in general ,not later than #i months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall conduct pilot projects under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 for the purpose of providing incentives to home health agencies to utilize home monitoring and communications technologies that-- 7,a7 enhance health outcomes for ,medicare beneficiaries2 and 7,b7 reduce expenditures under such title4 7#b7 ,site requirements 7,a7 ,urban and ,rural ,the ,secretary shall conduct the pilot projects under this section in both urban and rural areas4 7,b7 ,site in a small ,state ,the ,secretary shall conduct at least #c of the pilot projects in a ,state with a population of less than #a1jjj1jjj4 7#c7 ,definition of home health agency ,in this section1 the term home health agency has the meaning given that term in section #ahfa7o7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7o774 7b7 ,medicare beneficiaries within the scope of projects ,the ,secretary shall specify the criteria for identifying those ,medicare beneficiaries who shall be considered within the scope of the pilot projects under this section for purposes of the application of subsection 7c7 and for the assessment of the effectiveness of the home health agency in achieving the objectives of this section4 ,such criteria may provide for the inclusion in the projects of ,medicare beneficiaries who begin receiving home health services under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 after the date of the implementation of the projects4 7c7 ,incentives 7#a7 ,performance targets ,the ,secretary shall establish for each home health agency participating in a pilot project under this section a performance target using one of the following methodologies1 as determined appropriate by the ,secretary3 7,a7 ,adjusted historical performance target ,the ,secretary shall establish for the agency-- 7i7 a base expenditure amount equal to the average total payments made to the agency under parts ,a and ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 for ,medicare beneficiaries determined to be within the scope of the pilot project in a base period determined by the ,secretary2 and 7ii7 an annual per capita expenditure target for such beneficiaries1 reflecting the base expenditure amount adjusted for risk and adjusted growth rates4 7,b7 ,comparative performance target ,the ,secretary shall establish for the agency a comparative performance target equal to the average total payments under such parts ,a and ,b during the pilot project for comparable individuals in the same geographic area that are not determined to be within the scope of the pilot project4 7#b7 ,incentive ,subject to paragraph 7#c71 the ,secretary shall pay to each participating home care agency an incentive payment for each year under the pilot project equal to a portion of the ,medicare savings realized for such year relative to the performance target under paragraph 7#a74 7#c7 ,limitation on expenditures ,the ,secretary shall limit incentive payments under this section in order to ensure that the aggregate expenditures under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 7including incentive payments under this subsection7 do not exceed the amount that the ,secretary estimates would have been expended if the pilot projects under this section had not been implemented4 7d7 ,waiver authority ,the ,secretary may waive such provisions of titles ,,xi and ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq42 #db ,u4,s4,c4 #acie et seq47 as the ,secretary determines to be appropriate for the conduct of the pilot projects under this section4 7e7 ,report to ,congress ,not later than #e years after the date that the first pilot project under this section is implemented1 the ,secretary shall submit to ,congress a report on the pilot projects4 ,such report shall contain a detailed description of issues related to the expansion of the projects under subsection 7f7 and recommendations for such legislation and administrative actions as the ,secretary considers appropriate4 7f7 ,expansion ,if the ,secretary determines that any of the pilot projects under this section enhance health outcomes for ,medicare beneficiaries and reduce expenditures under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 the ,secretary may initiate comparable projects in additional areas4 7g7 ,incentive payments have no effect on other ,medicare payments to agencies ,an incentive payment under this section-- 7#a7 shall be in addition to the payments that a home health agency would otherwise receive under title ,,xviii of the ,social ,security ,act for the provision of home health services2 and 7#b7 shall have no effect on the amount of such payments4 #dai4 ,rural ,health ,quality ,advisory ,commission and demonstration projects 7a7 ,rural ,health ,quality ,advisory ,commission 7#a7 ,establishment ,not later than #f months after the date of the enactment of this section1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall establish a commission to be known as the ,rural ,health ,quality ,advisory ,commission 7in this section referred to as the ,commission74 7#b7 ,duties of commission 7,a7 ,national plan ,the ,commission shall develop1 coordinate1 and facilitate implementation of a national plan for rural health quality improvement4 ,the national plan shall-- 7i7 identify objectives for rural health quality improvement2 7ii7 identify strategies to eliminate known gaps in rural health system capacity and improve rural health quality2 and 7iii7 provide recommendations for ,federal programs to identify opportunities for strengthening and aligning policies and programs to improve rural health quality4 7,b7 ,demonstration projects ,the ,commission shall design demonstration projects to recommend to the ,secretary to test alternative models for rural health quality improvement1 including with respect to both personal and population health4 7,c7 ,monitoring ,the ,commission shall monitor progress toward the objectives identified pursuant to subparagraph 7,a77i74 7#c7 ,membership 7,a7 ,number ,the ,commission shall be composed of #aa members appointed by the ,secretary4 7,b7 ,selection ,the ,secretary shall select the members of the ,commission from among individuals with significant rural health care and health care quality expertise1 including expertise in clinical health care1 health care quality research1 population or public health1 or purchaser organizations4 7#d7 ,contracting authority ,subject to the availability of funds1 the ,commission may enter into contracts and make other arrangements1 as may be necessary to carry out the duties described in paragraph 7#b74 7#e7 ,staff ,upon the request of the ,commission1 the ,secretary may detail1 on a reimbursable basis1 any of the personnel of the ,office of ,rural ,health ,policy of the ,health ,resources and ,services ,administration1 the ,agency for ,healthcare ,research and ,quality1 or the ,centers for ,medicare ,medicaid ,services to the ,commission to assist in carrying out this subsection4 7#f7 ,reports to congress ,not later than #a year after the establishment of the ,commission1 and annually thereafter1 the ,commission shall submit a report to the ,congress on rural health quality4 ,each such report shall include the following3 7,a7 ,an inventory of relevant programs and recommendations for improved coordination and integration of policy and programs4 7,b7 ,an assessment of achievement of the objectives identified in the national plan developed under paragraph 7#b7 and recommendations for realizing such objectives4 7,c7 ,recommendations on ,federal legislation1 regulations1 or administrative policies to enhance rural health quality and outcomes4 7b7 ,rural ,health ,quality ,demonstration ,projects 7#a7 ,in general ,not later than #bgj days after the date of the enactment of this section1 the ,secretary1 in consultation with the ,rural ,health ,quality ,advisory ,commission1 the ,office of ,rural ,health ,policy of the ,health ,resources and ,services ,administration1 the ,agency for ,healthcare ,research and ,quality1 and the ,centers for ,medicare ,medicaid ,services1 shall make grants to eligible entities for a total of #e demonstration projects to implement and evaluate methods for improving the quality of health care in rural communities4 ,each such demonstration project shall include-- 7,a7 alternative community models that-- 7i7 will achieve greater integration of personal and population health services2 and 7ii7 address safety1 effectiveness1 patient- or community-centeredness1 timeliness1 efficiency1 and equity 7the #f aims identified by the ,national ,academy of ,medicine 7formerly known as the ,institute of ,medicine7 in its report entitled ,crossing the ,quality ,chasm3 ,a ,new ,health ,system for the #bast ,century released on ,march #a1 #bjja72 7,b7 innovative approaches to the financing and delivery of health services to achieve rural health quality goals2 and 7,c7 development of quality improvement support structures to assist rural health systems and professionals 7such as workforce support structures1 quality monitoring and reporting1 clinical care protocols1 and information technology applications74 7#b7 ,eligible entities ,in this subsection1 the term eligible entity means a consortium that-- 7,a7 shall include-- 7i7 at least one health care provider or health care delivery system located in a rural area2 and 7ii7 at least one organization representing multiple community stakeholders2 and 7,b7 may include other partners such as rural research centers4 7#c7 ,consultation ,in developing the program for awarding grants under this subsection1 the ,secretary shall consult with the ,administrator of the ,agency for ,healthcare ,research and ,quality1 rural health care providers1 rural health care researchers1 and private and nonprofit groups 7including national associations7 which are undertaking similar efforts4 7#d7 ,expedited waivers ,the ,secretary shall expedite the processing of any waiver that-- 7,a7 is authorized under title ,,xviii or ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq42 #db ,u4,s4,c4 #acif et seq472 and 7,b7 is necessary to carry out a demonstration project under this subsection4 7#e7 ,demonstration project sites ,the ,secretary shall ensure that the #e demonstration projects funded under this subsection are conducted at a variety of sites representing the diversity of rural communities in the ,united ,states4 7#f7 ,duration ,each demonstration project under this subsection shall be for a period of #d years4 7#g7 ,independent evaluation ,the ,secretary shall enter into an arrangement with an entity that has experience working directly with rural health systems for the conduct of an independent evaluation of the program carried out under this subsection4 7#h7 ,report ,not later than #a year after the conclusion of all of the demonstration projects funded under this subsection1 the ,secretary shall submit a report to the ,congress on the results of such projects4 ,the report shall include-- 7,a7 an evaluation of patient access to care1 patient outcomes1 and an analysis of the cost effectiveness of each such project2 and 7,b7 recommendations on ,federal legislation1 regulations1 or administrative policies to enhance rural health quality and outcomes4 7c7 ,appropriation 7#a7 ,in general ,out of funds in the ,treasury not otherwise appropriated1 there are appropriated to the ,secretary to carry out this section #cj1jjj1jjj for the period of fiscal years #bjba through #bjbe4 7#b7 ,availability 7,a7 ,in general ,funds appropriated under paragraph 7#a7 shall remain available for expenditure through fiscal year #bjbe4 7,b7 ,report ,for purposes of carrying out subsection 7b77#h71 funds appropriated under paragraph 7#a7 shall remain available for expenditure through fiscal year #bjbf4 7#c7 ,reservation ,of the amount appropriated under paragraph 7#a71 the ,secretary shall reserve-- 7,a7 #e1jjj1jjj to carry out subsection 7a72 and 7,b7 #be1jjj1jjj to carry out subsection 7b71 of which-- 7i7 #b percent shall be for the provision of technical assistance to grant recipients2 and 7ii7 #e percent shall be for independent evaluation under subsection 7b77#g74 #dbj4 ,rural health care services ,section #ccj;,a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c7 is amended to read as follows3 #ccj;,a4 ,rural health care services outreach1 rural health network development1 ,delta rural disparities and health systems development1 and small rural health care provider quality improvement grant programs 7a7 ,purpose ,the purpose of this section is to provide for grants-- 7#a7 under subsection 7b71 to promote rural health care services outreach2 7#b7 under subsection 7c71 to provide for the planning and implementation of integrated health care networks in rural areas2 7#c7 under subsection 7d71 to assist rural communities in the ,delta ,region to reduce health disparities and to promote and enhance health system development2 and 7#d7 under subsection 7e71 to provide for the planning and implementation of small rural health care provider quality improvement activities4 7b7 ,rural health care services outreach grants 7#a7 ,grants ,the ,director of the ,office of ,rural ,health ,policy of the ,health ,resources and ,services ,administration 7referred to in this section as the ,director7 may award grants to eligible entities to promote rural health care services outreach by expanding the delivery of health care services to include new and enhanced services in rural areas4 ,the ,director may award the grants for periods of not more than #c years4 7#b7 ,eligibility ,to be eligible to receive a grant under this subsection for a project1 an entity-- 7,a7 shall be a rural public or rural nonprofit private entity1 a facility that qualifies as a rural health clinic under title ,,xviii of the ,social ,security ,act1 a public or nonprofit entity existing exclusively to provide services to migrant and seasonal farm workers in rural areas1 or a ,tribal government whose grant-funded activities will be conducted within federally recognized ,tribal areas2 7,b7 shall represent a consortium composed of members-- 7i7 that include #c or more independently owned health care entities2 and 7ii7 that may be nonprofit or for-profit entities2 and 7,c7 shall not previously have received a grant under this subsection for the same or a similar project1 unless the entity is proposing to expand the scope of the project or the area that will be served through the project4 7#c7 ,applications ,to be eligible to receive a grant under this subsection1 an eligible entity shall prepare and submit to the ,director an application at such time1 in such manner1 and containing such information as the ,director may require1 including-- 7,a7 a description of the project that the eligible entity will carry out using the funds provided under the grant2 7,b7 a description of the manner in which the project funded under the grant will meet the health care needs of rural populations in the local community or region to be served2 7,c7 a plan for quantifying how health care needs will be met through identification of the target population and benchmarks of service delivery or health status1 such as-- 7i7 quantifiable measurements of health status improvement for projects focusing on health promotion2 or 7ii7 benchmarks of increased access to primary care1 including tracking factors such as the number and type of primary care visits1 identification of a medical home1 or other general measures of such access2 7,d7 a description of how the local community or region to be served will be involved in the development and ongoing operations of the project2 7,e7 a plan for sustaining the project after ,federal support for the project has ended2 7,f7 a description of how the project will be evaluated2 7,g7 the administrative capacity to submit annual performance data electronically as specified by the ,director2 and 7,h7 other such information as the ,director determines to be appropriate4 7c7 ,rural health network development grants 7#a7 ,grants 7,a7 ,in general ,the ,director may award rural health network development grants to eligible entities to promote1 through planning and implementation1 the development of integrated health care networks that have combined the functions of the entities participating in the networks in order to-- 7i7 achieve efficiencies and economies of scale2 7ii7 expand access to1 coordinate1 and improve the quality of the health care delivery system through development of organizational efficiencies2 7iii7 implement health information technology to achieve efficiencies1 reduce medical errors1 and improve quality2 7iv7 coordinate care and manage chronic illness2 and 7v7 strengthen the rural health care system as a whole in such a manner as to show a quantifiable return on investment to the participants in the network4 7,b7 ,grant periods ,the ,director may award such a rural health network development grant-- 7i7 for a period of #c years for implementation activities2 or 7ii7 for a period of #a year for planning activities to assist in the initial development of an integrated health care network1 if the proposed participants in the network do not have a history of collaborative efforts and a #c-year grant would be inappropriate4 7#b7 ,eligibility ,to be eligible to receive a grant under this subsection1 an entity-- 7,a7 shall be a rural public or rural nonprofit private entity1 a facility that qualifies as a rural health clinic under title ,,xviii of the ,social ,security ,act1 a public or nonprofit entity existing exclusively to provide services to migrant and seasonal farm workers in rural areas1 or a ,tribal government whose grant-funded activities will be conducted within federally recognized ,tribal areas2 7,b7 shall represent a network composed of participants-- 7i7 that include #c or more independently owned health care entities2 and 7ii7 that may be nonprofit or for-profit entities2 and 7,c7 shall not previously have received a grant under this subsection 7other than a #a-year grant for planning activities7 for the same or a similar project4 7#c7 ,applications ,to be eligible to receive a grant under this subsection1 an eligible entity1 in consultation with the appropriate ,state office of rural health or another appropriate ,state entity1 shall prepare and submit to the ,director an application at such time1 in such manner1 and containing such information as the ,director may require1 including-- 7,a7 a description of the project that the eligible entity will carry out using the funds provided under the grant2 7,b7 an explanation of the reasons why ,federal assistance is required to carry out the project2 7,c7 a description of-- 7i7 the history of collaborative activities carried out by the participants in the network2 7ii7 the degree to which the participants are ready to integrate their functions2 and 7iii7 how the local community or region to be served will benefit from and be involved in the activities carried out by the network2 7,d7 a description of how the local community or region to be served will experience increased access to quality health care services across the continuum of care as a result of the integration activities carried out by the network1 including a description of-- 7i7 return on investment for the community and the network members2 and 7ii7 other quantifiable performance measures that show the benefit of the network activities2 7,e7 a plan for sustaining the project after ,federal support for the project has ended2 7,f7 a description of how the project will be evaluated2 7,g7 the administrative capacity to submit annual performance data electronically as specified by the ,director2 and 7,h7 other such information as the ,director determines to be appropriate4 7d7 ,delta rural disparities and health systems development grants 7#a7 ,grants ,the ,director may award grants to eligible entities to support reduction of health disparities1 improve access to health care1 and enhance rural health system development in the ,delta ,region4 7#b7 ,eligibility ,to be eligible to receive a grant under this subsection1 an entity shall be a rural public or rural nonprofit private entity1 a facility that qualifies as a rural health clinic under title ,,xviii of the ,social ,security ,act1 a public or nonprofit entity existing exclusively to provide services to migrant and seasonal farm workers in rural areas1 or a ,tribal government whose grant-funded activities will be conducted within federally recognized ,tribal areas4 7#c7 ,applications ,to be eligible to receive a grant under this subsection1 an eligible entity shall prepare and submit to the ,director an application at such time1 in such manner1 and containing such information as the ,director may require1 including-- 7,a7 a description of the project that the eligible entity will carry out using the funds provided under the grant2 7,b7 an explanation of the reasons why ,federal assistance is required to carry out the project2 7,c7 a description of the manner in which the project funded under the grant will meet the health care needs of the ,delta ,region2 7,d7 a description of how the local community or region to be served will experience increased access to quality health care services as a result of the activities carried out by the entity2 7,e7 a description of how health disparities will be reduced or the health system will be improved2 7,f7 a plan for sustaining the project after ,federal support for the project has ended2 7,g7 a description of how the project will be evaluated including process and outcome measures related to the quality of care provided or how the health care system improves its performance2 7,h7 a description of how the grantee will develop an advisory group made up of representatives of the communities to be served to provide guidance to the grantee to best meet community need2 and 7,i7 other such information as the ,director determines to be appropriate4 7e7 ,small rural health care provider quality improvement grants 7#a7 ,grants ,the ,director may award grants to provide for the planning and implementation of small rural health care provider quality improvement activities4 ,the ,director may award the grants for periods of #a to #c years4 7#b7 ,eligibility ,to be eligible for a grant under this subsection1 an entity-- 7,a7 shall be-- 7i7 a rural public or rural nonprofit private health care provider or provider of health care services1 such as a rural health clinic2 or 7ii7 another rural provider or network of small rural providers identified by the ,director as a key source of local care2 and 7,b7 shall not previously have received a grant under this subsection for the same or a similar project4 7#c7 ,preference ,in awarding grants under this subsection1 the ,director shall give preference to facilities that qualify as rural health clinics under title ,,xviii of the ,social ,security ,act4 7#d7 ,applications ,to be eligible to receive a grant under this subsection1 an eligible entity shall prepare and submit to the ,director an application at such time1 in such manner1 and containing such information as the ,director may require1 including-- 7,a7 a description of the project that the eligible entity will carry out using the funds provided under the grant2 7,b7 an explanation of the reasons why ,federal assistance is required to carry out the project2 7,c7 a description of the manner in which the project funded under the grant will assure continuous quality improvement in the provision of services by the entity2 7,d7 a description of how the local community or region to be served will experience increased access to quality health care services as a result of the activities carried out by the entity2 7,e7 a plan for sustaining the project after ,federal support for the project has ended2 7,f7 a description of how the project will be evaluated including process and outcome measures related to the quality of care provided2 and 7,g7 other such information as the ,director determines to be appropriate4 7f7 ,general requirements 7#a7 ,prohibited uses of funds ,an entity that receives a grant under this section may not use funds provided through the grant-- 7,a7 to build or acquire real property2 or 7,b7 for construction4 7#b7 ,coordination with other agencies ,the ,director shall coordinate activities carried out under grant programs described in this section1 to the extent practicable1 with ,federal and ,state agencies and nonprofit organizations that are operating similar grant programs1 to maximize the effect of public dollars in funding meritorious proposals4 7g7 ,report ,not later than ,september #cj1 #bjbb1 the ,secretary shall prepare and submit to the appropriate committees of ,congress a report on the progress and accomplishments of the grant programs described in subsections 7b71 7c71 7d71 and 7e74 7h7 ,definition of ,delta ,region ,in this section1 the term ,delta ,region has the meaning given to the term region in section #chb;,a of the ,consolidated ,farm and ,rural ,development ,act 7#g ,u4,s4,c4 #bjji;aa74 7i7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #dj1jjj1jjj for fiscal year #bjba1 and such sums as may be necessary for each of fiscal years #bjbb through #bjbe4 4 #dba4 ,community health center collaborative access expansion ,section #ccj7r77#d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7r77#d77 is amended-- 7#a7 in subparagraph 7,a71 by striking primary health care services each place it appears and inserting primary health care and other mental1 dental1 and physical health services2 and 7#b7 in subparagraph 7,b7-- 7,a7 in clause 7i71 by striking and at the end2 7,b7 in clause 7ii71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following3 7iii7 in the case of a rural health clinic described in such subparagraph-- 7,i7 that such clinic provides1 to the extent possible1 enabling services1 such as transportation and language assistance 7including translation and interpretation72 and 7,,ii7 that the primary health care and other services described in such subparagraph are subject to full reimbursement according to the prospective payment system for ,federally qualified health center services under section #ahcd7o7 of the ,social ,security ,act4 4 #dbb4 ,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 #dbc4 ,scoring of preventive health savings ,section #bjb of the ,congressional ,budget and ,impoundment ,control ,act of #aigd 7#b ,u4,s4,c4 #fjb7 is amended by adding at the end the following3 7h7 ,scoring of preventive health savings 7#a7 ,determination by the ,director ,upon a request by the chairman or ranking minority member of the ,committee on the ,budget of the ,senate1 or by the chairman or ranking minority member of the ,committee on the ,budget of the ,house of ,representatives1 the ,director shall determine if a proposed measure would result in reductions in budget outlays in budgetary outyears through the use of preventive health and preventive health services4 7#b7 ,projections ,if the ,director determines that a measure would result in substantial reductions in budget outlays as described in paragraph 7#a71 the ,director-- 7,a7 shall include1 in any projection prepared by the ,director1 a description and estimate of the reductions in budget outlays in the budgetary outyears and a description of the basis for such conclusions2 and 7,b7 may prepare a budget projection that includes some or all of the budgetary outyears1 notwithstanding the time periods for projections described in subsection 7e7 and sections #cjh1 #djb1 and #dbd4 7#c7 ,definitions ,as used in this subsection-- 7,a7 the term budgetary outyears means the #b consecutive #aj-year periods beginning with the first fiscal year that is #aj years after the budget year provided for in the most recently agreed to concurrent resolution on the budget2 and 7,b7 the term preventive health means an action that focuses on the health of the public1 individuals1 and defined populations in order to protect1 promote1 and maintain health1 wellness1 and functional ability1 and prevent disease1 disability1 and premature death that is demonstrated by credible and publicly available epidemiological projection models1 incorporating clinical trials or observational studies in humans1 to avoid future health care costs4 4 #dbd4 ,sense of ,congress on ,maintenance of ,effort ,provisions ,regarding ,children's ,health ,it is the sense of the ,congress that-- 7#a7 the maintenance of effort provisions added to sections #aijb and #baje7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a2 #db ,u4,s4,c4 #acig;ee7d77 by sections #bjja7;b7 and #baja7;b7 of the ,patient ,protection and ,affordable ,care ,act were intended to maintain the eligibility standards for the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 and ,children's ,health ,insurance ,program under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig;aa et seq47 until the ,american ,health ,benefit ,exchanges in the ,states are fully operational2 7#b7 it is imperative that the maintenance of effort provisions are enforced to the strict standard intended by the ,congress through ,september #cj1 #bjbg2 7#c7 waiving the maintenance of effort provisions should not be permitted2 7#d7 the maintenance of effort provisions ensure the continued success of the ,medicaid program and ,children's ,health ,insurance ,program and were intended to specifically protect vulnerable and disabled adults1 children1 and senior citizens1 many of whom are also members of communities of color2 and 7#e7 the maintenance of effort provisions must be strictly enforced and proposals to weaken the maintenance of effort provisions must not be considered4 #dbe4 ,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 #dbf4 ,office of ,minority ,health in ,veterans ,health ,administration of ,department of ,veterans ,affairs 7a7 ,establishment and functions ,subchapter ,i of chapter #gc of title #ch1 ,united ,states ,code1 is amended by inserting after section #gcjh the following new section3 #gcjh;,a4 ,office of ,minority ,health 7a7 ,establishment ,there is established in the ,department within the ,office of the ,under ,secretary for ,health an office to be known as the ,office of ,minority ,health 7in this section referred to as the ,office74 7b7 ,head ,the ,director of the ,office of ,minority ,health shall be the head of the ,office4 ,the ,director of the ,office of ,minority ,health shall be appointed by the ,under ,secretary for ,health from among individuals qualified to perform the duties of the position4 7c7 ,functions ,the functions of the ,office are as follows3 7#a7 ,to establish short-range and long-range goals and objectives and coordinate all other activities within the ,veterans ,health ,administration that relate to disease prevention1 health promotion1 health care services delivery1 and health care research concerning veterans who are members of a racial or ethnic minority group4 7#b7 ,to support research1 demonstrations1 and evaluations to test new and innovative models for the discharge of activities described in paragraph 7#a74 7#c7 ,to increase knowledge and understanding of health risk factors for veterans who are members of a racial or ethnic minority group4 7#d7 ,to develop mechanisms that support better health care information dissemination1 education1 prevention1 and services delivery to veterans from disadvantaged backgrounds1 including veterans who are members of a racial or ethnic minority group4 7#e7 ,to enter into contracts or agreements with appropriate public and nonprofit private entities to develop and carry out programs to provide bilingual or interpretive services to assist veterans who are members of a racial or ethnic minority group and who lack proficiency in speaking the ,english language in accessing and receiving health care services through the ,veterans ,health ,administration4 7#f7 ,to carry out programs to improve access to health care services through the ,veterans ,health ,administration for veterans with limited proficiency in speaking the ,english language1 including the development and evaluation of demonstration and pilot projects for that purpose4 7#g7 ,to advise the ,under ,secretary for ,health on matters relating to the development1 implementation1 and evaluation of health professions education in decreasing disparities in health care outcomes between veterans who are members of a racial or ethnic minority group and other veterans1 including cultural competency as a method of eliminating such health disparities4 7#h7 ,to perform such other functions and duties as the ,secretary or the ,under ,secretary for ,health considers appropriate4 7d7 ,definitions ,in this section3 7#a7 ,the term racial or ethnic minority group means any of the following3 7,a7 ,american ,indians 7including ,alaska ,natives1 ,eskimos1 and ,aleuts74 7,b7 ,asian ,americans4 7,c7 ,native ,hawaiians and other ,pacific ,islanders4 7,d7 ,blacks4 7,e7 ,hispanics4 7#b7 ,the term ,hispanic means individuals whose origin is ,mexican1 ,puerto ,rican1 ,cuban1 ,central or ,south ,american1 or any other ,spanish-speaking country4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such subchapter is amended by inserting after the item relating to section #gcjh the following new item3 #gcjh;,a4 ,office of ,minority ,health4 4 #dbg4 ,study of ,,dsh payments to ensure hospital access for low-income patients 7a7 ,in general ,not later than ,january #a1 #bjba1 the ,comptroller ,general of the ,united ,states shall conduct a study on how amendments made by the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 and the ,health ,care and ,education ,reconciliation ,act of #bjaj 7,public ,law #aaa-aeb7 to titles ,,xviii and ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq42 #db ,u4,s4,c4 #acif et seq47 relating to disproportionate share hospital adjustment payments under ,medicare and ,medicaid 7and subsequent amendments made with respect to such payments7 affect the timely access to health care services for low-income patients4 ,such study shall-- 7#a7 evaluate and examine whether ,states electing to make medical assistance available under section #aijb7;a77#aj77;,a77i77,,viii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77i77,,viii77 7including ,states making such an election through a waiver of the ,state plan7 to individuals described in such section mitigate the need for payments to disproportionate share hospitals under section #ahhf7;d77#e77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,f77 and section #aibc of such ,act 7#db ,u4,s4,c4 #acifr-#d71 including the impact of such ,states electing to make medical assistance available to such individuals on-- 7,a7 the number of individuals in the ,united ,states who are without health insurance and the distribution of such individuals in relation to areas primarily served by disproportionate share hospitals2 and 7,b7 the low-income utilization rate of such hospitals and the resulting fiscal sustainability of such hospitals2 7#b7 evaluate the appropriate level and distribution of such payments among such disproportionate share hospitals for purposes of-- 7,a7 sufficiently accounting for the level of uncompensated care provided by such hospitals to low-income patients2 and 7,b7 providing timely access to health services for individuals in medically underserved areas2 and 7#c7 assess1 with respect to such disproportionate share hospitals-- 7,a7 the role played by such hospitals in providing critical access to emergency1 inpatient1 and outpatient health services1 as well as the location of such hospitals in relation to medically underserved areas2 and 7,b7 the extent to which such hospitals satisfy the requirements established for charitable hospital organizations under section #eja7r7 of the ,internal ,revenue ,code of #aihf with respect to community health needs assessments1 financial assistance policy requirements1 limitations on charges1 and billing and collection requirements4 7b7 ,reports 7#a7 ,report to ,congress ,not later than #ahj days after the date on which the study under subsection 7a7 is completed1 the ,comptroller ,general of the ,united ,states shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,finance of the ,senate a report that contains-- 7,a7 the results of the study2 7,b7 recommendations to ,congress for any legislative changes to the payments to disproportionate share hospitals under section #ahhf7;d77#e77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,f77 and section #aibc of such ,act 7#db ,u4,s4,c4 #acifr-#d7 that are needed to ensure access to health services for low-income patients that-- 7i7 are based on the number of individuals without health insurance1 the amount of uncompensated care provided by such hospitals1 and the impact of reduced payment levels on low-income communities2 and 7ii7 takes into account any reports submitted by the ,secretary of the ,treasury1 in consultation with the ,secretary of ,health and ,human ,services1 to congressional committees regarding the costs incurred by charitable hospital organizations for charity care1 bad debt1 nonreimbursed expenses for services provided to individuals under the ,medicare program under title ,,xviii of the ,social ,security ,act and the ,medicaid program under title ,,xix of such ,act1 and any community benefit activities provided by such organizations4 7#b7 ,report to the ,secretary of ,health and ,human ,services ,not later than #ahj days after the date on which the study under subsection 7a7 is completed1 the ,comptroller ,general of the ,united ,states shall submit to the ,secretary of ,health and ,human ,services a report that contains-- 7,a7 the results of the study2 and 7,b7 any recommendations for purposes of assisting in the development of the methodology for the adjustment of payments to disproportionate share hospitals1 as required under section #ahhf7r7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7r77 and the reduction of such payments under section #aibc7;f77#g7 of such ,act 7#db ,u4,s4,c4 #acifr-#d7;f77#g771 taking into account the reports referred to in paragraph 7#a77;,b77ii74 #dbh4 ,assistant ,secretary of the ,indian ,health ,service 7a7 ,references ,any reference in a law1 regulation1 document1 paper1 or other record of the ,united ,states to the ,director of the ,indian ,health ,service shall be deemed to be a reference to the ,assistant ,secretary of the ,indian ,health ,service4 7b7 ,executive ,schedule ,section #ecae of title #e1 ,united ,states ,code1 is amended in the matter relating to the ,assistant ,secretaries of ,health and ,human ,services by striking 7#f7 and inserting 7#g71 one of whom shall be the ,assistant ,secretary of the ,indian ,health ,service4 7c7 ,conforming amendment ,section #ecaf of title #e1 ,united ,states ,code1 is amended by striking ,director1 ,indian ,health ,service1 ,department of ,health and ,human ,services44 #dbi4 ,reauthorization of the ,native ,hawaiian ,health ,care ,improvement ,act 7a7 ,native ,hawaiian health care systems ,section #f7;h77#a7 of the ,native ,hawaiian ,health ,care ,improvement ,act 7#db ,u4,s4,c4 #aagje7;h77#a77 is amended by striking may be necessary for fiscal years #aiic through #bjai and inserting are necessary4 7b7 ,administrative grant for papa ola lokahi ,section #g7;b7 of the ,native ,hawaiian ,health ,care ,improvement ,act 7#db ,u4,s4,c4 #aagjf7;b77 is amended by striking may be necessary for fiscal years #aiic through #bjai and inserting are necessary4 7c7 ,native ,hawaiian health scholarships ,section #aj7;c7 of the ,native ,hawaiian ,health ,care ,improvement ,act 7#db ,u4,s4,c4 #aagji7;c77 is amended by striking may be necessary for fiscal years #aiic through #bjai and inserting are necessary4 #dcj4 ,availability of non-,english language speaking providers 7a7 ,in general ,section #acaa7;c77#a77;,b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77#a77;,b77 is amended by inserting before the semicolon the following3 and the ability of such provider to provide care in a language other than ,english either through the provider speaking such language or by the provider having a qualified interpreter for an individual with limited ,english proficiency 7as defined in section #cdjj of such ,act7 who speaks such language available during office hours4 7b7 ,effective date ,the amendment made by subsection 7a7 shall not apply to any plan beginning on or prior to the date that is #a year after the date of the enactment of this ,act4 #dca4 ,access to essential community providers 7a7 ,essential community providers ,section #acaa7;c77#a77;,c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77#a77;,c77 is amended-- 7#a7 by inserting 7i7 after 7,c72 and 7#b7 by adding at the end the following new clauses3 7ii7 not later than ,january #a1 #bjba1 increase the percentage of essential community providers as described in clause 7i7 included in its network by #aj percent annually 7based on the level in the plan for #bjaf7 until #ij percent of all federally qualified health centers and #ge percent of all other such essential community providers in the contract service area are in-network2 and 7iii7 include at least one essential community provider in each of the essential community provider categories described in section #aef4bce7;a77#b77;ii77,b7 of title #de1 ,code of ,federal ,regulations 7as in effect on the date of enactment of the ,health ,equity and ,accountability ,act of #bjbj71 in each county in the service area1 where available2 4 7b7 ,reporting requirements ,section #acaa7;e77#c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;e77#c77 is amended by adding at the end the following new subparagraph3 7,e7 ,data on essential community providers ,the ,secretary shall require qualified health plans to submit annually to the ,secretary data on the percentage of essential community providers as described in clause 7ii7 of subsection 7c77#a77;,c71 by county1 that contract with each qualified health plan offered in that county and the percentage of such essential community providers1 by category as described in clause 7iii7 of such subsection1 that contract with each qualified health plan offered in that county4 ,such data shall be made available to the general public4 4 7c7 ,essential ,community ,provider provisions applied under ,medicare and ,medicaid 7#a7 ,medicare ,section #aheb7;d77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;d77#a77 is amended-- 7,a7 by striking and at the end of subparagraph 7,d72 7,b7 by striking the period at the end of subparagraph 7,e7 and inserting 2 and2 and 7,c7 by adding at the end the following new subparagraph3 7,f7 the plan meets the requirements of clauses 7ii7 and 7iii7 of section #acaa7;c77#a77;,c7 of the ,patient ,protection and ,affordable ,care ,act 7relating to inclusion in networks of essential community providers74 4 7#b7 ,medicaid ,section #aicb7;b77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;b77#e77 is amended-- 7,a7 by striking and at the end of subparagraph 7,a72 7,b7 by striking the period at the end of subparagraph 7,b7 and inserting 2 and2 and 7,c7 by adding at the end the following new subparagraph3 7,c7 meets the requirements of clauses 7ii7 and 7iii7 of section #acaa7;c77#a77;,c7 of the ,patient ,protection and ,affordable ,care ,act 7relating to inclusion in networks of essential community providers7 with respect to services offered in the service area involved4 4 #dcb4 ,provider network adequacy in communities of color 7a7 ,in general ,section #acaa7;c77#a77;,b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77#a77;,b771 as amended by section #dcj7;a71 is further amended-- 7#a7 by inserting 7i7 after 7,b72 and 7#b7 by adding at the end the following new clauses3 7ii7 meet such network adequacy standards as the ,secretary may establish with regard to-- 7,i7 appointment wait time2 7,,ii7 travel time and distance to health care provider facilities and providers by public and private transit2 7,,iii7 hours of operation to accommodate individuals who cannot come to provider appointments during standard business hours2 and 7,,iv7 other network adequacy standards to ensure that care through these plans is accessible to diverse communities1 including individuals with limited ,english proficiency as defined in section #cdjj of such ,act2 and 7iii7 provide coverage for services for enrollees through out-of-network providers at no additional cost to the enrollees in cases where in-network providers are unable to comply with the standards established under subclause 7,,iii7 or 7,,iv7 of clause 7ii7 for such services and the out-of-network providers can deliver such services in compliance with such standards4 7b7 ,effective date ,the amendments made by subsection 7a7 shall not apply to plans beginning on or prior to the date that is #a year after the date of the enactment of the ,health ,equity and ,accountability ,act of #bjbj4 4 #dcc4 ,improving access to dental care 7a7 ,reports to ,congress 7#a7 ,,gao reports ,not later than #a year after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress-- 7,a7 a report on the ,alaska ,dental ,health ,aide ,therapists program and the ,dental ,therapist and ,advanced ,dental ,therapist programs in ,minnesota1 to assess the effectiveness of dental therapists in-- 7i7 improving access to timely dental care among communities of color2 7ii7 providing high-quality care2 7iii7 providing culturally competent care2 and 7iv7 providing accessible care to people with disabilities2 7,b7 a report on ,state variations in the use of dental hygienists and the effectiveness of expanding the scope of practice for dental hygienists in-- 7i7 improving access to timely dental care among communities of color2 7ii7 providing high-quality care2 7iii7 providing culturally competent care2 and 7iv7 providing accessible care to people with disabilities2 and 7,c7 a report on the use of telehealth services to enhance services provided by dental hygienists and therapists1 including recommendations for any modifications to the ,medicare program under title ,,xviii of the ,social ,security ,act and the ,medicaid program under title ,,xix of such ,act to better provide for telehealth consultations in conjunction with therapists' and hygienists' care4 7#b7 ,,hrsa report on dental shortage areas ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall submit to ,congress a report which details geographic dental access shortages and the preparedness of dental providers to offer culturally and linguistically appropriate1 affordable1 accessible1 and timely services4 7b7 ,expansion of dental health aid therapists in ,tribal communities ,section #aai7;d7 of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afafl7d77 is amended-- 7#a7 in paragraph 7#b71 by striking ,subject to and all that follows and inserting ,subject to paragraph 7#c71 in establishing a national program under paragraph 7#a71 the ,secretary shall not reduce the amounts provided for the ,community ,health ,aide ,program described in subsections 7a7 and 7b742 7#b7 by striking paragraph 7#c72 and 7#c7 by redesignating paragraph 7#d7 as paragraph 7#c74 7c7 ,coverage of dental services under the ,medicare program 7#a7 ,coverage ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is amended-- 7,a7 in subparagraph 7,,gg71 by striking and at the end2 7,b7 in subparagraph 7,,hh71 by striking the period and inserting 2 and2 and 7,c7 by adding at the end the following new subparagraph3 7,,ii7 oral health services 7as defined in subsection 7mmm772 4 7#b7 ,oral health services defined ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 as amended by sections #bjg7;b77#a7 and #dag7;a71 is amended by adding at the end the following new subsection3 7mmm7 ,oral ,health ,services 7#a7 ,the term oral health services means services 7as defined by the ,secretary7 that are necessary to prevent disease and promote oral health1 restore oral structures to health and function1 and treat emergency conditions4 7#b7 ,for purposes of paragraph 7#a71 such term shall include mobile and portable oral health services 7as defined by the ,secretary7 that-- 7,a7 are provided for the purpose of overcoming mobility1 transportation1 and access barriers for individuals2 and 7,b7 satisfy the standards and certification requirements established under section #aijb7;a77#hb77;,b7 for the ,state in which the services are provided4 4 7#c7 ,payment and coinsurance ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7,a7 by striking and before 7,,dd72 and 7,b7 by inserting before the semicolon at the end the following3 1 and 7,,ee7 with respect to oral health services 7as defined in section #ahfa7mmm771 the amount paid shall be 7i7 in the case of such services that are preventive1 #ajj percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section #ahdh1 and 7ii7 in the case of all other such services1 #hj percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section #ahdh4 7#d7 ,payment under physician fee schedule ,section #ahdh7;j77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c77 is amended by inserting 7#b77;,,ii71 after risk assessment714 7#e7 ,dentures ,section #ahfa7s77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#h77 is amended-- 7,a7 by striking 7other than dental7 and inserting 7including dentures72 and 7,b7 by striking internal body4 7#f7 ,repeal of ground for exclusion ,section #ahfb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7 is amended by striking paragraph 7#ab74 7#g7 ,effective date ,the amendments made by this section shall apply to services furnished on or after ,january #a1 #bjba4 7d7 ,coverage of dental services under the ,medicaid program 7#a7 ,in general ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7,a7 in subsection 7a77#aj71 by striking dental services and inserting oral health services 7as defined in subsection 7gg77#a772 and 7,b7 by adding at the end the following new subsection3 7gg7 7#a7 ,subject to paragraphs 7#b7 and 7#c71 for purposes of this title1 the term oral health services means services 7as defined by the ,secretary7 that are necessary to prevent disease and promote oral health1 restore oral structures to health and function1 and treat emergency conditions4 7#b7 ,for purposes of paragraph 7#a71 such term shall include-- 7,a7 dentures2 and 7,b7 mobile and portable oral health services 7as defined by the ,secretary7 that-- 7i7 are provided for the purpose of overcoming mobility1 transportation1 and access barriers for individuals2 and 7ii7 satisfy the standards and certification requirements established under section #aijb7;a77#hg77;,c7 for the ,state in which the services are provided4 7#c7 ,for purposes of paragraph 7#a71 such term shall not include dental care or services provided to individuals under the age of #ba under subsection 7r77#c74 4 7#b7 ,conforming amendments 7,a7 ,state plan requirements ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77 is amended-- 7i7 in paragraph 7#aj77;,a71 in the matter preceding clause 7i71 by inserting 7#aj71 after 7#e712 7ii7 in paragraph 7#he71 by striking and at the end2 7iii7 in paragraph 7#hf71 by striking the period at the end and inserting 2 and2 and 7iv7 by inserting after paragraph 7#hf7 the following3 7#hg7 provide for-- 7,a7 informing1 in writing1 all individuals who have been determined to be eligible for medical assistance of the availability of oral health services 7as defined in section #aije7;gg772 7,b7 conducting targeted outreach to pregnant women who have been determined to be eligible for medical assistance about the availability of medical assistance for such dental services and the importance of receiving dental care while pregnant2 and 7,c7 establishing and maintaining standards for and certification of mobile and portable oral health services 7as described in subsections 7r77#c77;,c7 and 7gg77#b77;,b7 of section #aije74 4 7,b7 ,definition of medical assistance ,section #aije7;a77#ab7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77#ab77 is amended by striking 1 dentures14 7#c7 ,mobile and portable oral health services under ,,epsdt ,section #aije7r77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7r77#c77 is amended-- 7,a7 in subparagraph 7,a77ii71 by striking 2 and and inserting a semicolon2 7,b7 in subparagraph 7,b71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following new subparagraph3 7,c7 which shall include mobile and portable oral health services 7as defined by the ,secretary7 that-- 7i7 are provided for the purpose of overcoming mobility1 transportation1 or access barriers for children2 and 7ii7 satisfy the standards and certification requirements established under section #aijb7;a77#hg77;,c7 for the ,state in which the services are provided4 4 7e7 ,oral health services as an essential health benefit ,section #acjb7;b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;b77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 in subparagraph 7,j71 by striking oral and2 and 7,b7 by adding at the end the following3 7,k7 ,oral health services for children and adults4 2 and 7#b7 by adding at the end the following3 7#f7 ,oral health services ,for purposes of paragraph 7#a77,k71 the term oral health services means services 7as defined by the ,secretary7 that are necessary to prevent any oral disease and promote oral health1 restore oral structures to health and function1 and treat emergency oral conditions4 4 7f7 ,demonstration program on training and employment of alternative dental health care providers for dental health care services for veterans in rural and other underserved communities 7#a7 ,demonstration program authorized ,the ,secretary of ,veterans ,affairs may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to increase access to dental health care services for veterans who are entitled to such services from the ,department of ,veterans ,affairs and reside in rural and other underserved communities4 7#b7 ,telehealth ,for purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care1 dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible4 7#c7 ,alternative dental health care providers defined ,in this subsection1 the term alternative dental health care providers has the meaning given that term in section #cdj;,g-#a7;a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;g-#a7;a77#b774 7#d7 ,authorization of appropriations ,there are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection4 7g7 ,demonstration program on training and employment of alternative dental health care providers for dental health care services for members of the ,armed ,forces and dependents lacking ready access to such services 7#a7 ,demonstration program authorized ,the ,secretary of ,defense may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to increase access to dental health care services for members of the ,armed ,forces and their dependents who lack ready access to such services1 including the following3 7,a7 ,members and dependents who reside in rural areas or areas otherwise underserved by dental health care providers4 7,b7 ,members of a reserve component of the ,armed ,forces in active status who are potentially deployable4 7#b7 ,telehealth ,for purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care1 dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible4 7#c7 ,definitions ,in this subsection3 7,a7 ,active status ,the term active status has the meaning given that term in section #aja7;d7 of title #aj1 ,united ,states ,code4 7,b7 ,alternative dental health care providers ,the term alternative dental health care providers has the meaning given that term in section #cdj;,g-#a7;a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;g-#a7;a77#b774 7#d7 ,authorization of appropriations ,there are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection4 7h7 ,demonstration program on training and employment of alternative dental health care providers for dental health care services for prisoners within the custody of the bureau of prisons 7#a7 ,demonstration program authorized ,the ,attorney ,general1 acting through the ,director of the ,bureau of ,prisons1 may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to increase access to dental health services for prisoners within the custody of the ,bureau of ,prisons4 7#b7 ,telehealth ,for purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care1 dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible4 7#c7 ,alternative dental health care providers defined ,in this subsection and subsection 7i71 the term alternative dental health care providers has the meaning given that term in section #cdj;,g-#a7;a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;g-#a7;a77#b774 7#d7 ,authorization of appropriations ,there are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection4 7i7 ,demonstration program on training and employment of alternative dental health care providers for dental health care services under the indian health service 7#a7 ,demonstration program authorized ,the ,secretary of ,health and ,human ,services1 acting through the ,indian ,health ,service1 may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to help eliminate oral health disparities and increase access to dental services through health programs operated by the ,indian ,health ,service1 ,indian tribes1 tribal organizations1 and urban ,indian organizations 7as the preceding #c terms are defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc774 7#b7 ,telehealth ,for purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care1 dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible4 7#c7 ,authorization of appropriations ,there are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection4 #dcd4 ,providing for a special enrollment period for pregnant individuals 7a7 ,public health service act ,section #bgjb7;b77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#a7;b77#b77 is amended by inserting including a special enrollment period for pregnant individuals1 beginning on the date on which the pregnancy is reported to the health insurance issuer before the period at the end4 7b7 ,patient protection and affordable care act ,section #acaa7;c77#f7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77#f77 is amended-- 7#a7 in subparagraph 7,c71 by striking and at the end2 7#b7 by redesignating subparagraph 7,d7 as subparagraph 7,e72 and 7#c7 by inserting after subparagraph 7,c7 the following new subparagraph3 7,d7 a special enrollment period for pregnant individuals1 beginning on the date on which the pregnancy is reported to the ,exchange2 and 4 7c7 ,special enrollment periods 7#a7 ,internal revenue code ,section #ihja7;f7 of the ,internal ,revenue ,code of #aihf 7#bf ,u4,s4,c4 #ihja7;f77 is amended by adding at the end the following new paragraph3 7#d7 ,for pregnant individuals 7,a7 ,a group health plan shall permit an employee who is eligible1 but not enrolled1 for coverage under the terms of the plan 7or a dependent of such an employee if the dependent is eligible1 but not enrolled1 for coverage under such terms7 to enroll for coverage under the terms of the plan upon pregnancy1 with the special enrollment period beginning on the date on which the pregnancy is reported to the group health plan or the pregnancy is confirmed by a health care provider4 7,b7 ,the ,secretary shall promulgate regulations with respect to the special enrollment period under subparagraph 7,a71 including establishing a time period for pregnant individuals to enroll in coverage and effective date of such coverage4 4 7#b7 ,,erisa ,section #gja7;f7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaha7;f77 is amended by adding at the end the following3 7#d7 ,for pregnant individuals 7,a7 ,a group health plan1 and a health insurance issuer offering group health insurance coverage in connection with a group health plan1 shall permit an employee who is eligible1 but not enrolled1 for coverage under the terms of the plan 7or a dependent of such an employee if the dependent is eligible1 but not enrolled1 for coverage under such terms7 to enroll for coverage under the terms of the plan upon pregnancy1 with the special enrollment period beginning on the date on which the pregnancy is reported to the group health plan or health insurance issuer or the pregnancy is confirmed by a health care provider4 7,b7 ,the ,secretary shall promulgate regulations with respect to the special enrollment period under subparagraph 7,a71 including establishing a time period for pregnant individuals to enroll in coverage and effective date of such coverage4 4 7d7 ,effective date ,the amendments made by this section shall apply with respect to plan years beginning on or after ,january #a1 #bjbb4 #dce4 ,coverage of maternity care for dependent children ,section #bgai;,a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ai;a7 is amended by adding at the end the following3 7e7 ,coverage of maternity care ,a group health plan1 or health insurance issuer offering group or individual health insurance coverage1 that provides coverage for dependants shall ensure that such plan or coverage includes coverage for maternity care associated with pregnancy1 childbirth1 and postpartum care for all participants1 beneficiaries1 or enrollees1 including dependants1 including coverage of labor and delivery4 ,such coverage shall be provided to all pregnant dependents regardless of age4 4 #dcf4 ,federal ,employee ,health ,benefit ,plans 7a7 ,coverage of pregnancy 7#a7 ,in general ,the ,director of the ,office of ,personnel ,management shall issue such regulations as are necessary to ensure that pregnancy is considered a change in family status and a qualifying life event for an individual who is eligible to enroll1 but is not enrolled1 in a health benefit plan under chapter #hi of title #e1 ,united ,states ,code4 7#b7 ,effective date ,the requirement in paragraph 7#a7 shall apply with respect to any contract entered into under section #hijb of such title beginning #ab months after the date of enactment of this ,act4 7b7 ,designating certain ,,fehbp-,related services as excepted services under the anti-,deficiency act 7#a7 ,in general ,section #hije of title #e1 ,united ,states ,code1 is amended by adding at the end the following3 7i7 ,any services by an officer or employee under this chapter relating to enrolling individuals in a health benefits plan under this chapter1 or changing the enrollment of an individual already so enrolled due to an event described in section #dcf7;a77#a7 of the ,health ,equity and ,accountability ,act of #bjbj1 shall be deemed1 for purposes of section #acdb of title #ca1 services for emergencies involving the safety of human life or the protection of property4 4 7#b7 ,application ,the amendment made by paragraph 7#a7 shall apply to any lapse in appropriations beginning on or after the date of enactment of this ,act4 #dcg4 ,continuation of ,medicaid income eligibility standard for pregnant individuals and infants ,section #aijb7l77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7l77#b77;,a77 is amended-- 7#a7 in clause 7i71 by striking and not more than #ahe percent2 7#b7 in clause 7ii7-- 7,a7 in subclause 7,i71 by striking and after the comma2 7,b7 in subclause 7,,ii71 by striking the period at the end and inserting 1 and2 and 7,c7 by adding at the end the following3 7,,iii7 ,january #a1 #bjba1 is the percentage provided under clause 7v74 2 and 7#c7 by adding at the end the following new clause3 7v7 ,the percentage provided under clause 7ii7 for medical assistance provided on or after ,january #a1 #bjba1 with respect to individuals described in subparagraph 7,a7 or 7,b7 of paragraph 7#a7 shall not be less than-- 7,i7 the percentage specified for such individuals by the ,state in an amendment to its ,state plan 7whether approved or not7 as of ,january #a1 #bjad2 or 7,,ii7 if no such percentage is specified as of ,january #a1 #bjad1 the percentage established for such individuals under the ,state's authorizing legislation or provided for under the ,state's appropriations as of that date4 4 ,c ,advancing ,health ,equity ,through ,payment and ,delivery ,reform #dda4 ,sense of ,congress ,it is the sense of ,congress that-- 7#a7 the sustainability of the health care system in the ,united ,states hinges on restructuring how health care is paid for1 shifting away from paying for the volume of services provided to the value the services provide2 7#b7 high value care is care that provides higher quality care more efficiently1 achieving greater health improvement and better health outcomes at lower cost 7per patient and overall72 7#c7 a high value health care system must deliver timely1 accessible1 well-coordinated1 high-quality1 culturally centered1 and language-appropriate care to everyone2 7#d7 eliminating health disparities and achieving health equity must be central to efforts to achieve a high value health care system2 7#e7 eliminating such disparities and achieving such equity will require tailored interventions and targeted investments to address inequities in health and health care to make sure that health care delivery and payment efforts are responsive to and inclusive of the needs of communities of color and other communities experiencing disparities2 and 7#f7 new models of value-based payment and care delivery should consider the holistic needs of and other factors with respect to the patient population1 including with respect to behavioral health1 oral health1 history of adverse childhood experiences and adverse community environments1 social determinants of health1 social risk factors1 unmet social needs1 and the burden of intergenerational racial and other inequities4 #ddb4 ,centers for ,medicare ,medicaid ,services reporting and value based programs 7a7 ,advancing ,health ,equity in ,reporting and ,value ,based ,payment ,programs 7#a7 ,in general ,the ,administrator of the ,centers for ,medicare ,medicaid ,services 7in this section referred to as the ,administrator7 shall require that a clinician or other professional participating in any pay-for-reporting or value based payment program stratify clinical quality measures by disparity variables1 including race1 ethnicity1 sex1 primary language1 disability status1 sexual orientation1 gender identity1 and socioeconomic status4 ,a clinician or other professional may use existing demographic data collection fields in certified electronic health record technology 7as defined in section #ahdh7o77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#d777 to carry out such data stratification under the preceding sentence4 ,such stratified data will assist clinicians and other professionals in the identification of disparities obscured in aggregated data and assist with the provision of interventions that target reducing those disparities4 7#b7 ,clinician ,in assessing performance in any value-based payment program1 the ,administrator shall incorporate a clinician or other professional's performance in reducing disparities across race1 ethnicity1 sex1 primary language1 disability status1 sexual orientation1 gender identity1 and socioeconomic status4 ,linking performance payments to the reduction of health care disparities across such variables will assist in holding clinicians and other professionals accountable for providing quality care that can lead to decreased health inequities4 7#c7 ,requirement of adoption of cert ,all entities1 clinicians1 or other professionals participating in the ,quality ,payment ,program of the ,centers for ,medicare ,medicaid ,services shall be required to adopt #bjae certified electronic health record technology 7as so defined7 as a condition of participating in such program4 7b7 ,quality improvement activities ,the ,administrator1 upon yearly review of the ,quality ,payment ,program1 shall add quality improvement activities that implement the ,culturally and ,linguistically ,accessible ,standards 7,,clas7 as ,improvement ,activities under the ,quality ,payment ,program4 #ddc4 ,development and testing of disparity reducing delivery and payment models 7a7 ,in general ,the ,center for ,medicare and ,medicaid ,innovation established under section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7 7in this section referred to as the ,,cmi7 shall establish a dedicated fund to identify1 test1 evaluate1 and scale delivery and payment models under the applicable titles 7as defined in subsection 7a77#d77;,b7 of such section7 that target health disparities among racial and ethnic minorities1 including models that support high-value non-medical services that address socially determined barriers to health1 including ,english proficiency status1 low health literacy1 case management1 transportation1 enrollment assistance needs1 stable and affordable housing1 utility assistance1 employment and career development1 and nutrition and food security which will help to reduce disparities and impact the overall cost of care4 7b7 ,amendment to ,social ,security ,act ,the second sentence of section #aaae;,a7a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7a77#a77 is amended by inserting and improve health equity after expenditures4 7c7 ,pilot programs ,the ,,cmi shall prioritize the testing of models under such section #aaae;,a that include partnerships with entities1 including community based organizations or other nonprofit entities1 to help address socially determined barriers to health and health care4 7d7 ,alternatives ,any model tested by the ,,cmi under such #aaae;,a shall include measures to assess and track the impact of the model on health disparities1 using existing measures such as the ,healthcare ,disparities and ,cultural ,competency ,measures endorsed by the entity with a contract under section #ahij7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7a771 and stratified by race1 ethnicity1 ,english proficiency1 gender identity1 sexual orientation1 and disability status4 #ddd4 ,diversity in ,centers for ,medicare and ,medicaid consultation 7a7 ,in general ,in carrying out the duties under this section1 the ,,cmi shall consult representatives of relevant ,federal agencies1 and clinical and analytical experts with expertise in medicine and health care management1 specifically such experts with expertise in-- 7#a7 the health care needs of minority1 rural1 and underserved populations2 and 7#b7 the financial needs of safety net1 community based1 rural1 and critical access providers1 including federally qualified health centers4 7b7 ,open door forums ,the ,,cmi shall use open door forums or other mechanisms to seek external feedback from interested parties and incorporate that feedback into the development of models4 #dde4 ,supporting safety net and community-based providers to compete in value-based payment systems 7a7 ,in general ,any pay-for-performance or alternative payment model that is developed and tested by the ,center for ,medicare and ,medicaid ,innovation established under section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a71 or any other agency of the ,department of ,health and ,human ,services with respect to the programs under titles ,,xviii1 ,,xix1 or ,,xxi of such ,act1 shall be assessed for potential impact on safety net1 community based1 and critical access providers1 including ,federally qualified health centers4 7b7 ,new models ,the rollout of any such models shall include training and additional up front resources for community based and safety net providers to enable those providers to participate in the model4 ,d ,health ,empowerment ,zones #dea4 ,short title ,this subtitle may be cited as the ,health ,empowerment ,zone ,act of #bjbj4 #deb4 ,findings ,congress finds the following3 7#a7 ,numerous studies and reports1 including the #bjae ,national ,healthcare ,quality and ,disparities ,report of the ,agency for ,healthcare ,research and ,quality and the #bjjb report of the ,institute of ,medicine entitled ,unequal ,treatment3 ,confronting ,racial and ,ethnic ,disparities in ,health ,care1 document the extensiveness to which health disparities exist across the country4 7#b7 ,these studies have found that1 on average1 racial and ethnic minorities are disproportionately afflicted with chronic and acute conditions--such as cancer1 diabetes1 musculoskeletal disease1 obesity1 and hypertension--and suffer worse health outcomes1 worse health status1 and higher mortality rates than their ,white counterparts4 7#c7 ,several recent studies also show that health disparities are a function of not only access to health care1 but also the social determinants of health--including the environment1 the physical structure of communities1 nutrition and food options1 educational attainment and health literacy1 employment1 race1 ethnicity1 immigration status1 geography1 and language preference--that directly and indirectly affect the health1 health care1 and wellness of individuals and communities4 7#d7 ,integrally involving and fully supporting the communities most affected by health inequities in the assessment1 planning1 launch1 and evaluation of health disparity elimination efforts are among the leading recommendations made to adequately address and ultimately reduce health disparities4 7#e7 ,recommendations also include supporting the efforts of community stakeholders from a broad cross section--including local businesses1 local departments of commerce1 education1 labor1 urban planning1 and transportation1 and community-based and other nonprofit organizations1 including national and regional intermediaries with demonstrated capacity to serve low-income urban communities--to find areas of common ground around health disparity elimination and collaborate to improve the overall health and wellness of a community and its residents4 #dec4 ,designation of health empowerment zones 7a7 ,in general ,the ,secretary may1 at the request of an eligible community partnership described in subsection 7b77#a71 designate an eligible area described in subsection 7b77#b7 as a health empowerment zone for the purpose of eligibility for a grant under section #dee4 7b7 ,eligibility criteria 7#a7 ,eligible community partnership ,a community partnership is eligible to submit a request under this section if the partnership-- 7,a7 demonstrates widespread public support from key individuals and entities in the eligible area1 including members of the target community1 ,state and local governments1 nonprofit organizations including national and regional intermediaries with demonstrated capacity to serve low-income urban communities1 and community and industry leaders1 for designation of the eligible area as a health empowerment zone2 and 7,b7 includes representatives of-- 7i7 a broad cross section of stakeholders and residents from communities in the eligible area experiencing disproportionate disparities in health status and health care2 and 7ii7 organizations1 facilities1 and institutions that have a history of working within and serving such communities4 7#b7 ,eligible area ,an area is eligible to be designated as a health empowerment zone under this section if one or more communities in the area experience disproportionate disparities in health status and health care4 ,in determining whether a community experiences such disparities1 the ,secretary shall consider data collected by the ,department of ,health and ,human ,services focusing on the following areas3 7,a7 ,access to affordable1 high-quality health services4 7,b7 ,the prevalence of disproportionate rates of certain illnesses or diseases including the following3 7i7 ,arthritis1 osteoporosis1 chronic back conditions1 and other musculoskeletal diseases4 7ii7 ,cancer4 7iii7 ,chronic kidney disease4 7iv7 ,diabetes4 7v7 ,injury 7intentional and unintentional74 7vi7 ,violence 7intimate and nonintimate74 7vii7 ,maternal and paternal illnesses and diseases4 7viii7 ,infant mortality4 7ix7 ,mental illness and other disabilities4 7x7 ,substance use disorder treatment and prevention1 including underage drinking4 7xi7 ,nutrition1 obesity1 and overweight conditions4 7xii7 ,heart disease4 7xiii7 ,hypertension4 7xiv7 ,cerebrovascular disease or stroke4 7xv7 ,tuberculosis4 7xvi7 ,,hiv_/,,aids and other sexually transmitted infections4 7xvii7 ,viral hepatitis4 7xviii7 ,asthma4 7xix7 ,tooth decay and other oral health issues4 7,c7 ,within the community1 the historical and persistent presence of conditions that have been found to contribute to health disparities including any such conditions respecting any of the following3 7i7 ,poverty4 7ii7 ,educational status and the quality of community schools4 7iii7 ,income4 7iv7 ,access to high-quality affordable health care4 7v7 ,work and work environment4 7vi7 ,environmental conditions in the community1 including with respect to clean water1 clean air1 and the presence or absence of pollutants4 7vii7 ,language and ,english proficiency4 7viii7 ,access to affordable healthy food4 7ix7 ,access to ethnically and culturally diverse health and human service providers and practitioners4 7x7 ,access to culturally and linguistically competent health and human services and health and human service providers4 7xi7 ,health-supporting infrastructure4 7xii7 ,health insurance that is adequate and affordable4 7xiii7 ,race1 racism1 and bigotry 7conscious and unconscious74 7xiv7 ,sexual orientation4 7xv7 ,health literacy4 7xvi7 ,place of residence 7such as urban areas1 rural areas1 and reservations of ,indian tribes74 7xvii7 ,stress4 7c7 ,procedure 7#a7 ,request ,a request under subsection 7a7 shall-- 7,a7 describe the bounds of the area to be designated as a health empowerment zone and the process used to select those bounds2 7,b7 demonstrate that the partnership submitting the request is an eligible community partnership described in subsection 7b77#a72 7,c7 demonstrate that the area is an eligible area described in subsection 7b77#b72 7,d7 include a comprehensive assessment of disparities in health status and health care experience by one or more communities in the area2 7,e7 set forth-- 7i7 a vision and a set of values for the area2 and 7ii7 a comprehensive and holistic set of goals to be achieved in the area through designation as a health empowerment zone2 and 7,f7 include a strategic plan and an action plan for achieving the goals described in subparagraph 7,e77ii74 7#b7 ,approval ,not later than #fj days after the receipt of a request for designation of an area as a health empowerment zone under this section1 the ,secretary shall approve or disapprove the request4 7d7 ,minimum number ,the ,secretary-- 7#a7 shall designate not more than #aaj health empowerment zones under this section2 and 7#b7 of such zones designated under paragraph 7#a71 shall designate at least one health empowerment zone in each of the several ,states1 the ,district of ,columbia1 and each territory or possession of the ,united ,states4 #ded4 ,assistance to those seeking designation ,at the request of any organization or entity seeking to submit a request under section #dec7;a71 the ,secretary shall provide technical assistance1 and may award a grant1 to assist such organization or entity-- 7#a7 to form an eligible community partnership described in section #dec7;b77#a72 7#b7 to complete a health assessment1 including an assessment of health disparities under section #dec7;c77#a77;,d72 or 7#c7 to prepare and submit a request1 including a strategic plan1 in accordance with section #dec4 #dee4 ,benefits of designation 7a7 ,priority ,in awarding a grant under subsection 7b71 a ,federal official shall give priority to any applicant that-- 7#a7 meets the eligibility criteria for the grant2 7#b7 proposes to use the grant for activities in a health empowerment zone2 and 7#c7 demonstrates that such activities will directly and significantly further the goals of the strategic plan approved for such zone under section #dec4 7b7 ,grants for initial implementation of strategic plan 7#a7 ,in general ,upon designating an eligible area as a health empowerment zone at the request of an eligible community partnership1 the ,secretary shall1 subject to the availability of appropriations1 make a grant to the community partnership for implementation of the strategic plan for such zone4 7#b7 ,grant period ,a grant under paragraph 7#a7 for a health empowerment zone shall be for a period of #b years and may be renewed1 except that the total period of grants under paragraph 7#a7 for such zone may not exceed #aj years4 7#c7 ,limitation ,in awarding grants under this subsection1 the ,secretary shall not give less priority to an applicant or reduce the amount of a grant because the ,secretary rendered technical assistance or made a grant to the same applicant under section #ded4 7#d7 ,reporting ,the ,secretary shall establish metrics for measuring the progress of grantees under this subsection and1 based on such metrics1 require each such grantee to report to the ,secretary not less than every #f months on the progress in implementing the strategic plan for the health empowerment zone4 #def4 ,definition of ,secretary ,in this subtitle1 the term ,secretary means the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,health ,resources and ,services ,administration and the ,deputy ,assistant ,secretary for ,minority ,health1 and in cooperation with the ,director of the ,office of ,community ,services and the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities4 #deg4 ,authorization of appropriations ,to carry out this subtitle1 there is authorized to be appropriated #ajj1jjj1jjj for fiscal year #bjba4 ,v ,,improving ,,health ,,outcomes ,,for ,,women1 ,,children1 ,,and ,,families ,a ,in ,general #eja4 ,grants to promote health for underserved communities ,part ,q of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;h 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 #ejb4 ,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 ,,chip ,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 for lawfully present individuals 7#a7 ,in general ,section #djb7;a77#b77;,j7 of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afab7;a77#b77;,j77 is amended-- 7,a7 in the subparagraph heading1 by striking certain children inserting children and lawfully present individuals2 and 7,b7 by striking who is under #ah years of age4 and inserting 8who is-- 7i7 under #ba years of age2 or 7ii7 lawfully present in the ,united ,states4 4 7#b7 ,conforming amendments 7,a7 ,section #djb7;a77#c7 of such ,act 7#h ,u4,s4,c4 #afab7;a77#c77 is amended by striking subparagraph 7,b7 and inserting the following3 7,b7 ,,snap 7food stamp program7 ,the supplemental nutrition assistance program established under the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjaa et seq47 7referred to in this title as ,,snap or the food stamp program74 4 7,b7 ,section #djc7;c77#b77,l7 of such ,act 7#db ,u4,s4,c4 #afac7;c77#b77,l77 is amended by striking #ah and all that follows through the period and inserting #ba1 or to individuals who are lawfully present in the ,united ,states1 under the supplemental nutrition assistance program established under the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjaa et seq4744 7,c7 ,section #e7;i77#b77;,e7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjad7;i77#b77;,e77 is amended by striking #ah years of age4 and inserting #ba years of age1 or who is lawfully present in the ,united ,states44 7d7 ,nonapplication of sponsor deeming2 assuring eligibility for families ,section #dba7;d7 of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afca7;d77 is amended by striking paragraph 7#c7 and inserting the following3 7#c7 ,this section shall not apply to assistance or benefits under the supplemental nutrition assistance program established under the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjaa et seq47 for a qualified alien who is eligible under section #djb7;a77#b77;,j7 and for any member of the household of such qualified alien4 4 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 7viii71 respectively2 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 applicants who may be exempt from that provision2 4 #ejc4 ,repeal of denial of ,,snap benefits ,section #aae of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#ba ,u4,s4,c4 #hfb;a7 is amended-- 7#a7 in subsection 7a71 by striking for-- and all that follows and inserting for assistance under any ,state program funded under part ,a of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq4742 7#b7 in subsection 7b7-- 7,a7 by striking 7#a7 ,program of temporary assistance for needy families4--2 and 7,b7 by striking paragraph 7#b72 and 7#c7 in subsection 7e71 by striking it-- and all that follows and inserting the term in section #dai7e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fai7e77 when referring to assistance provided under a ,state program funded under paragraph ,a of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq4744 #ejd4 ,birth defects prevention1 risk reduction1 and awareness 7a7 ,in general ,the ,secretary shall establish and implement a birth defects prevention and public awareness program1 consisting of the activities described in subsections 7c7 and 7d74 7b7 ,definitions ,in this section3 7#a7 ,maternal ,the term maternal refers to persons who are pregnant or breastfeeding of all gender identities4 7#b7 ,pregnancy and breastfeeding information services ,the term pregnancy and breastfeeding information services includes only-- 7,a7 information services to provide accurate1 evidence-based1 clinical information regarding maternal exposures during pregnancy that may be associated with birth defects or other health risks1 such as exposures to medications1 chemicals1 infections1 foodborne pathogens1 illnesses1 nutrition1 or lifestyle factors2 7,b7 information services to provide accurate1 evidence-based1 clinical information regarding maternal exposures during breastfeeding that may be associated with health risks to a breast-fed infant1 such as exposures to medications1 chemicals1 infections1 foodborne pathogens1 illnesses1 nutrition1 lifestyle1 or climate- and weather-related factors2 7,c7 the provision of accurate1 evidence-based information weighing risks of exposures during breastfeeding against the benefits of breastfeeding2 and 7,d7 the provision of information described in subparagraph 7,a71 7,b71 or 7,c7 through counselors1 websites1 fact sheets1 telephonic or electronic communication1 community outreach efforts1 or other appropriate means4 7#c7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,centers for ,disease ,control and ,prevention4 7c7 ,nationwide media campaign ,in carrying out subsection 7a71 the ,secretary shall conduct or support a nationwide media campaign to increase awareness among health care providers and at-risk populations about pregnancy and breastfeeding information services4 7d7 ,grants for pregnancy and breastfeeding information services 7#a7 ,in general ,in carrying out subsection 7a71 the ,secretary shall award grants to ,state or regional agencies or organizations for any of the following3 7,a7 ,information services ,the provision of1 or campaigns to increase awareness about1 pregnancy and breastfeeding information services4 7,b7 ,surveillance and research ,the conduct or support of-- 7i7 surveillance of or research on-- 7,i7 maternal exposures and maternal health conditions that may influence the risk of birth defects1 prematurity1 or other adverse pregnancy outcomes2 and 7,,ii7 maternal exposures that may influence health risks to a breastfed infant2 or 7ii7 networking to facilitate surveillance or research described in this subparagraph4 7#b7 ,preference for certain ,states ,the ,secretary1 in making any grant under this subsection1 shall give preference to ,states1 otherwise equally qualified1 that have a pregnancy and breastfeeding information service in place4 7#c7 ,matching funds ,the ,secretary may only award a grant under this subsection to a ,state or regional agency or organization that agrees1 with respect to the costs to be incurred in carrying out the grant activities1 to make available 7directly or through donations from public or private entities7 non-,federal funds toward such costs in an amount equal to not less than #be percent of the amount of the grant4 7#d7 ,coordination ,the ,secretary shall ensure that activities funded through a grant under this subsection are coordinated1 to the maximum extent practicable1 with other birth defects prevention and environmental health activities of the ,federal ,government1 including with respect to pediatric environmental health specialty units and children's environmental health centers4 7e7 ,evaluation ,in furtherance of the program under subsection 7a71 the ,secretary shall provide for an evaluation of pregnancy and breastfeeding information services to identify efficient and effective models of-- 7#a7 providing information2 7#b7 raising awareness and increasing knowledge about birth defects prevention measures and targeting education to at-risk groups2 7#c7 modifying risk behaviors2 or 7#d7 other outcome measures as determined appropriate by the ,secretary4 7f7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated #e1jjj1jjj for fiscal year #bjba1 #f1jjj1jjj for fiscal year #bjbb1 #g1jjj1jjj for fiscal year #bjbc1 #h1jjj1jjj for fiscal year #bjbd1 and #i1jjj1jjj for fiscal year #bjbe4 #eje4 ,,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 ,,dc1 increased from #ah4h percent in #bjjj1 to #bc4h percent in #bjad1 to #bf4f percent in #bjah4 ,this estimated rate is on par with such rate for underdeveloped nations such as ,iraq and ,afghanistan4 7#c7 ,it is estimated that more than #fj percent of maternal deaths in the ,united ,states are preventable4 7#d7 ,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#e7 ,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#f7 ,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#g7 ,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#h7 ,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#i7 ,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#aj7 ,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#aa7 ,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#ab7 ,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#ac7 ,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#ad7 ,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#ae7 ,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#af7 ,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#ag7 ,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#ah7 ,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#ai7 ,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#bj7 ,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#ba7 ,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#bb7 ,the rising maternal mortality rate in the ,united ,states is driven predominantly by the disproportionately high rates of ,african-,american maternal mortality4 7#bc7 ,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#bd7 ,african-,american women are twice as likely to experience postpartum depression1 and disproportionately higher rates of preeclampsia compared to ,white women4 7#be7 ,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 ongoing 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 subsection 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 paragraph1 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 paragraph 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 subparagraph 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 subparagraph 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 clause 7i71 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 clause 7i74 7,d7 ,maternal safety bundle defined ,for purposes of this paragraph1 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 paragraph1 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 paragraph 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 paragraph 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 paragraph1 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 paragraph1 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 certain oral health services for pregnant and postpartum women 7i7 ,medicaid ,subsection 7gg7 of section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 as added by section #dcc7;d71 is amended-- 7,i7 in paragraph 7#a71 by striking paragraphs 7#b7 and 7#c7 and inserting paragraphs 7#b71 7#c71 and 7#d72 and 7,,ii7 by adding at the end the following new paragraph3 7#d7 ,such term shall include1 in the case of a woman who is pregnant 7or during the #a-year period beginning on the last day of her pregnancy7 preventive1 diagnostic1 periodontal1 and restorative services recommended for perinatal oral health care and dental care during pregnancy by 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 7as defined in section #aije7;gg7 and including services for pregnant and postpartum women described in paragraph 7#d7 of such section7 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 #e 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 ,ineligibility 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 #e 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 section #dcc7;d71 is further amended-- 7,i7 in subsection 7b71 by striking and 7ff7 and inserting 7ff71 and 7hh72 and 7,,ii7 by adding at the end the following3 7hh7 ,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 7#db ,u4,s4,c4 #bhj;g et seq47 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 7,a7 ,definition of breastfeeding woman ,section #ag7;b7 of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aghf7;b77 is amended by striking paragraph 7#a7 and inserting the following3 7#a7 ,breastfeeding woman ,the term breastfeeding woman means a woman who is not more than #b years postpartum and is breastfeeding the infant of the woman4 4 7,b7 ,certification ,section #ag7;d77#c77;,a77ii7 of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aghf7;d77#c77;,a77ii77 is amended-- 7i7 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 7ii7 in subclause 7,i7 7as so designated71 by striking #a year and all that follows through earlier and inserting #b years postpartum2 and 7iii7 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 #bjah1 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 #ejf4 ,rural maternal and obstetric modernization of services 7a7 ,short title ,this section may be cited as the ,rural ,maternal and ,obstetric ,modernization of ,services ,act or the ,rural ,,moms ,act4 7b7 ,improving rural maternal and obstetric care data 7#a7 ,maternal mortality and morbidity activities ,section #cja of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bda7 is amended-- 7,a7 by redesignating subsections 7e7 through 7h7 as subsections 7f7 through 7i71 respectively2 and 7,b7 by inserting after subsection 7d71 the following3 7e7 ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall expand1 intensify1 and coordinate the activities of the ,centers for ,disease ,control and ,prevention with respect to maternal mortality and morbidity4 4 7#b7 ,office of ,women's ,health ,section #caj;,a7b77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdbs7b77#a77 is amended by striking and sociocultural contexts and inserting sociocultural 7including race1 ethnicity1 language1 class1 and income7 contexts1 including among ,indians 7as defined in section #d of the ,indian ,health ,care ,improvement ,act71 and geographic contexts1 after biological14 7#c7 ,safe motherhood ,section #cag,k7b77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;b77#b77 is amended-- 7,a7 in subparagraph 7,l71 by striking and at the end2 7,b7 by redesignating subparagraph 7,m7 as subparagraph 7,n72 and 7,c7 by inserting after subparagraph 7,l71 the following3 7,m7 an examination of the relationship between maternal health services in rural areas and outcomes in delivery and postpartum care2 and 4 7#d7 ,office of ,research on ,women's ,health ,section #dhf of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhg;d7 is amended-- 7,a7 in subsection 7b7-- 7i7 by redesignating paragraphs 7#d7 through 7#i7 as paragraphs 7#e7 through 7#aj71 respectively2 7ii7 by inserting after paragraph 7#c7 the following3 7#d7 carry out paragraphs 7#a7 and 7#b7 with respect to pregnancy1 with priority given to deaths related to pregnancy2 2 and 7iii7 in paragraph 7#e7 7as so redesignated71 by striking through 7#c7 and inserting through 7#d72 and 7,b7 in subsection 7d77#d77;,a77iv71 by inserting 1 including maternal mortality and other maternal morbidity outcomes before the semicolon4 7c7 ,rural ,obstetric ,network ,grants ,the ,public ,health ,service ,act is amended by inserting after section #cag,l-#a 7#db ,u4,s4,c4 #bdg;b-#ac;a7 the following3 #cag,l-#b4 ,rural ,obstetric ,network ,grants 7a7 ,in general ,for the purpose of enabling the ,secretary 7through grants1 contracts1 or otherwise71 acting through the ,administrator of the ,health ,resources and ,services ,administration1 to establish collaborative improvement and innovation networks 7referred to in this section as rural obstetric networks7 to improve outcomes in birth and maternal morbidity and mortality1 there is appropriated to the ,secretary1 out of any money in the ,treasury not otherwise appropriated1 #c1jjj1jjj for each of fiscal years #bjba through #bjbe4 ,such amounts shall remain available until expended4 7b7 ,use of funds ,amounts appropriated under subsection 7a7 shall be used for the establishment of collaborative improvement and innovation networks to improve maternal health in rural areas by improving outcomes in birth and maternal morbidity and mortality4 ,rural obstetric networks established in accordance with this section shall-- 7#a7 assist pregnant women and other individuals in rural areas in connecting with prenatal1 labor and birth1 and postpartum care to improve outcomes in birth and maternal mortality and morbidity2 7#b7 identify successful prenatal1 labor and birth1 and postpartum health delivery models for individuals in rural areas1 including evidence-based home visiting programs and successful1 culturally competent models with positive maternal health outcomes that advance health equity2 7#c7 develop a model for collaboration between health facilities that have an obstetric health unit and health facilities that do not have an obstetric health unit2 7#d7 provide training and guidance for health facilities that do not have obstetric health units2 7#e7 collaborate with academic institutions that can provide regional expertise and research on access1 outcomes1 needs assessments1 and other identified data2 and 7#f7 measure and address inequities in birth outcomes among rural residents1 with an emphasis on ,black residents and residents who are ,indians 7as defined in section #d of the ,indian ,health ,care ,improvement ,act74 7c7 ,requirements for establishment ,not later than #f months after the date of enactment of this section1 the ,secretary shall establish rural obstetric health networks in at least #e regions4 7d7 ,definitions ,in this section3 7#a7 ,frontier area ,the term frontier area means a frontier county1 as defined in section #ahhf7;d77#c77;,e77iii77,,iii7 of the ,social ,security ,act4 7#b7 ,indian2 ,indian tribe ,the terms ,indian and ,indian tribe have the meanings given such terms in section #d of the ,indian ,health ,care ,improvement ,act4 7#c7 ,region ,the term region means a ,state1 ,indian tribe1 rural area1 or frontier area4 7#d7 ,rural area ,the term rural area has the meaning given that term in section #ahhf7;d77#b77;,d7 of the ,social ,security ,act4 7#e7 ,state ,the term ,state has the meaning given that term for purposes of title ,v of the ,social ,security ,act4 4 7d7 ,telehealth network and telehealth resource centers grant programs ,section #ccj;,i of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c-#ad7 is amended-- 7#a7 in subsection 7f77#c71 by adding at the end the following3 7,m7 ,providers of maternal care services1 including prenatal1 labor and birth1 and postpartum care services1 and entities operating obstetric care units4 2 7#b7 in subsection 7h77#a77;,b71 by striking or prenatal and inserting or prenatal1 labor and birth1 or postpartum2 and 7#c7 in subsection 7j77#a77;,b71 by inserting equipment useful for caring for pregnant individuals1 including ultrasound machines and fetal monitoring equipment1 and other before equipment4 7e7 ,rural maternal and obstetric care training demonstration ,part ,d of title ,,vii of the ,public ,health ,service ,act is amended by inserting after section #gfj 7#db ,u4,s4,c4 #bidk7 the following3 #gfj;,a4 ,rural maternal and obstetric care training demonstration 7a7 ,in general ,the ,secretary shall establish a training demonstration program to award to eligible entities-- 7#a7 grants to support training for physicians1 medical residents1 and fellows 7including physicians1 residents1 and fellows in family medicine and obstetrics and gynecology7 to practice maternal and obstetric medicine in rural community-based settings2 7#b7 grants to support training for licensed and accredited nurse practitioners1 physician assistants1 certified nurse midwives1 certified midwives1 certified professional midwives1 home visiting nurses1 or non-clinical professionals such as doulas and community health workers1 to provide maternal care services in rural community-based settings2 and 7#c7 grants to-- 7,a7 support establishing1 maintaining1 or improving academic units or programs that provide training for students or faculty1 including through clinical experiences and research1 to improve maternal care in rural areas2 or 7,b7 develop evidence-based practices or recommendations for the design of the units or programs described in subparagraph 7,a71 including curriculum content standards4 7b7 ,activities 7#a7 ,training for physicians1 medical residents1 and fellows ,a recipient of a grant under subsection 7a77#a7-- 7,a7 shall use the grant funds to plan1 develop1 and operate a training program for the physicians1 medical residents1 and fellows described in subsection 7a77#a7 to provide maternal and obstetric health care services in rural community-based settings2 and 7,b7 may use the grant funds to provide additional support for the administration of the program or to meet the costs of projects to establish1 maintain1 or improve faculty development1 or departments1 divisions1 or other units necessary to implement such training4 7#b7 ,training for other providers ,a recipient of a grant under subsection 7a77#b7-- 7,a7 shall use the grant funds to plan1 develop1 or operate a training program for the individuals described in subsection 7a77#b7 to provide maternal health care services in rural1 community-based settings2 and 7,b7 may use the grant funds to provide additional support for the administration of the program or to meet the costs of projects to establish1 maintain1 or improve faculty development1 or departments1 divisions1 or other units necessary to implement such program4 7#c7 ,academic units or programs ,a recipient of a grant under subsection 7a77#c7 shall enter into a partnership with organizations such as an education accrediting organization 7such as the ,liaison ,committee on ,medical ,education1 the ,accreditation ,council for ,graduate ,medical ,education1 the ,commission on ,osteopathic ,college ,accreditation1 the ,accreditation ,commission for ,education in ,nursing1 the ,commission on ,collegiate ,nursing ,education1 the ,accreditation ,commission for ,midwifery ,education1 or the ,accreditation ,review ,commission on ,education for the ,physician ,assistant7 to carry out activities under subsection 7a77#c74 7#d7 ,training program requirements ,the recipient of a grant under subsection 7a77#a7 or 7a77#b7 shall ensure that training programs carried out under the grant include instruction on-- 7,a7 maternal mental health1 including perinatal depression and anxiety and postpartum depression2 7,b7 maternal substance use disorder2 7,c7 social determinants of health that impact individuals living in rural communities1 including poverty1 social isolation1 access to nutrition1 education1 transportation1 and housing2 and 7,d7 implicit bias4 7c7 ,eligible entities 7#a7 ,training for physicians1 medical residents1 and fellows ,to be eligible to receive a grant under subsection 7a77#a71 an entity shall-- 7,a7 be a consortium consisting of-- 7i7 at least one teaching health center 7as defined in section #gdi;,a7f772 or 7ii7 the sponsoring institution 7or parent institution of the sponsoring institution7 of-- 7,i7 an obstetrics and gynecology or family medicine residency program that is accredited by the ,accreditation ,council for ,graduate ,medical ,education 7or the parent institution of such a program72 or 7,,ii7 a fellowship in maternal or obstetric medicine1 as determined appropriate by the ,secretary2 or 7,b7 be an entity described in subparagraph 7,a77ii7 that provides opportunities for medical residents or fellows to train in rural community-based settings4 7#b7 ,training for other providers ,to be eligible to receive a grant under subsection 7a77#b71 an entity shall be-- 7,a7 a teaching health center 7as defined in section #gdi;,a7f772 7,b7 a federally qualified health center 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act72 7,c7 a community mental health center 7as defined in section #ahfa7;ff77#c77;,b7 of the ,social ,security ,act72 7,d7 a rural health clinic 7as defined in section #ahfa7;aa7 of the ,social ,security ,act72 7,e7 a freestanding birth center 7as defined in section #aije7l77#c7 of the ,social ,security ,act72 7,f7 a health center operated by-- 7i7 the ,indian ,health ,service1 an ,indian tribe1 or a tribal organization 7as such terms are defined in section #d of the ,indian ,health ,care ,improvement ,act72 or 7ii7 a ,native ,hawaiian ,health ,care ,system 7as defined in section #ab of the ,native ,hawaiian ,health ,care ,improvement ,act72 or 7,g7 an entity with a demonstrated record of success in providing academic training for nurse practitioners1 physician assistants1 certified nurse-midwives1 certified midwives1 certified professional midwives1 home visiting nurses1 or non-clinical professionals1 such as doulas and community health workers4 7#c7 ,academic units or programs ,to be eligible to receive a grant under subsection 7a77#c71 an entity shall be a school of medicine or osteopathic medicine1 a nursing school1 a physician assistant training program1 an accredited public or nonprofit private hospital1 an accredited medical residency program1 a school accredited by the ,midwifery ,education and ,accreditation ,council1 or a public or private nonprofit entity which the ,secretary has determined is capable of carrying out activities supported by such grant4 7#d7 ,application ,to be eligible to receive a grant under subsection 7a71 an entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require1 including an estimate of the amount to be expended to conduct training activities under the grant 7including ancillary and administrative costs74 7d7 ,duration ,grants awarded under this section shall be for a minimum of #e years4 7e7 ,study and report 7#a7 ,study 7,a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall conduct a study on the results of the demonstration program under this section4 7,b7 ,data submission ,not later than #ij days after the completion of the first year of the training program1 and each subsequent year for the duration of the grant1 that the program is in effect1 each recipient of a grant under subsection 7a7 shall submit to the ,secretary such data as the ,secretary may require for analysis for the report described in paragraph 7#b74 7#b7 ,report to ,congress ,not later than #a year after receipt of the data described in paragraph 7#a77;,b71 the ,secretary shall submit to ,congress a report that includes-- 7,a7 an analysis of the effect of the demonstration program under this section on the quality1 quantity1 and distribution of maternal1 including prenatal1 labor and birth1 and postpartum care services and the demographics of the recipients of those services2 7,b7 an analysis of maternal and infant health outcomes 7including quality of care1 morbidity1 and mortality7 before and after implementation of the program in the communities served by entities participating in the demonstration2 and 7,c7 recommendations on whether the demonstration program under this section should be expanded4 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section1 #e1jjj1jjj for each of fiscal years #bjba through #bjbe4 4 7f7 ,,gao report ,not later than #a year after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to the appropriate committees of ,congress a report on the maternal1 including prenatal1 labor and birth1 and postpartum1 care in rural areas4 ,such report shall include the following3 7#a7 ,the location of gaps in maternal and obstetric clinicians and health professionals1 including non-clinical professionals such as doulas and community health workers4 7#b7 ,the location of gaps in facilities able to provide maternal1 including prenatal1 labor and birth1 and postpartum1 care in rural areas1 including care for high-risk pregnancies4 7#c7 ,the gaps in data on maternal mortality and recommendations to standardize the format on collecting data related to maternal mortality and morbidity4 7#d7 ,the gaps in maternal health by race and ethnicity in rural communities1 with a focus on racial inequities for ,black residents and among ,indian ,tribes and residents who are ,indian 7as such terms are defined in section #d of the ,indian ,health ,care ,improvement ,act74 7#e7 ,a list of specific activities that the ,secretary of ,health and ,human ,services plans to conduct on maternal1 including prenatal1 labor and birth1 and postpartum1 care4 7#f7 ,a plan for completing such activities4 7#g7 ,an explanation of ,federal agency involvement and coordination needed to conduct such activities4 7#h7 ,a budget for conducting such activities4 7#i7 ,other information that the ,comptroller ,general determines appropriate4 #ejg4 ,decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood 7a7 ,establishment ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,health ,resources and ,services ,administration and in consultation with the ,director of the ,centers for ,disease ,control and ,prevention and the ,director of the ,national ,institutes of ,health 7in this section referred to as the ,secretary71 shall establish and implement a culturally and linguistically competent public health awareness and education campaign to provide information that is focused on decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood1 including educating individuals about safe sleep environments1 sleep positions1 and reducing exposure to smoking during pregnancy and after birth4 7b7 ,targeted ,populations ,the campaign under subsection 7a7 shall be designed to reduce health disparities through the targeting of populations with high rates of sudden unexpected infant death and sudden unexplained death in childhood4 7c7 ,consultation ,in establishing and implementing the campaign under subsection 7a71 the ,secretary shall consult with national organizations representing health care providers1 including nurses and physicians1 parents1 child care providers1 children's advocacy and safety organizations1 maternal and child health programs1 nutrition professionals focusing on women1 infants1 and children1 and other individuals and groups determined necessary by the ,secretary for such establishment and implementation4 7d7 ,grants 7#a7 ,in general ,in carrying out the campaign under subsection 7a71 the ,secretary shall award grants to national organizations1 ,state and local health departments1 and community-based organizations for the conduct of education and outreach programs for nurses1 parents1 child care providers1 public health agencies1 and community organizations4 7#b7 ,application ,to be eligible to receive a grant under paragraph 7#a71 an entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjba through #bjbe4 #ejh4 ,reducing unintended teenage pregnancies ,title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bda et seq47 is amended by adding at the end the following3 ,w ,youth ,access to ,sexual ,health ,services #cii,,oo4 ,authorization of grants to support the access of marginalized youth to sexual health services 7a7 ,grants ,the ,secretary may award grants on a competitive basis to eligible entities to support the access of marginalized youth to sexual health services4 7b7 ,use of funds ,an eligible entity that is awarded a grant under subsection 7a7 may use the funds to-- 7#a7 provide medically accurate and complete and age-1 developmentally1 and culturally appropriate sexual health information to marginalized youth1 including information on how to access sexual health services2 7#b7 promote effective communication regarding sexual health among marginalized youth2 7#c7 promote and support better health1 education1 and economic opportunities for school-age parents2 and 7#d7 train individuals who work with marginalized youth to promote-- 7,a7 the prevention of unintended pregnancy2 7,b7 the prevention of sexually transmitted infections1 including the human immunodeficiency virus 7,,hiv72 7,c7 healthy relationships2 and 7,d7 the development of safe and supportive environments4 7c7 ,application ,to be awarded a grant under subsection 7a71 an eligible entity shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7d7 ,priority ,in awarding grants under subsection 7a71 the ,secretary shall give priority to eligible entities-- 7#a7 with a history of supporting the access of marginalized youth to sexuality education or sexual health services2 and 7#b7 that plan to serve marginalized youth that are not served by ,federal adolescent programs for the prevention of pregnancy1 ,,hiv1 and other sexually transmitted infections4 7e7 ,requirements ,the ,secretary may not award a grant under subsection 7a7 to an eligible entity unless-- 7#a7 such eligible entity has formed a partnership with a community organization2 and 7#b7 such eligible entity agrees-- 7,a7 to employ a scientifically effective strategy2 7,b7 that all information provided to marginalized youth will be-- 7i7 age- and developmentally appropriate2 7ii7 medically accurate and complete2 7iii7 scientifically based2 and 7iv7 provided in the language and cultural context that is most appropriate for the individuals served by the eligible entity2 and 7,c7 that for each year the eligible entity receives grant funds under subsection 7a71 the eligible entity will submit to the ,secretary an annual report that includes-- 7i7 the use of grant funds by the eligible entity2 7ii7 how the use of grant funds has increased the access of marginalized youth to sexual health services2 and 7iii7 such other information as the ,secretary may require4 7f7 ,publication and evaluations 7#a7 ,evaluations ,not less than once every two years after the date of the enactment of this part1 the ,secretary shall evaluate the effectiveness of whichever of the following is greater3 7,a7 ,eight grants awarded under subsection 7a74 7,b7 ,ten percent of the grants awarded under subsection 7a74 7#b7 ,publication ,the ,secretary shall make available to the public-- 7,a7 the evaluations required under paragraph 7#a72 and 7,b7 the reports required under subsection 7e77#b77;,c74 7g7 ,limitations ,no funds made available to an eligible entity under this section may be used by such entity to provide access to sexual health services that-- 7#a7 withhold sexual health-promoting or life-saving information2 7#b7 are medically inaccurate or have been scientifically shown to be ineffective2 7#c7 promote gender stereotypes2 7#d7 are insensitive or unresponsive to the needs of young people1 including-- 7,a7 youth with varying gender identities1 gender expressions1 and sexual orientations2 7,b7 sexually active youth2 7,c7 pregnant or parenting youth2 7,d7 survivors of sexual abuse or assault2 and 7,e7 youth of all physical1 developmental1 and mental abilities2 or 7#e7 are inconsistent with the ethical imperatives of medicine and public health4 7h7 ,transfer of funds ,any unobligated balance of funds made available under section #eaj7;f7 of the ,social ,security ,act 7as in effect on the day before the date of the enactment of this part7 are hereby transferred and made available to the ,secretary to carry out this section4 ,the amounts transferred and made available to carry out this section shall remain available until expended4 7i7 ,definitions ,in this section3 7#a7 ,community organization ,the term community organization includes a ,state or local health or education agency1 public school1 youth-focused organization that is faith-based and community-based1 juvenile justice entity1 or other organization that provides confidential and appropriate sexuality education or sexual health services to marginalized youth4 7#b7 ,eligible entity ,the term eligible entity includes a ,state or local health or education agency1 public school1 nonprofit organization1 hospital1 or an ,indian ,tribe or ,tribal organization 7as such terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd774 7#c7 ,marginalized youth ,the term marginalized youth means a person under the age of #bf that is disadvantaged by underlying structural barriers and social inequity4 7#d7 ,medically accurate and complete ,the term medically accurate and complete1 when used with respect to information1 means information that-- 7,a7 is supported by research and recognized as accurate1 objective1 and complete by leading medical1 psychological1 psychiatric1 or public health organizations and agencies2 and 7,b7 does not withhold any information relating to the effectiveness and benefits of correct and consistent use of condoms or other contraceptives and pregnancy prevention methods4 7#e7 ,scientifically effective strategy ,the term scientifically effective strategy means a strategy that-- 7,a7 is widely recognized by leading medical and public health agencies as effective in promoting sexual health awareness and healthy behavior2 and 7,b7 either-- 7i7 has been demonstrated to be effective on the basis of rigorous scientific research2 or 7ii7 incorporates characteristics of effective programs4 7#f7 ,sexual health services ,the term sexual health services includes-- 7,a7 sexual health information1 education1 and counseling2 7,b7 contraception2 7,c7 emergency contraception2 7,d7 condoms and other barrier methods to prevent pregnancy or sexually transmitted infections2 7,e7 routine gynecological care1 including human papillomavirus 7,,hpv7 vaccines and cancer screenings2 7,f7 pre-exposure prophylaxis or post-exposure prophylaxis2 7,g7 mental health services2 7,h7 sexual assault survivor services2 and 7,i7 other prevention1 care1 or treatment4 4 #eji4 ,gestational diabetes ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq47 is amended by adding after section #cag;,h the following3 #cag;,h-#a4 ,gestational diabetes 7a7 ,understanding and monitoring gestational diabetes 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 in consultation with the ,diabetes ,mellitus ,interagency ,coordinating ,committee established under section #dbi and representatives of appropriate national health organizations1 shall develop a multisite gestational diabetes research project within the diabetes program of the ,centers for ,disease ,control and ,prevention to expand and enhance surveillance data and public health research on gestational diabetes4 7#b7 ,areas to be addressed ,the research project developed under paragraph 7#a7 shall address-- 7,a7 procedures to establish accurate and efficient systems for the collection of gestational diabetes data within each ,state and commonwealth1 territory1 or possession of the ,united ,states2 7,b7 the progress of collaborative activities with the ,national ,vital ,statistics ,system1 the ,national ,center for ,health ,statistics1 and ,state health departments with respect to the standard birth certificate1 in order to improve surveillance of gestational diabetes2 7,c7 postpartum methods of tracking individuals with gestational diabetes after delivery as well as targeted interventions proven to lower the incidence of type #b diabetes in that population2 7,d7 variations in the distribution of diagnosed and undiagnosed gestational diabetes1 and of impaired fasting glucose tolerance and impaired fasting glucose1 within and among groups of pregnant individuals2 and 7,e7 factors and culturally sensitive interventions that influence risks and reduce the incidence of gestational diabetes and related complications during childbirth1 including cultural1 behavioral1 racial1 ethnic1 geographic1 demographic1 socioeconomic1 and genetic factors4 7#c7 ,report ,not later than #b years after the date of the enactment of this section1 and annually thereafter1 the ,secretary shall generate a report on the findings and recommendations of the research project including prevalence of gestational diabetes in the multisite area and disseminate the report to the appropriate ,federal and non-,federal agencies4 7b7 ,expansion of gestational diabetes research 7#a7 ,in ,general ,the ,secretary shall expand and intensify public health research regarding gestational diabetes4 ,such research may include-- 7,a7 developing and testing novel approaches for improving postpartum diabetes testing or screening and for preventing type #b diabetes in individuals who can become pregnant with a history of gestational diabetes2 and 7,b7 conducting public health research to further understanding of the epidemiologic1 socioenvironmental1 behavioral1 translation1 and biomedical factors and health systems that influence the risk of gestational diabetes and the development of type #b diabetes in individuals who can become pregnant with a history of gestational diabetes4 7#b7 ,authorization of ,appropriations ,there is authorized to be appropriated to carry out this subsection #e1jjj1jjj for each of fiscal years #bjba through #bjbe4 7c7 ,demonstration grants ,to lower the rate of gestational diabetes 7#a7 ,in ,general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall award grants1 on a competitive basis1 to eligible entities for demonstration projects that implement evidence-based interventions to reduce the incidence of gestational diabetes1 the recurrence of gestational diabetes in subsequent pregnancies1 and the development of type #b diabetes in individuals who can become pregnant with a history of gestational diabetes4 7#b7 ,priority ,in making grants under this subsection1 the ,secretary shall give priority to projects focusing on-- 7,a7 helping individuals who can become pregnant who have #a or more risk factors for developing gestational diabetes2 7,b7 working with individuals who can become pregnant with a history of gestational diabetes during a previous pregnancy2 7,c7 providing postpartum care for individuals who can become pregnant with gestational diabetes2 7,d7 tracking cases where individuals who can become pregnant with a history of gestational diabetes developed type #b diabetes2 7,e7 educating mothers with a history of gestational diabetes about the increased risk of their child developing diabetes2 7,f7 working to prevent gestational diabetes and prevent or delay the development of type #b diabetes in individuals who can become pregnant with a history of gestational diabetes2 and 7,g7 achieving outcomes designed to assess the efficacy and cost-effectiveness of interventions that can inform decisions on long-term sustainability1 including third-party reimbursement4 7#c7 ,application ,an eligible entity desiring to receive a grant under this subsection shall submit to the ,secretary-- 7,a7 an application at such time1 in such manner1 and containing such information as the ,secretary may require2 and 7,b7 a plan to-- 7i7 lower the rate of gestational diabetes during pregnancy2 or 7ii7 develop methods of tracking individuals who can become pregnant with a history of gestational diabetes and develop effective interventions to lower the incidence of the recurrence of gestational diabetes in subsequent pregnancies and the development of type #b diabetes4 7#d7 ,uses of ,funds ,an eligible entity receiving a grant under this subsection shall use the grant funds to carry out demonstration projects described in paragraph 7#a71 including-- 7,a7 expanding community-based health promotion education1 activities1 and incentives focused on the prevention of gestational diabetes and development of type #b diabetes in individuals who can become pregnant with a history of gestational diabetes2 7,b7 aiding ,state- and ,tribal-based diabetes prevention and control programs to collect1 analyze1 disseminate1 and report surveillance data on individuals who can become pregnant with1 and at risk for1 gestational diabetes1 the recurrence of gestational diabetes in subsequent pregnancies1 and1 for individuals who can become pregnant with a history of gestational diabetes1 the development of type #b diabetes2 and 7,c7 training and encouraging health care providers-- 7i7 to promote risk assessment1 high-quality care1 and self-management for gestational diabetes and the recurrence of gestational diabetes in subsequent pregnancies2 and 7ii7 to prevent the development of type #b diabetes in individuals who can become pregnant with a history of gestational diabetes1 and its complications in the practice settings of the health care providers4 7#e7 ,report ,not later than #d years after the date of the enactment of this section1 the ,secretary shall prepare and submit to the ,congress a report concerning the results of the demonstration projects conducted through the grants awarded under this subsection4 7#f7 ,definition of ,eligible ,entity ,in this subsection1 the term eligible entity means a nonprofit organization 7such as a nonprofit academic center or community health center7 or a ,state1 ,tribal1 or local health agency4 7#g7 ,authorization of ,appropriations ,there is authorized to be appropriated to carry out this subsection #e1jjj1jjj for each of fiscal years #bjba through #bjbe4 7d7 ,postpartum followup regarding gestational diabetes ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall work with the ,state- and ,tribal-based diabetes prevention and control programs assisted by the ,centers to encourage postpartum followup after gestational diabetes1 as medically appropriate1 for the purpose of reducing the incidence of gestational diabetes1 the recurrence of gestational diabetes in subsequent pregnancies1 the development of type #b diabetes in individuals with a history of gestational diabetes1 and related complications4 4 #eaj4 ,emergency contraception education and information programs 7a7 ,emergency ,contraception ,public ,education ,program 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall develop and disseminate to the public medically accurate and complete information on emergency contraceptives4 7#b7 ,dissemination ,the ,secretary may disseminate medically accurate and complete information under paragraph 7#a7 directly or through arrangements with nonprofit organizations1 community health workers including promotores1 consumer groups1 institutions of higher education1 clinics1 the media1 and ,federal1 ,state1 and local agencies4 7#c7 ,information ,the information disseminated under paragraph 7#a7 shall-- 7,a7 include1 at a minimum1 a description of emergency contraceptives and an explanation of the use1 safety1 efficacy1 affordability1 and availability1 including over-the-counter access1 of such contraceptives and options for access without cost-sharing through insurance and other programs2 and 7,b7 be pilot tested for consumer comprehension1 cultural and linguistic appropriateness1 and acceptance of the messages across geographically1 racially1 ethnically1 and linguistically diverse populations4 7b7 ,emergency ,contraception ,information ,program for ,health ,care ,providers 7#a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration and in consultation with major medical and public health organizations1 shall develop and disseminate to health care providers1 including pharmacists1 information on emergency contraceptives4 7#b7 ,information ,the information disseminated under paragraph 7#a7 shall include1 at a minimum-- 7,a7 information describing the use1 safety1 efficacy1 and availability of emergency contraceptives1 and options for access without cost-sharing through insurance and other programs2 7,b7 a recommendation regarding the use of such contraceptives2 and 7,c7 information explaining how to obtain copies of the information developed under subsection 7a7 for distribution to the patients of the providers4 7c7 ,definitions ,in this section3 7#a7 ,health care provider ,the term health care provider means an individual who is licensed or certified under ,state law to provide health care services and who is operating within the scope of such license4 ,such term shall include a pharmacist4 7#b7 ,institution of higher education ,the term institution of higher education has the same meaning given such term in section #aja7;a7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja7;a774 7#c7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7d7 ,authorization of ,appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of the fiscal years #bjba through #bjbe4 #eaa4 ,comprehensive sex education programs 7a7 ,purposes2 finding2 sense of congress 7#a7 ,purposes ,the purposes of this section are to provide young people with comprehensive sex education programs that-- 7,a7 promote and uphold the rights of young people to information in order to make healthy decisions about their sexual health2 7,b7 provide the information and skills all young people need to make informed1 responsible1 and healthy decisions in order to become sexually healthy adults and have healthy relationships2 7,c7 provide information about the prevention of unintended pregnancy1 sexually transmitted infections1 including ,,hiv1 dating violence1 sexual assault1 bullying1 and harassment2 and 7,d7 provide resources and information on topics ranging from gender stereotyping and gender roles and stigma and socio-cultural influences surrounding sex and sexuality4 7#b7 ,finding on required resources ,in order to provide the comprehensive sex education described in paragraph 7#a71 ,congress finds that increased resources are required for sex education programs that-- 7,a7 substantially incorporate elements of evidence-based programs or characteristics of effective programs2 7,b7 cover a broad range of topics1 including medically accurate and complete information that is age and developmentally appropriate about all the aspects of sex1 sexual health1 and sexuality2 7,c7 are gender and gender identity-sensitive1 emphasizing the importance of equality and the social environment for achieving sexual and reproductive health and overall well-being2 7,d7 promote educational achievement1 critical thinking1 decision making1 self-esteem1 and self-efficacy2 7,e7 help develop healthy attitudes and insights necessary for understanding relationships between oneself and others and society2 7,f7 foster leadership skills and community engagement by-- 7i7 promoting principles of fairness1 human dignity1 and respect2 and 7ii7 engaging young people as partners in their communities2 and 7,g7 are culturally and linguistically appropriate1 reflecting the diverse circumstances and realities of young people4 7#c7 ,sense of congress ,it is the sense of ,congress that-- 7,a7 federally funded sex education programs should aim to-- 7i7 provide information about a range of human sexuality topics1 including-- 7,i7 human development1 healthy relationships1 personal skills2 7,,ii7 sexual behavior including abstinence2 7,,iii7 sexual health including preventing unintended pregnancy2 7,,iv7 sexually transmitted infections including ,,hiv2 and 7,v7 society and culture2 7ii7 promote safe and healthy relationships2 7iii7 promote gender equity2 7iv7 use1 and be informed by1 the best scientific information available2 7v7 be culturally appropriate and inclusive of youth with varying gender identities1 gender expressions1 and sexual orientations2 7vi7 be built on characteristics of effective programs2 7vii7 expand the existing body of research on comprehensive sex education programs through program evaluation2 7viii7 expand training programs for teachers of comprehensive sex education2 7ix7 build on programs funded under section #eac of the ,social ,security ,act 7#db ,u4,s4,c4 #gac7 and the ,office of ,adolescent ,health's ,teen ,pregnancy ,prevention ,program1 funded under title ,,ii of the ,consolidated ,appropriations ,act1 #bjaj 7,public ,law #aaa-aag2 #abc ,stat4 #cbec71 and on programs supported through the ,centers for ,disease ,control and ,prevention 7,,cdc72 and 7x7 promote and uphold the rights of young people to information in order to make healthy and autonomous decisions about their sexual health2 and 7,b7 no ,federal funds should be used for health education programs that-- 7i7 withhold health-promoting or life-saving information about sexuality-related topics1 including ,,hiv2 7ii7 are medically inaccurate or have been scientifically shown to be ineffective2 7iii7 promote gender or racial stereotypes2 7iv7 are insensitive and unresponsive to the needs of sexually active young people2 7v7 are insensitive and unresponsive to the needs of survivors of sexual violence2 7vi7 are insensitive and unresponsive to the needs of youth of all physical1 developmental1 and mental abilities2 7vii7 are insensitive and unresponsive to the needs of youth with varying gender identities1 gender expressions1 and sexual orientations2 or 7viii7 are inconsistent with the ethical imperatives of medicine and public health4 7b7 ,grants for comprehensive sex education for adolescents 7#a7 ,program authorized ,the ,secretary of ,health and ,human ,services1 in coordination with the ,associate ,commissioner of the ,family and ,youth ,services ,bureau of the ,administration on ,children1 ,youth1 and ,families of the ,department of ,health and ,human ,services1 the ,director of the ,office of ,adolescent ,health1 the ,director of the ,division of ,adolescent and ,school ,health within the ,centers for ,disease ,control and ,prevention and the ,secretary of ,education1 shall award grants1 on a competitive basis1 to eligible entities to enable such eligible entities to carry out programs that provide adolescents with comprehensive sex education1 as described in paragraph 7#f74 7#b7 ,duration ,grants awarded under this section shall be for a period of #e years4 7#c7 ,eligible entity ,in this section1 the term eligible entity means a public or private entity that focuses on adolescent health and education or has experience working with adolescents4 7#d7 ,applications ,an eligible entity desiring a grant under this subsection shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require1 including an assurance to participate in the evaluation described in subsection 7e74 7#e7 ,priority ,in awarding grants under this section1 the ,secretary shall give priority to eligible entities that-- 7,a7 are ,state or local public entities2 7,b7 are entities not currently receiving funds under-- 7i7 section #eac of the ,social ,security ,act 7#db ,u4,s4,c4 #gac72 7ii7 the ,office of ,adolescent ,health's ,teen ,pregnancy ,prevention ,program1 funded under title ,,ii of the ,consolidated ,appropriations ,act1 #bjaj 7,public ,law #aaa-aag2 #abc ,stat4 #cbec71 or any substantially similar successive program2 or 7iii7 the ,centers for ,disease ,control and ,prevention's ,division of ,adolescent and ,school ,health2 and 7,c7 address health inequities among young people that face systemic barriers resulting in disproportionate rates of not less than one of the following3 7i7 ,unintended pregnancies4 7ii7 ,sexually transmitted infections1 including ,,hiv4 7iii7 ,dating violence and sexual violence4 7#f7 ,use of funds 7,a7 ,in general ,each eligible entity that receives a grant under this section shall use the grant funds to carry out an education program that provides adolescents with comprehensive sex education that-- 7i7 is age and developmentally appropriate2 7ii7 is medically accurate and complete2 7iii7 substantially incorporates elements of evidence-based sex education instruction2 or 7iv7 creates a demonstration project based on characteristics of effective programs4 7,b7 ,contents of comprehensive sex education programs ,the comprehensive sex education programs funded under this section shall include instruction and materials that address-- 7i7 the physical1 social1 and emotional changes of human development including1 human anatomy1 reproduction1 and sexual development2 7ii7 healthy relationships1 including friendships1 within families1 and society1 that are based on mutual respect1 and the ability to distinguish between healthy and unhealthy relationships1 including-- 7,i7 effective communication1 negotiation and refusal skills1 including the skills to recognize and report inappropriate or abusive sexual advances2 7,,ii7 bodily autonomy1 setting and respecting personal boundaries1 practicing personal safety1 and consent2 and 7,,iii7 the limitations and harm of gender- role stereotypes1 violence1 coercion1 bullying1 harassment1 and intimidation in relationships2 7iii7 healthy decision-making skills about sexuality and relationships that include-- 7,i7 critical thinking1 problem solving1 self-efficacy1 stress-management1 self-care1 and decision making2 7,,ii7 individual values and attitudes2 7,,iii7 the promotion of positive body images2 7,,iv7 developing an understanding that there are a range of body types and encouraging positive feeling about students' own body types2 7,v7 information on how to respect others and ensure safety on the internet and when using other forms of digital communication2 7,,vi7 information on local services and resources where students can obtain additional information related to bullying1 harassment1 dating violence and sexual assault1 suicide prevention1 and other related care2 7,,vii7 encouragement for youth to communicate with their parents or guardians1 health and social service professionals1 and other trusted adults about sexuality and intimate relationships2 7,,viii7 information on how to create a safe environment for all students and others in society2 7,,ix7 examples of varying types of relationships1 couples1 and family structures2 and 7,x7 affirmative representation of varying gender identities1 gender expressions1 and sexual orientations1 including individuals and relationships between same sex couples and their families2 7iv7 abstinence1 delaying age of first sexual activity1 the use of condoms1 preventive medication1 vaccination1 birth control1 and other sexually transmitted infection prevention measures1 and the options for pregnancy1 including parenting1 adoption1 and abortion1 including-- 7,i7 the importance of effectively using condoms1 preventive medication1 and applicable vaccinations to protect against sexually transmitted infections1 including ,,hiv2 7,,ii7 the benefits of effective contraceptive and condom use in avoiding unintended pregnancy2 7,,iii7 the relationship between substance use and sexual health and behaviors2 and 7,,iv7 information about local health services where students can obtain additional information and services related to sexual and reproductive health and other related care2 7v7 through affirmative recognition1 the roles that traditions1 values1 religion1 norms1 gender roles1 acculturation1 family structure1 health beliefs1 and political power play in how students make decisions that affect their sexual health1 using examples of various types of races1 ethnicities1 cultures1 and families1 including single-parent households and young families2 7vi7 information about gender identity1 gender expression1 and sexual orientation for all students1 including-- 7,i7 affirmative recognition that people have different gender identities1 gender expressions1 and sexual orientations2 and 7,,ii7 community resources that can provide additional support for individuals with varying gender identities1 gender expressions1 and sexual orientations2 and 7vii7 opportunities to explore the roles that race1 ethnicity1 immigration status1 disability status1 economic status1 homelessness1 foster care status1 and language within different communities affect sexual attitudes in society and culture and how this may impact student sexual health4 7c7 ,grants for comprehensive sex education at institutions of higher education 7#a7 ,program authorized ,the ,secretary1 in coordination with the ,secretary of ,education1 shall award grants1 on a competitive basis1 to institutions of higher education or consortia of such institutions to enable such institutions to provide young people with comprehensive sex education1 as described in paragraph 7#e77;,b74 7#b7 ,duration ,grants awarded under this subsection shall be for a period of #e years4 7#c7 ,applications ,an institution of higher education or consortium of such institutions desiring a grant under this subsection shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require1 including an assurance to participate in the evaluation described in subsection 7e74 7#d7 ,priority ,in awarding grants under this subsection1 the ,secretary shall give priority to an institution of higher education that-- 7,a7 has an enrollment of needy students1 as defined in section #cah7;b7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajei;e7b772 7,b7 is a ,hispanic-serving institution1 as defined in section #ejb7;a7 of such ,act 7#bj ,u4,s4,c4 #aaja;a7a772 7,c7 is a ,tribal ,college or ,university1 as defined in section #caf7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;c7b772 7,d7 is an ,alaska ,native-serving institution1 as defined in section #cag7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7,e7 is a ,native ,hawaiian-serving institution1 as defined in section #cag7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7,f7 is a ,predominately ,black ,institution1 as defined in section #cah7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;e7b772 7,g7 is a ,native ,american-serving1 nontribal institution1 as defined in section #cai7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;f7b772 7,h7 is an ,asian ,american and ,native ,american ,pacific ,islander-serving institution1 as defined in section #cbj7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;g7b772 or 7,i7 is a minority institution1 as defined in section #cfe of such ,act 7#bj ,u4,s4,c4 #ajfgk71 with an enrollment of needy students1 as defined in section #cab of such ,act 7#bj ,u4,s4,c4 #ajeh74 7#e7 ,uses of funds 7,a7 ,in general ,an institution of higher education1 or a consortium1 receiving a grant under this subsection shall use grant funds to integrate issues relating to comprehensive sex education into the institution of higher education1 or consortium1 in order to reach a large number of students1 by carrying out #a or more of the following activities3 7i7 ,developing or adopting educational content for issues relating to comprehensive sex education that will be incorporated into student orientation1 general education1 or core courses4 7ii7 ,developing or adopting1 and implementing schoolwide educational programming outside of class that delivers elements of comprehensive sex education programs to students1 faculty1 and staff4 7iii7 ,developing or adopting innovative technology-based approaches to deliver sex education to students1 faculty1 and staff4 7iv7 ,developing or adopting1 and implementing peer-outreach and education programs to generate discussion1 educate1 and raise awareness among students about issues relating to comprehensive sex education4 7,b7 ,contents of sex education programs ,each institution of higher education's program of comprehensive sex education funded under this section shall include instruction and materials that address the contents required under subsection 7b77#f74 7d7 ,grants for pre-,service and in-,service teacher training 7#a7 ,program authorized ,the ,secretary1 in coordination with the ,director of the ,centers for ,disease ,control and ,prevention and the ,secretary of ,education1 shall award grants1 on a competitive basis1 to eligible entities to enable such eligible entities to carry out the activities described in paragraph 7#e74 7#b7 ,duration ,grants awarded under this section shall be for a period of #e years4 7#c7 ,eligible entity ,in this section1 the term eligible entity means-- 7,a7 a ,state educational agency1 as defined in section #haja of the ,elementary and ,secondary ,education of #aife 7#bj ,u4,s4,c4 #ghja72 7,b7 a local educational agency1 as defined in section #haja of the ,elementary and ,secondary ,education of #aife 7#bj ,u4,s4,c4 #ghja72 7,c7 an ,indian ,tribe or ,tribal organization1 as defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd72 7,d7 a ,state or local department of health2 7,e7 a ,state or local department of education2 7,f7 an educational service agency1 as defined in section #haja of the ,elementary and ,secondary ,education of #aife 7#bj ,u4,s4,c4 #ghja72 7,g7 a nonprofit institution of higher education1 as defined in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja72 7,h7 a national or statewide nonprofit organization that has as its primary purpose the improvement of provision of comprehensive sex education through training and effective teaching of comprehensive sex education2 or 7,i7 a consortium of nonprofit organizations that has as its primary purpose the improvement of provision of comprehensive sex education through training and effective teaching of comprehensive sex education4 7#d7 ,application ,an eligible entity desiring a grant under this subsection shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require1 including an assurance to participate in the evaluation described in subsection 7e74 7#e7 ,authorized activities 7,a7 ,required activity ,each eligible entity receiving a grant under this section shall use grant funds for professional development and training of relevant faculty1 school administrators1 teachers1 and staff1 in order to increase effective teaching of comprehensive sex education students4 7,b7 ,permissible activities ,each eligible entity receiving a grant under this section may use grant funds to-- 7i7 provide research-based training of teachers for comprehensive sex education for adolescents as a means of broadening student knowledge about issues related to human development1 healthy relationships1 personal skills1 and sexual behavior1 including abstinence1 sexual health1 and society and culture2 7ii7 support the dissemination of information on effective practices and research findings concerning the teaching of comprehensive sex education2 7iii7 support research on-- 7,i7 effective comprehensive sex education teaching practices2 and 7,,ii7 the development of assessment instruments and strategies to document-- 7aa7 student understanding of comprehensive sex education2 and 7bb7 the effects of comprehensive sex education2 7iv7 convene national conferences on comprehensive sex education1 in order to effectively train teachers in the provision of comprehensive sex education2 and 7v7 develop and disseminate appropriate research-based materials to foster comprehensive sex education4 7,c7 ,subgrants ,each eligible entity receiving a grant under this subsection may award subgrants to nonprofit organizations that possess a demonstrated record of providing training to faculty1 school administrators1 teachers1 and staff on comprehensive sex education to-- 7i7 train teachers in comprehensive sex education2 7ii7 support internet or distance learning related to comprehensive sex education2 7iii7 promote rigorous academic standards and assessment techniques to guide and measure student performance in comprehensive sex education2 7iv7 encourage replication of best practices and model programs to promote comprehensive sex education2 7v7 develop and disseminate effective1 research-based comprehensive sex education learning materials2 7vi7 develop academic courses on the pedagogy of sex education at institutions of higher education2 or 7vii7 convene ,state-based conferences to train teachers in comprehensive sex education and to identify strategies for improvement4 7e7 ,impact evaluation and reporting 7#a7 ,multi-year evaluation 7,a7 ,in general ,not later than #f months after the date of the enactment of this ,act1 the ,secretary shall enter into a contract with a nonprofit organization with experience in conducting impact evaluations1 to conduct a multi-year evaluation on the impact of the grants under subsections 7b71 7c71 and 7d71 and to report to ,congress and the ,secretary on the findings of such evaluation4 7,b7 ,evaluation ,the evaluation conducted under this subsection shall-- 7i7 be conducted in a manner consistent with relevant1 nationally recognized professional and technical evaluation standards2 7ii7 use sound statistical methods and techniques relating to the behavioral sciences1 including quasi-experimental designs1 inferential statistics1 and other methodologies and techniques that allow for conclusions to be reached2 7iii7 be carried out by an independent organization that has not received a grant under subsection 7b71 7c71 or 7d72 and 7iv7 be designed to provide information on-- 7,i7 output measures1 such as the number of individuals served under the grant and the number of hours of instruction2 7,,ii7 outcome measures1 including measures relating to-- 7aa7 the knowledge that individuals participating in the grant program have gained in each of the following age and developmentally appropriate areas-- 7,,aa7 growth and development2 7,,bb7 relationship dynamics2 7,,cc7 ways to prevent unintended pregnancy and sexually transmitted infections1 including ,,hiv2 and 7,,dd7 sexual health2 7bb7 the age and developmentally appropriate skills that individuals participating in the grant program have gained regarding-- 7,,aa7 negotiation and communication2 7,,bb7 decision making and goal setting2 7,,cc7 interpersonal skills and healthy relationships2 and 7,,dd7 condom use2 and 7cc7 the behaviors of adolescents participating in the grant program1 including data about-- 7,,aa7 age of first intercourse2 7,,bb7 condom and contraceptive use at first intercourse2 7,,cc7 recent condom and contraceptive use2 7,,dd7 substance use2 7,,ee7 dating abuse and lifetime history of sexual assault1 dating violence1 bullying1 harassment1 stalking2 and 7,,ff7 academic performance2 and 7,,iii7 other measures necessary to evaluate the impact of the grant program4 7,c7 ,report ,not later than #f years after the date of enactment of this ,act1 the organization conducting the evaluation under this subsection shall prepare and submit to the appropriate committees of ,congress and the ,secretary an evaluation report4 ,such report shall be made publicly available1 including on the website of the ,department of ,health and ,human ,services4 7#b7 ,secretary's report to congress ,not later than #a year after the date of the enactment of this ,act1 and annually thereafter for a period of #e years1 the ,secretary shall prepare and submit to the appropriate committees of ,congress a report on the activities to provide adolescents and young people with comprehensive sex education and pre-service and in-service teacher training funded under this section4 ,the ,secretary's report to ,congress shall include-- 7,a7 a statement of how grants awarded by the ,secretary meet the purposes described in subsection 7a77#a72 and 7,b7 information about-- 7i7 the number of eligible entities and institutions of higher education that are receiving grant funds under subsections 7b71 7c71 and 7d72 7ii7 the specific activities supported by grant funds awarded under subsections 7b71 7c71 and 7d72 7iii7 the number of adolescents served by grant programs funded under subsection 7b72 7iv7 the number of young people served by grant programs funded under subsection 7c72 7v7 the number of faculty1 school administrators1 teachers1 and staff trained under subsection 7d72 and 7vi7 the status of the evaluation required under paragraph 7#a74 7f7 ,nondiscrimination ,programs funded under this section shall not discriminate on the basis of actual or perceived sex1 race1 color1 ethnicity1 national origin1 disability1 sexual orientation1 gender identity1 or religion4 ,nothing in this section shall be construed to invalidate or limit rights1 remedies1 procedures1 or legal standards available under any other ,federal law or any law of a ,state or a political subdivision of a ,state1 including the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;a et seq471 title ,,ix of the ,education ,amendments of #aigb 7#bj ,u4,s4,c4 #afha et seq471 section #ejd of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gid71 the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abaja et seq471 and section #aeeg of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahaaf74 7g7 ,limitation ,no ,federal funds provided under this section may be used for health education programs that-- 7#a7 withhold health-promoting or life-saving information about sexuality-related topics1 including ,,hiv2 7#b7 are medically inaccurate or have been scientifically shown to be ineffective2 7#c7 promote gender or racial stereotypes2 7#d7 are insensitive and unresponsive to the needs of sexually active young people2 7#e7 are insensitive and unresponsive to the needs of pregnant or parenting young people2 7#f7 are insensitive and unresponsive to the needs of survivors of sexual abuse or assault2 7#g7 are insensitive and unresponsive to the needs of youth of all physical1 developmental1 or mental abilities2 7#h7 are insensitive and unresponsive to individuals with varying gender identities1 gender expressions1 and sexual orientations2 or 7#i7 are inconsistent with the ethical imperatives of medicine and public health4 7h7 ,amendments to other laws 7#a7 ,amendment to the ,public ,health ,service ,act ,section #bejj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ee7 is amended by striking subsections 7b7 through 7d7 and inserting the following3 7b7 ,contents of programs ,all programs of education and information receiving funds under this title shall include information about the potential effects of intravenous substance abuse4 4 7#b7 ,amendments to the ,elementary and ,secondary ,education ,act of #aife ,section #hebf of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #gijf7 is amended-- 7,a7 by striking paragraph 7#c72 7,b7 by redesignating paragraphs 7#d7 and 7#e7 as paragraphs 7#c7 and 7#d71 respectively2 7,c7 in paragraph 7#c71 as redesignated by subparagraph 7,b71 by inserting or after the semicolon2 7,d7 in paragraph 7#d71 as redesignated by subparagraph 7,b71 by striking 2 or and inserting a period2 and 7,e7 by striking paragraph 7#f74 7i7 ,definitions ,in this section3 7#a7 ,adolescents ,the term adolescents means individuals who are ages #aj through #ai at the time of commencement of participation in a program supported under this section4 7#b7 ,age and developmentally appropriate ,the term age and developmentally appropriate means topics1 messages1 and teaching methods suitable to particular age1 age group of children and adolescents1 or developmental levels1 based on cognitive1 emotional1 social1 and behavioral capacity of most students at that age level4 7#c7 ,appropriate committees of congress ,the term appropriate committees of ,congress means the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate1 the ,committee on ,appropriations of the ,senate1 the ,committee on ,energy and ,commerce of the ,house of ,representatives1 the ,committee on ,education and ,labor of the ,house of ,representatives1 and the ,committee on ,appropriations of the ,house of ,representatives4 7#d7 ,characteristics of effective programs ,the term characteristics of effective programs means the aspects of evidence-based programs1 including development1 content1 and implementation of such programs1 that-- 7,a7 have been shown to be effective in terms of increasing knowledge1 clarifying values and attitudes1 increasing skills1 and impacting upon behavior2 and 7,b7 are widely recognized by leading medical and public health agencies to be effective in changing sexual behaviors that lead to sexually transmitted infections1 including ,,hiv1 unintended pregnancy1 and dating violence and sexual assault among young people4 7#e7 ,comprehensive sex education ,the term comprehensive sex education means instructional part of a comprehensive school health education approach which addresses the physical1 mental1 emotional1 and social dimensions of human sexuality2 designed to motivate and assist students to maintain and improve their sexual health1 prevent disease and reduce sexual health-related risk behaviors2 and enable and empower students to develop and demonstrate age and developmentally appropriate sexuality and sexual health-related knowledge1 attitudes1 skills1 and practices4 7#f7 ,consent ,the term consent means affirmative1 conscious1 and voluntary agreement to engage in interpersonal1 physical1 or sexual activity4 7#g7 ,culturally appropriate ,the term culturally appropriate means materials and instruction that respond to culturally diverse individuals1 families and communities in an inclusive1 respectful and effective manner2 including materials and instruction that are inclusive of race1 ethnicity1 languages1 cultural background1 religion1 sex1 gender identity1 sexual orientation1 and different abilities4 7#h7 ,evidence-based ,the term evidence-based1 when used with respect to sex education instruction1 means a sex education program that has been proven through rigorous evaluation to be effective in changing sexual behavior or incorporates elements of other programs that have been proven to be effective in changing sexual behavior4 7#i7 ,gender expression ,the term gender expression1 when used with respect to a sex education program1 means the expression of one's gender1 such as through behavior1 clothing1 haircut1 or voice1 and which may or may not conform to socially defined behaviors and characteristics typically associated with being either masculine or feminine4 7#aj7 ,gender identity ,except with respect to subsection 7f71 the term gender identity1 when used with respect to a sex education program1 means the gender-related identity1 appearance1 mannerisms1 or other gender-related characteristics of an individual1 regardless of the individual's designated sex at birth including a person's deeply held sense or knowledge of their own gender2 such as male1 female1 both or neither4 7#aa7 ,inclusive ,the term inclusive1 when used with respect to a sex education program1 means curriculum that ensures that students from historically marginalized communities are reflected in classroom materials and lessons4 7#ab7 ,institution of higher education ,the term institution of higher education has the meaning given the term in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja74 7#ac7 ,medically accurate and complete ,the term medically accurate and complete1 when used with respect to a sex education program1 means that-- 7,a7 the information provided through the program is verified or supported by the weight of research conducted in compliance with accepted scientific methods and is published in peer-reviewed journals1 where applicable2 or 7,b7 7i7 the program contains information that leading professional organizations and agencies with relevant expertise in the field recognize as accurate1 objective1 and complete2 and 7ii7 the program does not withhold information about the effectiveness and benefits of correct and consistent use of condoms and other contraceptives4 7#ad7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#ae7 ,sexual development ,the term sexual development means the lifelong process of physical1 behavioral1 cognitive1 and emotional growth and change as it relates to an individual's sexuality and sexual maturation1 including puberty1 identity development1 socio-cultural influences1 and sexual behaviors4 7#af7 ,sexual orientation ,except with respect to subsection 7f71 the term sexual orientation1 when used with respect to a sex education program1 means an individual's attraction1 including physical or emotional1 to the same or different gender4 7#ag7 ,young people ,the term young people means individuals who are ages #aj through #bd at the time of commencement of participation in a program supported under this section4 7j7 ,funding 7#a7 ,appropriation ,for the purpose of carrying out this section1 there is appropriated #ge1jjj1jjj for each of fiscal years #bjba through #bjbf4 ,amounts appropriated under this subsection shall remain available until expended4 7#b7 ,reservations of funds 7,a7 ,the ,secretary shall reserve #ej percent of the amount appropriated under paragraph 7#a7 for the purposes of awarding grants for comprehensive sex education for adolescents under subsection 7c74 7,b7 ,the ,secretary shall reserve #be percent of the amount appropriated under paragraph 7#a7 for the purposes of awarding grants for comprehensive sex education at institutes of higher education under subsection 7d74 7,c7 ,the ,secretary shall reserve #bj percent of the amount appropriated under paragraph 7#a7 for the purposes of awarding grants for pre-service and in-service teacher training under subsection 7e74 7,d7 ,the ,secretary shall reserve #b percent of the amount appropriated under paragraph 7#a7 for the purpose of carrying out the impact evaluation and reporting required under subsection 7a74 7#c7 ,secretarial responsibilities ,the ,secretary shall reserve #c percent of the amount appropriated under paragraph 7#a7 for each fiscal year for expenditures by the ,secretary to provide1 directly or through a competitive grant process1 research1 training1 and technical assistance1 including dissemination of research and information regarding effective and promising practices1 providing consultation and resources1 and developing resources and materials to support the activities of recipients of grants4 ,in carrying out such functions1 the ,secretary shall collaborate with a variety of entities that have expertise in adolescent sexual health development1 education1 and promotion4 7#d7 ,reprogramming of abstinence only until marriage program funding ,the unobligated balance of funds made available to carry out section #eaj of the ,social ,security ,act 7#db ,u4,s4,c4 #gaj7 7as in effect on the day before the date of enactment of this ,act7 are hereby transferred and shall be used by the ,secretary to carry out this section4 ,the amounts transferred and made available to carry out this section shall remain available until expended4 7#e7 ,repeal of abstinence only until marriage program ,section #eaj of the ,social ,security ,act 7#db ,u4,s4,c4 #gaj7 is repealed4 #eab4 ,compassionate assistance for rape emergencies 7a7 ,medicare 7#a7 ,limitation on payment ,section #ahff7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77 is amended-- 7,a7 by moving the indentation of subparagraph 7,w7 #b ems to the left2 7,b7 in subparagraph 7,x7-- 7i7 by moving the indentation #b ems to the left2 and 7ii7 by striking and at the end2 7,c7 in subparagraph 7,y71 by striking the period at the end and inserting 2 and2 and 7,d7 by inserting after subparagraph 7,y7 the following new subparagraph3 7,z7 in the case of a hospital or critical access hospital1 to adopt and enforce a policy to ensure compliance with the requirements of subsection 7l7 and to meet the requirements of such subsection4 4 7#b7 ,assistance to victims ,section #ahff of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7 is amended by adding at the end the following new subsection3 7l7 ,compassionate assistance for rape emergencies 7#a7 ,in general ,for purposes of section #ahff7;a77#a77,z71 a hospital meets the requirements of this subsection if the hospital provides each of the services described in paragraph 7#b7 to each individual1 whether or not eligible for benefits under this title or under any other form of health insurance1 who comes to the hospital on or after ,january #a1 #bjba1 and-- 7,a7 who states to hospital personnel that they are victims of sexual assault2 7,b7 who is accompanied by an individual who states to hospital personnel that the individual is a victim of sexual assault2 or 7,c7 whom hospital personnel1 during the course of treatment and care for the individual1 have reason to believe is a victim of sexual assault4 7#b7 ,required services described ,for purposes of paragraph 7#a71 the services described in this subparagraph are the following3 7,a7 ,provision of medically and factually accurate and unbiased written and oral information about emergency contraception that-- 7i7 is written in clear and concise language2 7ii7 is readily comprehensible2 7iii7 includes an explanation that emergency contraceptives-- 7,i7 has been approved by the ,food and ,drug ,administration for individuals and is a safe and effective way to prevent pregnancy after unprotected intercourse or contraceptive failure if taken in a timely manner2 7,,ii7 is more effective the sooner it is taken2 and 7,,iii7 does not cause an abortion and cannot interrupt an established pregnancy2 7iv7 meets such conditions regarding the provision of such information in languages other than ,english as the ,secretary may establish2 and 7v7 is provided without regard to the ability of the individual or their family to pay costs associated with the provision of such information to the individual4 7,b7 ,immediate offer to provide emergency contraception to the individual at the hospital and1 in the case that the individual accepts such offer1 immediate provision to the individual of such contraception on the same day it is requested without regard to the inability of the individual or their family to pay costs associated with the offer and provision of such contraception4 7,c7 ,development and implementation of a written policy to ensure that an individual is present at the hospital1 or on-call1 who-- 7i7 has authority to dispense or prescribe emergency contraception1 independently1 or under a protocol prepared by a physician for the administration of emergency contraception at the hospital to a victim of sexual assault2 and 7ii7 is trained to comply with the requirements of this section4 7,d7 ,provision of medically and factually accurate and unbiased written and oral information and counseling about post-exposure prophylaxis 7,,pep7 protocol for the prevention of ,,hiv4 7,e7 ,immediately offer to begin ,,pep to the individual at the hospital except in cases where the medical professional's best judgement is that further evaluation is required or that such a regimen will be substantially detrimental to the individual's health4 ,such provision shall be offered regardless of the individual's ability to pay4 ,hospitals shall be responsible for ensuring adequate supply of ,,pep medications to provide to patients4 7#c7 ,hospital defined ,for purposes of this paragraph1 the term hospital includes a critical access hospital1 as defined in section #ahfa7mm77#a74 4 7b7 ,limitation on payment under ,medicaid ,section #aijc7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7i77 is amended by inserting after paragraph 7#h7 the following new paragraph3 7#i7 with respect to any amount expended for care or services furnished under the plan by a hospital on or after ,january #a1 #bjba1 unless such hospital meets the requirements specified in section #ahff7l7 for purposes of title ,,xviii2 4 #eac4 ,access to birth control duties of pharmacies to ensure provision of ,,fda-approved contraception ,part ,b of title ,,ii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bch et seq47 is amended by adding at the end the following3 #bdi4 ,duties of pharmacies to ensure provision of ,,fda-approved contraception 7a7 ,in general ,subject to subsection 7c71 a pharmacy that receives ,food and ,drug ,administration-approved drugs or devices in interstate commerce shall maintain compliance with the following3 7#a7 ,if a customer requests a contraceptive or a medication related to a contraceptive1 including emergency contraception1 that is in stock1 the pharmacy shall ensure that the contraceptive is provided to the customer without delay4 7#b7 ,if a customer requests a contraceptive or a medication related to a contraceptive that is not in stock and the pharmacy in the normal course of business stocks contraception1 the pharmacy shall immediately inform the customer that the contraceptive is not in stock and without delay offer the customer the following options3 7,a7 ,if the customer prefers to obtain the contraceptive or a medication related to a contraceptive through a referral or transfer1 the pharmacy shall-- 7i7 locate a pharmacy of the customer's choice or the closest pharmacy confirmed to have the contraceptive or a medication related to a contraceptive in stock2 and 7ii7 refer the customer or transfer the prescription to that pharmacy4 7,b7 ,if the customer prefers for the pharmacy to order the contraceptive or a medication related to a contraceptive1 the pharmacy shall obtain the contraceptive or medication under the pharmacy's standard procedure for expedited ordering of medication and notify the customer when the contraceptive or medication arrives4 7#c7 ,the pharmacy shall ensure that-- 7,a7 the pharmacy does not operate an environment in which customers are intimidated1 threatened1 or harassed in the delivery of services relating to a request for contraception or a medication related to a contraceptive2 7,b7 the pharmacy's employees do not interfere with or obstruct the delivery of services relating to a request for contraception or a medication related to a contraceptive2 7,c7 the pharmacy's employees do not intentionally misrepresent or deceive customers about the availability of a contraceptive or a medication related to a contraceptive1 or the mechanism of action of such contraceptive or medication2 7,d7 the pharmacy's employees do not breach medical confidentiality with respect to a request for a contraceptive or a medication related to a contraceptive or threaten to breach such confidentiality2 or 7,e7 the pharmacy's employees do not refuse to return a valid1 lawful prescription for a contraceptive or a medication related to a contraceptive upon customer request4 7b7 ,contraceptives not ordinarily stocked ,nothing in subsection 7a77#b7 shall be construed to require any pharmacy to comply with such subsection if the pharmacy does not ordinarily stock contraceptives or a medication related to a contraceptive in the normal course of business4 7c7 ,refusals pursuant to standard pharmacy practice ,this section does not prohibit a pharmacy from refusing to provide a contraceptive or a medication related to a contraceptive to a customer in accordance with any of the following3 7#a7 ,if it is unlawful to dispense the contraceptive or a medication related to a contraceptive to the customer without a valid1 lawful prescription and no such prescription is presented4 7#b7 ,if the customer is unable to pay for the contraceptive or the medication related to a contraceptive4 7#c7 ,if the employee of the pharmacy refuses to provide the contraceptive or a medication related to a contraceptive on the basis of a professional clinical judgment4 7d7 ,relation to other law 7#a7 ,rule of construction ,nothing in this section shall be construed to invalidate or limit rights1 remedies1 procedures1 or legal standards under title ,,vii of the ,civil ,rights ,act of #aifd4 7#b7 ,certain claims ,the ,religious ,freedom ,restoration ,act of #aiic shall not provide a basis for a claim concerning1 or a defense to a claim under1 this section1 or provide a basis for challenging the application or enforcement of this section4 7e7 ,preemption ,this section does not preempt any provision of ,state law or any professional obligation made applicable by a ,state board or other entity responsible for licensing or discipline of pharmacies or pharmacists1 to the extent that such ,state law or professional obligation provides protections for customers that are greater than the protections provided by this section4 7f7 ,enforcement 7#a7 ,civil penalty ,a pharmacy that violates a requirement of subsection 7a7 is liable to the ,united ,states for a civil penalty in an amount not exceeding #a1jjj per day of violation1 not to exceed #ajj1jjj for all violations adjudicated in a single proceeding4 7#b7 ,private cause of action ,any person aggrieved as a result of a violation of a requirement of subsection 7a7 may1 in any court of competent jurisdiction1 commence a civil action against the pharmacy involved to obtain appropriate relief1 including actual and punitive damages1 injunctive relief1 and a reasonable attorney's fee and cost4 7#c7 ,limitations ,a civil action under paragraph 7#a7 or 7#b7 may not be commenced against a pharmacy after the expiration of the #e-year period beginning on the date on which the pharmacy allegedly engaged in the violation involved4 7g7 ,definitions ,in this section3 7#a7 ,contraception ,the term contraception or contraceptive means any drug or device approved by the ,food and ,drug ,administration to prevent pregnancy4 7#b7 ,employee ,the term employee means a person hired1 by contract or any other form of an agreement1 by a pharmacy4 7#c7 ,medication related to a contraceptive ,the term medication related to a contraceptive means any drug or device approved by the ,food and ,drug ,administration that a medical professional determines necessary to use before or in conjunction with a contraceptive4 7#d7 ,pharmacy ,the term pharmacy means an entity that-- 7,a7 is authorized by a ,state to engage in the business of selling prescription drugs at retail2 and 7,b7 employs one or more employees4 7#e7 ,product ,the term product means a ,food and ,drug ,administration-approved drug or device4 7#f7 ,professional clinical judgment ,the term professional clinical judgment means the use of professional knowledge and skills to form a clinical judgment1 in accordance with prevailing medical standards4 7#g7 ,without delay ,the term without delay1 with respect to a pharmacy providing1 providing a referral for1 or ordering contraception1 or transferring the prescription for contraception1 means within the usual and customary timeframe at the pharmacy for providing1 providing a referral for1 or ordering other products1 or transferring the prescription for other products1 respectively4 7h7 ,effective date ,this section shall take effect on the #cast day after the date of the enactment of this section1 without regard to whether the ,secretary has issued any guidance or final rule regarding this section4 4 #ead4 ,additional focus area for the ,office on ,women's ,health ,section #bbi7;b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bcg;a7b77 is amended-- 7#a7 in paragraph 7#f71 at the end1 by striking and2 7#b7 in paragraph 7#g71 at the end1 by striking the period and inserting a semicolon2 and 7#c7 by adding at the end the following new paragraph3 7#h7 facilitate policymakers1 health system leaders and providers1 consumers1 and other stakeholders in understanding optimal maternity care and support for the provision of such care1 including the priorities of-- 7,a7 protecting1 promoting1 and supporting the innate capacities of childbearing individuals and their newborns for childbirth1 breastfeeding1 and attachment2 7,b7 using obstetric interventions only when such interventions are supported by strong1 high-quality evidence1 and minimizing overuse of maternity practices that have been shown to have benefit in limited situations and that can expose women1 infants1 or both to risk of harm if used routinely and indiscriminately1 including continuous electronic fetal monitoring1 labor induction1 epidural analgesia1 primary cesarean section1 and routine repeat cesarean birth2 7,c7 reliably incorporating noninvasive1 evidence-based practices that have documented correlation with considerable improvement in outcomes with no detrimental side effects1 such as smoking cessation programs in pregnancy and proven models of group prenatal care that integrate health assessment1 education1 and support into a unified program and supporting evidence-based breastfeeding promotion efforts with respect for a breastfeeding individual's personal decision making2 7,d7 a shared understanding of the qualifications of licensed providers of maternity care and the best evidence about the safety1 satisfaction1 outcomes1 and costs of their care1 and appropriate deployment of such caregivers within the maternity care workforce to address the needs of childbearing individuals and newborns and the growing shortage of maternity caregivers2 7,e7 a shared understanding of the results of the best available research comparing hospital1 birth center1 and planned home births1 including information about each setting's safety1 satisfaction1 outcomes1 and costs2 7,f7 high-quality1 evidence-based childbirth education that promotes a natural1 healthy1 and safe approach to pregnancy1 childbirth1 and early parenting2 is taught by certified educators1 peer counselors1 and health professionals2 and promotes informed decision making by childbearing individuals2 and 7,g7 developing measures that enable a more robust1 balanced set of standardized maternity care measures1 including performance and quality measures2 4 #eae4 ,interagency ,coordinating ,committee on the ,promotion of ,optimal ,maternity ,outcomes 7a7 ,in general ,part ,a of title ,,ii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bjb et seq47 is amended by adding at the end the following3 #bbi;,a4 ,interagency ,coordinating ,committee on the ,promotion of ,optimal ,maternity ,outcomes 7a7 ,in general ,the ,secretary1 acting through the ,deputy ,assistant ,secretary for ,women's ,health under section #bbi and in collaboration with the ,federal officials specified in subsection 7b71 shall establish the ,interagency ,coordinating ,committee on the ,promotion of ,optimal ,maternity ,outcomes 7referred to in this section as the ,,iccpom74 7b7 ,other agencies ,the officials specified in this subsection are the ,secretary of ,labor1 the ,secretary of ,defense1 the ,secretary of ,veterans ,affairs1 the ,surgeon ,general1 the ,director of the ,centers for ,disease ,control and ,prevention1 the ,administrator of the ,health ,resources and ,services ,administration1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 the ,director of the ,indian ,health ,service1 the ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration1 the ,director of the ,national ,institute of ,child ,health and ,human ,development1 the ,director of the ,agency for ,healthcare ,research and ,quality1 the ,assistant ,secretary for ,children and ,families1 the ,deputy ,assistant ,secretary for ,minority ,health1 the ,director of the ,office of ,personnel ,management1 and such other ,federal officials as the ,secretary of ,health and ,human ,services determines to be appropriate4 7c7 ,chair ,the ,deputy ,assistant ,secretary for ,women's ,health shall serve as the chair of the ,,iccpom4 7d7 ,duties ,the ,,iccpom shall guide policy and program development across the ,federal ,government with respect to promotion of optimal maternity care1 provided1 however1 that nothing in this section shall be construed as transferring regulatory or program authority from an agency to the ,,iccpom4 7e7 ,consultations ,the ,,iccpom shall actively seek the input of1 and shall consult with1 all appropriate and interested stakeholders1 including ,state health departments1 public health research and interest groups1 foundations1 childbearing individuals and their advocates1 and maternity care professional associations and organizations1 reflecting racially1 ethnically1 demographically1 and geographically diverse communities4 7f7 ,annual report 7#a7 ,in general ,the ,secretary1 on behalf of the ,,iccpom1 shall annually submit to ,congress a report that summarizes-- 7,a7 all programs and policies of ,federal agencies 7including the ,medicare ,program under title ,,xviii of the ,social ,security ,act and the ,medicaid program under title ,,xix of such ,act7 designed to promote optimal maternity care1 focusing particularly on programs and policies that support the adoption of evidence based maternity care1 as defined by timely1 scientifically sound systematic reviews2 7,b7 all programs and policies of ,federal agencies 7including the ,medicare ,program under title ,,xviii of the ,social ,security ,act and the ,medicaid program under title ,,xix of such ,act7 designed to address the problems of maternal mortality and morbidity1 infant mortality1 prematurity1 and low birth weight1 including such programs and policies designed to address racial and ethnic disparities with respect to each of such problems2 7,c7 the extent of progress in reducing maternal mortality and infant mortality1 low birth weight1 and prematurity at ,state and national levels2 and 7,d7 such other information regarding optimal maternity care 7such as quality and performance measures7 as the ,secretary determines to be appropriate4 ,the information specified in subparagraph 7,c7 shall be included in each such report in a manner that disaggregates such information by race1 ethnicity1 and indigenous status in order to determine the extent of progress in reducing racial and ethnic disparities and disparities related to indigenous status4 7#b7 ,certain information ,each report under paragraph 7#a7 shall include information 7disaggregated by race1 ethnicity1 and indigenous status1 as applicable7 on the following rates and costs by ,state3 7,a7 ,the rate of primary cesarean deliveries and repeat cesarean deliveries4 7,b7 ,the rate of vaginal births after cesarean4 7,c7 ,the rate of vaginal breech births4 7,d7 ,the rate of induction of labor4 7,e7 ,the rate of freestanding birth center births4 7,f7 ,the rate of planned and unplanned home birth4 7,g7 ,the rate of attended births by provider1 including by an obstetrician-gynecologist1 family practice physician1 obstetrician-gynecologist physician assistant1 certified nurse-midwife1 certified midwife1 and certified professional midwife4 7,h7 ,the cost of maternity care disaggregated by place of birth and provider of care1 including-- 7i7 uncomplicated vaginal birth2 7ii7 complicated vaginal birth2 7iii7 uncomplicated cesarean birth2 and 7iv7 complicated cesarean birth4 7g7 ,authorization of appropriations ,there is authorized to be appropriated1 in addition to amounts authorized to be appropriated under section #bbi7;e71 to carry out this section #a1jjj1jjj for each of the fiscal years #bjba through #bjbe4 4 7b7 ,conforming amendments 7#a7 ,inclusion as duty of ,,hhs office on women's health ,section #bbi7;b7 of such ,act 7#db ,u4,s4,c4 #bcg;a7b771 as amended by section #ead1 is further amended by adding at the end the following new paragraph3 7#i7 establish the ,interagency ,coordinating ,committee on the ,promotion of ,optimal ,maternity ,outcomes in accordance with section #bbi;,a2 and 4 7#b7 ,treatment of biennial reports ,section #bbi7;d7 of such ,act 7#db ,u4,s4,c4 #bcg;a7d77 is amended by inserting 7other than under subsection 7b77#i77 after under this section4 #eaf4 ,consumer education campaign ,section #bbi7;b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bcg;a7b771 as amended by sections #ead and #eae1 is further amended by adding at the end the following3 7#aj7 not later than one year after the date of the enactment of the ,health ,equity and ,accountability ,act of #bjbj1 develop and implement a #d-year culturally and linguistically appropriate multimedia consumer education campaign that is designed to promote understanding and acceptance of evidence-based maternity practices and models of care for optimal maternity outcomes among individuals of childbearing ages and families of such individuals and that-- 7,a7 highlights the importance of protecting1 promoting1 and supporting the innate capacities of childbearing individuals and their newborns for childbirth1 breastfeeding1 and attachment2 7,b7 promotes understanding of the importance of using obstetric interventions when medically necessary and when supported by strong1 high-quality evidence2 7,c7 highlights the widespread overuse of maternity practices that have been shown to have benefit when used appropriately in situations of medical necessity1 but which can expose pregnant individuals1 infants1 or both to risk of harm if used routinely and indiscriminately1 including continuous fetal monitoring1 labor induction1 epidural anesthesia1 elective primary cesarean section1 and repeat cesarean delivery2 7,d7 emphasizes the noninvasive maternity practices that have strong proven correlation or may be associated with considerable improvement in outcomes with no detrimental side effects1 and are significantly underused in the ,united ,states1 including smoking cessation programs in pregnancy1 group model prenatal care1 continuous labor support1 nonsupine positions for birth1 and external version to turn breech babies at term2 7,e7 educates consumers about the qualifications of licensed providers of maternity care and the best evidence about their safety1 satisfaction1 outcomes1 and costs2 7,f7 informs consumers about the best available research comparing birth center births1 planned home births1 and hospital births1 including information about each setting's safety1 satisfaction1 outcomes1 and costs2 7,g7 fosters participation in high-quality1 evidence-based childbirth education that promotes a natural1 healthy1 and safe approach to pregnancy1 childbirth1 and early parenting2 is taught by certified educators1 peer counselors1 and health professionals2 and promotes informed decision making by childbearing individuals2 and 7,h7 is pilot tested for consumer comprehension1 cultural sensitivity1 and acceptance of the messages across geographically1 racially1 ethnically1 and linguistically diverse populations4 4 #eag4 ,bibliographic database of systematic reviews for care of childbearing individuals and newborns 7a7 ,in general ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 through the ,agency for ,healthcare ,research and ,quality1 shall-- 7#a7 make publicly available an online bibliographic database identifying systematic reviews1 including an explanation of the level and quality of evidence1 for care of childbearing individuals and newborns2 and 7#b7 initiate regular updates that incorporate newly issued and updated systematic reviews4 7b7 ,sources ,to aim for a comprehensive inventory of systematic reviews relevant to maternal and newborn care1 the database shall identify reviews from diverse sources1 including-- 7#a7 scientific peer-reviewed journals2 7#b7 databases1 including ,cochrane ,database of ,systematic ,reviews1 ,clinical ,evidence1 and ,database of ,abstracts of ,reviews of ,effects2 and 7#c7 internet websites of agencies and organizations throughout the world that produce such systematic reviews4 7c7 ,features ,the database shall-- 7#a7 provide bibliographic citations for each record within the database1 and for each such citation include an explanation of the level and quality of evidence2 7#b7 include abstracts1 as available2 7#c7 provide reference to companion documents as may exist for each review1 such as evidence tables and guidelines or consumer educational materials developed from the review2 7#d7 provide links to the source of the full review and to any companion documents2 7#e7 provide links to the source of a previous version or update of the review2 7#f7 be searchable by intervention or other topic of the review1 reported outcomes1 author1 title1 and source2 and 7#g7 offer to users periodic electronic notification of database updates relating to users' topics of interest4 7d7 ,outreach ,not later than the first date the database is made publicly available and periodically thereafter1 the ,secretary of ,health and ,human ,services shall publicize the availability1 features1 and uses of the database under this section to the stakeholders described in subsection 7e74 7e7 ,consultation ,for purposes of developing the database under this section and maintaining and updating such database1 the ,secretary of ,health and ,human ,services shall convene and consult with an advisory committee composed of relevant stakeholders1 including-- 7#a7 ,federal ,medicaid administrators and ,state agencies administrating ,state plans under title ,,xix of the ,social ,security ,act pursuant to section #aijb7;a77#e7 of such ,act 7#db ,u4,s4,c4 #acif;a7a77#e772 7#b7 providers of maternity and newborn care from both academic and community-based settings1 including obstetrician-gynecologists1 family physicians1 certified nurse midwives1 certified midwives1 certified professional midwives1 physician assistants1 perinatal nurses1 pediatricians1 and nurse practitioners2 7#c7 maternal-fetal medicine specialists2 7#d7 neonatologists2 7#e7 childbearing individuals and advocates for such individuals1 including childbirth educators certified by a nationally accredited program1 representing communities that are diverse in terms of race1 ethnicity1 indigenous status1 and geographic area2 7#f7 employers and purchasers2 7#g7 health facility and system leaders1 including both hospital and birth center facilities2 7#h7 journalists2 and 7#i7 bibliographic informatics specialists4 7f7 ,authorization of appropriations ,there is authorized to be appropriated #b1ejj1jjj for each of the fiscal years #bjba through #bjbc for the purpose of developing the database and such sums as may be necessary for each subsequent fiscal year for updating the database and providing outreach and notification to users1 as described in this section4 #eah4 ,expansion of ,,cdc ,prevention ,research ,centers ,program to include ,centers on ,optimal ,maternity ,outcomes 7a7 ,in general ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 shall support the establishment of additional ,prevention ,research ,centers under the ,prevention ,research ,center ,program administered by the ,centers for ,disease ,control and ,prevention4 ,such additional centers shall each be known as a ,center for ,excellence on ,optimal ,maternity ,outcomes4 7b7 ,research ,each ,center for ,excellence on ,optimal ,maternity ,outcomes shall-- 7#a7 conduct at least one focused program of research to improve maternity outcomes1 including the reduction of cesarean birth rates1 elective inductions1 prematurity rates1 and low birth weight rates within an underserved population that has a disproportionately large burden of suboptimal maternity outcomes1 including maternal mortality and morbidity1 infant mortality1 prematurity1 or low birth weight1 which such program shall include developing performance and quality measures for accountability2 7#b7 work with partners on special interest projects1 as specified by the ,centers for ,disease ,control and ,prevention and other relevant agencies within the ,department of ,health and ,human ,services1 and on projects funded by other sources2 and 7#c7 involve a minimum of two distinct birth setting models1 such as-- 7,a7 a hospital labor and delivery model and freestanding birth center model2 or 7,b7 a hospital labor and delivery model and planned home birth model4 7c7 ,interdisciplinary providers ,each ,center for ,excellence on ,optimal ,maternity ,outcomes shall include the following interdisciplinary providers of maternity care3 7#a7 ,obstetrician-gynecologists4 7#b7 ,at least two of the following providers3 7,a7 ,family practice physicians4 7,b7 ,nurse practitioners4 7,c7 ,physician assistants4 7,d7 ,certified professional midwives4 7d7 ,services ,research conducted by each ,center for ,excellence on ,optimal ,maternity ,outcomes shall include at least #b 7and preferably more7 of the following supportive provider services3 7#a7 ,mental health4 7#b7 ,doula labor support4 7#c7 ,nutrition education4 7#d7 ,childbirth education4 7#e7 ,social work4 7#f7 ,physical therapy or occupation therapy4 7#g7 ,substance abuse services4 7#h7 ,home visiting4 7e7 ,coordination ,the programs of research at each of the ,centers of ,excellence on ,optimal ,maternity ,outcomes shall complement and not replicate the work of the other4 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #b1jjj1jjj for each of the fiscal years #bjba through #bjbe4 #eai4 ,expanding models allowed to be tested by ,center for ,medicare ,medicaid ,innovation to include maternity care models ,section #aaae;,a7b77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,b77 is amended by adding at the end the following new clause3 7xxviii7 ,promoting evidence-based models of care that have been associated with reductions in maternal and infant health disparities1 including incorporating the use of doula and promotoras support for pregnant and childbearing individuals into evidence-based models of prenatal care1 labor and delivery1 and postpartum care1 and supporting the appropriate use of out-of-hospital birth models1 including births at home and in freestanding birth centers4 4 #ebj4 ,development of interprofessional maternity care educational models and tools 7a7 ,in general ,not later than #f months after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 acting in conjunction with the ,administrator of ,health ,resources and ,services ,administration1 shall convene1 for a #a-year period1 an ,interprofessional ,maternity ,provider ,education ,commission to discuss and make recommendations for-- 7#a7 a consensus standard physiologic maternity care curriculum that takes into account the core competencies for basic midwifery practice such as those developed by the ,american ,college of ,nurse ,midwives and the ,north ,american ,registry of ,midwives1 and the educational objectives for physicians practicing in obstetrics and gynecology as determined by the ,council on ,resident ,education in ,obstetrics and ,gynecology2 7#b7 suggestions for multidisciplinary use of the consensus physiologic curriculum2 7#c7 strategies to integrate and coordinate education across maternity care disciplines1 including recommendations to increase medical and midwifery student exposure to out-of-hospital birth2 and 7#d7 pilot demonstrations of interprofessional educational models4 7b7 ,participants ,the ,commission shall include maternity care educators1 curriculum developers1 service leaders1 certification leaders1 and accreditation leaders from the various professions that provide maternity care in the ,united ,states4 ,such professions shall include obstetrician gynecologists1 certified nurse midwives or certified midwives1 family practice physicians1 nurse practitioners1 physician assistants1 certified professional midwives1 and perinatal nurses4 ,additionally1 the ,commission shall include representation from maternity care consumer advocates4 7c7 ,curriculum ,the consensus standard physiologic maternity care curriculum described in subsection 7a77#a7 shall-- 7#a7 have a public health focus with a foundation in health promotion and disease prevention2 7#b7 foster physiologic childbearing and woman and family centered care2 7#c7 integrate strategies to reduce maternal and infant morbidity and mortality2 7#d7 incorporate recommendations to ensure respectful1 safe1 and seamless consultation1 referral1 transport1 and transfer of care when necessary2 7#e7 include cultural sensitivity and strategies to decrease disparities in maternity outcomes2 and 7#f7 include implicit bias training4 7d7 ,report ,not later than #f months after the final meeting of the ,commission1 the ,secretary of ,health and ,human ,services shall-- 7#a7 submit to ,congress a report containing the recommendations made by the ,commission under this section2 and 7#b7 make such report publicly available4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #a1jjj1jjj for each of the fiscal years #bjba and #bjbb1 and such sums as are necessary for each of the fiscal years #bjbc through #bjbe4 #eba4 ,including services furnished by certain students1 interns1 and residents supervised by certified nurse midwives within inpatient hospital services under ,medicare 7a7 ,in general ,section #ahfa7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7b77 is amended-- 7#a7 in paragraph 7#f71 by striking 2 or at the end and inserting 1 or in the case of services in a hospital or osteopathic hospital by a student midwife or an intern or resident-in-training under a teaching program previously described in this paragraph who is in the field of obstetrics and gynecology1 if such student midwife1 intern1 or resident-in-training is supervised by a certified nurse-midwife to the extent permitted under applicable ,state law and as may be authorized by the hospital22 7#b7 in paragraph 7#g71 by striking the period at the end and inserting 2 or2 and 7#c7 by adding at the end the following new paragraph3 7#h7 a certified nurse-midwife where the hospital has a teaching program approved as specified in paragraph 7#f71 if-- 7,a7 the hospital elects to receive any payment due under this title for reasonable costs of such services2 and 7,b7 all certified nurse-midwives in such hospital agree not to bill charges for professional services rendered in such hospital to individuals covered under the insurance program established by this title4 4 7b7 ,effective date ,the amendments made by subsection 7a7 shall apply to services furnished on or after the date of the enactment of this ,act4 #ebb4 ,grants to professional organizations to increase diversity in maternal1 reproductive1 and sexual health professionals 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 through the ,administrator of the ,health ,resources and ,services ,administration1 shall carry out a grant program under which the ,secretary may make to eligible organizations-- 7#a7 for fiscal year #bjba1 planning grants described in subsection 7b72 and 7#b7 for the subsequent #d-year period1 implementation grants described in subsection 7c74 7b7 ,planning grants 7#a7 ,in general ,planning grants described in this subsection are grants for the following purposes3 7,a7 ,to collect data and identify any workforce disparities1 with respect to a health profession1 at each of the following areas along the health professional continuum3 7i7 ,pipeline availability with respect to students at the high school and college or university levels considering and working toward entrance in the profession1 including barriers triggered by criminal records4 7ii7 ,entrance into the training program for the profession4 7iii7 ,graduation from such training program4 7iv7 ,entrance into practice1 including barriers triggered by criminal records4 7v7 ,retention in practice for more than a #e-year period4 7,b7 ,to develop one or more strategies to address the workforce disparities within the health profession1 as identified under 7and in response to the findings pursuant to7 subparagraph 7,a74 7#b7 ,application ,to be eligible to receive a grant under this subsection1 an eligible health professional organization shall submit to the ,secretary of ,health and ,human ,services an application in such form and manner and containing such information as specified by the ,secretary4 7#c7 ,amount ,each grant awarded under this subsection shall be for an amount not to exceed #cjj1jjj4 7#d7 ,report ,each recipient of a grant under this subsection shall submit to the ,secretary of ,health and ,human ,services a report containing-- 7,a7 information on the extent and distribution of workforce disparities identified through the grant2 and 7,b7 reasonable objectives and strategies developed to address such disparities within a #e-1 #aj-1 and #be-year period4 7c7 ,implementation grants 7#a7 ,in general ,implementation grants described in this subsection are grants to implement one or more of the strategies developed pursuant to a planning grant awarded under subsection 7b74 7#b7 ,application ,to be eligible to receive a grant under this subsection1 an eligible health professional organization shall submit to the ,secretary of ,health and ,human ,services an application in such form and manner as specified by the ,secretary4 ,each such application shall contain information on the capability of the organization to carry out a strategy described in paragraph 7#a71 involvement of partners or coalitions1 plans for developing sustainability of the efforts after the culmination of the grant cycle1 and any other information specified by the ,secretary4 7#c7 ,amount ,each grant awarded under this subsection shall be for an amount not to exceed #ejj1jjj each year during the #d-year period of the grant4 7#d7 ,reports ,for each of the first #c years for which an eligible health professional organization is awarded a grant under this subsection1 the organization shall submit to the ,secretary of ,health and ,human ,services a report on the activities carried out by such organization through the grant during such year and objectives for the subsequent year4 ,for the fourth year for which an eligible health professional organization is awarded a grant under this subsection1 the organization shall submit to the ,secretary a report that includes an analysis of all the activities carried out by the organization through the grant and a detailed plan for continuation of out-reach efforts4 7d7 ,eligible health professional organization defined ,for purposes of this section1 the term eligible health professional organization means a professional organization representing obstetrician-gynecologists1 certified nurse midwives1 certified midwives1 family practice physicians1 nurse practitioners whose scope of practice includes maternity or sexual and reproductive health care1 physician assistants whose scope of practice includes obstetrical or sexual and reproductive health care1 or certified professional midwives1 adolescent medicine specialists1 and pediatricians who provide sexual and reproductive health care4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #b1jjj1jjj for fiscal year #bjba and #c1jjj1jjj for each of the fiscal years #bjbb through #bjbe4 #ebc4 ,interagency update to the quality family planning guidelines 7a7 ,in general ,not later than six months after the date of enactment of this ,act1 the ,director of the ,centers for ,disease ,control and ,prevention and the ,office of ,population ,affairs shall review and expand the #bjad ,quality ,family ,planning ,guidelines to address-- 7#a7 health disparities2 and 7#b7 the importance of patient-directed contraceptive decision making4 7b7 ,consultation ,in carrying out subsection 7a71 the ,director of the ,centers for ,disease ,control and ,prevention and the ,office of ,population ,affairs shall convene a meeting1 and solicit the views of1 stakeholders including experts on health disparities1 experts on reproductive coercion1 representatives of provider organizations1 patient advocates1 reproductive justice organizations1 organizations that represent racial and ethnic minority communities1 organizations that represent people with disabilities1 organizations that represent ,,lgbtq persons1 and organizations that represent people with limited ,english proficiency4 #ebd4 ,dissemination of the quality family planning guidelines 7a7 ,in general ,not later than six months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services and the ,director of the ,centers for ,disease ,control and ,prevention shall-- 7#a7 develop a plan for outreach to publicly funded health care providers1 including federally qualified health centers and branches of the ,indian ,health ,service1 about the quality family planning guidelines referred to in section #ebc2 and 7#b7 award grants to eligible entities to implement these guidelines for all patients seeking family planning services4 7b7 ,definition ,in this section1 the term eligible entity means a publicly funded health care provider that serves persons of reproductive age4 ,b ,pregnancy ,screening #eca4 ,pregnancy intention screening initiative demonstration program ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq471 as amended by section #eje7;c77#f71 is further amended by adding at the end the following3 #cii,v-#h4 ,pregnancy intention screening initiative demonstration program 7a7 ,program establishment ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall establish a demonstration program to facilitate the clinical adoption of pregnancy intention screening initiatives by health care and social services providers4 7b7 ,grants ,the ,secretary may carry out the demonstration program through awarding grants to eligible entities to implement pregnancy intention screening initiatives1 collect data1 and evaluate such initiatives4 7c7 ,eligible ,entities 7#a7 ,in general ,an eligible entity under this section is an entity described in paragraph 7#b7 that provides non-directive1 comprehensive1 medically accurate information4 7#b7 ,entities described ,for purposes of paragraph 7#a71 an entity described in this paragraph is a community-based organization1 voluntary health organization1 public health department1 community health center1 or other interested public or private primary1 behavioral1 or other health care or social service provider or organization4 7d7 ,pregnancy intention screening initiative ,for purposes of this section1 the term pregnancy intention screening initiative means any initiative by an eligible entity to routinely screen women with respect to their pregnancy intentions and goals to either prevent unintended pregnancies or improve the likelihood of healthy pregnancies1 in order to better provide health care that meets the contraceptive or pre-pregnancy needs and goals of such women4 7e7 ,evaluation 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall1 by grant or contract1 and after consultation as described in paragraph 7#b71 conduct an evaluation of the demonstration program1 with respect to pregnancy intention screening initiatives1 conducted under this section4 ,such evaluation shall include3 7,a7 ,assessment of the implementation of pregnancy intention screening protocols among a diverse group of patients and providers1 including collecting data on the experiences and outcomes for diverse patient populations in a variety of clinical settings4 7,b7 ,analysis of outcome measures that will facilitate effective and widespread adoption of such protocols by health care providers for inquiring about and responding to pregnancy goals of women with both contraceptive and pre-pregnancy care4 7,c7 ,consideration of health disparities among the population served4 7,d7 ,assessment of the equitable and voluntary application of such initiatives to minority and medically underserved communities4 7,e7 ,assessment of the training1 capacity1 and ongoing technical assistance needed for providers to effectively implement such pregnancy intention screening protocols4 7,f7 ,assessment of whether referral systems for selected protocols follow evidence-based standards that ensure access to comprehensive health services and appropriate follow-up care4 7,g7 ,measuring through rigorous methods the effect of such initiatives on key health outcomes4 7#b7 ,consultation with independent1 expert advisory panel ,in conducting the evaluation under paragraph 7#a71 the ,director of the ,centers for ,disease ,control and ,prevention shall consult with physicians1 physician assistants1 advanced practice registered nurses1 nurse midwives1 and other health care providers who specialize in women's health1 and other experts in public health1 clinical practice1 program evaluation1 and research4 7#c7 ,report ,not later than one year after the last day of the demonstration program under this section1 the ,director of the ,centers for ,disease ,control and ,prevention shall submit to ,congress a report on the results of the evaluation conducted under paragraph 7#a7 and shall make the report publicly available4 7f7 ,funding 7#a7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #aj1jjj1jjj for each of fiscal years #bjba through #bjbe4 7#b7 ,limitation ,not more than #bj percent of funds appropriated to carry out this section pursuant to paragraph 7#a7 for a fiscal year may be used for purposes of the evaluation under subsection 7e74 4 ,,vi ,mental health #fja4 ,mental health findings ,congress finds the following3 7#a7 ,despite the existence of effective treatments1 inequities lie in the availability1 accessibility1 and quality of mental health services for racial and ethnic minorities and people with disabilities4 7#b7 ,these inequities have powerful significance for minority groups and for society as a whole4 7#c7 ,racial and ethnic minorities and people with disabilities bear a greater burden from unmet mental health needs and thus suffer a greater loss to their overall health and productivity4 7#d7 ,improving community conditions and one's home environment1 paired with high-quality1 accessible1 and culturally tailored mental health services1 can reduce the likelihood1 frequency1 and intensity of challenges to one's mental health4 7#e7 ,the presence of strong social connections and trust1 opportunities to experience and share cultural identity1 safe gathering places1 and economic opportunity are community factors that benefit mental health4 7#f7 ,the social1 physical1 and economic conditions in communities can have tremendous influence on daily stressors that shape mental health outcomes4 7#g7 ,the foremost barriers include the cost of care1 societal stigma1 and the fragmented organization of services4 7#h7 ,people with disabilities who are racial or ethnic minorities may have co-occurring mental health conditions which1 without proper accommodations and support1 further stigmatize them and limit their participation in society4 7#i7 ,african-,american1 ,latinx1 ,asian ,american1 ,pacific ,islander1 ,native1 and other people of color have attitudes toward mental health challenges that are another barrier to seeking mental health care4 7#aj7 ,mental illness retains considerable stigma in many communities of color1 including those of ,asian ,americans and ,pacific ,islanders1 and seeking treatment is not always encouraged4 7#aa7 ,addressing mental health stigma and increasing culturally appropriate treatment modalities in communities will help to increase utilization of mental health services for people who have trouble functioning because of mental health challenges4 7#ab7 ,there is a link between mental health diagnosis and the likelihood of an individual committing suicide4 7#ac7 ,a comprehensive public health approach to behavioral health fosters protective factors in racial and ethnic communities that support mental health4 7#ad7 ,approaches to mental health and addressing trauma must keep in mind the historical and cultural trauma that has impacted many communities of color4 7#ae7 ,treatment modalities must keep approaches of individual communities to mental health in mind1 including by considering-- 7,a7 approaches to cultural healing practices2 and 7,b7 the mental health professionals needed for such practices1 such as peer support specialists4 7#af7 ,approaches to mental health and addressing trauma must keep in mind the concept of intersectionality of individuals2 that individuals may have many inequities that shape the way they process and experience everyday life4 #fjb4 ,coverage of marriage and family therapist services1 mental health counselor services1 substance abuse counselor services1 and peer support specialist services under part ,b of the ,medicare program 7a7 ,coverage of ,services 7#a7 ,in general ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b771 as amended by section #dca7;c71 is amended-- 7,a7 in subparagraph 7,,hh71 by striking and at the end2 7,b7 in subparagraph 7,,ii71 by adding and after the semicolon at the end2 and 7,c7 by adding at the end the following new subparagraph3 7,,jj7 marriage and family therapist services 7as defined in subsection 7nnn77#a771 mental health counselor services 7as defined in subsection 7nnn77#c771 substance abuse counselor services 7as defined in subsection 7nnn77#e771 and peer support specialist services 7as defined in subsection 7nnn77#g772 4 7#b7 ,definitions ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 as amended by sections #bjg7;b77#a71 #dag7;a71 and #dcc7;c71 is amended by adding at the end the following new subsection3 7nnn7 ,marriage and ,family ,therapist ,services2 ,marriage and ,family ,therapist2 ,mental ,health ,counselor ,services2 ,mental ,health ,counselor2 substance abuse counselor services2 substance abuse counselor2 peer support specialist services2 peer support specialist 7#a7 ,the term marriage and family therapist services means services performed by a marriage and family therapist 7as defined in paragraph 7#b77 for the diagnosis and treatment of mental illnesses1 which the marriage and family therapist is legally authorized to perform under ,state law 7or the ,state regulatory mechanism provided by ,state law7 of the ,state in which such services are performed1 as would otherwise be covered if furnished by a physician or as an incident to a physician's professional service1 but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services4 7#b7 ,the term marriage and family therapist means an individual who-- 7,a7 possesses a master's or doctoral degree that qualifies for licensure or certification as a marriage and family therapist pursuant to ,state law1 including but not limited to1 clinical social workers and occupational therapists2 7,b7 after obtaining such degree has performed at least #b years of clinical supervised experience in marriage and family therapy2 and 7,c7 in the case of an individual performing services in a ,state that provides for licensure or certification of marriage and family therapists1 is licensed or certified as a marriage and family therapist in such ,state4 7#c7 ,the term mental health counselor services means services performed by a mental health counselor 7as defined in paragraph 7#d77 for the diagnosis and treatment of mental illnesses that the mental health counselor is legally authorized to perform under ,state law 7or the ,state regulatory mechanism provided by the ,state law7 of the ,state in which such services are performed1 as would otherwise be covered if furnished by a physician or as incident to a physician's professional service1 but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services4 7#d7 ,the term mental health counselor means an individual who-- 7,a7 possesses a master's or doctor's degree in mental health counseling or a related field1 including clinical social workers and occupational therapists2 7,b7 after obtaining such a degree has performed at least #b years of supervised mental health counselor practice2 and 7,c7 in the case of an individual performing services in a ,state that provides for licensure or certification of mental health counselors or professional counselors1 is licensed or certified as a mental health counselor or professional counselor in such ,state4 7#e7 ,the term substance abuse counselor services means services performed by a substance abuse counselor 7as defined in paragraph 7#f77 for the diagnosis and treatment of substance abuse and addiction that the substance abuse counselor is legally authorized to perform under ,state law 7or the ,state regulatory mechanism provided by the ,state law7 of the ,state in which such services are performed1 as would otherwise be covered if furnished by a physician or as incident to a physician's professional service1 but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services4 7#f7 ,the term substance abuse counselor means an individual who-- 7,a7 has performed at least #b years of supervised substance abuse counselor practice2 7,b7 in the case of an individual performing services in a ,state that provides for licensure or certification of substance abuse counselors or professional counselors1 is licensed or certified as a substance abuse counselor or professional counselor in such ,state2 or 7,c7 is a drug and alcohol counselor as defined in section #dj4bha of title #di1 ,code of ,federal ,regulations4 7#g7 ,the term peer support specialist services means services performed by a peer support specialist 7as defined in paragraph 7#h77 for the well-being of individuals needing mental health support that the peer support specialist is legally authorized to perform under ,state law 7or the ,state regulatory mechanism provided by the ,state law7 of the ,state in which such services are performed1 as would otherwise be covered if furnished by a physician or as incident to a physician's professional service1 but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services4 7#h7 ,the term peer support specialist means an individual who-- 7,a7 is an individual living in recovery with mental illness1 addiction1 or systems involvement2 7,b7 has skills learned in formal training2 7,c7 uses assets-based framing in speaking about mental health1 recovery1 and well-being2 and 7,d7 delivers services in behavioral health settings to promote mind-body recovery and resiliency4 4 7#c7 ,provision for payment under part ,b ,section #ahcb7;a77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciek7a77#b77;,b77 is amended-- 7,a7 by striking and at the end of clause 7iv72 and 7,b7 by adding at the end the following new clause3 7v7 marriage and family therapist services1 mental health counselor services1 substance abuse counselor services1 and peer support specialist services2 and 4 7#d7 ,amount of payment ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a771 as amended by section #dca7;c77#c71 is amended-- 7,a7 by striking and before 7,,dd72 and 7,b7 by inserting before the semicolon at the end the following3 1 and 7,,ee7 with respect to marriage and family therapist services1 mental health counselor services1 substance abuse counselor services1 and peer support specialist services under section #ahfa7s77#b77;,,jj71 the amounts paid shall be #hj percent of the lesser of the actual charge for the services or #ge percent of the amount determined for payment of a psychologist under subparagraph 7,l74 7#e7 ,exclusion of marriage and family therapist services1 mental health counselor services1 and peer support specialist services from skilled nursing facility prospective payment system ,section #ahhh7;e77#b77;,a77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieyy7e77#b77;,a77ii77 is amended by inserting marriage and family therapist services 7as defined in section #ahfa7nnn77#a771 mental health counselor services 7as defined in section #ahfa7nnn77#c771 and peer support specialist services 7as defined in section #ahfa7nnn77#g77 after qualified psychologist services14 7#f7 ,inclusion of marriage and family therapists1 mental health counselors1 and substance abuse counselors as practitioners for assignment of claims ,section #ahdb7;b77#ah77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieu7b77#ah77;,c77 is amended by adding at the end the following new clauses3 7vii7 ,a marriage and family therapist 7as defined in section #ahfa7nnn77#b774 7viii7 ,a mental health counselor 7as defined in section #ahfa7nnn77#d774 7ix7 ,a substance abuse counselor 7as defined in section #ahfa7nnn77#f774 7x7 ,a peer support specialist 7as defined in section #ahfa7nnn77#h774 4 7b7 ,coverage of ,certain ,mental ,health ,services ,provided in ,certain ,settings 7#a7 ,rural health clinics and federally qualified health centers ,section #ahfa7;aa77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#a77;,b77 is amended by striking or by a clinical social worker 7as defined in subsection 7hh77#a771 and inserting 1 by a clinical social worker 7as defined in subsection 7hh77#a771 by a marriage and family therapist 7as defined in subsection 7nnn77#b771 or by a mental health counselor 7as defined in subsection 7nnn77#d771 or by a substance abuse counselor 7as defined in section #ahfa 7nnn77#f771 or by a peer support specialist 7as defined in section #ahfa7nnn77#h7744 7#b7 ,hospice programs ,section #ahfa7;dd77#b77;,b77i77,,iii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7dd77#b77;,b77i77,,iii77 is amended by inserting or one marriage and family therapist 7as defined in subsection 7nnn77#b77 after social worker4 7c7 ,authorization of ,marriage and ,family ,therapists ,to ,develop ,discharge ,plans for ,posthospital ,services ,section #ahfa7;ee77#b77;,g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ee77#b77;,g77 is amended by inserting marriage and family therapist 7as defined in subsection 7nnn77#b771 after social worker14 7d7 ,effective ,date ,the amendments made by this section shall apply with respect to services furnished on or after ,january #a1 #bjba4 #fjc4 ,integrated ,health ,care ,demonstration ,program ,part ,d of title ,v of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;dd et seq47 is amended by adding at the end the following3 #eec4 ,interprofessional health care teams for provision of behavioral health care in primary care settings 7a7 ,grants ,the ,secretary1 acting through the ,assistant ,secretary for ,mental ,health and ,substance ,use1 shall award grants to eligible entities for the purpose of establishing interprofessional health care teams that provide behavioral health care4 7b7 ,eligible entities ,to be eligible to receive a grant under this section1 an entity shall be a ,federally qualified health center 7as defined in section #ahfa7;aa7 of the ,social ,security ,act71 rural health clinic1 women's health clinic1 or behavioral health program 7including any such program operated by a community-based organization7 serving a high proportion of individuals from racial and ethnic minority groups 7as defined in section #agjg7;g774 7c7 ,loan forgiveness ,to encourage qualified allied health professionals to enter the mental health field1 an eligible entity receiving a grant under this section shall agree to use not less than #aj1jjj of the grant funds on a loan forgiveness program for practitioners who commit to working in the mental health field for a period of #b years4 7d7 ,scientifically and culturally based ,integrated health care funded through this section shall be scientifically and culturally based1 taking into consideration the results of the most recent peer-reviewed research available4 7e7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #bj1jjj1jjj for each of fiscal years #bjba through #bjbe4 4 #fjd4 ,addressing racial and ethnic mental health disparities research gaps 7a7 ,in general ,not later than #f months after the date of the enactment of this ,act1 the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities shall enter into an arrangement with the ,national ,academy of ,sciences to carry out the activities under subsection 7b71 or1 if the ,national ,academy of ,sciences declines to enter into such an arrangement1 the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities1 in cooperation with the ,agency for ,healthcare ,research and ,quality1 shall carry out the activities under subsection 7b74 7b7 ,activities ,the applicable entity under subsection 7a7 shall-- 7#a7 conduct a study with respect to mental health disparities in racial and ethnic minority groups 7as defined in section #agjg7;g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g7772 and 7#b7 submit to ,congress a report on the results of such study1 including-- 7,a7 a compilation of information on the dynamics of mental health outcomes in such racial and ethnic minority groups2 7,b7 the degree of the co-occurrence of mental conditions with other disabilities in such racial and ethnic groups1 including physical disabilities1 mental disabilities1 and mental disorders or mental health conditions which co-occur with one another2 7,c7 a compilation of information on the impact of exposure to community violence1 community trauma1 adverse childhood experiences1 weather extremes worsened by climate change 7such as heat waves1 hurricanes1 and wildfires71 substance use1 and other psychological traumas1 on mental disorders in such racial and minority groups1 stratified by household income level2 7,d7 a compilation of information on the impact of the intersectionality of transgender individuals in racial and ethnic minority groups2 and 7,e7 a description of how protective factors contrast and compare among different communities of color1 identifying cultural strengths4 #fje4 ,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 #fjf4 ,geoaccess study ,the ,assistant ,secretary for ,mental ,health and ,substance ,use shall-- 7#a7 conduct a study to-- 7,a7 determine which geographic areas of the ,united ,states have shortages of specialty mental health providers2 and 7,b7 assess the preparedness of speciality mental health providers to deliver culturally and linguistically appropriate1 affordable1 and accessible services2 and 7#b7 submit a report to ,congress on the results of such study4 #fjg4 ,asian ,american1 ,native ,hawaiian1 ,pacific ,islander1 and ,hispanic and ,latino behavioral and mental health outreach and education strategies ,part ,d of title ,v of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;dd et seq471 as amended by section #fjc1 is further amended by adding at the end the following new section3 #eed4 ,behavioral and mental health outreach and education strategies 7a7 ,in general ,the ,secretary1 acting through the ,assistant ,secretary for ,mental ,health and ,substance ,use1 shall1 in coordination with advocacy and behavioral and mental health organizations serving populations of ,asian ,american1 ,native ,hawaiian1 ,pacific ,islander1 and ,hispanic and ,latino individuals or communities1 develop and implement an outreach and education strategy to promote behavioral and mental health1 clarify that behavioral and mental health conditions are treatable and that reasonable accommodations are required under section #ejd of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gid7 and titles ,,ii and ,,iii of the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abaca et seq471 and reduce stigma associated with mental health conditions and substance abuse among the ,asian ,american1 ,native ,hawaiian1 ,pacific ,islander1 and ,hispanic and ,latino populations4 ,such strategy shall-- 7#a7 be designed to-- 7,a7 meet the diverse cultural and language needs of the various ,asian ,american1 ,native ,hawaiian1 ,pacific ,islander1 and ,hispanic and ,latino populations2 and 7,b7 ensure such strategies are developmentally 7with respect to the beneficiary's relative age and experience7 and age appropriate1 as well as cognitively accessible to persons with cognitive disabilities2 7#b7 increase awareness of symptoms of mental illnesses common among such populations1 taking into account differences within subgroups 7such as gender1 gender identity1 age1 sexual orientation1 disability1 and ethnicity7 of such populations2 7#c7 provide information on evidence-based1 culturally and linguistically appropriate and adapted interventions and treatments2 7#d7 ensure full participation of1 and engage1 both consumers and community members in the development and implementation of materials2 and 7#e7 seek to broaden the perspective among both individuals in such communities and stakeholders serving such communities to use a comprehensive public health approach to promoting behavioral health that addresses a holistic view of health by focusing on the intersection between behavioral and physical health4 7b7 ,reports ,beginning not later than #a year after the date of the enactment of this section and annually thereafter1 the ,secretary1 acting through the ,assistant ,secretary1 shall submit to ,congress1 and make publicly available1 a report on the extent to which the strategy developed and implemented under subsection 7a7 increased behavioral and mental health outcomes associated with mental health conditions and substance abuse among ,asian ,american1 ,native ,hawaiian1 ,pacific ,islander1 and ,hispanic and ,latino populations4 7c7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #cjj1jjj for fiscal year #bjba4 4 #fjh4 ,mental health in schools 7a7 ,purpose ,it is the purpose of this section to-- 7#a7 revise1 increase funding for1 and expand the scope of the ,project ,,aware ,state ,educational ,agency ,grant ,program carried out by the ,secretary of ,health and ,human ,services1 in order to provide access to more comprehensive school-based mental health services and supports2 7#b7 provide for comprehensive staff development for school and community service personnel working in the school2 7#c7 provide for comprehensive training to improve health and academic outcomes for children with1 or at risk for1 mental health conditions1 for parents or guardians1 siblings1 and other family members of such children1 and for concerned members of the community2 7#d7 provide for comprehensive1 universal1 evidence-based screening to identify children and adolescents with potential mental health conditions or unmet emotional health needs2 7#e7 recognize best practices for the delivery of mental health care in school-based settings1 including school-based health centers2 7#f7 provide for comprehensive training for parents or guardians1 siblings1 other family members1 and concerned members of the community on behalf of children and adolescents experiencing mental health trauma1 disorder1 or disability2 and 7#g7 establish formal working relationships between health1 human service1 and educational entities that support the mental and emotional health of children and adolescents in the school setting4 7b7 ,technical amendments ,the second part ,g 7relating to services provided through religious organizations7 of title ,v of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bijkk et seq47 is amended-- 7#a7 by redesignating such part as part ,j2 and 7#b7 by redesignating sections #eha through #ehd as sections #eif through #eif;,c1 respectively4 7c7 ,school-,based mental health and children and violence ,section #eha of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;hh7 7relating to children and violence7 is amended to read as follows3 #eha4 ,school-based mental health2 children and adolescents 7a7 ,in general ,the ,secretary1 in consultation with the ,secretary of ,education1 shall1 through grants1 contracts1 or cooperative agreements awarded to eligible entities described in subsection 7c71 provide comprehensive school-based mental health services and supports to assist children in local communities and schools 7including schools funded by the ,bureau of ,indian ,education7 dealing with traumatic experiences1 grief1 bereavement1 risk of suicide1 and violence4 ,such services and supports shall be-- 7#a7 developmentally1 linguistically1 and culturally appropriate2 7#b7 trauma-informed2 and 7#c7 incorporate positive behavioral interventions and supports4 7b7 ,activities ,grants1 contracts1 or cooperative agreements awarded under subsection 7a71 shall1 as appropriate1 be used for-- 7#a7 implementation of school and community-based mental health programs that-- 7,a7 build awareness of individual trauma and the intergenerational1 continuum of impacts of trauma on populations2 7,b7 train appropriate staff to identify1 and screen for1 signs of trauma exposure1 mental health disorders1 or risk of suicide2 and 7,c7 incorporate positive behavioral interventions1 family engagement1 student treatment1 and multigenerational supports to foster the health and development of children1 prevent mental health disorders1 and ameliorate the impact of trauma2 7#b7 technical assistance to local communities with respect to the development of programs described in paragraph 7#a72 7#c7 facilitating community partnerships among families1 students1 law enforcement agencies1 education agencies1 mental health and substance use disorder service systems1 family-based mental health service systems1 child welfare agencies1 health care providers 7including primary care physicians1 mental health professionals1 and other professionals who specialize in children's mental health such as child and adolescent psychiatrists71 institutions of higher education1 faith-based programs1 trauma networks1 and other community-based systems to address child and adolescent trauma1 mental health issues1 and violence2 and 7#d7 establishing and promoting best practices that are either evidence- or culturally-based for children and adolescents to share their experiences of individual and community trauma1 including their exposure to violence1 with trusted adults4 7c7 ,requirements 7#a7 ,in general ,to be eligible for a grant1 contract1 or cooperative agreement under subsection 7a71 an entity shall be a partnership that includes-- 7,a7 a ,state educational agency1 as defined in section #haja of the ,elementary and ,secondary ,education ,act of #aife1 in coordination with one or more local educational agencies1 as defined in section #haja of the ,elementary and ,secondary ,education ,act of #aife1 or a consortium of any entities described in subparagraph 7,b71 7,c71 7,d71 or 7,e7 of section #haja7cj7 of such ,act2 and 7,b7 at least #a community-based mental health provider1 including a public or private mental health entity1 health care entity1 family-based mental health entity1 trauma network1 or other community-based entity1 as determined by the ,secretary 7and which may include additional entities such as a human services agency1 law enforcement or juvenile justice entity1 child welfare agency1 an institution of higher education1 or another entity1 as determined by the ,secretary74 7#b7 ,compliance with ,,hipaa ,any patient records developed by covered entities through activities under the grant shall meet the regulations promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif4 7#c7 ,compliance with ,,ferpa ,section #ddd of the ,general ,education ,provisions ,act 7commonly known as the ,family ,educational ,rights and ,privacy ,act of #aigd7 shall apply to any entity that is a member of the partnership in the same manner that such section applies to an educational agency or institution 7as that term is defined in such section74 7d7 ,geographical distribution ,the ,secretary shall ensure that grants1 contracts1 or cooperative agreements under subsection 7a7 will be distributed equitably among the regions of the country and among urban and rural areas4 7e7 ,duration of awards ,with respect to a grant1 contract1 or cooperative agreement under subsection 7a71 the period during which payments under such an award will be made to the recipient shall be #e years1 with options for renewal4 7f7 ,evaluation and measures of outcomes 7#a7 ,development of process ,the ,assistant ,secretary shall develop a fiscally appropriate process for evaluating activities carried out under this section4 ,such process shall include-- 7,a7 the development of guidelines for the submission of program data by grant1 contract1 or cooperative agreement recipients2 7,b7 the development of measures of outcomes 7in accordance with paragraph 7#b77 to be applied by such recipients in evaluating programs carried out under this section2 and 7,c7 the submission of annual reports by such recipients concerning the effectiveness of programs carried out under this section4 7#b7 ,measures of outcomes ,the ,assistant ,secretary shall develop measures of outcomes to be applied by recipients of assistance under this section to evaluate the effectiveness of programs carried out under this section1 including outcomes related to the student1 family1 and local educational systems supported by this ,act4 7#c7 ,submission of annual data ,an eligible entity described in subsection 7c7 that receives a grant1 contract1 or cooperative agreement under this section shall annually submit to the ,assistant ,secretary a report that includes data to evaluate the success of the program carried out by the entity based on whether such program is achieving the purposes of the program4 ,such reports shall utilize the measures of outcomes under paragraph 7#b7 in a reasonable manner to demonstrate the progress of the program in achieving such purposes4 7#d7 ,evaluation by assistant secretary ,based on the data submitted under paragraph 7#c71 the ,assistant ,secretary shall annually submit to ,congress a report concerning the results and effectiveness of the programs carried out with assistance received under this section4 7#e7 ,limitation ,an eligible entity shall use not more than #bj percent of amounts received under a grant under this section to carry out evaluation activities under this subsection4 7g7 ,information and education ,the ,secretary shall disseminate best practices based on the findings of the knowledge development and application under this section4 7h7 ,amount of grants and authorization of appropriations 7#a7 ,amount of grants ,a grant under this section shall be in an amount that is not more than #b1jjj1jjj for each of the first #e fiscal years following the date of enactment of this section4 ,the ,secretary shall determine the amount of each such grant based on the population of children up to age #ba of the area to be served under the grant4 7#b7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section1 #acj1jjj1jjj for each of fiscal years #bjba through #bjbd4 4 7d7 ,conforming amendment ,part ,g of title ,v of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;hh et seq471 as amended by this section1 is further amended by striking the part heading and inserting the following3 ,g ,school-based mental health 4 #fji4 ,building an effective workforce in mental health 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 in coordination with the ,assistant ,secretary for ,mental ,health and ,substance ,use1 the ,administrator of the ,health ,resources and ,services ,administration1 and the ,secretary of ,labor1 shall1 in coordination with advocacy and behavioral and mental health organizations serving people of color-- 7#a7 develop1 strengthen1 and implement strategies to bolster career pathways for mental health professionals2 and 7#b7 identify the breadth of settings where mental and behavioral health care can take place4 7b7 ,contents ,strategies under subsection 7a7 shall include-- 7#a7 the variety of settings where mental health professionals are needed1 including community-based organizations1 women's centers1 shelters1 organizations focused on youth development1 workforce agencies1 job placement and development centers1 emergency rooms1 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 #aghf71 food banks1 legal aid1 and benefit issuers as defined in section #c of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjab72 7#b7 defining career pathways in mental and behavioral health1 to help communities understand the variety of careers in mental and behavioral health that are available2 7#c7 building career pathways in mental and behavioral health as part of the curriculum at the postsecondary education level2 7#d7 providing accessible training and certification pathways for lay health workers such as community health workers and other peer support individuals to ensure that careers pay a living wage2 7#e7 creating incentives for students in the fields of occupational therapy1 social work1 medicine1 and nursing to learn more about mental health1 and to include a mental health rotation as a part of the health professional curricula2 7#f7 including training and education for teachers about the basics of section #ejd of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gid7 and individualized education programs 7as defined in section #fad7;d7 of the ,individuals with ,disabilities ,education ,act 7#bj ,u4,s4,c4 #adad7;d7772 7#g7 researching1 developing1 and implementing programs for mental and behavioral health professionals to prevent burnout2 and 7#h7 finding better and increased avenues to ensure equity by providing better loan forgiveness programs1 including a focus area within the ,national ,health ,service ,corps focused on community trauma4 #faj4 ,mental health at the border 7a7 ,short title ,this section may be cited as the ,immigrants' ,mental ,health ,act of #bjbj4 7b7 ,definitions ,in this section3 7#a7 ,forward operating base ,the term forward operating base means a permanent facility established by ,u4,s4 ,customs and ,border ,protection in forward or remote locations1 and designated as such by ,u4,s4 ,customs and ,border ,protection4 7#b7 ,u4,s4 ,customs and ,border ,protection facility ,the term ,u4,s4 ,customs and ,border ,protection facility means any of the following facilities at which migrants are typically detained on behalf of ,u4,s4 ,customs and ,border ,protection3 7,a7 ,u4,s4 ,border ,patrol stations4 7,b7 ,ports of entry4 7,c7 ,checkpoints4 7,d7 ,forward operating bases4 7,e7 ,secondary inspection areas4 7,f7 ,short-term custody facilities4 7c7 ,training for certain ,,cbp personnel in mental health issues 7#a7 ,training to identify risk factors and warning signs in immigrants and refugees 7,a7 ,in general ,the ,commissioner of ,u4,s4 ,customs and ,border ,protection1 in consultation with the ,assistant ,secretary for ,mental ,health and ,substance ,use1 the ,administrator of the ,health ,resources and ,services ,administration1 and nongovernmental experts in the delivery of health care in humanitarian crises and in the delivery of health care to children1 shall develop and implement a training curriculum for ,u4,s4 ,customs and ,border ,protection agents and officers assigned to ,u4,s4 ,customs and ,border ,protection facilities to enable such agents and officers to identify the risk factors and warning signs in immigrants and refugees of mental health issues relating to trauma4 7,b7 ,requirements ,the training curriculum described in subparagraph 7,a7 shall-- 7i7 apply to all ,u4,s4 ,customs and ,border ,protection agents and officers working at ,u4,s4 ,customs and ,border ,protection facilities2 7ii7 provide for crisis intervention using a trauma-informed approach2 and 7iii7 provide for mental health screenings for immigrants and refugees arriving at the border in their preferred language or with appropriate language assistance4 7#b7 ,training to address mental health and wellness of ,,cbp agents and officers 7,a7 ,in general ,the ,commissioner of ,u4,s4 ,customs and ,border ,protection1 in consultation with the ,assistant ,secretary for ,mental ,health and ,substance ,use1 the ,administrator of the ,health ,resources and ,services ,administration1 and nongovernmental experts in the delivery of mental health care1 shall develop and implement a training curriculum for ,u4,s4 ,customs and ,border ,protection agents and officers assigned to ,u4,s4 ,customs and ,border ,protection facilities to address the mental health and wellness of individuals working at such facilities4 7,b7 ,requirements ,the training curriculum described in subparagraph 7,a7 shall be designed to help ,u4,s4 ,customs and ,border ,protection agents and officers working at ,u4,s4 ,customs and ,border ,protection facilities-- 7i7 to better manage their own stress and the stress of their coworkers2 and 7ii7 to be more aware of the psychological pressures experienced during their jobs4 7#c7 ,annual review of training ,beginning with respect to fiscal year #bjbb1 the ,assistant ,secretary for ,mental ,health and ,substance ,use shall-- 7,a7 conduct an annual review of the training implemented pursuant to paragraphs 7#a7 and 7#b72 and 7,b7 submit the results of each such review1 including any recommendations for improvement of such training1 to-- 7i7 the ,commissioner of ,u4,s4 ,customs and ,border ,protection2 7ii7 the ,committee on ,appropriations of the ,senate2 7iii7 the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate2 7iv7 the ,committee on ,homeland ,security and ,governmental ,affairs of the ,senate2 7v7 the ,committee on ,appropriations of the ,house of ,representatives2 7vi7 the ,committee on ,energy and ,commerce of the ,house of ,representatives2 7vii7 the ,committee on ,homeland ,security of the ,house of ,representatives2 and 7viii7 the ,committee on the ,judiciary of the ,house of ,representatives4 7#d7 ,authorization of appropriations ,there is authorized to be appropriated1 to carry out this subsection-- 7,a7 for fiscal year #bjba1 #ej1jjj to develop the training required under paragraphs 7#a7 and 7#b72 and 7,b7 for each of the fiscal years #bjbb through #bjbf-- 7i7 #bj1jjj to implement the training required under paragraphs 7#a7 and 7#b72 and 7ii7 such sums as may be necessary to review and make recommendations for such training pursuant to paragraph 7#c74 7d7 ,staffing border facilities and detention centers 7#a7 ,in general ,the ,commissioner of ,u4,s4 ,customs and ,border ,protection shall adequately evaluate the mental health needs of immigrants1 refugees1 border patrol agents1 and staff by assigning not fewer than #a qualified mental or behavioral health expert to each ,u4,s4 ,customs and ,border ,protection facility4 7#b7 ,qualifications ,a mental or behavioral health expert is qualified for an assignment described in paragraph 7#a7 if the expert-- 7,a7 is bilingual2 7,b7 is well-versed in culturally appropriate and trauma-informed interventions2 and 7,c7 has particular expertise in child or adolescent mental health or family mental health4 7#c7 ,authorization of appropriations ,there is authorized to be appropriated #c1jjj1jjj for each of the fiscal years #bjba through #bjbe to carry out this subsection4 7e7 ,prohibition against sharing ,department of ,health and ,human ,services mental health information for asylum determinations1 immigration hearings1 or deportation proceedings ,the officers1 employees1 and agents of the ,department of ,health and ,human ,services1 including the ,office of ,refugee ,resettlement1 may not share with the ,department of ,homeland ,security1 and the officers1 employees1 and agents of the ,department of ,homeland ,security may not request or receive from the ,department of ,health and ,human ,services1 for the purposes of an asylum determination1 immigration hearing1 or deportation proceeding1 any information or record that-- 7#a7 concerns the mental health of an alien2 and 7#b7 was obtained or produced by a mental or behavioral health professional while the alien was in a shelter or otherwise in the custody of the ,federal ,government4 ,,vii ,addressing high impact minority diseases ,a ,cancer #gja4 ,lung cancer mortality reduction 7a7 ,short title ,this section may be cited as the ,lung ,cancer ,mortality ,reduction ,act of #bjbj4 7b7 ,findings ,congress makes the following findings3 7#a7 ,lung cancer is the leading cause of cancer death for both men and women1 accounting for #be percent of all cancer deaths4 7#b7 ,lung cancer kills more people annually than breast cancer1 prostate cancer1 colon cancer1 liver cancer1 melanoma1 and kidney cancer combined4 7#c7 ,since the ,national ,cancer ,act of #aiga 7,public ,law #ib-bah2 #he ,stat4 #ggh71 coordinated and comprehensive research has raised the #e-year survival rates for breast cancer to #ij percent1 for prostate cancer to #ii percent1 and for colon cancer to #fd percent4 7#d7 ,the #e-year survival rate for lung cancer is still only #ah percent1 and a similar coordinated and comprehensive research effort is required to achieve increases in lung cancer survivability rates4 7#e7 ,sixty percent of lung cancer cases are now diagnosed in nonsmokers or former smokers4 7#f7 ,two-thirds of nonsmokers diagnosed with lung cancer are women4 7#g7 ,certain minority populations1 such as ,african-,american males1 have disproportionately high rates of lung cancer incidence and mortality1 despite their smoking rate being similar to other racial groups4 7#h7 ,members of the ,baby ,boomer ,generation are entering their #fjs1 the most common age at which people develop lung cancer4 7#i7 ,tobacco addiction and exposure to other lung cancer carcinogens such as ,agent ,orange and other herbicides and battlefield emissions are serious problems among military personnel and war veterans4 7#aj7 ,significant and rapid improvements in lung cancer mortality can be expected through greater use and access to lung cancer screening tests for at-risk individuals4 7#aa7 ,recent research has shown that screening with low-dose computed tomography scan reduced lung cancer death mortality by #bj percent for those with a high risk of lung cancer through early detection4 ,the ,centers for ,medicare ,medicaid ,services supports annual lung cancer screening for high-risk patients with low-dose computed tomography4 7#ab7 ,additional strategies are necessary to further enhance the existing tests and therapies available to diagnose and treat lung cancer in the future4 7#ac7 ,the ,august #bjja ,report of the ,lung ,cancer ,progress ,review ,group of the ,national ,cancer ,institute stated that funding for lung cancer research was far below the levels characterized for other common malignancies and far out of proportion to its massive health impact4 7#ad7 ,the ,report of the ,lung ,cancer ,progress ,review ,group identified as its highest priority the creation of integrated1 multidisciplinary1 multi-institutional research consortia organized around the problem of lung cancer rather than around specific research disciplines4 7#ae7 ,the ,united ,states must enhance its response to the issues raised in the ,report of the ,lung ,cancer ,progress ,review ,group1 and this can be accomplished through the establishment of a coordinated effort designed to reduce the lung cancer mortality rate by #ej percent by #bjbj and targeted funding to support this coordinated effort4 7c7 ,sense of ,congress concerning investment in lung cancer research ,it is the sense of the ,congress that-- 7#a7 lung cancer mortality reduction should be made a national public health priority2 and 7#b7 a comprehensive mortality reduction program coordinated by the ,secretary of ,health and ,human ,services is justified and necessary to adequately address and reduce lung cancer mortality4 7d7 ,lung ,cancer ,mortality ,reduction ,program 7#a7 ,in ,general ,subpart #a of part ,c of title ,,iv of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe et seq47 is amended by adding at the end the following3 #dag;,h4 ,lung ,cancer ,mortality ,reduction ,program 7a7 ,in ,general ,not later than #f months after the date of the enactment of the ,health ,equity and ,accountability ,act of #bjbj1 the ,secretary1 in consultation with the ,secretary of ,defense1 the ,secretary of ,veterans ,affairs1 the ,director of the ,national ,institutes of ,health1 the ,director of the ,centers for ,disease ,control and ,prevention1 the ,commissioner of ,food and ,drugs1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities1 and other members of the ,lung ,cancer ,advisory ,board established under section #gja of the ,health ,equity and ,accountability ,act of #bjbj1 shall implement a comprehensive program1 to be known as the ,lung ,cancer ,mortality ,reduction ,program1 to achieve a reduction of at least #be percent in the mortality rate of lung cancer by #bjbj4 7b7 ,requirements ,the ,program shall include at least the following3 7#a7 ,with respect to the ,national ,institutes of ,health-- 7,a7 a strategic review and prioritization by the ,national ,cancer ,institute of research grants to achieve the goal of the ,lung ,cancer ,mortality ,reduction ,program in reducing lung cancer mortality2 7,b7 the provision of funds to enable the ,airway ,biology and ,disease ,branch of the ,national ,heart1 ,lung1 and ,blood ,institute to expand its research programs to include predispositions to lung cancer1 the interrelationship between lung cancer and other pulmonary and cardiac disease1 and the diagnosis and treatment of those interrelationships2 7,c7 the provision of funds to enable the ,national ,institute of ,biomedical ,imaging and ,bioengineering to expedite the development of computer-assisted diagnostic1 surgical1 treatment1 and drug-testing innovations to reduce lung cancer mortality1 such as through expansion of the ,institute's ,quantum ,grant ,program and ,image-,guided ,interventions programs2 and 7,d7 the provision of funds to enable the ,national ,institute of ,environmental ,health ,sciences to implement research programs relative to the lung cancer incidence4 7#b7 ,with respect to the ,food and ,drug ,administration-- 7,a7 activities under section #ebi;,b of the ,federal ,food1 ,drug1 and ,cosmetic ,act2 and 7,b7 activities under section #efa of the ,federal ,food1 ,drug1 and ,cosmetic ,act to expand access to investigational drugs and devices for the diagnosis1 monitoring1 or treatment of lung cancer4 7#c7 ,with respect to the ,centers for ,disease ,control and ,prevention1 the establishment of an early disease research and management program under section #aeaa4 7#d7 ,with respect to the ,agency for ,healthcare ,research and ,quality1 the conduct of a biannual review of lung cancer screening1 diagnostic1 and treatment protocols1 and the issuance of updated guidelines4 7#e7 ,the promotion 7including education7 of lung cancer screening within minority and rural populations and the study of the effectiveness of efforts to increase such screening4 7#f7 ,the cooperation and coordination of all minority and health disparity programs within the ,department of ,health and ,human ,services to ensure that all aspects of the ,lung ,cancer ,mortality ,reduction ,program under this section adequately address the burden of lung cancer on minority and rural populations4 7#g7 ,the cooperation and coordination of all tobacco control and cessation programs within agencies of the ,department of ,health and ,human ,services to achieve the goals of the ,lung ,cancer ,mortality ,reduction ,program under this section with particular emphasis on the coordination of drug and other cessation treatments with early detection protocols4 4 7#b7 ,federal ,food1 ,drug1 and ,cosmetic ,act ,subchapter ,b of chapter ,v of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cfj;aaa et seq47 is amended by adding at the end the following3 #ebi;,b4 ,drugs relating to lung cancer 7a7 ,in general ,the provisions of this subchapter shall apply to a drug described in subsection 7b7 to the same extent and in the same manner as such provisions apply to a drug for a rare disease or condition4 7b7 ,qualified drugs ,a drug described in this subsection is-- 7#a7 a chemoprevention drug for precancerous conditions of the lung2 7#b7 a drug for targeted therapeutic treatments1 including any vaccine1 for lung cancer2 or 7#c7 a drug to curtail or prevent nicotine addiction4 7c7 ,board ,the ,board established under section #gja of the ,health ,equity and ,accountability ,act of #bjbj shall monitor the program implemented under this section4 4 7#c7 ,access to ,unapproved ,therapies ,section #efa7;e7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cfj;bbb7e77 is amended by inserting before the period the following3 and shall include expanding access to drugs under section #ebi;,b1 with substantial consideration being given to whether the totality of information available to the ,secretary regarding the safety and effectiveness of an investigational drug1 as compared to the risk of morbidity and death from the disease1 indicates that a patient may obtain more benefit than risk if treated with the drug4 7#d7 ,,cdc ,title ,,xv of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjk et seq47 is amended by adding at the end the following3 #aeaa4 ,early disease research and management program ,the ,secretary shall establish and implement an early disease research and management program targeted at the high incidence and mortality rates of lung cancer among minority and low-income populations4 4 7e7 ,department of defense and the department of veterans affairs ,the ,secretary of ,defense and the ,secretary of ,veterans ,affairs1 each in coordination with the ,secretary of ,health and ,human ,services1 shall engage-- 7#a7 in the implementation within the ,department of ,defense and the ,department of ,veterans ,affairs of an early detection and disease management research program for military personnel and veterans whose smoking history and exposure to carcinogens during active duty service has increased their risk for lung cancer2 and 7#b7 in the implementation of coordinated care programs for military personnel and veterans diagnosed with lung cancer4 7f7 ,lung cancer advisory board 7#a7 ,in ,general ,the ,secretary of ,health and ,human ,services shall convene a ,lung ,cancer ,advisory ,board 7referred to in this section as the ,board7-- 7,a7 to monitor the programs established under this section 7and the amendments made by this section72 and 7,b7 to provide annual reports to the ,congress concerning benchmarks1 expenditures1 lung cancer statistics1 and the public health impact of such programs4 7#b7 ,composition ,the ,board shall be comprised of-- 7,a7 the ,secretary of ,health and ,human ,services2 7,b7 the ,secretary of ,defense2 7,c7 the ,secretary of ,veterans ,affairs2 and 7,d7 #b representatives each from the fields of clinical medicine focused on lung cancer1 lung cancer research1 imaging1 drug development1 and lung cancer advocacy1 to be appointed by the ,secretary of ,health and ,human ,services4 7g7 ,authorization of appropriations 7#a7 ,in general ,to carry out this section 7and the amendments made by this section71 there are authorized to be appropriated #ge1jjj1jjj for fiscal year #bjba and such sums as may be necessary for each of fiscal years #bjbb through #bjbe4 7#b7 ,lung ,cancer ,mortality ,reduction ,program ,the amounts appropriated under paragraph 7#a7 shall be allocated as follows3 7,a7 #be1jjj1jjj for fiscal year #bjba1 and such sums as may be necessary for each of fiscal years #bjbb through #bjbe1 for the activities described in section #dag;,h7b77#a77;,b7 of the ,public ,health ,service ,act1 as added by subsection 7d72 7,b7 #be1jjj1jjj for fiscal year #bjba1 and such sums as may be necessary for each of fiscal years #bjbb through #bjbe1 for the activities described in section #dag;,h7b77#a77;,c7 of the ,public ,health ,service ,act2 7,c7 #aj1jjj1jjj for fiscal year #bjba1 and such sums as may be necessary for each of fiscal years #bjbb through #bjbe1 for the activities described in section #dag;,h7b77#a77;,d7 of the ,public ,health ,service ,act2 and 7,d7 #ae1jjj1jjj for fiscal year #bjba1 and such sums as may be necessary for each of fiscal years #bjbb through #bjbe1 for the activities described in section #dag;,h7b77#c7 of the ,public ,health ,service ,act4 #gjb4 ,expanding prostate cancer research1 outreach1 screening1 testing1 access1 and treatment effectiveness 7a7 ,short title ,this section may be cited as the ,prostate ,research1 ,outreach1 ,screening1 ,testing1 ,access1 and ,treatment ,effectiveness ,act of #bjbj or the ,,prostate ,act4 7b7 ,findings ,congress makes the following findings3 7#a7 ,prostate cancer is the second leading cause of cancer death among men4 7#b7 ,in #bjbj1 an estimated #aia1icj individuals in the ,united ,states will be diagnosed with prostate cancer and approximately #cc1ccj will die from the disease4 7#c7 ,roughly #b1jjj1jjj to #c1jjj1jjj people in the ,united ,states are living with a diagnosis of prostate cancer and its consequences4 7#d7 ,although prostate cancer generally affects older individuals1 younger men are also at risk for the disease1 and when prostate cancer appears in early middle age1 it frequently takes on a more aggressive form4 7#e7 ,there are significant racial and ethnic disparities that demand attention1 for example1 ,african ,americans have prostate cancer mortality rates that are more than double those in the ,white population4 7#f7 ,underserved rural populations have higher rates of mortality compared to their urban counterparts1 and innovative and cost-efficient methods to improve rural access to high-quality care should take advantage of advances in telehealth to diagnose and treat prostate cancer when appropriate4 7#g7 ,certain populations of veterans may have nearly twice the incidence of prostate cancer as the general population of the ,united ,states4 7#h7 ,urologists may constitute the specialists who diagnose and treat the vast majority of prostate cancer patients4 7#i7 ,although much basic and translational research has been completed and much is currently known1 there are still many unanswered questions1 such as the extent to which known disparities are attributable to disease etiology1 access to care1 or education and awareness in the community4 7#aj7 ,causes of prostate cancer are not known4 ,there is not good information regarding how to differentiate accurately1 early on1 between aggressive and indolent forms of the disease4 ,as a result1 there is significant overtreatment in prostate cancer4 ,there are no treatments that can durably arrest growth or cure prostate cancer once it has metastasized4 7#aa7 ,a significant proportion of cases may be clinically indolent and overdiagnosed1 resulting in significant overtreatment4 ,more accurate tests will allow men and their families to face less physical1 psychological1 financial1 and emotional trauma1 and billions of dollars could be saved in private and public health care systems4 7#ab7 ,prostate cancer research and health care programs across ,federal agencies should be coordinated to improve accountability and actively encourage the translation of research into practice and to identify and implement best practices in order to foster an integrated and consistent focus on effective prevention1 diagnosis1 and treatment of the disease4 7c7 ,prostate cancer coordination and education 7#a7 ,interagency prostate cancer coordination and education task force ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs1 in cooperation with the ,secretary of ,defense and the ,secretary of ,health and ,human ,services1 shall establish an ,interagency ,prostate ,cancer ,coordination and ,education ,task ,force 7in this section referred to as the ,prostate ,cancer ,task ,force74 7#b7 ,duties ,the ,prostate ,cancer ,task ,force shall-- 7,a7 develop a summary of advances in prostate cancer research supported or conducted by ,federal agencies relevant to the diagnosis1 prevention1 and treatment of prostate cancer1 including psychosocial impairments related to prostate cancer treatment1 and compile a list of best practices that warrant broader adoption in health care programs2 7,b7 consider establishing1 and advocating for1 a guidance to enable physicians to allow screening of men who are age #gd or older1 on a case-by-case basis1 taking into account quality of life and family history of prostate cancer2 7,c7 share and coordinate information on research and health care program activities by the ,federal ,government1 including activities related to-- 7i7 determining how to improve research and health care programs1 including psychosocial impairments related to prostate cancer treatment2 7ii7 identifying any gaps in the overall research inventory and in health care programs2 7iii7 identifying opportunities to promote translation of research into practice2 and 7iv7 maximizing the effects of ,federal ,government efforts by identifying opportunities for collaboration and leveraging of resources in research and health care programs that serve individuals who are susceptible to or diagnosed with prostate cancer2 7,d7 develop a comprehensive interagency strategy and advise relevant ,federal agencies in the solicitation of proposals for collaborative1 multidisciplinary research and health care programs1 including proposals to evaluate factors that may be related to the etiology of prostate cancer1 that would-- 7i7 result in innovative approaches to study emerging scientific opportunities or eliminate knowledge gaps in research to improve the prostate cancer research portfolio of the ,federal ,government2 and 7ii7 outline key research questions1 methodologies1 and knowledge gaps2 7,e7 develop a coordinated message related to screening and treatment for prostate cancer to be reflected in educational and beneficiary materials for ,federal health programs as such documents are updated2 and 7,f7 not later than #b years after the date of the establishment of the ,prostate ,cancer ,task ,force1 submit to the expert advisory panels appointed under paragraph 7#d7 to be reviewed and returned within #cj days1 and then within #ij days submitted to ,congress1 recommendations-- 7i7 regarding any appropriate changes to research and health care programs1 including recommendations to improve the research portfolio of the ,department of ,veterans ,affairs1 the ,department of ,defense1 the ,national ,institutes of ,health1 and other ,federal agencies to ensure that scientifically based strategic planning is implemented in support of research and health care program priorities2 7ii7 designed to ensure that the research and health care programs and activities of the ,department of ,veterans ,affairs1 the ,department of ,defense1 the ,department of ,health and ,human ,services1 and other ,federal agencies are free of unnecessary duplication2 7iii7 regarding public participation in decisions relating to prostate cancer research and health care programs to increase the involvement of patient advocates1 community organizations1 and medical associations representing a broad geographical area2 7iv7 on how to best disseminate information on prostate cancer research and progress achieved by health care programs2 7v7 about how to expand partnerships between public entities1 including ,federal agencies1 and private entities to encourage collaborative1 cross-cutting research and health care delivery2 7vi7 assessing any cost savings and efficiencies realized through the efforts identified and supported in this subsection and recommending expansion of those efforts that have proved most promising while also ensuring against any conflicts in directives in law2 7vii7 identifying key priority action items from among the recommendations2 and 7viii7 with respect to the level of funding needed by each agency to implement the recommendations contained in the report4 7#c7 ,members of the ,prostate ,cancer ,task ,force ,the ,prostate ,cancer ,task ,force shall be comprised of representatives from such ,federal agencies1 as the head of each such applicable agency determines necessary1 so as to coordinate a uniform message relating to prostate cancer screening and treatment where appropriate1 including representatives of the following3 7,a7 ,the ,department of ,veterans ,affairs1 including representatives of each relevant program area of the ,department of ,veterans ,affairs4 7,b7 ,the ,prostate ,cancer ,research ,program of the ,congressionally ,directed ,medical ,research ,program of the ,department of ,defense4 7,c7 ,the ,department of ,health and ,human ,services1 including1 at a minimum1 representatives of each of the following3 7i7 ,the ,national ,institutes of ,health4 7ii7 ,national research institutes and centers1 including the ,national ,cancer ,institute1 the ,national ,institute of ,allergy and ,infectious ,diseases1 and the ,office of ,minority ,health4 7iii7 ,the ,centers for ,medicare ,medicaid ,services4 7iv7 ,the ,food and ,drug ,administration4 7v7 ,the ,centers for ,disease ,control and ,prevention4 7vi7 ,the ,agency for ,healthcare ,research and ,quality4 7vii7 ,the ,health ,resources and ,services ,administration4 7#d7 ,appointing expert advisory panels ,the ,prostate ,cancer ,task ,force shall appoint expert advisory panels1 as the task force determines appropriate1 to provide input and concurrence from individuals and organizations from the medical1 prostate cancer patient and advocate1 research1 and delivery communities with expertise in prostate cancer diagnosis1 treatment1 and research1 including practicing urologists1 primary care providers1 and others1 and individuals with expertise in education and outreach to underserved populations affected by prostate cancer4 7#e7 ,meetings ,the ,prostate ,cancer ,task ,force shall convene not less frequently than twice each year1 or more frequently as the ,secretary of ,veterans ,affairs determines to be appropriate4 7#f7 ,federal ,advisory ,committee ,act ,the ,federal ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 shall apply to the ,prostate ,cancer ,task ,force4 7#g7 ,sunset ,date ,the ,prostate ,cancer ,task ,force shall terminate on ,september #cj1 #bjbe4 7d7 ,prostate cancer research 7#a7 ,research coordination program 7,a7 ,in general ,the ,secretary of ,veterans ,affairs1 in coordination with the ,secretary of ,defense and the ,secretary of ,health and ,human ,services1 shall establish and carry out a program to coordinate and intensify prostate cancer research4 7,b7 ,elements ,the program established under subparagraph 7,a7 shall-- 7i7 develop advances in diagnostic and prognostic methods and tests1 including biomarkers and an improved prostate cancer screening blood test1 including improvements or alternatives to the prostate specific antigen test and additional tests to distinguish indolent from aggressive disease2 7ii7 develop better understanding of the etiology of the disease 7including an analysis of lifestyle factors proven to be involved in higher rates of prostate cancer1 such as obesity and diet1 and in different ethnic1 racial1 and socioeconomic groups1 such as the ,african-,american1 ,latino or ,hispanic1 and ,american ,indian populations and men with a family history of prostate cancer7 to improve prevention efforts2 7iii7 expand basic research into prostate cancer1 including studies of fundamental molecular and cellular mechanisms2 7iv7 identify and provide clinical testing of novel agents for the prevention and treatment of prostate cancer2 7v7 establish clinical registries for prostate cancer2 7vi7 use the ,national ,institute of ,biomedical ,imaging and ,bioengineering and the ,national ,cancer ,institute for assessment of appropriate imaging modalities2 and 7vii7 address such other matters relating to prostate cancer research as may be identified by the ,federal agencies participating in the program under this subsection4 7,c7 ,underserved minority grant program ,in carrying out the program established under subparagraph 7,a71 the ,secretary shall-- 7i7 award grants to eligible entities to carry out components of the research outlined in subparagraph 7,b72 7ii7 integrate and build upon existing knowledge gained from comparative effectiveness research2 and 7iii7 recognize and address-- 7,i7 the racial and ethnic disparities in the incidence and mortality rates of prostate cancer and men with a family history of prostate cancer2 7,,ii7 any barriers in access to care and participation in clinical trials that are specific to racial1 ethnic1 and other underserved minorities and men with a family history of prostate cancer2 7,,iii7 outreach and educational efforts to raise awareness among the populations described in subclause 7,,ii72 and 7,,iv7 appropriate access and utilization of imaging modalities4 7#b7 ,prostate ,cancer ,advisory ,board 7,a7 ,in general ,there is established in the ,office of the ,chief ,scientist of the ,food and ,drug ,administration a ,prostate ,cancer ,scientific ,advisory ,board4 7,b7 ,duties ,the board established under subparagraph 7,a7 shall be responsible for accelerating real-time sharing of the latest research data and accelerating movement of new medicines to patients4 7e7 ,telehealth and rural access pilot projects 7#a7 ,establishment of pilot projects 7,a7 ,in general ,the ,secretary of ,veterans ,affairs1 in cooperation with the ,secretary of ,defense and the ,secretary of ,health and ,human ,services 7referred to in this subsection collectively as the ,secretaries7 shall establish #d-year telehealth pilot projects for the purpose of analyzing the clinical outcomes and cost-effectiveness associated with telehealth services in a variety of geographic areas that contain high proportions of medically underserved populations1 including ,african ,americans1 ,latinos or ,hispanics1 ,american ,indians or ,alaska ,natives1 and those in rural areas4 7,b7 ,efficient and effective care ,pilot projects established under subparagraph 7,a7 shall promote efficient use of specialist care through better coordination of primary care and physician extender teams in underserved areas and more effectively employ tumor boards to better counsel patients4 7#b7 ,eligible entities 7,a7 ,in general ,the ,secretaries shall select eligible entities to participate in the pilot projects established under this subsection4 7,b7 ,priority ,in selecting eligible entities to participate in the pilot projects under this subsection1 the ,secretaries shall give priority to entities located in medically underserved areas1 particularly those that include ,african ,americans1 ,latinos and ,hispanics1 and facilities of the ,indian ,health ,service1 including facilities operated by the ,indian ,health ,service1 tribally operated facilities1 and ,urban ,indian ,clinics1 and those in rural areas4 7#c7 ,evaluation ,the ,secretaries shall1 through the pilot projects1 evaluate-- 7,a7 the effective and economic delivery of care in diagnosing and treating prostate cancer with the use of telehealth services in medically underserved and ,tribal areas including collaborative uses of health professionals and integration of the range of telehealth and other technologies2 7,b7 the effectiveness of improving the capacity of nonmedical providers and nonspecialized medical providers to provide health services for prostate cancer in medically underserved and ,tribal areas1 including the exploration of innovative medical home models with collaboration between urologists1 other relevant medical specialists1 including oncologists1 radiologists1 and primary care teams1 and coordination of care through the efficient use of primary care teams and physician extenders2 and 7,c7 the effectiveness of using telehealth services to provide prostate cancer treatment in medically underserved areas1 including the use of tumor boards to facilitate better patient counseling4 7#d7 ,report ,not later than #a year after the completion of the pilot projects under this subsection1 the ,secretaries shall submit to ,congress a report describing the outcomes of such pilot projects1 including any cost savings and efficiencies realized1 and providing recommendations1 if any1 for expanding the use of telehealth services4 7f7 ,education and awareness 7#a7 ,campaign 7,a7 ,in general ,the ,secretary of ,veterans ,affairs shall develop a national education campaign for prostate cancer4 7,b7 ,elements ,the campaign developed under subparagraph 7,a7 shall involve the use of written educational materials and public service announcements consistent with the findings of the ,prostate ,cancer ,task ,force under subsection 7c7 that are intended to encourage men to seek prostate cancer screening when appropriate4 7#b7 ,racial disparities and the population of men with a family history of prostate cancer ,in developing the campaign under paragraph 7#a71 the ,secretary shall ensure that educational materials and public service announcements used in the campaign are more readily available in communities experiencing racial disparities in the incidence and mortality rates of prostate cancer and to men of any race classification with a family history of prostate cancer4 7#c7 ,grants ,in carrying out the campaign under this subsection1 the ,secretary shall award grants to nonprofit private entities to enable such entities to test alternative outreach and education strategies4 7g7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section for the period of fiscal years #bjba through #bjbe an amount equal to the amount of savings for the ,federal ,government projected to be achieved over such period by implementation of this section4 #gjc4 ,prostate research1 imaging1 and men's education 7,,prime7 7a7 ,short title ,this section may be cited as the ,prostate ,research1 ,imaging1 and ,men's ,education ,act of #bjbj or the ,,prime ,act of #bjbj4 7b7 ,findings ,congress makes the following findings3 7#a7 ,prostate cancer has reached epidemic proportions1 particularly among ,african-,american men1 and strikes and kills men in numbers comparable to the number of women who lose their lives from breast cancer4 7#b7 ,life-saving breakthroughs in screening1 diagnosis1 and treatment of breast cancer resulted from the development of advanced imaging technologies led by the ,federal ,government4 7#c7 ,men should have accurate and affordable prostate cancer screening exams and minimally invasive treatment tools1 similar to what women have for breast cancer4 7#d7 ,while it is important for men to take advantage of current prostate cancer screening techniques1 a recent ,,nci-funded study demonstrated that the most common available methods of detecting prostate cancer 7,,psa blood test and physical exams7 are not foolproof1 causing numerous false alarms and false reassurances4 7#e7 ,the absence of advanced imaging technologies for prostate cancer causes the lack of accurate information critical for clinical decisions1 resulting in missed cancers and lost lives1 as well as unnecessary and costly medical procedures1 with related complications4 7#f7 ,with prostate imaging tools1 men and their families would face less physical1 psychological1 financial1 and emotional trauma and billions of dollars could be saved in private and public health care systems4 7c7 ,research and development of prostate cancer imaging technologies 7#a7 ,expansion of ,research ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 acting through the ,director of the ,national ,institutes of ,health and the ,administrator of the ,health ,resources and ,services ,administration1 and in consultation with the ,secretary of ,defense1 shall carry out a program to expand and intensify research to develop innovative advanced imaging technologies for prostate cancer detection1 diagnosis1 and treatment comparable to state-of-the-art mammography technologies4 7#b7 ,early ,stage ,research ,in implementing the program under paragraph 7#a71 the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall carry out a grant program to encourage the early stages of research in prostate imaging to develop and implement new ideas1 proof of concepts1 and pilot studies for high-risk technologic innovation in prostate cancer imaging that would have a high potential impact for improving patient care1 including individualized care1 quality of life1 and cost-effectiveness4 7#c7 ,large ,scale ,later ,stage ,research ,in implementing the program under paragraph 7#a71 the ,secretary1 acting through the ,director of the ,national ,institutes of ,health1 shall utilize the ,national ,institute of ,biomedical ,imaging and ,bioengineering and the ,national ,cancer ,institute for advanced stages of research in prostate imaging1 including technology development and clinical trials for projects determined by the ,secretary to have demonstrated promising preliminary results and proof of concept4 7#d7 ,interdisciplinary private-,public partnerships ,in developing the program under paragraph 7#a71 the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall establish interdisciplinary private-public partnerships to develop and implement research strategies for expedited innovation in imaging and image-guided treatment and to conduct such research4 7#e7 ,racial ,disparities ,in developing the program under paragraph 7#a71 the ,secretary shall recognize and address-- 7,a7 the racial disparities in the incidences of prostate cancer and mortality rates with respect to such disease2 and 7,b7 any barriers in access to care and participation in clinical trials that are specific to racial minorities4 7#f7 ,authorization of ,appropriations 7,a7 ,in general ,subject to subparagraph 7,b71 there is authorized to be appropriated to carry out this section1 #ajj1jjj1jjj for each of the fiscal years #bjba through #bjbe4 7,b7 ,specific allocations ,of the amount authorized to be appropriated under subparagraph 7,a7 for each of the fiscal years described in such subparagraph-- 7i7 no less than #aj percent may be appropriated to carry out the grant program under paragraph 7#b72 and 7ii7 no more than #a percent may be appropriated to carry out paragraph 7#d74 7d7 ,public awareness and education campaign 7#a7 ,national campaign ,the ,secretary shall carry out a national campaign to increase the awareness and knowledge of individuals in the ,united ,states with respect to the need for prostate cancer screening and for improved detection technologies4 7#b7 ,requirements ,the national campaign conducted under this subsection shall include-- 7,a7 roles for the ,health ,resources ,services ,administration1 the ,office of ,minority ,health of the ,department of ,health and ,human ,services1 the ,centers for ,disease ,control and ,prevention1 and the ,office of ,minority ,health and ,health ,equity of the ,centers for ,disease ,control and ,prevention2 and 7,b7 the development and distribution of written educational materials1 and the development and placing of public service announcements1 that are intended to encourage men to seek prostate cancer screening and to create awareness of the need for improved imaging technologies for prostate cancer screening and diagnosis1 including in vitro blood testing and imaging technologies4 7#c7 ,racial ,disparities ,in developing the national campaign under paragraph 7#a71 the ,secretary shall recognize and address-- 7,a7 the racial disparities in the incidences of prostate cancer and mortality rates with respect to such disease2 and 7,b7 any barriers in access to care and participation in clinical trials that are specific to racial minorities4 7#d7 ,grants ,the ,secretary shall establish a program to award grants to nonprofit private entities to enable such entities to test alternative outreach and education strategies to increase the awareness and knowledge of individuals in the ,united ,states with respect to the need for prostate cancer screening and improved imaging technologies4 7#e7 ,authorization of ,appropriations ,there is authorized to be appropriated to carry out this section1 #aj1jjj1jjj for each of fiscal years #bjba through #bjbe4 7e7 ,improving prostate cancer screening blood tests 7#a7 ,in ,general ,the ,secretary1 in coordination with the ,secretary of ,defense1 shall carry out research to develop an improved prostate cancer screening blood test using in-vitro detection4 7#b7 ,authorization of ,appropriations ,there is authorized to be appropriated to carry out this section1 #bj1jjj1jjj for each of fiscal years #bjba through #bjbe4 7f7 ,reporting and compliance 7#a7 ,report and strategy ,not later than #ab months after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report that details the strategy of the ,secretary for implementing the requirements of this section and the status of such efforts4 7#b7 ,full ,compliance ,not later than #cf months after the date of the enactment of this ,act1 and annually thereafter1 the ,secretary shall submit to ,congress a report that-- 7,a7 describes the research and development and public awareness and education campaigns funded under this section2 7,b7 provides evidence that projects involving high-risk1 high impact technologic innovation1 proof of concept1 and pilot studies are prioritized2 7,c7 provides evidence that the ,secretary recognizes and addresses any barriers in access to care and participation in clinical trials that are specific to racial minorities in the implementation of this section2 7,d7 contains assurances that all the other provisions of this section are fully implemented2 and 7,e7 certifies compliance with the provisions of this section1 or in the case of a ,federal agency that has not complied with any of such provisions1 an explanation as to such failure to comply4 #gjd4 ,prostate cancer detection research and education 7a7 ,short title ,this section may be cited as the ,prostate ,cancer ,detection ,research and ,education ,act4 7b7 ,plan ,to develop and validate a test or tests for prostate cancer 7#a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 acting through the ,director of the ,national ,institutes of ,health1 shall establish an advisory council on prostate cancer 7referred to in this section as the advisory council7 to draft a plan for the development and validation of an accurate test or tests1 such as biomarkers or imaging1 to detect and diagnose prostate cancer4 7#b7 ,advisory council 7,a7 ,membership 7i7 ,federal members ,the advisory council shall be comprised of the following experts3 7,i7 ,a designee of the ,centers for ,disease ,control and ,prevention4 7,,ii7 ,a designee of the ,centers for ,medicare ,medicaid ,services4 7,,iii7 ,a designee of the ,office of the ,director of the ,national ,cancer ,institute4 7,,iv7 ,a designee of the ,director of the ,department of ,defense ,congressionally ,directed ,medical ,research ,programs4 7,v7 ,a designee of the ,director of the ,national ,institute of ,biomedical ,imaging and ,bioengineering4 7,,vi7 ,a designee of the ,director of the ,national ,institute of ,general ,medical ,sciences4 7,,vii7 ,a designee of the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities4 7,,viii7 ,a designee of the ,office of the ,director of the ,national ,institutes of ,health4 7,,ix7 ,a designee of the ,food and ,drug ,administration4 7,x7 ,a designee of the ,agency for ,healthcare ,research and ,quality4 7,,xi7 ,a designee of the ,director of the ,telemedicine and ,advanced ,technology ,research ,center of the ,department of ,defense4 7ii7 ,non-federal members ,in addition to the members described in clause 7i71 the advisory council shall include #h expert members from outside the ,federal ,government to be appointed by the ,secretary1 which shall include-- 7,i7 #b prostate cancer patient advocates2 7,,ii7 #b health care providers with a range of expertise and experience in prostate cancer2 and 7,,iii7 #d leading researchers with prostate cancer-related expertise in a range of clinical disciplines4 7,b7 ,meetings ,the advisory council shall meet quarterly and such meetings shall be open to the public4 7,c7 ,advice ,the advisory council shall advise the ,secretary1 or the ,secretary's designee4 7,d7 ,annual report ,not later than #a year after the date of enactment of this ,act1 the advisory council shall provide to the ,secretary1 or the ,secretary's designee1 and ,congress-- 7i7 an initial evaluation of all federally funded efforts in prostate cancer research relating to the development and validation of an accurate test or tests to detect and diagnose prostate cancer2 7ii7 a plan for the development and validation of a reliable test or tests for the detection and accurate diagnosis of prostate cancer2 and 7iii7 a set of standards for prostate cancer screening1 developed in coordination with the ,united ,states ,preventive ,services ,task ,force1 to ensure that any tools for screening1 detection1 and diagnosis developed in accordance with the plan under clause 7ii7 will meet the requirements of the ,task ,force for recommendation as a proven preventive or diagnostic service4 7,e7 ,termination ,the advisory council shall terminate on ,december #ca1 #bjbd4 7#c7 ,funding ,notwithstanding any other provision of law1 the ,secretary may make available #a1jjj1jjj1 from any unobligated amounts appropriated to the ,national ,institutes of ,health1 for each of fiscal years #bjba through #bjbe to carry out this subsection4 7c7 ,coordination and intensification of prostate cancer research 7#a7 ,in general ,the ,director of the ,national ,institutes of ,health1 in consultation with the ,secretary of ,defense1 shall coordinate and intensify research in accordance with the plan provided under subsection 7b77#b77;,d77ii71 with particular attention provided to leveraging existing research to develop and validate a test or tests1 such as biomarkers or imaging1 to detect and accurately diagnose prostate cancer in order to improve quality of life for millions of individuals in the ,united ,states1 and decrease health care system costs4 7#b7 ,funding ,notwithstanding any other provision of law1 the ,secretary may make available #cj1jjj1jjj1 from any unobligated amounts appropriated to the ,national ,institutes of ,health1 for each of fiscal years #bjbb through #bjbf to carry out this subsection4 7d7 ,public awareness and education campaign 7#a7 ,national campaign ,the ,secretary1 in coordination with the ,director of the ,national ,institutes of ,health and the ,director of the ,centers for ,disease ,control and ,prevention1 shall carry out a national campaign to increase the awareness and knowledge of prostate cancer4 7#b7 ,requirements ,the national campaign conducted under paragraph 7#a7 shall include-- 7,a7 roles for the ,national ,cancer ,institute1 the ,national ,institute on ,minority ,health and ,health ,disparities1 the ,office of ,minority ,health of the ,department of ,health and ,human ,services1 and the ,office of ,minority ,health and ,health ,equity of the ,centers for ,disease ,control and ,prevention2 and 7,b7 the development and distribution of written educational materials1 and the development and placing of public service announcements1 that are intended to encourage men to seek prostate cancer screening when symptoms are present1 when they have a family history of prostate cancer1 or if they belong to a high-risk population4 7#c7 ,racial disparities ,in developing the national campaign under paragraph 7#a71 the ,secretary shall recognize and address-- 7,a7 the racial disparities in the incidences of prostate cancer and mortality rates with respect to such disease2 and 7,b7 any barriers in access to patient care and participation in clinical trials that are specific to racial minorities4 7#d7 ,grants ,the ,secretary shall establish a program to award grants to nonprofit private entities to enable such entities to test alternative outreach and education strategies to increase the awareness and knowledge of individuals in the ,united ,states with respect to prostate cancer4 7#e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this subsection1 #e1jjj1jjj for each of fiscal years #bjba through #bjbe4 #gje4 ,national ,prostate ,cancer ,council 7a7 ,short title ,this section may be cited as the ,national ,prostate ,cancer ,plan ,act4 7b7 ,national prostate cancer council 7#a7 ,establishment ,there is established in the ,office of the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 the ,national ,prostate ,cancer ,council on ,screening1 ,early ,detection1 ,assessment1 and ,monitoring of ,prostate ,cancer 7referred to in this section as the ,council74 7#b7 ,purpose of the council ,the ,council shall-- 7,a7 develop and implement a national strategic plan for the accelerated creation1 advancement1 and testing of diagnostic tools to improve screening1 early detection1 assessment1 and monitoring of prostate cancer1 including-- 7i7 early detection of aggressive prostate cancer to save lives2 7ii7 monitoring of tumor response to treatment1 including recurrence and progression2 and 7iii7 accurate assessment and surveillance of indolent disease to reduce unnecessary biopsies and treatment2 7,b7 provide information and coordination of prostate cancer research and services across all ,federal agencies2 7,c7 review diagnostic tools and their overall effectiveness at screening1 detecting1 assessing1 and monitoring of prostate cancer2 7,d7 evaluate all programs in prostate cancer that are in existence on the date of enactment of this ,act1 including ,federal budget requests and approvals and public-private partnerships2 7,e7 submit an annual report to the ,secretary and ,congress on the creation and implementation of the national strategic plan under subparagraph 7,a72 and 7,f7 ensure the inclusion of men at high-risk for prostate cancer1 including men from minority ethnic and racial populations and men who are least likely to receive care1 in clinical1 research1 and service efforts1 with the purpose of decreasing health disparities4 7#c7 ,membership 7,a7 ,federal members ,the ,council shall be led by the ,secretary or designee and comprised of the following experts3 7i7 ,two representatives of the ,national ,institutes of ,health1 including #a representative of the ,national ,institute of ,biomedical ,imaging and ,bioengineering and #a representative of the ,national ,cancer ,institute4 7ii7 ,a representative of the ,centers for ,disease ,control and ,prevention4 7iii7 ,a representative of the ,centers for ,medicare ,medicaid ,services4 7iv7 ,a designee of the ,director of the ,department of ,defense ,congressionally ,directed ,medical ,research ,programs4 7v7 ,a designee of the ,director of the ,office of ,minority ,health4 7vi7 ,a representative of the ,food and ,drug ,administration4 7vii7 ,a representative of the ,agency for ,healthcare ,research and ,quality4 7,b7 ,non-federal members ,in addition to the members described in subparagraph 7,a71 the ,council shall include #ad expert members from outside the ,federal ,government1 which shall include-- 7i7 #f prostate cancer patient advocates1 including-- 7,i7 #b patient-survivors2 7,,ii7 #b caregivers of prostate cancer patients2 and 7,,iii7 #b representatives from national prostate cancer disease organizations that fund research or have demonstrated experience in providing assistance to patients1 families1 and medical professionals1 including information on health care options1 education1 and referral2 and 7ii7 #h health care stakeholders with specific expertise in prostate cancer research in the critical areas of clinical expertise1 including medical oncology1 radiology1 radiation oncology1 urology1 and pathology4 7#d7 ,meetings ,the ,council shall meet quarterly and meetings shall be open to the public4 7#e7 ,advice ,the ,council shall advise the ,secretary1 or the ,secretary's designee4 7#f7 ,annual report ,the ,council shall submit annual reports1 beginning not later than #a year after the date of enactment of this ,act1 to the ,secretary or the ,secretary's designee and to ,congress4 ,the annual report shall include-- 7,a7 in the first year-- 7i7 an evaluation of all federally funded efforts in prostate cancer research and gaps relating to the development and validation of diagnostic tools for prostate cancer2 and 7ii7 recommendations for priority actions to expand1 eliminate1 coordinate1 or condense programs based on the performance1 mission1 and purpose of the programs2 and 7,b7 annually thereafter for #e years-- 7i7 an outline for the development and implementation of a national research plan for creation and validation of accurate diagnostic tools to improve prostate cancer care in accordance with paragraph 7#a72 7ii7 roles for the ,national ,cancer ,institute1 ,national ,institute on ,minority ,health and ,health ,disparities1 and the ,office of ,minority ,health of the ,department of ,health and ,human ,services2 7iii7 an analysis of the disparities in the incidence and mortality rates of prostate cancer in men at high risk of the disease1 including individuals with family history1 increasing age1 or ,african-,american heritage2 and 7iv7 a review of the progress towards the realization of the proposed strategic plan4 7#g7 ,termination ,the ,council shall terminate on ,december #ca1 #bjbe4 #gjf4 ,improved ,medicaid coverage for certain breast and cervical cancer patients in the territories 7a7 ,elimination of funding limitations ,section #aajh7;g77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7;g77#d77 is amended-- 7#a7 by striking paragraphs 7#a71 7#b71 7#c71 and 7#d7 of 2 and 7#b7 by adding at the end the following3 ,with respect to fiscal years beginning with fiscal year #bjba1 payment for medical assistance for individuals who are eligible for such assistance only on the basis of section #aijb7;a77#aj77;,a77ii77,,xviii7 shall not be taken into account in applying subsection 7f7 7as increased in accordance with this subsection7 to ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa for such fiscal year44 7b7 ,application of enhanced ,,fmap for highest ,state ,section #aije7;b7 of such ,act 7#db ,u4,s4,c4 #acif;d7b77 is amended by adding at the end the following3 ,notwithstanding the first sentence of this subsection1 with respect to medical assistance described in clause 7#d7 of such sentence that is furnished in ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa in a fiscal year1 the ,federal medical assistance percentage is equal to the highest such percentage applied under such clause for such fiscal year for any of the #ej ,states or the ,district of ,columbia that provides such medical assistance for any portion of such fiscal year44 7c7 ,effective date ,the amendments made by this section shall apply to payment for medical assistance for items and services furnished on or after ,october #a1 #bjba4 #gjg4 ,cancer prevention and treatment demonstration for ethnic and racial minorities 7a7 ,demonstration 7#a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall conduct demonstration projects for the purpose of developing models and evaluating methods that-- 7,a7 improve the quality of items and services provided to target individuals in order to facilitate reduced disparities in early detection and treatment of cancer2 7,b7 improve clinical outcomes1 satisfaction1 quality of life1 appropriate use of items and services covered under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 and referral patterns with respect to target individuals with cancer2 7,c7 eliminate disparities in the rate of preventive cancer screening measures1 such as ,pap smears1 prostate cancer screenings1 colon cancer screenings1 breast cancer screenings1 and computed tomography scans1 for lung cancer among target individuals2 7,d7 promote collaboration with community-based organizations to ensure cultural competency of health care professionals and linguistic access for target individuals who are persons with limited ,english proficiency2 and 7,e7 encourage the incorporation of community health workers to increase the efficiency and appropriateness of cancer screening programs4 7#b7 ,community health worker defined ,in this section1 the term community health worker includes a community health advocate1 a lay health worker1 a community health representative1 a peer health promoter1 a community health outreach worker1 and a promotore de salud1 who promotes health or nutrition within the community in which the individual resides4 7#c7 ,target individual defined ,in this section1 the term target individual means an individual of a racial and ethnic minority group1 as defined in section #agjg7;g77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a771 who is entitled to benefits under part ,a1 and enrolled under part ,b1 of title ,,xviii of the ,social ,security ,act4 7b7 ,program design 7#a7 ,initial design ,not later than #a year after the date of the enactment of this ,act1 the ,secretary shall evaluate best practices in the private sector1 community programs1 and academic research of methods that reduce disparities among individuals of racial and ethnic minority groups in the prevention and treatment of cancer and shall design the demonstration projects based on such evaluation4 7#b7 ,number and project areas ,not later than #b years after the date of the enactment of this ,act1 the ,secretary shall implement at least #i demonstration projects1 including the following3 7,a7 ,two projects1 each of which shall target different ethnic subpopulations1 for each of the #d following major racial and ethnic minority groups3 7i7 ,american ,indians and ,alaska ,natives1 ,eskimos1 and ,aleuts4 7ii7 ,asian ,americans4 7iii7 ,blacks and ,african ,americans4 7iv7 ,latinos and ,hispanics4 7v7 ,native ,hawaiians and other ,pacific ,islanders4 7,b7 ,one project within the ,pacific ,islands or ,united ,states insular areas4 7,c7 ,at least one project in a rural area4 7,d7 ,at least one project in an inner-city area4 7#c7 ,expansion of projects2 implementation of demonstration project results ,the ,secretary shall continue the existing demonstration projects and may expand the number of demonstration projects if the initial report under subsection 7c7 contains an evaluation that demonstration projects-- 7,a7 reduce expenditures under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq472 or 7,b7 do not increase expenditures under such ,medicare program and reduce racial and ethnic health disparities in the quality of health care services provided to target individuals and increase satisfaction of ,medicare beneficiaries and health care providers4 7c7 ,report to ,congress 7#a7 ,in general ,not later than #b years after the date the ,secretary implements the initial demonstration projects1 and biannually thereafter1 the ,secretary shall submit to ,congress a report regarding the demonstration projects4 7#b7 ,content of report ,each report under paragraph 7#a7 shall include the following3 7,a7 ,a description of the demonstration projects4 7,b7 ,an evaluation of-- 7i7 the cost-effectiveness of the demonstration projects2 7ii7 the quality of the health care services provided to target individuals under the demonstration projects2 and 7iii7 beneficiary and health care provider satisfaction under the demonstration projects4 7,c7 ,any other information regarding the demonstration projects that the ,secretary determines to be appropriate4 7d7 ,waiver authority ,the ,secretary shall waive compliance with the requirements of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 to such extent and for such period as the ,secretary determines is necessary to conduct demonstration projects4 #gjh4 ,reducing cancer disparities within ,medicare 7a7 ,development of measures of disparities in quality of cancer care 7#a7 ,development of measures ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall enter into an agreement with an entity that specializes in developing quality measures for cancer care under which the entity shall develop a uniform set of measures to evaluate disparities in the quality of cancer care and annually update such set of measures4 7#b7 ,measures to be included ,such set of measures shall include1 with respect to the treatment of cancer1 measures of patient outcomes1 the process for delivering medical care related to such treatment1 patient counseling and engagement in decision-making1 patient experience of care1 resource use1 and practice capabilities1 such as care coordination4 7b7 ,establishment of reporting process 7#a7 ,in general ,the ,secretary shall establish a reporting process that requires and provides for a method for health care providers specified under paragraph 7#b7 to submit to the ,secretary and make public data on the performance of such providers during each reporting period through use of the measures developed pursuant to subsection 7a74 ,such data shall be submitted in a form and manner and at a time specified by the ,secretary4 7#b7 ,specification of providers to report on measures ,the ,secretary shall specify the classes of ,medicare providers of services and suppliers1 including hospitals1 cancer centers1 physicians1 primary care providers1 and specialty providers1 that will be required under such process to publicly report on the measures specified under subsection 7a74 7#c7 ,assessment of changes ,under such reporting process1 the ,secretary shall establish a format that assesses changes in both the absolute and relative disparities in cancer care over time4 ,these measures shall be presented in an easily comprehensible format1 such as those presented in the final publications relating to ,healthy ,people #bjaj or the ,national ,healthcare ,disparities ,report4 7#d7 ,initial implementation ,the ,secretary shall implement the reporting process under this subsection for reporting periods beginning not later than #f months after the date that measures are first established under subsection 7a74 #gji4 ,cancer clinical trials 7a7 ,short title ,this section may be cited as the ,henrietta ,lacks ,enhancing ,cancer ,research ,act of #bjbj4 7b7 ,findings ,congress finds as follows3 7#a7 ,only a small percent of patients participate in cancer clinical trials1 even though most express an interest in clinical research4 ,there are several obstacles that restrict individuals from participating including lack of available local trials1 restrictive eligibility criteria1 transportation to trial sites1 taking time off from work1 and potentially increased medical and nonmedical costs4 ,ultimately1 about #a in #e cancer clinical trials fail because of lack of patient enrollment4 7#b7 ,groups that are generally underrepresented in clinical trials include racial and ethnic minorities and older1 rural1 and lower-income individuals4 7#c7 ,henrietta ,lacks1 an ,african-,american woman1 was diagnosed with cervical cancer at the age of #ca1 and despite receiving painful radium treatments1 passed away on ,october #d1 #aiea4 7#d7 ,medical researchers took samples of ,henrietta ,lacks' tumor during her treatment and the ,he,la cell line from her tumor proved remarkably resilient4 7#e7 ,he,la cells were the first immortal line of human cells4 ,henrietta ,lacks' cells were unique1 growing by the millions1 commercialized and distributed worldwide to researchers1 resulting in advances in medicine4 7#f7 ,henrietta ,lacks' prolific cells continue to grow and contribute to remarkable advances in medicine1 including the development of the polio vaccine1 as well as drugs for treating the effects of cancer1 ,,hiv_/,,aids1 hemophilia1 leukemia1 and ,parkinson's disease4 ,these cells have been used in research that has contributed to our understanding of the effects of radiation and zero gravity on human cells4 ,these immortal cells have informed research on chromosomal conditions1 cancer1 gene mapping1 and precision medicine4 7#g7 ,henrietta ,lacks and her immortal cells have made a significant contribution to global health1 scientific research1 quality of life1 and patient rights4 7#h7 ,for more than #bj years1 the advances made possible by ,henrietta ,lacks' cells were without her or her family's consent1 and the revenues they generated were not known to or shared with her family4 7#i7 ,henrietta ,lacks and her family's experience is fundamental to modern and future bioethics policies and informed consent laws that benefit patients nationwide by building patient trust2 promoting ethical research that benefits all individuals1 including traditionally underrepresented populations2 and protecting research participants4 7c7 ,,gao study on barriers to participation in federally funded cancer clinical trials by populations that have been traditionally underrepresented in such trials 7#a7 ,in general ,not later than #b years after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall-- 7,a7 complete a study that-- 7i7 reviews what actions ,federal agencies have taken to help to address barriers to participation in federally funded cancer clinical trials by populations that have been traditionally underrepresented in such trials1 and identifies challenges1 if any1 in implementing such actions2 and 7ii7 identifies additional actions that can be taken by ,federal agencies to address barriers to participation in federally funded cancer clinical trials by populations that have been traditionally underrepresented in such trials2 and 7,b7 submit a report to the ,congress on the results of such study1 including recommendations on potential changes in practices and policies to improve participation in such trials by such populations4 7#b7 ,inclusion of clinical trials ,the study under paragraph 7#a77;,a7 shall include review of cancer clinical trials that are largely funded by ,federal agencies1 including the ,national ,institutes of ,health1 the ,department of ,defense1 the ,department of ,veterans ,affairs1 the ,agency for ,healthcare ,research and ,quality1 the ,food and ,drug ,administration1 and such other ,federal agencies as the ,comptroller ,general of the ,united ,states may identify4 ,b ,viral ,hepatitis and ,liver ,cancer ,control and ,prevention #gaa4 ,viral hepatitis and liver cancer control and prevention 7a7 ,short title ,this subtitle may be cited as the ,viral ,hepatitis and ,liver ,cancer ,control and ,prevention ,act of #bjbj4 7b7 ,findings ,congress finds the following3 7#a7 ,in the ,united ,states1 nearly #e1jjj1jjj persons are living with the hepatitis ,b virus 7referred to in this section as ,,hbv7 or the hepatitis ,c virus 7referred to in this section as ,,hcv74 7#b7 ,in the ,united ,states1 chronic ,,hbv and ,,hcv are the most common causes of liver cancer1 the second deadliest and fastest growing cancer in this country4 ,such viruses are the most common cause of chronic liver disease1 liver cirrhosis1 and the most common indications for liver transplantation4 ,at least #ba1jjj deaths per year in the ,united ,states can be attributed to chronic ,,hbv and ,,hcv4 ,chronic ,,hcv is also a leading cause of death in ,americans living with ,,hiv_/,,aids2 many of those living with ,,hiv_/,,aids are coinfected with chronic ,,hbv1 chronic ,,hcv1 or both4 7#c7 ,according to the ,centers for ,disease ,control and ,prevention 7referred to in this section as the ,,cdc71 approximately #b percent of the population of the ,united ,states is living with chronic ,,hbv1 chronic ,,hcv1 or both4 ,the ,,cdc has recognized ,,hcv as the ,nation's most common chronic bloodborne virus infection and ,,hbv as the deadliest vaccine-preventable disease4 7#d7 ,,hbv is transmitted through contact with infectious blood1 semen1 or other bodily fluids and is #ajj times more infectious than ,,hiv4 ,,hcv is transmitted by contact with infectious blood1 particularly through percutaneous exposures 7such as puncture through the skin74 7#e7 ,the ,,cdc estimates that in #bjaf1 more than #da1jjj people in the ,united ,states were newly infected with ,,hcv and nearly #ba1jjj people in the ,united ,states were newly infected with ,,hbv4 ,these estimates could be much higher due to many reasons1 including lack of screening education and awareness1 and perceived marginalization of the populations at risk4 7#f7 ,in #bjab1 ,,cdc released new guidelines recommending every person born between #aide and #aife receive a one-time test for ,,hcv4 ,among the estimated #ajb1jjj1jjj 7#a1fjj1jjj chronically ,,hcv-infected7 eligible for screening1 birth-cohort screening leads to #hd1jjj fewer cases of decompensated cirrhosis1 #df1jjj fewer cases of hepatocellular carcinoma1 #aj1jjj fewer liver transplants1 and #gh1jjj fewer ,,hcv-related deaths gained versus risk-based screening4 7#g7 ,in #bjac1 the ,united ,states ,preventive ,services ,task ,force 7referred to in this section as the ,,uspstf7 issued a ,grade ,b rating for screening for ,,hcv infection in persons at high risk for infection and adults born between #aide and #aife4 ,in #bjad1 the ,,uspstf issued a ,grade ,b for screening for ,,hbv in persons at high-risk of hepatitis ,b infection4 ,in #bjji1 the ,,uspstf issued a ,grade ,a for screening pregnant women for ,,hbv during their first prenatal visit1 and in #bjai1 reaffirmed this grade4 7#h7 ,there were #ei outbreaks 7#bd of ,,hbv and #cf of ,,hcv1 including one of both ,,hbv and ,,hcv7 reported to ,,cdc for investigation from #bjjh through #bjaf related to health care-associated infection of ,,hbv and ,,hcv1 #ef of which occurred in non-hospital settings4 ,there were more than #aae1ihc patients potentially exposed to one of the viruses4 7#i7 ,chronic ,,hbv and chronic ,,hcv usually do not cause symptoms early in the course of the disease1 but after many years of a clinically silent phase1 ,,cdc estimates show more than #cc percent of infected individuals will develop cirrhosis1 end-stage liver disease1 or liver cancer4 ,since most individuals with chronic ,,hbv1 ,,hcv1 or both are unaware of their infection1 they do not know to take precautions to prevent the spread of their infection and can unknowingly exacerbate their own disease progression4 7#aj7 ,,hbv and ,,hcv disproportionately affect certain populations in the ,united ,states4 ,although representing only about #f percent of the population1 ,asian ,americans and ,pacific ,islanders account for half of all chronic ,,hbv cases in the ,united ,states4 ,baby ,boomers 7those born between #aide and #aife7 account for approximately #ge percent of domestic chronic ,,hcv cases4 ,in addition1 ,african ,americans1 ,latinos1 and ,american ,indian and ,native ,alaskans are among the groups which have disproportionately high rates of ,,hbv or ,,hcv infections in the ,united ,states4 7#aa7 ,for both chronic ,,hbv and chronic ,,hcv1 behavioral changes and appropriate medical care can slow disease progression if diagnosis is made early4 ,early diagnosis1 which is determined through simple blood tests1 can reduce the risk of transmission and disease progression through education and vaccination of household members and other susceptible persons at risk4 7#ab7 ,advancements have led to the development of improved diagnostic tests for viral hepatitis4 ,these tests1 including rapid1 point of care testing and others in development1 can facilitate testing1 notification of results and post-test counseling1 and referral to care at the time of the testing visit4 ,in particular1 these tests are also advantageous because they can be used simultaneously with ,,hiv rapid testing for persons at risk for both ,,hcv and ,,hiv infections4 7#ac7 ,for those chronically infected with ,,hbv or ,,hcv1 regular monitoring can lead to the early detection of liver cancer at a stage where a cure is still possible4 ,liver cancer is the second deadliest cancer in the ,united ,states2 however1 liver cancer has received little funding for research1 prevention1 or treatment4 7#ad7 ,treatment for chronic ,,hcv can eradicate the disease in approximately #ij percent of those currently treated4 ,while there is no cure for chronic ,,hbv1 available treatments can effectively suppress viral replication in the overwhelming majority of those treated1 thereby reducing the risk of transmission and progression to liver scarring or liver cancer4 7#ae7 ,to combat the viral hepatitis epidemic in the ,united ,states1 in ,february #bjag1 the ,department of ,health and ,human ,services released its ,national ,viral ,hepatitis ,action ,plan #bjag-bjbj 7referred to in this section as the ,,hhs ,action ,plan74 ,in ,march #bjag1 the ,national ,academies of ,sciences1 ,engineering1 and ,medicine released a report entitled1 ,a ,national ,strategy for the ,elimination of ,hepatitis ,b and ,c3 ,phase ,two ,report 7referred to in this section as the ,,nas report71 recommending specific actions to eliminate viral hepatitis as public health problems in the ,united ,states by #bjcj4 7#af7 ,the annual health care costs attributable to ,,hbv and ,,hcv in the ,united ,states are significant4 ,for ,,hbv1 it is estimated to be approximately #b1ejj1jjj1jjj 7#b1jjj per infected person74 ,in #bjjj1 the lifetime cost of ,,hbv--before the availability of most current therapies--was approximately #hj1jjj per chronically infected person1 totaling more than #ajj1jjj1jjj1jjj4 ,for ,,hcv1 medical costs for patients are expected to increase from #cj1jjj1jjj1jjj in #bjji to over #he1jjj1jjj1jjj in #bjbd4 ,avoiding these costs by screening and diagnosing individuals earlier--and connecting them to appropriate treatment and care1 will save lives and critical health care dollars4 ,currently1 without a comprehensive screening1 testing1 and diagnosis program1 most patients are diagnosed too late when they need a liver transplant costing at least #cad1jjj for uncomplicated cases or when they have liver cancer or end-stage liver disease which costs #cj1ihj to #aaj1egf per hospital admission4 ,as health care costs continue to grow1 it is critical that the ,federal ,government invests in effective mechanisms to avoid documented cost drivers4 7#ag7 ,according to the ,,nas report in #bjaj1 chronic ,,hbv and ,,hcv infections cause substantial morbidity and mortality despite being preventable and treatable4 ,deficiencies in the implementation of established guidelines for the prevention1 diagnosis1 and medical management of chronic ,,hbv and ,,hcv infections perpetuate personal and economic burdens4 ,existing grants are not sufficient for the scale of the health burden presented by ,,hbv and ,,hcv4 7#ah7 ,screening and testing for ,,hbv and ,,hcv is aligned with the goal of ,healthy ,people #bjbj to increase immunization rates and reduce preventable infectious diseases4 ,awareness of disease and access to prevention and treatment remain essential components for reducing infectious disease transmission4 7#ai7 ,federal support is necessary to increase knowledge and awareness of ,,hbv and ,,hcv and to assist ,state and local prevention and control efforts in reducing the morbidity and mortality of these epidemics4 7#bj7 ,the ,centers for ,disease ,control and ,prevention reported a #bcc percent increase in hepatitis ,c cases from #bjaj to #bjaf1 stemming from the opioid1 heroin1 and overdose epidemics affecting communities nationwide4 ,from #bjad to #bjae1 the number of reported cases of acute hepatitis ,b infection in the ,united ,states rose for the first time since #bjjf1 increasing by #bj4g percent1 which is also largely attributable to the opioid epidemic4 7#ba7 ,the ,secretary of ,health and ,human ,services has the discretion to carry out this subtitle 7including the amendments made by this subtitle7 directly and through whichever of the agencies of the ,public ,health ,service the ,secretary determines to be appropriate1 which may 7in the ,secretary's discretion7 include the ,centers for ,disease ,control and ,prevention1 the ,health ,resources and ,services ,administration1 the ,substance ,abuse and ,mental ,health ,services ,administration1 the ,national ,institutes of ,health 7including the ,national ,institute on ,minority ,health and ,health ,disparities71 and other agencies of such ,service4 7c7 ,biennial assessment of ,,hhs hepatitis ,b and hepatitis ,c prevention1 education1 research1 and medical management plan ,title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bda et seq471 as amended by title ,v1 is further amended-- 7#a7 by striking section #cag,n 7#db ,u4,s4,c4 #bdg;b-#ae72 and 7#b7 by adding after part ,w1 as added by section #ejh1 the following3 ,x ,biennial assessment of ,,hhs ,hepatitis ,b and ,hepatitis ,c prevention1 education1 research1 and medical management plan #cii,,pp4 ,biennial ,update of the ,plan 7a7 ,in general ,the ,secretary shall conduct a biennial assessment of the ,secretary's plan for the prevention1 control1 and medical management of1 and education and research relating to1 hepatitis ,b and hepatitis ,c1 for the purposes of-- 7#a7 incorporating into such plan new knowledge or observations relating to hepatitis ,b and hepatitis ,c 7such as knowledge and observations that may be derived from clinical1 laboratory1 and epidemiological research and disease detection1 prevention1 and surveillance outcomes72 7#b7 addressing gaps in the coverage or effectiveness of the plan2 and 7#c7 evaluating and1 if appropriate1 updating recommendations1 guidelines1 or educational materials of the ,centers for ,disease ,control and ,prevention or the ,national ,institutes of ,health for health care providers or the public on viral hepatitis in order to be consistent with the plan4 7b7 ,publication of notice of assessments ,not later than ,october #a of the first even-numbered year beginning after the date of the enactment of this part1 and ,october #a of each even-numbered year thereafter1 the ,secretary shall publish in the ,federal ,register a notice of the results of the assessments conducted under paragraph 7#a74 ,such notice shall include-- 7#a7 a description of any revisions to the plan referred to in subsection 7a7 as a result of the assessment2 7#b7 an explanation of the basis for any such revisions1 including the ways in which such revisions can reasonably be expected to further promote the original goals and objectives of the plan2 and 7#c7 in the case of a determination by the ,secretary that the plan does not need revision1 an explanation of the basis for such determination4 #cii,,pp-#a4 ,elements of program 7a7 ,education and awareness programs ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 the ,administrator of the ,health ,resources and ,services ,administration1 and the ,assistant ,secretary for ,mental ,health and ,substance ,use1 and in accordance with the plan referred to in section #cii,,pp7a71 shall implement programs to increase awareness and enhance knowledge and understanding of hepatitis ,b and hepatitis ,c4 ,such programs shall include-- 7#a7 the conduct of culturally and linguistically appropriate health education in primary and secondary schools1 college campuses1 public awareness campaigns1 and community outreach activities 7especially to the ethnic communities with high rates of chronic hepatitis ,b and chronic hepatitis ,c and other high-risk groups7 to promote public awareness and knowledge about the value of hepatitis ,a and hepatitis ,b immunization2 risk factors1 transmission1 and prevention of hepatitis ,b and hepatitis ,c2 the value of screening for the early detection of hepatitis ,b and hepatitis ,c2 and options available for the treatment of chronic hepatitis ,b and chronic hepatitis ,c2 7#b7 the promotion of immunization programs that increase awareness and access to hepatitis ,a and hepatitis ,b vaccines for susceptible adults and children2 7#c7 the training of health care professionals regarding the importance of vaccinating individuals infected with hepatitis ,c and individuals who are at risk for hepatitis ,c infection against hepatitis ,a and hepatitis ,b2 7#d7 the training of health care professionals regarding the importance of vaccinating individuals chronically infected with hepatitis ,b and individuals who are at risk for chronic hepatitis ,b infection against the hepatitis ,a virus2 7#e7 the training of health care professionals and health educators to make them aware of the high rates of chronic hepatitis ,b and chronic hepatitis ,c in certain adult ethnic populations1 and the importance of prevention1 detection1 and medical management of hepatitis ,b and hepatitis ,c and of liver cancer screening2 7#f7 the development and distribution of health education curricula 7including information relating to the special needs of individuals infected with or at risk of hepatitis ,b and hepatitis ,c1 such as the importance of prevention and early intervention1 regular monitoring1 the recognition of psychosocial needs1 appropriate treatment1 and liver cancer screening7 for individuals providing hepatitis ,b and hepatitis ,c counseling2 and 7#g7 support for the implementation of the curricula described in paragraph 7#f7 by ,state and local public health agencies4 7b7 ,immunization1 prevention1 and control programs 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall support the integration of activities described in paragraph 7#c7 into existing clinical and public health programs at ,state1 local1 territorial1 and ,tribal levels 7including community health clinics1 programs for the prevention and treatment of ,,hiv_/,,aids1 sexually transmitted infections1 and substance abuse1 and programs for individuals in correctional settings74 7#b7 ,coordination of development of ,federal screening guidelines 7,a7 ,references ,for purposes of this subsection1 the term ,,cdc ,director means the ,director of the ,centers for ,disease ,control and ,prevention1 and the term ,,ahrq ,director means the ,director of the ,agency for ,healthcare ,research and ,quality4 7,b7 ,agency for healthcare research and quality ,due to the rapidly evolving standard of care associated with diagnosing and treating viral hepatitis infection1 the ,,ahrq ,director shall convene the ,preventive ,services ,task ,force under section #iae7;a7 to review its recommendation for screening for ,,hbv and ,,hcv infection every #c years4 7#c7 ,activities 7,a7 ,voluntary testing programs 7i7 ,in general ,the ,secretary shall establish a mechanism by which to support and promote the development of ,state1 local1 territorial1 and tribal voluntary hepatitis ,b and hepatitis ,c testing programs to screen the high-prevalence populations to aid in the early identification of chronically infected individuals4 7ii7 ,confidentiality of the test results ,the ,secretary shall prohibit the use of the results of a hepatitis ,b or hepatitis ,c test conducted by a testing program developed or supported under this subparagraph for any of the following3 7,i7 ,issues relating to health insurance4 7,,ii7 ,to screen or determine suitability for employment4 7,,iii7 ,to discharge a person from employment4 7,b7 ,counseling regarding viral hepatitis ,the ,secretary shall support ,state1 local1 territorial1 and tribal programs in a wide variety of settings1 including those providing primary and specialty health care services in nonprofit private and public sectors1 to-- 7i7 provide individuals with ongoing risk factors for hepatitis ,b and hepatitis ,c infection with client-centered education and counseling which concentrates on-- 7,i7 promoting testing of individuals that have been exposed to their blood1 family members1 and their sexual partners2 and 7,,ii7 changing behaviors that place individuals at risk for infection2 7ii7 provide individuals chronically infected with hepatitis ,b or hepatitis ,c with education1 health information1 and counseling to reduce their risk of-- 7,i7 dying from end-stage liver disease and liver cancer2 and 7,,ii7 transmitting viral hepatitis to others2 and 7iii7 provide women chronically infected with hepatitis ,b or hepatitis ,c who are pregnant or of childbearing age with culturally and linguistically appropriate health information1 such as how to prevent hepatitis ,b perinatal infection1 and to alleviate fears associated with pregnancy or raising a family4 7,c7 ,immunization ,the ,secretary shall support ,state1 local1 territorial1 and tribal efforts to expand the current vaccination programs to protect every child in the ,nation and all susceptible adults1 particularly those infected with hepatitis ,c and high-prevalence ethnic populations and other high-risk groups1 from the risks of acute and chronic hepatitis ,b infection by-- 7i7 ensuring continued funding for hepatitis ,b vaccination for all children #ah years of age or younger through the ,vaccines for ,children program2 7ii7 ensuring that the recommendations of the ,advisory ,committee on ,immunization ,practices of the ,centers for ,disease ,control and ,prevention are followed regarding the birth dose of hepatitis ,b vaccinations for newborns2 7iii7 requiring proof of hepatitis ,b vaccination for entry into public or private daycare1 preschool1 elementary school1 secondary school1 and institutions of higher education2 7iv7 expanding the availability of hepatitis ,b vaccination for all adults to protect them from becoming acutely or chronically infected1 including ethnic and other populations with high prevalence rates of chronic hepatitis ,b infection2 7v7 expanding the availability of hepatitis ,b vaccination for all adults1 particularly those of reproductive age 7women and men less than #de years of age71 to protect them from the risk of hepatitis ,b infection2 7vi7 ensuring the vaccination of individuals infected1 or at risk for infection1 with hepatitis ,c against hepatitis ,a1 hepatitis ,b1 and other infectious diseases1 as appropriate1 for which such individuals may be at increased risk2 and 7vii7 ensuring the vaccination of individuals infected1 or at risk for infection1 with hepatitis ,b against hepatitis ,a virus and other infectious diseases1 as appropriate1 for which such individuals may be at increased risk4 7,d7 ,medical referral ,the ,secretary shall support ,state1 local1 territorial1 and tribal programs that support-- 7i7 referral of persons chronically infected with hepatitis ,b or hepatitis ,c-- 7,i7 for medical evaluation to determine the appropriateness for antiviral treatment to reduce the risk of progression to cirrhosis and liver cancer2 and 7,,ii7 for ongoing medical management including regular monitoring of liver function and screening for liver cancer2 and 7ii7 referral of persons infected with acute or chronic hepatitis ,b infection or acute or chronic hepatitis ,c infection for drug and alcohol abuse treatment where appropriate4 7#d7 ,increased support for adult viral hepatitis prevention coordinators ,the ,secretary1 acting through the ,,cdc ,director1 shall provide increased support to adult viral hepatitis prevention coordinators in ,state1 local1 territorial1 and tribal health departments in order to enhance the additional management1 networking1 and technical expertise needed to ensure successful integration of hepatitis ,b and hepatitis ,c prevention and control activities into existing public health programs4 7c7 ,epidemiological surveillance 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall support the establishment and maintenance of a national chronic and acute hepatitis ,b and hepatitis ,c surveillance program1 in order to identify-- 7,a7 trends in the incidence of acute and chronic hepatitis ,b and acute and chronic hepatitis ,c2 7,b7 trends in the prevalence of acute and chronic hepatitis ,b and acute and chronic hepatitis ,c infection among groups that may be disproportionately affected2 and 7,c7 trends in liver cancer and end-stage liver disease incidence and deaths1 caused by chronic hepatitis ,b and chronic hepatitis ,c in the high-risk ethnic populations4 7#b7 ,seroprevalence and liver cancer studies ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall prepare a report outlining the population-based seroprevalence studies currently underway1 future planned studies1 the criteria involved in determining which seroprevalence studies to conduct1 defer1 or suspend1 and the scope of those studies1 the economic and clinical impact of hepatitis ,b and hepatitis ,c1 and the impact of chronic hepatitis ,b and chronic hepatitis ,c infections on the quality of life4 ,not later than one year after the date of the enactment of this part1 the ,secretary shall submit the report to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives4 7#c7 ,confidentiality ,the ,secretary shall not disclose any individually identifiable information identified under paragraph 7#a7 or derived through studies under paragraph 7#b74 7d7 ,research ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 the ,director of the ,national ,cancer ,institute1 and the ,director of the ,national ,institutes of ,health1 shall-- 7#a7 conduct epidemiologic and community-based research to develop1 implement1 and evaluate best practices for hepatitis ,b and hepatitis ,c prevention especially in the ethnic populations with high rates of chronic hepatitis ,b and chronic hepatitis ,c and other high-risk groups2 7#b7 conduct research on hepatitis ,b and hepatitis ,c natural history1 pathophysiology1 improved treatments and prevention 7such as the hepatitis ,c vaccine71 and noninvasive tests that help to predict the risk of progression to liver cirrhosis and liver cancer2 7#c7 conduct research that will lead to better noninvasive or blood tests to screen for liver cancer1 and more effective treatments of liver cancer caused by chronic hepatitis ,b and chronic hepatitis ,c2 and 7#d7 conduct research comparing the effectiveness of screening1 diagnostic1 management1 and treatment approaches for chronic hepatitis ,b1 chronic hepatitis ,c1 and liver cancer in the affected communities4 7e7 ,underserved and disproportionately affected populations ,in carrying out this section1 the ,secretary shall provide expanded support for individuals with limited access to health education1 testing1 and health care services and groups that may be disproportionately affected by hepatitis ,b and hepatitis ,c4 7f7 ,evaluation of program ,the ,secretary shall develop benchmarks for evaluating the effectiveness of the programs and activities conducted under this section and make determinations as to whether such benchmarks have been achieved4 #cii,,pp-#b4 ,grants 7a7 ,in general ,the ,secretary may award grants to1 or enter into contracts or cooperative agreements with1 ,states1 political subdivisions of ,states1 territories1 ,indian tribes1 or nonprofit entities that have special expertise relating to hepatitis ,b1 hepatitis ,c1 or both1 to carry out activities under this part4 7b7 ,application ,to be eligible for a grant1 contract1 or cooperative agreement under subsection 7a71 an entity shall prepare and submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 #cii,,pp-#c4 ,authorization of appropriations ,there are authorized to be appropriated to carry out this part #ij1jjj1jjj for fiscal year #bjba1 #ij1jjj1jjj for fiscal year #bjbb1 #aaj1jjj1jjj for fiscal year #bjbc1 #acj1jjj1jjj for fiscal year #bjbd1 and #aej1jjj1jjj for fiscal year #bjbe4 4 ,c ,acquired ,bone ,marrow ,failure ,diseases #gba4 ,acquired bone marrow failure diseases 7a7 ,short title ,this subtitle may be cited as the ,bone ,marrow ,failure ,disease ,research and ,treatment ,act of #bjbj4 7b7 ,findings ,the ,congress finds the following3 7#a7 ,between #bj1jjj and #cj1jjj people in the ,united ,states are diagnosed each year with myelodysplastic syndromes1 aplastic anemia1 paroxysmal nocturnal hemoglobinuria1 and other acquired bone marrow failure diseases4 7#b7 ,acquired bone marrow failure diseases have a debilitating and often fatal impact on those diagnosed with these diseases4 7#c7 ,while some treatments for acquired bone marrow failure diseases can prolong and improve the quality of patients' lives1 there is no single cure for these diseases4 7#d7 ,the prevalence of acquired bone marrow failure diseases in the ,united ,states will continue to grow as the general public ages4 7#e7 ,evidence exists suggesting that acquired bone marrow failure diseases occur more often in minority populations1 particularly in ,asian-,american and ,latino or ,hispanic populations4 7#f7 ,the ,national ,heart1 ,lung1 and ,blood ,institute and the ,national ,cancer ,institute have conducted important research into the causes of and treatments for acquired bone marrow failure diseases4 7#g7 ,the ,national ,marrow ,donor ,program ,registry has made significant contributions to the fight against bone marrow failure diseases by connecting millions of potential marrow donors with individuals and families suffering from these conditions4 7#h7 ,despite these advances1 a more comprehensive ,federal strategic effort among numerous ,federal agencies is needed to discover a cure for acquired bone marrow failure disorders4 7#i7 ,greater ,federal surveillance of acquired bone marrow failure diseases is needed to gain a better understanding of the causes of acquired bone marrow failure diseases4 7#aj7 ,the ,federal ,government should increase its research support for and engage with public and private organizations in developing a comprehensive approach to combat and cure acquired bone marrow failure diseases4 7c7 ,national ,acquired ,bone ,marrow ,failure ,disease ,registry ,title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bda et seq47 is amended by inserting after section #cag,v 7as added by section #aaj7 the following3 #cag,w4 ,national ,acquired ,bone ,marrow ,failure ,disease ,registry 7a7 ,establishment of registry 7#a7 ,in general ,not later than #f months after the date of the enactment of this section1 the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall-- 7,a7 develop a system to collect data on acquired bone marrow failure diseases2 and 7,b7 establish and maintain a national and publicly available registry1 to be known as the ,national ,acquired ,bone ,marrow ,failure ,disease ,registry1 in accordance with paragraph 7#c74 7#b7 ,recommendations of advisory committee ,in carrying out this subsection1 the ,secretary shall take into consideration the recommendations of the ,advisory ,committee on ,acquired ,bone ,marrow ,failure ,diseases established under subsection 7b74 7#c7 ,purposes of registry ,the ,national ,acquired ,bone ,marrow ,failure ,disease ,registry shall-- 7,a7 identify the incidence and prevalence of acquired bone marrow failure diseases in the ,united ,states2 7,b7 be used to collect and store data on acquired bone marrow failure diseases1 including data concerning-- 7i7 the age1 race or ethnicity1 general geographic location1 sex1 and family history of individuals who are diagnosed with acquired bone marrow failure diseases1 and any other characteristics of such individuals determined appropriate by the ,secretary2 7ii7 the genetic and environmental factors that may be associated with developing acquired bone marrow failure diseases2 7iii7 treatment approaches for dealing with acquired bone marrow failure diseases2 7iv7 outcomes for individuals treated for acquired bone marrow failure diseases1 including outcomes for recipients of stem cell therapeutic products as contained in the database established pursuant to section #cgi;,a2 and 7v7 any other factors pertaining to acquired bone marrow failure diseases determined appropriate by the ,secretary2 and 7,c7 be made available-- 7i7 to the general public2 and 7ii7 to researchers to facilitate further research into the causes of1 and treatments for1 acquired bone marrow failure diseases in accordance with standard practices of the ,centers for ,disease ,control and ,prevention4 7b7 ,advisory committee 7#a7 ,establishment ,not later than #f months after the date of the enactment of this section1 the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall establish an advisory committee1 to be known as the ,advisory ,committee on ,acquired ,bone ,marrow ,failure ,diseases4 7#b7 ,members ,the members of the ,advisory ,committee on ,acquired ,bone ,marrow ,failure ,diseases shall be appointed by the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 and shall include at least one representative from each of the following3 7,a7 ,a national patient advocacy organization with experience advocating on behalf of patients suffering from acquired bone marrow failure diseases4 7,b7 ,the ,national ,institutes of ,health1 including at least one representative from each of-- 7i7 the ,national ,cancer ,institute2 7ii7 the ,national ,heart1 ,lung1 and ,blood ,institute2 and 7iii7 the ,office of ,rare ,diseases4 7,c7 ,the ,centers for ,disease ,control and ,prevention4 7,d7 ,clinicians with experience in-- 7i7 diagnosing or treating acquired bone marrow failure diseases2 or 7ii7 medical data registries4 7,e7 ,epidemiologists who have experience with data registries4 7,f7 ,publicly or privately funded researchers who have experience researching acquired bone marrow failure diseases4 7,g7 ,the entity operating the ,c4,w4 ,bill ,young ,cell ,transplantation ,program established pursuant to section #cgi and the entity operating the ,c4,w4 ,bill ,young ,cell ,transplantation ,program ,outcomes ,database4 7#c7 ,responsibilities ,the ,advisory ,committee on ,acquired ,bone ,marrow ,failure ,diseases shall provide recommendations to the ,secretary on the establishment and maintenance of the ,national ,acquired ,bone ,marrow ,failure ,disease ,registry1 including recommendations on the collection1 maintenance1 and dissemination of data4 7#d7 ,public availability ,the ,secretary shall make the recommendations of the ,advisory ,committee on ,acquired ,bone ,marrow ,failure ,disease publicly available4 7c7 ,grants ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 may award grants to1 and enter into contracts and cooperative agreements with1 public or private nonprofit entities for the management of1 as well as the collection1 analysis1 and reporting of data to be included in1 the ,national ,acquired ,bone ,marrow ,failure ,disease ,registry4 7d7 ,definition ,in this section1 the term acquired bone marrow failure disease means-- 7#a7 myelodysplastic syndromes2 7#b7 aplastic anemia2 7#c7 paroxysmal nocturnal hemoglobinuria2 7#d7 pure red cell aplasia2 7#e7 acute myeloid leukemia that has progressed from myelodysplastic syndromes2 or 7#f7 large granular lymphocytic leukemia4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #c1jjj1jjj for each of fiscal years #bjba through #bjbe4 4 7d7 ,pilot studies through the agency for toxic substances and disease registry 7#a7 ,pilot studies ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,agency for ,toxic ,substances and ,disease ,registry1 shall conduct pilot studies to determine which environmental factors1 including exposure to toxins1 may cause acquired bone marrow failure diseases4 7#b7 ,collaboration with the ,radiation ,injury ,treatment ,network ,in carrying out the directives of this section1 the ,secretary may collaborate with the ,radiation ,injury ,treatment ,network of the ,c4,w4 ,bill ,young ,cell ,transplantation ,program established pursuant to section #cgi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bgdk7 to-- 7,a7 augment data for the pilot studies authorized by this section2 7,b7 access technical assistance that may be provided by the ,radiation ,injury ,treatment ,network2 or 7,c7 perform joint research projects4 7#c7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #a1jjj1jjj for each of fiscal years #bjba through #bjbe4 7e7 ,minority-,focused programs on acquired bone marrow failure diseases ,title ,,xvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju et seq47 is amended by inserting after section #agjg;,a the following3 #agjg;,b4 ,minority-focused programs on acquired bone marrow failure disease 7a7 ,information and referral services 7#a7 ,in general ,not later than #f months after the date of the enactment of this section1 the ,secretary1 acting through the ,deputy ,assistant ,secretary for ,minority ,health1 shall establish and coordinate outreach and informational programs targeted to minority populations affected by acquired bone marrow failure diseases4 7#b7 ,program requirements ,minority-focused outreach and informational programs authorized by this section at the ,national ,minority ,health ,resource ,center supported under section #agjg7;b77#h7 7including by means of the ,center's website1 through appropriate locations such as the ,center's knowledge center1 and through appropriate programs such as the ,center's resource persons network7 and through minority health consultants located at each ,department of ,health and ,human ,services regional office-- 7,a7 shall make information about treatment options and clinical trials for acquired bone marrow failure diseases publicly available2 and 7,b7 shall provide referral services for treatment options and clinical trials4 7b7 ,hispanic and ,asian-,american and pacific islander outreach 7#a7 ,in general ,the ,secretary1 acting through the ,deputy ,assistant ,secretary for ,minority ,health1 shall undertake a coordinated outreach effort to connect ,hispanic1 ,asian-,american1 and ,pacific ,islander communities with comprehensive services focused on treatment of1 and information about1 acquired bone marrow failure diseases4 7#b7 ,collaboration ,in carrying out this subsection1 the ,secretary may collaborate with public health agencies1 nonprofit organizations1 community groups1 and online entities to disseminate information about treatment options and clinical trials for acquired bone marrow failure diseases4 7c7 ,grants and cooperative agreements 7#a7 ,in general ,not later than #f months after the date of the enactment of this section1 the ,secretary1 acting through the ,deputy ,assistant ,secretary for ,minority ,health1 shall award grants to1 or enter into cooperative agreements with1 entities to perform research on acquired bone marrow failure diseases4 7#b7 ,requirement ,grants and cooperative agreements authorized by this subsection shall be awarded or entered into on a competitive1 peer-reviewed basis4 7#c7 ,scope of research ,research funded under this section shall examine factors affecting the incidence of acquired bone marrow failure diseases in minority populations4 7d7 ,definition ,in this section1 the term acquired bone marrow failure disease has the meaning given to such term in section #cag,w7d74 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #b1jjj1jjj for each of fiscal years #bjba through #bjbe4 4 7f7 ,diagnosis and quality of care for acquired bone marrow failure diseases 7#a7 ,grants ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality1 shall award grants to entities to improve diagnostic practices and quality of care with respect to patients with acquired bone marrow failure diseases4 7#b7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #b1jjj1jjj for each of fiscal years #bjba through #bjbe4 7g7 ,definition ,in this section1 the term acquired bone marrow failure disease has the meaning given such term in section #cag,w7d7 of the ,public ,health ,service ,act1 as added by subsection 7c74 ,d ,cardiovascular ,disease1 ,chronic ,disease1 ,obesity1 and ,other ,disease ,issues #gca4 ,guidelines for disease screening for minority patients 7a7 ,in general ,the ,secretary1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality1 shall convene a series of meetings to develop guidelines for disease screening for minority patient populations that have a higher than average risk for many chronic diseases and cancers4 7b7 ,participants ,in convening meetings under subsection 7a71 the ,secretary shall ensure that meeting participants include representatives of-- 7#a7 professional societies and associations2 7#b7 minority health organizations2 7#c7 health care researchers and providers1 including those with expertise in minority health2 7#d7 ,federal health agencies1 including the ,office of ,minority ,health1 the ,national ,institute on ,minority ,health and ,health ,disparities1 and the ,national ,institutes of ,health2 and 7#e7 other experts as the ,secretary determines appropriate4 7c7 ,diseases ,screening guidelines for minority populations shall be developed as appropriate under subsection 7a7 for-- 7#a7 hypertension2 7#b7 hypercholesterolemia2 7#c7 diabetes2 7#d7 cardiovascular disease2 7#e7 cancers1 including breast1 prostate1 colon1 cervical1 and lung cancer2 7#f7 other pulmonary problems including sleep apnea2 7#g7 asthma2 7#h7 kidney diseases2 7#i7 eye diseases and disorders1 including glaucoma2 7#aj7 ,,hiv_/,,aids and sexually transmitted infections2 7#aa7 uterine fibroids2 7#ab7 autoimmune disease2 7#ac7 mental health conditions2 7#ad7 dental health conditions and oral diseases1 including oral cancer2 7#ae7 environmental and related health illnesses and conditions2 7#af7 sickle cell disease and sickle cell trait2 7#ag7 violence and injury prevention and control2 7#ah7 genetic and related conditions2 7#ai7 heart disease and stroke2 7#bj7 tuberculosis2 7#ba7 chronic obstructive pulmonary disease2 7#bb7 musculoskeletal diseases1 arthritis1 and obesity2 and 7#bc7 other diseases determined appropriate by the ,secretary4 7d7 ,dissemination ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall publish and disseminate to health care provider organizations the guidelines developed under subsection 7a74 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjba through #bjbe4 #gcb4 ,,cdc ,wisewoman ,screening ,program ,section #aeji of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjn-#d;a7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by striking the heading and inserting ,in ,general4--2 and 7,b7 in the matter preceding paragraph 7#a71 by striking may make grants and all that follows through purpose and inserting the following3 may make grants to such ,states for the purpose2 and 7#b7 in subsection 7d77#a71 by striking there are authorized and all that follows through the period and inserting there are authorized to be appropriated #bc1jjj1jjj for fiscal year #bjba1 #be1cjj1jjj for fiscal year #bjbb1 #bg1hjj1jjj for fiscal year #bjbc1 #cj1hjj1jjj for fiscal year #bjbd1 and #cd1jjj1jjj for fiscal year #bjbe44 #gcc4 ,report on cardiovascular care for women and minorities ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq471 as amended by section #eca1 is further amended by adding at the end the following3 #cii,v-#i4 ,report on cardiovascular care for women and minorities ,not later than ,september #cj1 #bjba1 and annually thereafter1 the ,secretary shall prepare and submit to ,congress a report on the quality of and access to care for women and minorities with heart disease1 stroke1 and other cardiovascular diseases4 ,the report shall contain recommendations for eliminating disparities in1 and improving the treatment of1 heart disease1 stroke1 and other cardiovascular diseases in women1 racial and ethnic minorities1 those for whom ,english is not their primary language1 and individuals with disabilities4 4 #gcd4 ,coverage of comprehensive tobacco cessation services in ,medicaid and private health insurance 7a7 ,requiring ,medicaid coverage of counseling and pharmacotherapy for cessation of tobacco use ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7#a7 in subsection 7a77#d77;,d71 by striking by pregnant women2 and 7#b7 in subsection 7bb7-- 7,a7 by striking by pregnant women each place it appears2 7,b7 in paragraph 7#a71 in the matter before subparagraph 7,a71 by inserting by individuals before who use tobacco2 and 7,c7 in paragraph 7#b77;,a71 by striking with respect to pregnant women4 7b7 ,exception from optional restriction under ,medicaid prescription drug coverage ,section #aibg7;d77#b77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7;d77#b77;,f77 is amended-- 7#a7 by striking 1 in the case of pregnant women2 and 7#b7 by striking under the over-the-counter monograph process4 7c7 ,state monitoring and promoting of comprehensive tobacco cessation services under ,medicaid ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a771 as amended by section #dcc7;d77#b77;,a71 is amended-- 7#a7 by striking and at the end of paragraph 7#hf72 7#b7 by striking the period at the end of paragraph 7#hg7 and inserting 2 and2 and 7#c7 by inserting after paragraph 7#hg7 the following new paragraph3 7#hh7 provide for the ,state to monitor and promote the use of comprehensive tobacco cessation services under the ,state plan1 including conducting an outreach campaign to increase awareness of1 and the benefits of using1 such services among-- 7,a7 individuals entitled to medical assistance under the ,state plan who use tobacco products2 and 7,b7 clinicians and others who provide services to individuals entitled to medical assistance under the ,state plan4 4 7d7 ,federal reimbursement for medicaid outreach campaign ,to increase awareness ,section #aijc7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77 is amended-- 7#a7 by striking the period at the end of paragraph 7#g7 and inserting 2 plus2 and 7#b7 by inserting after paragraph 7#g7 the following new paragraph3 7#h7 an amount equal to #ij percent of the sums expended during each quarter which are attributable to the development1 implementation1 and evaluation of an outreach campaign to-- 7,a7 increase awareness of comprehensive tobacco cessation services covered in the ,state plan among-- 7i7 individuals who are likely to be eligible for medical assistance under the ,state plan2 and 7ii7 clinicians and others who provide services to individuals who are likely to be eligible for medical assistance under the ,state plan2 and 7,b7 increase awareness of the benefits of using comprehensive tobacco cessation services covered in the ,state plan among-- 7i7 individuals who are likely to be eligible for medical assistance under the ,state plan2 and 7ii7 clinicians and others who provide services to individuals who are likely to be eligible for medical assistance under the ,state plan about the benefits of using comprehensive tobacco cessation services4 4 7e7 ,removal of cost sharing for counseling and pharmacotherapy for cessation of tobacco use under ,medicaid 7#a7 ,general cost sharing limitations ,section #aiaf of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo7 is amended-- 7,a7 in subsections 7a77#b77;,b7 and 7b77#b77;,b71 by striking and counseling and pharmacotherapy for cessation of tobacco use by pregnant women 7as defined in section #aije7;bb77 and covered outpatient drugs 7as defined in subsection 7k77#b7 of section #aibg and including nonprescription drugs described in subsection 7d77#b7 of such section7 that are prescribed for purposes of promoting1 and when used to promote1 tobacco cessation by pregnant women in accordance with the ,guideline referred to in section #aije7;bb77#b77;,a7 each place it appears2 and 7,b7 in each of subsections 7a77#b77;,b7 and 7b77#b77;,b7 by inserting and counseling and pharmacotherapy for cessation of tobacco use 7as defined in section #aije;d7bb77 and covered outpatient drugs 7as defined in subsection 7k77#b7 of section #aibg and including nonprescription drugs described in subsection 7d77#b7 of such section7 that are prescribed for purposes of promoting1 and when used to promote1 tobacco cessation in accordance with the ,guideline referred to in section #aije7;bb77#b77;,a7 after 7or at the option of the ,state1 any services furnished to pregnant women4 7#b7 ,application to alternative cost sharing ,section #aiaf;,a7b77#c77;,b7 of such ,act 7#db ,u4,s4,c4 #acifo-#a7;b77#c77;,b77 is amended-- 7,a7 in clause 7iii71 by striking 1 and counseling and pharmacotherapy for cessation of tobacco use by pregnant women 7as defined in section #aije7;bb772 and 7,b7 by adding at the end the following3 7xii7 ,counseling and pharmacotherapy for cessation of tobacco use 7as defined in section #aije7;bb77 and covered outpatient drugs 7as defined in subsection 7k77#b7 of section #aibg and including nonprescription drugs described in subsection 7d77#b7 of such section7 that are prescribed for purposes of promoting1 and when used to promote1 tobacco cessation in accordance with the ,guideline referred to in section #aije7;bb77#b77;,a74 4 7f7 ,no prior authorization for tobacco cessation drugs under medicaid ,section #aibg7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7 is amended-- 7#a7 by striking in paragraph 7#a77;,a7 ,a ,state and inserting ,except as otherwise provided in paragraph 7#f71 a ,state2 7#b7 by redesignating paragraphs 7#f7 and 7#g7 as paragraphs 7#g7 and 7#h71 respectively2 and 7#c7 by inserting after paragraph 7#e7 the following3 7#f7 ,no prior authorization programs for tobacco cessation drugs ,a ,state plan under this title shall not require1 as a condition of coverage or payment for a covered outpatient drug for which ,federal financial participation is available in accordance with this section1 the approval of an agent when used to promote smoking cessation1 including agents approved by the ,food and ,drug ,administration for the purposes of promoting1 and when used to promote1 tobacco cessation4 4 7g7 ,comprehensive coverage of tobacco cessation coverage in private health insurance ,section #bgac of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ac7 is amended by adding at the end the following3 7d7 ,no prior authorization ,a group health plan and a health insurance issuer offering group or individual health insurance coverage shall not impose any prior authorization requirement for tobacco cessation counseling and pharmacotherapy that has in effect a rating of ,a or ,b in the current recommendations of the ,united ,states ,preventive ,services ,task ,force4 4 7h7 ,effective date ,the amendments made by this section shall apply to items and services furnished on or after ,january #a1 #bjba4 #gce4 ,clinical research funding for oral health 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall expand and intensify the conduct and support of the research activities of the ,national ,institutes of ,health and the ,national ,institute of ,dental and ,craniofacial ,research to improve the oral health of the population through the prevention and management of oral diseases and conditions4 7b7 ,included research activities ,research activities under subsection 7a7 shall include-- 7#a7 comparative effectiveness research and clinical disease management research addressing early childhood caries and oral cancer2 and 7#b7 awarding of grants and contracts to support the training and development of health services researchers1 comparative effectiveness researchers1 and clinical researchers whose research improves the oral health of the population4 #gcf4 ,participation by ,medicaid beneficiaries in approved clinical trials 7a7 ,in general ,title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is amended by adding at the end the following new section3 #aidg4 ,participation in an approved clinical trial 7a7 ,coverage of routine patient costs associated with approved clinical trials 7#a7 ,inclusion ,subject to paragraph 7#b71 routine patient costs shall include all items and services consistent with the medical assistance provided under the ,state plan that would otherwise be provided to the individual under such ,state plan if such individual was not enrolled in an approved clinical trial1 including any items or services related to the prevention1 detection1 and treatment of any medical complications that arise as a result of participation in the approved clinical trial4 7#b7 ,exclusion ,for purposes of paragraph 7#a71 routine patient costs does not include-- 7,a7 the investigational item1 device1 or service itself2 7,b7 items and services that are provided solely to satisfy data collection and analysis needs and that are not used in the direct clinical management of the patient2 or 7,c7 a service that is clearly inconsistent with widely accepted and established standards of care for a particular diagnosis4 7#c7 ,information concerning clinical trials 7,a7 ,in general ,subject to subparagraph 7,b71 the ,secretary1 in consultation with relevant stakeholders1 shall develop a single standardized electronic form for use by the individual or the referring health care provider to submit to the ,state agency administering the ,state plan in order to verify that the clinical trial meets the conditions established for an approved clinical trial 7as defined in subsection 7c774 7,b7 ,excluded information ,for purposes of subparagraph 7,a7 or any such request by the ,state agency for information regarding a clinical trial1 an individual or referring health care provider shall not be required to submit-- 7i7 the clinical protocol document for the clinical trial2 or 7ii7 subject to subparagraph 7,c71 any additional information other than such information as is required pursuant to the form described in subparagraph 7,a74 7,c7 ,optional information ,for purposes of subparagraphs 7,a7 and 7,b77ii71 the form may include a requirement that the referring health care provider attest that the individual is eligible to participate in the clinical trial pursuant to the trial protocol and that individual participation in such trial would be appropriate4 7,d7 ,review of information 7i7 ,in general ,a ,state plan under this title shall establish a process for timely review by the ,state agency of the form and information submitted pursuant to subparagraph 7,a7 and1 not later than #dh hours after receipt of such form1 confirmation that the information provided in such form satisfies the requirements established under such subparagraph1 with such process to include establishment and operation of a #bd-;hour1 toll-free telephone number and email address to provide for expedited communication4 7ii7 ,failure to respond ,if an individual or the referring health care provider does not receive a response or request for additional information from the ,state agency following the #dh-;hour period described in clause 7i71 the information provided in the form may be presumed to satisfy the requirements established under this paragraph4 7b7 ,encouragement of participation in approved clinical trials 7#a7 ,reasonably accessible provider ,for purposes of participation in an approved clinical trial by an individual eligible for medical assistance under this title1 the ,state agency administering the ,state plan shall make reasonable efforts to ensure that the individual is provided with access to a provider who is-- 7,a7 participating in the approved clinical trial2 7,b7 located not more than #be miles from the residence of the individual 7or1 if no such provider is available1 as close as possible to the residence of the individual72 and 7,c7 a participating provider under the ,state plan or has been deemed to be a participating provider under the ,state plan for purposes of providing medical assistance to the individual during their participation in the approved clinical trial4 7#b7 ,informational materials ,the ,state agency administering the plan approved under this title shall develop informational materials and programs to encourage participating providers to make appropriate referrals to physicians and other appropriate health care professionals who can provide individuals with access to approved clinical trials4 7c7 ,definition of approved clinical trial ,the term approved clinical trial has the same meaning as provided under subsection 7d7 of the section #bgji of the ,public ,health ,service ,act that relates to coverage for individuals participating in approved clinical trials4 4 7b7 ,conforming amendment ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a771 as amended by section #gcd7;c71 is amended-- 7#a7 by striking and at the end of paragraph 7#hg72 7#b7 by striking the period at the end of paragraph 7#hh7 and inserting 2 and2 and 7#c7 by inserting after paragraph 7#hh7 the following new paragraph3 7#hi7 provide that participation in an approved clinical trial and coverage of routine patient costs associated with such trial for an individual eligible for medical assistance under this title is conducted in accordance with the requirements under section #aidg4 4 7c7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 the amendments made by this section shall apply to calendar quarters beginning on or after ,october #a1 #bjba4 7#b7 ,delay permitted for state plan amendment ,in the case of a ,state plan for medical assistance under title ,,xix of the ,social ,security ,act 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 requirements imposed by the amendments made by this section1 the ,state plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of such session shall be deemed to be a separate regular session of the ,state legislature4 #gcg4 ,guide on evidence-based strategies for public health department obesity prevention programs 7a7 ,development and dissemination of an evidence-,based strategies guide ,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 not later than #b years after the date of enactment of this ,act1 shall-- 7#a7 develop a guide on evidence-based strategies for ,state1 territorial1 and local health departments to use to build and maintain effective obesity prevention and reduction programs1 and1 in consultation with stakeholders that have expertise in ,tribal health1 a guide on such evidence-based strategies with respect to ,indian ,tribes and ,tribal organizations for such ,indian ,tribes and ,tribal organizations to use for such purpose1 both of which guides shall-- 7,a7 describe an integrated program structure for implementing interventions proven to be effective in preventing and reducing the incidence of obesity2 and 7,b7 recommend-- 7i7 optimal resources1 including staffing and infrastructure1 for promoting nutrition and obesity prevention and reduction2 and 7ii7 strategies for effective obesity prevention programs for ,state and local health departments1 ,indian ,tribes1 and ,tribal organizations1 including strategies related to-- 7,i7 the application of evidence-based and evidence-informed practices to prevent and reduce obesity rates2 7,,ii7 the development1 implementation1 and evaluation of obesity prevention and reduction strategies for specific communities and populations2 7,,iii7 demonstrated knowledge of obesity prevention practices that reduce associated preventable diseases1 health conditions1 death1 and health care costs2 7,,iv7 best practices for the coordination of efforts to prevent and reduce obesity and related chronic diseases2 7,v7 addressing the underlying risk factors and social determinants of health that impact obesity rates2 and 7,,vi7 interdisciplinary coordination between relevant public health officials specializing in fields such as nutrition1 physical activity1 epidemiology1 communications1 and policy implementation1 and collaboration between public health officials and community-based organizations2 and 7#b7 disseminate the guides and current research1 evidence-based practices1 tools1 and educational materials related to obesity prevention1 consistent with the guides1 to ,state and local health departments1 ,indian ,tribes1 and ,tribal organizations4 7b7 ,technical assistance ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall provide technical assistance to ,state and local health departments1 ,indian ,tribes1 and ,tribal organizations to support such health departments in implementing the guides developed under subsection 7a77#a74 7c7 ,indian ,tribes2 ,tribal organizations ,in this section1 the terms ,indian ,tribe and ,tribal organization have the meanings given the terms ,indian tribe and tribal organization1 respectively1 in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 ,e ,,hiv_/,,aids #gda4 ,statement of policy ,it is the policy of the ,united ,states to achieve an ,,aids-free generation1 and to-- 7#a7 expand access to lifesaving antiretroviral therapy for people living with ,,hiv and immediately link people to continuous and coordinated high-quality care when they learn they are living with ,,hiv2 7#b7 expand targeted efforts to prevent ,,hiv infection using a combination of effective1 evidence-based approaches1 including routine ,,hiv screening1 and universal access to ,,hiv prevention tools in communities disproportionately impacted by ,,hiv1 particularly communities of color2 7#c7 ensure laws1 policies1 and regulations do not impede access to prevention1 treatment1 and care for people living with ,,hiv or disproportionately impacted by ,,hiv2 7#d7 accelerate research for more efficacious ,,hiv prevention and treatments tools1 a cure1 and a vaccine2 and 7#e7 respect the human rights and dignity of persons living with ,,hiv4 #gdb4 ,findings ,the ,congress finds the following3 7#a7 ,over #a1ajj1jjj people are estimated to be living with ,,hiv in the ,united ,states according to the ,centers for ,disease ,control and ,prevention1 #ad percent of whom are unaware they are living with ,,hiv4 7#b7 ,annually there are about #cg1fjj new ,,hiv infections and #ae1hjj deaths in people with an ,,hiv diagnosis in #ej ,states and #f dependent areas of the ,united ,states4 7#c7 ,the ,centers for ,disease ,control and ,prevention estimates that1 in #bjag1 there were approximately #ch1gjj people newly diagnosed with ,,hiv4 ,the estimated number of annual new ,,hiv infections declined #i percent from #bjaj to #bjaf4 ,however1 the number of new infections is increasing among certain populations1 such as ,latino gay and bisexual men1 where annual infections increase #ba percent4 7#d7 ,,hiv disproportionately affects certain populations in the ,united ,states4 ,though ,african ,americans represent approximately #ab percent of the population1 ,african ,americans account for almost half 7#db percent7 of all people living with ,,hiv in the ,united ,states4 ,african-,american men who have sex with men account for #bf percent of all new ,,hiv infections and have remained stable from #bjaj to #bjaf4 7#e7 ,disparities continue to exist among ,latinos and ,hispanics2 in #bjag1 ,latinos and ,hispanics made up #ah percent of the ,united ,states population and #bf percent of new infections4 7#f7 ,though the rate of new infections among ,american ,indians and ,alaska ,natives 7referred to in this section as ,,ai_/,,an7 is proportional to their population size1 from #bjaj to #bjaf1 the annual number of ,,hiv diagnoses increased #df percent among ,,ai_/,,an overall and #ha percent among ,,ai_/,,an gay and bisexual men4 7#g7 ,asian ,americans account for about #b percent of new ,,hiv infections1 but in #bjac1 #bb percent were undiagnosed1 the highest rate of undiagnosed ,,hiv among any race or ethnicity4 ,between #bjaj and #bjaf1 the number of ,asians receiving an ,,hiv diagnosis increased by #db percent4 7#h7 ,the latest data from the ,centers for ,disease ,control and ,prevention indicates that new infections among women declined #ba percent between #bjaj and #bjaf4 7#i7 ,the history of ,,hiv shows that culturally relevant and gender-responsive supportive services1 including psychosocial support1 treatment literacy1 case management1 and transportation are necessary strategies to reach and engage women and girls in medical care4 7#aj7 ,among the #c1jjj1jjj ,,hiv testing events reported to the ,centers for ,disease ,control and ,prevention in #bjag1 the percentage of transgender people who received a new ,,hiv diagnosis was #c times the national average4 ,a #bjai systematic review and meta-analysis found that an estimated #ad percent of transgender women have ,,hiv4 ,by race_/ethnicity1 an estimated #dd percent of ,black_/,african-,american transgender women1 #bf percent of ,hispanic_/,latina transgender women1 and #g percent of ,white transgender women have ,,hiv4 ,the limited data available on transgender individuals point to a disproportionate burden of ,,hiv infection4 7#aa7 ,stigma and discrimination contribute to such disparities4 7#ab7 ,the ,centers for ,disease ,control and ,prevention has determined that increasing the proportion of people who know their ,,hiv status is an essential component of comprehensive ,,hiv treatment and prevention efforts and that early diagnosis is critical in order for people with ,,hiv to receive life-extending therapy4 ,additionally1 the ,centers for ,disease ,control and ,prevention recommend routine ,,hiv screening in health care settings for all patients aged #ac to #fd1 regardless of risk4 7#ac7 ,in #aiih1 ,congress created the ,national ,minority ,,aids ,initiative to provide technical assistance1 build capacity1 and strengthen outreach efforts among local institutions and community-based organizations that serve racial and ethnic minorities living with or vulnerable to ,,hiv4 7#ad7 ,to combat the ,,hiv epidemic in the ,united ,states1 the ,national ,,hiv_/,,aids ,strategy 7referred to in this section as ,,nhas7 provides a framework of increasing access to care1 reducing new infections1 and eliminating ,,hiv-related health disparities4 ,the vision of ,,nhas is ,the ,united ,states will become a place where new ,,hiv infections are rare and when they do occur1 every person1 regardless of age1 gender1 race_/ethnicity1 gender identity1 or socioeconomic circumstance1 will have unfettered access to high quality1 life-extending care1 free from stigma and discrimination44 7#ae7 ,in ,january #bjai1 the ,department of ,health and ,human ,services began implementing the initiative ,ending the ,,hiv ,epidemic3 ,a ,plan for ,america4 ,the initiative seeks to reduce the number of new ,,hiv infections in the ,united ,states by #ge percent by #bjbe1 and then by at least #ij percent by #bjcj1 for an estimated #bej1jjj total ,,hiv infection averted4 7#af7 ,at present1 many ,states and ,united ,states territories have criminal statutes based on exposure to ,,hiv4 ,most of these laws were adopted before the availability of effective antiretroviral treatment for ,,hiv_/,,aids4 7#ag7 ,research shows that stable housing leads to better health outcomes for those living with ,,hiv4 ,inadequate or unstable housing is not only a barrier to effective treatment1 but also increases the likelihood of engaging in risky behaviors leading to ,,hiv infection4 ,insecure housing puts people with ,,hiv_/,,aids at risk of premature death from exposure to other diseases1 poor nutrition1 and lack of medical care4 7#ah7 ,due to advances in treatment1 many people living with ,,hiv today are living healthy lives and have the ability and desire to fully participate in all aspects of community life1 including employment4 ,research associates being employed with tremendous economic1 social1 and health benefits for many people living with ,,hiv4 7#ai7 ,the common benefits associated with employment include income1 autonomy1 productivity1 and status within society1 daily structure1 making a contribution to one's community1 and increased skills and self-esteem4 ,research also indicates that many people with disabilities1 including people living with ,,hiv1 report perceiving themselves as being less disabled or not disabled at all1 when working4 ,furthermore1 some studies link working with better physical and mental health outcomes for people living with ,,hiv when compared to those who are not working4 ,preliminary data also suggest that transitioning to employment is associated with reduced ,,hiv-related health risk behavior for many people4 7#bj7 ,in ,july #bjab1 the ,food and ,drug ,administration approved the first drug to be used as pre-exposure prophylaxis 7,pr,e,p74 ,pr,e,p reduces the risk of ,,hiv infection in ,,hiv-negative individuals4 ,studies have shown that ,pr,e,p reduces ,,hiv transmission from sex by about #ii percent when taken consistently4 ,despite increases in ,pr,e,p uptake1 ,pr,e,p use remains low among gay and bisexual men of color4 ,the ,centers for ,disease ,control and ,prevention found that uptake was lower among ,african-,american 7#bf percent7 and ,latino 7#cj percent7 men compared with ,white men 7#db percent74 ,similarly1 ,pr,e,p awareness was lower among ,african-,american 7#hf percent7 and ,latino 7#hg percent7 men compared with ,white men 7#ie percent74 ,while clinical research on transgender populations and ,pr,e,p is currently limited1 the ,centers for ,disease ,control and ,prevention recommends ,pr,e,p use in transgender populations4 ,in ,september #bjai1 the ,food and ,drug ,administration approved the second drug to be used as ,pr,e,p4 7#ba7 ,syringe service programs have been associated with lowered ,,hiv infections1 lower hepatitis ,c infections1 and increased linkage to substance use treatment4 7#bb7 ,there is now conclusive scientific evidence that a person living with ,,hiv who is on antiretroviral therapy and is durably virally suppressed 7defined as having a consistent viral load of less than #bjj copies_/ml7 does not sexually transmit ,,hiv4 ,the conclusive evidence about the highly effective preventative benefits of antiretroviral therapy provides an unprecedented opportunity to improve the lives of people living with ,,hiv1 improve treatment uptake and adherence1 and advocate for expanded access to treatment and care4 #gdc4 ,additional funding for ,,aids drug assistance program treatments ,section #bfbc of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#ca;b7 is amended by adding at the end the following3 7c7 ,additional funding for ,,aids drug assistance program treatments ,in addition to amounts otherwise authorized to be appropriated for carrying out this subpart1 there are authorized to be appropriated such sums as may be necessary to carry out sections #bfab7;b77#c77;,b7 and #bfaf for each of fiscal years #bjba through #bjbd4 4 #gdd4 ,enhancing the national ,,hiv surveillance system 7a7 ,grants ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall make grants to ,states to support integration of public health surveillance systems into all electronic health records in order to allow rapid communications between the clinical setting and health departments1 by means that include-- 7#a7 providing technical assistance and policy guidance to ,state and local health departments1 clinical providers1 and other agencies serving individuals with ,,hiv to improve the interoperability of data systems relevant to monitoring ,,hiv care and supportive services2 7#b7 capturing longitudinal data pertaining to the initiation and ongoing prescription or dispensing of antiretroviral therapy for individuals diagnosed with ,,hiv 7such as through pharmacy-based reporting72 7#c7 obtaining information-- 7,a7 on a voluntary basis1 on sexual orientation and gender identity2 and 7,b7 on sources of coverage 7or the lack of coverage7 for medical treatment 7including coverage through the ,medicaid program1 the ,medicare program1 the program under title ,,xxvi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#aa et seq472 commonly referred to as the ,ryan ,white ,,hiv_/,,aids ,program71 other public funding1 private insurance1 and health maintenance organizations72 and 7#d7 obtaining and using current geographic markers of residence 7such as current address1 zip code1 partial zip code1 and census block74 7b7 ,privacy and security safeguards ,in carrying out this section1 the ,secretary of ,health and ,human ,services shall ensure that appropriate privacy and security safeguards are met to prevent unauthorized disclosure of protected health information and compliance with the ,,hipaa privacy and security law 7as defined in section #cjji of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ai77 and other relevant laws and regulations4 7c7 ,prohibition against improper use of data ,no grant under this section may be used to allow or facilitate the collection or use of surveillance or clinical data or records-- 7#a7 for punitive measures of any kind1 civil or criminal1 against the subject of such data or records2 or 7#b7 for imposing any requirement or restriction with respect to an individual without the individual's written consent4 7d7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for each of fiscal years #bjba through #bjbd4 #gde4 ,evidence-based strategies for improving linkage to and retention in appropriate care 7a7 ,strategies ,the ,secretary of ,health and ,human ,services1 in collaboration with the ,director of the ,centers for ,disease ,control and ,prevention1 the ,assistant ,secretary for ,mental ,health and ,substance ,use1 the ,director of the ,office of ,,aids ,research1 the ,administrator of the ,health ,resources and ,services ,administration1 and the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall-- 7#a7 identify evidence-based strategies most effective at addressing the multifaceted issues that impede disease status awareness and linkage to and retention in appropriate care1 taking into consideration health care systems issues1 clinic and provider issues1 and individual psychosocial1 environmental1 and other contextual factors2 7#b7 support the wide-scale implementation of the evidence-based strategies identified pursuant to paragraph 7#a71 including through incorporating such strategies into health care coverage supported by the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 the program under title ,,xxvi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#aa et seq42 commonly referred to as the ,ryan ,white ,,hiv_/,,aids ,program71 and health plans purchased through an ,american ,health ,benefit ,exchange established pursuant to section #acaa of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca72 and 7#c7 not later than #a year after the date of the enactment of this ,act1 submit a report to the ,congress on the status of activities under paragraphs 7#a7 and 7#b74 7b7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjba through #bjbd4 #gdf4 ,improving entry into and retention in care and antiretroviral adherence for persons with ,,hiv 7a7 ,sense of congress ,it is the sense of ,congress that ,,aids research has led to scientific advancements that have-- 7#a7 saved the lives of millions of people living with ,,hiv2 7#b7 prevented millions from new diagnoses2 and 7#c7 had broad benefits that extend far beyond helping people at risk for or living with ,,hiv4 7b7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,national ,institutes of ,health1 shall expand1 intensify1 and coordinate operational and translational research and other activities of the ,national ,institutes of ,health regarding methods-- 7#a7 to increase adoption of evidence-based adherence strategies within ,,hiv care and treatment programs2 7#b7 to increase ,,hiv testing and case detection rates2 7#c7 to reduce ,,hiv-related health disparities2 7#d7 to ensure that research to improve adherence to ,,hiv care and treatment programs address the unique concerns of women2 7#e7 to integrate ,,hiv prevention and care services with mental health and substance use prevention and treatment delivery systems2 7#f7 to increase knowledge on the implementation of preexposure prophylaxis 7referred to in this section as ,pr,e,p71 including with respect to-- 7,a7 who can benefit most from ,pr,e,p2 7,b7 how to provide ,pr,e,p safely and efficiently2 7,c7 how to integrate ,pr,e,p with other essential prevention methods such as condoms2 and 7,d7 how to ensure high levels of adherence2 and 7#g7 to increase knowledge of undetectable and untransmittable1 when a person living with ,,hiv who is on antiretroviral therapy and is durably virally suppressed 7defined as having a consistent viral load of less than #bjj copies_/ml7 cannot sexually transmit ,,hiv4 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 #bjbd4 #gdg4 ,services to reduce ,,hiv_/,,aids in racial and ethnic minority communities 7a7 ,in general ,for the purpose of reducing new ,,hiv diagnoses in racial and ethnic minority communities1 the ,secretary of ,health and ,human ,services1 acting through the ,deputy ,assistant ,secretary for ,minority ,health1 may make grants to public health agencies and faith-based organizations to conduct-- 7#a7 outreach activities related to ,,hiv prevention and testing activities2 7#b7 ,,hiv prevention activities2 and 7#c7 ,,hiv testing activities4 7b7 ,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 #bjbd4 #gdh4 ,minority ,,aids initiative 7a7 ,expanded funding ,the ,secretary of ,health and ,human ,services1 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health1 the ,director of the ,centers for ,disease ,control and ,prevention1 the ,administrator of the ,health ,resources and ,services ,administration1 and the ,assistant ,secretary for ,mental ,health and ,substance ,use1 shall provide funds and carry out activities to expand the ,minority ,,aids ,initiative4 7b7 ,use of funds ,the additional funds made available under this section may be used1 through the ,minority ,,aids ,initiative1 to support the following activities3 7#a7 ,providing technical assistance and infrastructure support to reduce ,,hiv_/,,aids in minority populations4 7#b7 ,increasing minority populations' access to ,,hiv prevention and care services4 7#c7 ,building strong community programs and partnerships to address ,,hiv prevention and the health care needs of specific racial and ethnic minority populations4 7c7 ,priority interventions ,within the racial and ethnic minority populations referred to in subsection 7b71 priority in conducting intervention services shall be given to-- 7#a7 men who have sex with men2 7#b7 youth2 7#c7 persons who engage in intravenous drug abuse2 7#d7 women2 7#e7 homeless individuals2 and 7#f7 individuals incarcerated or in the penal system4 7d7 ,authorization of appropriations ,for carrying out this section1 there are authorized to be appropriated #faj1jjj1jjj for fiscal year #bjba and such sums as may be necessary for each of fiscal years #bjbb through #bjbe4 #gdi4 ,health care professionals treating individuals with ,,hiv 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall expand1 intensify1 and coordinate workforce initiatives of the ,health ,resources and ,services ,administration to increase the capacity of the health workforce focusing primarily on ,,hiv to meet the demand for culturally competent care1 and may award grants for any of the following3 7#a7 ,development of curricula for training primary care providers in ,,hiv_/,,aids prevention and care1 including routine ,,hiv testing4 7#b7 ,support to expand access to culturally and linguistically accessible benefits counselors1 trained peer navigators1 and mental and behavioral health professionals with expertise in ,,hiv4 7#c7 ,training health care professionals to provide care to individuals living with ,,hiv4 7#d7 ,development by grant recipients under title ,,xxvi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#aa et seq42 commonly referred to as the ,ryan ,white ,,hiv_/,,aids ,program7 and other persons1 of policies for providing culturally relevant and sensitive treatment to individuals living with ,,hiv1 with particular emphasis on treatment to racial and ethnic minorities1 men who have sex with men1 and women1 young people1 and children living with ,,hiv4 7#e7 ,development and implementation of programs to increase the use of telehealth to respond to ,,hiv-specific health care needs in rural and minority communities1 with particular emphasis given to medically underserved communities and insular areas4 7#f7 ,evaluating interdisciplinary medical provider care team models that promote high-quality care1 with particular emphasis on care to racial and ethnic minorities4 7#g7 ,training health care professionals to make them aware of the high rates of chronic hepatitis ,b and chronic hepatitis ,c in adult racial and ethnic populations1 and the importance of prevention1 detection1 and medical management of hepatitis ,b and hepatitis ,c and of liver cancer screening4 7#h7 ,development of curricula for training primary care providers that ,,hiv and tuberculosis are significant mutual comorbidities1 and that a patient who tests positive for one disease should be offered and encouraged to receive testing for the other4 7b7 ,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 #bjbd4 #gej4 ,,hiv_/,,aids provider loan repayment program 7a7 ,in general ,the ,secretary may enter into an agreement with any physician1 nurse practitioner1 or physician assistant under which-- 7#a7 the physician1 nurse practitioner1 or physician assistant agrees to serve as a medical provider for a period of not less than #b years-- 7,a7 at a ,ryan ,white-funded or title ,x-funded facility with a critical shortage of doctors 7as determined by the ,secretary72 or 7,b7 in an area with a high incidence of ,,hiv_/,,aids2 and 7#b7 the ,secretary agrees to make payments in accordance with subsection 7b7 on the professional education loans of the physician1 nurse practitioner1 or physician assistant4 7b7 ,manner of payments ,the payments described in subsection 7a7 shall be made by the ,secretary as follows3 7#a7 ,upon completion by the physician1 nurse practitioner1 or physician assistant for whom the payments are to be made of the first year of the service specified in the agreement entered into with the ,secretary under subsection 7a71 the ,secretary shall pay #cj percent of the principal of and the interest on the individual's professional education loans4 7#b7 ,upon completion by the physician1 nurse practitioner1 or physician assistant of the second year of such service1 the ,secretary shall pay another #cj percent of the principal of and the interest on such loans4 7#c7 ,upon completion by that individual of a third year of such service1 the ,secretary shall pay another #be percent of the principal of and the interest on such loans4 7c7 ,applicability of certain provisions ,subpart ,,iii of part ,d of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedl et seq47 shall1 except as inconsistent with this section1 apply to the program carried out under this section in the same manner and to the same extent as such provisions apply to the ,national ,health ,service ,corps loan repayment program4 7d7 ,reports ,not later than #ah months after the date of the enactment of this ,act1 and annually thereafter1 the ,secretary shall prepare and submit to ,congress a report describing the program carried out under this section1 including statements regarding the following3 7#a7 ,the number of physicians1 nurse practitioners1 and physician assistants enrolled in the program4 7#b7 ,the number and amount of loan repayments4 7#c7 ,the placement location of loan repayment recipients at facilities described in subsection 7a77#a74 7#d7 ,the default rate and actions required4 7#e7 ,the amount of outstanding default funds4 7#f7 ,to the extent that it can be determined1 the reason for the default4 7#g7 ,the demographics of individuals participating in the program4 7#h7 ,an evaluation of the overall costs and benefits of the program4 7e7 ,definitions ,in this section3 7#a7 ,,hiv_/,,aids ,the term ,,hiv_/,,aids means human immunodeficiency virus and acquired immune deficiency syndrome4 7#b7 ,nurse practitioner ,the term nurse practitioner means a registered nurse who has completed an accredited graduate degree program in advanced nurse practice and has successfully passed a national certification exam4 7#c7 ,physician ,the term physician means a graduate of a school of medicine who has completed postgraduate training in general or pediatric medicine4 7#d7 ,physician assistant ,the term physician assistant means a medical provider who completed an accredited physician assistant training program and successfully passed the ,physician ,assistant ,national ,certifying ,examination4 7#e7 ,professional education loan ,the term professional education loan-- 7,a7 means a loan that is incurred for the cost of attendance 7including tuition1 other reasonable educational expenses1 and reasonable living costs7 at a school of medicine1 nursing1 or physician assistant training program2 and 7,b7 includes only the portion of the loan that is outstanding on the date the physician1 nurse practitioner1 or physician assistant involved begins the service specified in the agreement under subsection 7a74 7#f7 ,ryan ,white-funded ,the term ,ryan ,white-funded means1 with respect to a facility1 receiving funds under title ,,xxvi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#aa et seq474 7#g7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#h7 ,school of ,medicine ,the term school of medicine has the meaning given to that term in section #gii;,b of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #biep74 7#i7 ,title x-funded ,the term title ,x-funded means1 with respect to a facility1 receiving funds under title ,x of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj et seq474 7f7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjba through #bjbd4 #gea4 ,dental education loan repayment program 7a7 ,in general ,the ,secretary may enter into an agreement with any dentist under which-- 7#a7 the dentist agrees to serve as a dentist for a period of not less than #b years at a facility with a critical shortage of dentists 7as determined by the ,secretary7 in an area with a high incidence of ,,hiv_/,,aids2 and 7#b7 the ,secretary agrees to make payments in accordance with subsection 7b7 on the dental education loans of the dentist4 7b7 ,manner of payments ,the payments described in subsection 7a7 shall be made by the ,secretary as follows3 7#a7 ,upon completion by the dentist for whom the payments are to be made of the first year of the service specified in the agreement entered into with the ,secretary under subsection 7a71 the ,secretary shall pay #cj percent of the principal of and the interest on the dental education loans of the dentist4 7#b7 ,upon completion by the dentist of the second year of such service1 the ,secretary shall pay another #cj percent of the principal of and the interest on such loans4 7#c7 ,upon completion by that individual of a third year of such service1 the ,secretary shall pay another #be percent of the principal of and the interest on such loans4 7c7 ,applicability of certain provisions ,subpart ,,iii of part ,d of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedl et seq47 shall1 except as inconsistent with this section1 apply to the program carried out under this section in the same manner and to the same extent as such provisions apply to the ,national ,health ,service ,corps ,loan ,repayment ,program4 7d7 ,reports ,not later than #ah months after the date of the enactment of this ,act1 and annually thereafter1 the ,secretary shall prepare and submit to the ,congress a report describing the program carried out under this section1 including statements regarding the following3 7#a7 ,the number of dentists enrolled in the program4 7#b7 ,the number and amount of loan repayments4 7#c7 ,the placement location of loan repayment recipients at facilities described in subsection 7a77#a74 7#d7 ,the default rate and actions required4 7#e7 ,the amount of outstanding default funds4 7#f7 ,to the extent that it can be determined1 the reason for the default4 7#g7 ,the demographics of individuals participating in the program4 7#h7 ,an evaluation of the overall costs and benefits of the program4 7e7 ,definitions ,in this section3 7#a7 ,dental education loan ,the term dental education loan-- 7,a7 means a loan that is incurred for the cost of attendance 7including tuition1 other reasonable educational expenses1 and reasonable living costs7 at a school of dentistry2 and 7,b7 includes only the portion of the loan that is outstanding on the date the dentist involved begins the service specified in the agreement under subsection 7a74 7#b7 ,dentist ,the term dentist means a graduate of a school of dentistry who has completed postgraduate training in general or pediatric dentistry4 7#c7 ,,hiv_/,,aids ,the term ,,hiv_/,,aids means human immunodeficiency virus and acquired immune deficiency syndrome4 7#d7 ,school of dentistry ,the term school of dentistry has the meaning given to that term in section #gii;,b of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #biep74 7#e7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7f7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for each of fiscal years #bjba through #bjbd4 #geb4 ,reducing new ,,hiv infections among injecting drug users 7a7 ,sense of congress ,it is the sense of ,congress that providing sterile syringes and sterilized equipment to injecting drug users substantially reduces risk of ,,hiv infection1 increases the probability that they will initiate drug treatment1 and does not increase drug use4 7b7 ,in general ,the ,secretary of ,health and ,human ,services may provide grants and technical assistance for the purpose of reducing the rate of ,,hiv infections among injecting drug users through a comprehensive package of services for such users1 including the provision of sterile syringes1 education and outreach1 access to infectious disease testing1 overdose prevention1 and treatment for drug dependence4 7c7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjba through #bjbd4 #gec4 ,report on impact of ,,hiv_/,,aids in vulnerable populations 7a7 ,in general ,the ,secretary shall submit to ,congress and the ,president an annual report on the impact of ,,hiv_/,,aids for racial and ethnic minority communities1 women1 and youth aged #bd and younger4 7b7 ,contents ,the report under subsection 7a7 shall include information on the-- 7#a7 progress that has been made in reducing the impact of ,,hiv_/,,aids in such communities2 7#b7 opportunities that exist to make additional progress in reducing the impact of ,,hiv_/,,aids in such communities2 7#c7 challenges that may impede such additional progress2 and 7#d7 ,federal funding necessary to achieve substantial reductions in ,,hiv_/,,aids in racial and ethnic minority communities4 #ged4 ,national ,,hiv_/,,aids observance days 7a7 ,national observance days ,it is the sense of ,congress that national observance days highlighting the impact of ,,hiv on communities of color include the following3 7#a7 ,national ,black ,,hiv_/,,aids ,awareness ,day4 7#b7 ,national ,latino ,,aids ,awareness ,day4 7#c7 ,national ,asian and ,pacific ,islander ,,hiv_/,,aids ,awareness ,day4 7#d7 ,national ,native ,american ,,hiv_/,,aids ,awareness ,day4 7#e7 ,national ,youth ,,hiv_/,,aids ,awareness ,day4 7b7 ,call to action ,it is the sense of ,congress that the ,president should call on members of communities of color-- 7#a7 to become involved at the local community level in ,,hiv testing1 policy1 and advocacy2 7#b7 to become aware1 engaged1 and empowered on the ,,hiv epidemic within their communities2 and 7#c7 to urge members of their communities to reduce risk factors1 practice safe sex and other preventive measures1 be tested for ,,hiv1 and seek care when appropriate4 #gee4 ,review of all ,federal and ,state laws1 policies1 and regulations regarding the criminal prosecution of individuals for ,,hiv-related offenses 7a7 ,definitions ,in this section3 7#a7 ,,hiv ,the term ,,hiv has the meaning given to the term in section #bfhi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#hh74 7#b7 ,state ,the term ,state includes the ,district of ,columbia1 ,american ,samoa1 the ,commonwealth of the ,northern ,mariana ,islands1 ,guam1 ,puerto ,rico1 and the ,united ,states ,virgin ,islands4 7b7 ,sense of ,congress regarding laws or regulations directed at people living with ,,hiv ,it is the sense of ,congress that ,federal and ,state laws1 policies1 and regulations regarding people living with ,,hiv-- 7#a7 should not place unique or additional burdens on such individuals solely as a result of their ,,hiv status2 and 7#b7 should instead demonstrate a public health-oriented1 evidence-based1 medically accurate1 and contemporary understanding of-- 7,a7 the multiple factors that lead to ,,hiv transmission2 7,b7 the relative risk of ,,hiv transmission routes2 7,c7 the current health implications of living with ,,hiv2 7,d7 the associated benefits of treatment and support services for people living with ,,hiv2 7,e7 the impact of punitive ,,hiv-specific laws and policies on public health1 on people living with or affected by ,,hiv1 and on their families and communities2 and 7,f7 the current science on ,,hiv prevention and treatment1 including pre-exposure prophylaxis 7,pr,e,p71 post-exposure prophylaxis 7,,pep71 and viral suppression4 7c7 ,review of all ,federal and ,state laws1 policies1 and regulations regarding the criminal prosecution of individuals for ,,hiv-,related offenses 7#a7 ,review of ,federal and ,state laws 7,a7 ,in general ,not later than #ij days after the date of the enactment of this ,act1 the ,attorney ,general1 the ,secretary of ,health and ,human ,services1 and the ,secretary of ,defense acting jointly 7in this paragraph and paragraph 7#b7 referred to as the designated officials7 shall initiate a national review of ,federal and ,state laws1 policies1 regulations1 and judicial precedents and decisions regarding criminal and related civil commitment cases involving people living with ,,hiv1 including in regards to the ,uniform ,code of ,military ,justice4 7,b7 ,consultation ,in carrying out the review under subparagraph 7,a71 the designated officials shall ensure diverse participation and consultation from each ,state1 including with-- 7i7 ,state attorneys general 7or their representatives72 7ii7 ,state public health officials 7or their representatives72 7iii7 ,state judicial and court system officers1 including judges1 district attorneys1 prosecutors1 defense attorneys1 law enforcement1 and correctional officers2 7iv7 members of the ,united ,states ,armed ,forces1 including members of other ,federal services subject to the ,uniform ,code of ,military ,justice2 7v7 people living with ,,hiv1 particularly those who have been subject to ,,hiv-related prosecution or who are from communities whose members have been disproportionately subject to ,,hiv-specific arrests and prosecutions2 7vi7 legal advocacy and ,,hiv service organizations that work with people living with ,,hiv2 7vii7 nongovernmental health organizations that work on behalf of people living with ,,hiv2 and 7viii7 trade organizations or associations representing persons or entities described in clauses 7i7 through 7vii74 7,c7 ,relation to other reviews ,in carrying out the review under subparagraph 7,a71 the designated officials may utilize other existing reviews of criminal and related civil commitment cases involving people living with ,,hiv1 including any such review conducted by any ,federal or ,state agency or any public health1 legal advocacy1 or trade organization or association if the designated officials determine that such reviews were conducted in accordance with the principles set forth in subsection 7b74 7#b7 ,report ,no later than #ahj days after initiating the review required by paragraph 7#a71 the ,attorney ,general shall transmit to ,congress and make publicly available a report containing the results of the review1 which includes the following3 7,a7 ,for each ,state and for the ,uniform ,code of ,military ,justice1 a summary of the relevant laws1 policies1 regulations1 and judicial precedents and decisions regarding criminal cases involving people living with ,,hiv1 including1 if applicable1 the following3 7i7 ,a determination of whether such laws1 policies1 regulations1 and judicial precedents and decisions place any unique or additional burdens upon people living with ,,hiv4 7ii7 ,a determination of whether such laws1 policies1 regulations1 and judicial precedents and decisions demonstrate a public health-oriented1 evidence-based1 medically accurate1 and contemporary understanding of-- 7,i7 the multiple factors that lead to ,,hiv transmission2 7,,ii7 the relative risk of ,,hiv transmission routes2 7,,iii7 the current health implications of living with ,,hiv2 7,,iv7 the associated benefits of treatment and support services for people living with ,,hiv2 7,v7 the impact of punitive ,,hiv-specific laws and policies on public health1 on people living with or affected by ,,hiv1 and on their families and communities2 and 7,,vi7 the current science on ,,hiv prevention and treatment1 including pre-exposure prophylaxis 7,pr,e,p71 post-exposure prophylaxis 7,,pep71 and viral suppression4 7iii7 ,an analysis of the public health and legal implications of such laws1 policies1 regulations1 and judicial precedents1 including an analysis of the consequences of having a similar penal scheme applied to comparable situations involving other communicable diseases4 7iv7 ,an analysis of the proportionality of punishments imposed under ,,hiv-specific laws1 policies1 regulations1 and judicial precedents1 taking into consideration penalties attached to violation of ,state laws against similar degrees of endangerment or harm1 such as driving while intoxicated or transmission of other communicable diseases1 or more serious harms1 such as vehicular manslaughter offenses4 7,b7 ,an analysis of common elements shared among ,state laws1 policies1 regulations1 and judicial precedents4 7,c7 ,a set of best practice recommendations directed to ,state governments1 including ,state attorneys general1 public health officials1 and judicial officers1 in order to ensure that laws1 policies1 regulations1 and judicial precedents regarding people living with ,,hiv are in accordance with the principles set forth in subsection 7b74 7,d7 ,recommendations for adjustments to the ,uniform ,code of ,military ,justice1 as may be necessary1 in order to ensure that laws1 policies1 regulations1 and judicial precedents regarding people living with ,,hiv are in accordance with the principles set forth in subsection 7b74 7#c7 ,guidance ,within #ij days of the release of the report required by paragraph 7#b71 the ,attorney ,general and the ,secretary of ,health and ,human ,services1 acting jointly1 shall develop and publicly release updated guidance for ,states based on the set of best practice recommendations required by paragraph 7#b77;,c7 in order to assist ,states dealing with criminal and related civil commitment cases regarding people living with ,,hiv4 7#d7 ,monitoring and evaluation system ,within #fj days of the release of the guidance required by paragraph 7#c71 the ,attorney ,general and the ,secretary of ,health and ,human ,services1 acting jointly1 shall establish an integrated monitoring and evaluation system which includes1 where appropriate1 objective and quantifiable performance goals and indicators to measure progress toward statewide implementation in each ,state of the best practice recommendations required in paragraph 7#b77;,c71 including to monitor1 track1 and evaluate the effectiveness of assistance provided pursuant to subsection 7d74 7#e7 ,adjustments to federal laws1 policies1 or regulations ,within #ij days of the release of the report required by paragraph 7#b71 the ,attorney ,general1 the ,secretary of ,health and ,human ,services1 and the ,secretary of ,defense1 acting jointly1 shall develop and transmit to the ,president and the ,congress1 and make publicly available1 such proposals as may be necessary to implement adjustments to ,federal laws1 policies1 or regulations1 including to the ,uniform ,code of ,military ,justice1 based on the recommendations required by paragraph 7#b77;,d71 either through ,executive order or through changes to statutory law4 7#f7 ,authorization of appropriations 7,a7 ,in general ,there are authorized to be appropriated such sums as may be necessary for the purpose of carrying out this subsection4 ,amounts authorized to be appropriated by the preceding sentence are in addition to amounts otherwise authorized to be appropriated for such purpose4 7,b7 ,availability of funds ,amounts appropriated pursuant to the authorization of appropriations in subparagraph 7,a7 are authorized to remain available until expended4 7d7 ,authorization ,to provide grants 7#a7 ,grants by attorney general 7,a7 ,in general ,the ,attorney ,general may provide assistance to eligible ,state and local entities and eligible nongovernmental organizations for the purpose of incorporating the best practice recommendations developed under subsection 7c77#b77;,c7 within relevant ,state laws1 policies1 regulations1 and judicial decisions regarding people living with ,,hiv4 7,b7 ,authorized activities ,the assistance authorized by subparagraph 7,a7 may include-- 7i7 direct technical assistance to eligible ,state and local entities in order to develop1 disseminate1 or implement ,state laws1 policies1 regulations1 or judicial decisions that conform with the best practice recommendations developed under subsection 7c77#b77;,c72 7ii7 direct technical assistance to eligible nongovernmental organizations in order to provide education and training1 including through classes1 conferences1 meetings1 and other educational activities1 to eligible ,state and local entities2 and 7iii7 subcontracting authority to allow eligible ,state and local entities and eligible nongovernmental organizations to seek technical assistance from legal and public health experts with a demonstrated understanding of the principles underlying the best practice recommendations developed under subsection 7c77#b77;,c74 7#b7 ,grants by ,secretary of ,health and ,human ,services 7,a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 may provide assistance to ,state and local public health departments and eligible nongovernmental organizations for the purpose of supporting eligible ,state and local entities to incorporate the best practice recommendations developed under subsection 7c77#b77;,c7 within relevant ,state laws1 policies1 regulations1 and judicial decisions regarding people living with ,,hiv4 7,b7 ,authorized activities ,the assistance authorized by subparagraph 7,a7 may include-- 7i7 direct technical assistance to ,state and local public health departments in order to support the development1 dissemination1 or implementation of ,state laws1 policies1 regulations1 or judicial decisions that conform with the set of best practice recommendations developed under subsection 7c77#b77;,c72 7ii7 direct technical assistance to eligible nongovernmental organizations in order to provide education and training1 including through classes1 conferences1 meetings1 and other educational activities1 to ,state and local public health departments2 and 7iii7 subcontracting authority to allow ,state and local public health departments and eligible nongovernmental organizations to seek technical assistance from legal and public health experts with a demonstrated understanding of the principles underlying the best practice recommendations developed under subsection 7c77#b77;,c74 7#c7 ,limitation ,as a condition of receiving assistance through this subsection1 eligible ,state and local entities1 ,state and local public health departments1 and eligible nongovernmental organizations shall agree-- 7,a7 not to place any unique or additional burdens on people living with ,,hiv solely as a result of their ,,hiv status2 and 7,b7 that if the entity1 department1 or organization promulgates any laws1 policies1 regulations1 or judicial decisions regarding people living with ,,hiv1 such actions shall demonstrate a public health-oriented1 evidence-based1 medically accurate1 and contemporary understanding of-- 7i7 the multiple factors that lead to ,,hiv transmission2 7ii7 the relative risk of ,,hiv transmission routes2 7iii7 the current health implications of living with ,,hiv2 7iv7 the associated benefits of treatment and support services for people living with ,,hiv2 7v7 the impact of punitive ,,hiv-specific laws and policies on public health1 on people living with or affected by ,,hiv1 and on their families and communities2 and 7vi7 the current science on ,,hiv prevention and treatment1 including pre-exposure prophylaxis 7,pr,e,p71 post-exposure prophylaxis 7,,pep71 and viral suppression4 7#d7 ,report ,no later than #a year after the date of the enactment of this ,act1 and annually thereafter1 the ,attorney ,general and the ,secretary of ,health and ,human ,services1 acting jointly1 shall transmit to ,congress and make publicly available a report describing1 for each ,state1 the impact and effectiveness of the assistance provided through this section4 ,each such report shall include-- 7,a7 a detailed description of the progress each ,state has made1 if any1 in implementing the best practice recommendations developed under subsection 7c77#b77;,c7 as a result of the assistance provided under this subsection1 and based on the performance goals and indicators established as part of the monitoring and evaluation system in subsection 7c77#d72 7,b7 a brief summary of any outreach efforts undertaken during the prior year by the ,attorney ,general and the ,secretary of ,health and ,human ,services to encourage ,states to seek assistance under this subsection in order to implement the best practice recommendations developed under subsection 7c77#b77;,c72 7,c7 a summary of how assistance provided through this subsection is being utilized by eligible ,state and local entities1 ,state and local public health departments1 and eligible nongovernmental organizations and1 if applicable1 any contractors1 including with respect to nongovernmental organizations1 the type of technical assistance provided1 and an evaluation of the impact of such assistance on eligible ,state and local entities2 and 7,d7 a summary and description of eligible ,state and local entities1 ,state and local public health departments1 and eligible nongovernmental organizations receiving assistance through this subsection1 including if applicable1 a summary and description of any contractors selected to assist in implementing such assistance4 7#e7 ,definitions ,for the purposes of this subsection3 7,a7 ,eligible state and local entities ,the term eligible ,state and local entities means the relevant individuals1 offices1 or organizations that directly participate in the development1 dissemination1 or implementation of ,state laws1 policies1 regulations1 or judicial decisions1 including-- 7i7 ,state governments1 including ,state attorneys general1 ,state departments of justice1 and ,state ,national ,guards1 or their equivalents2 7ii7 ,state judicial and court systems1 including trial courts1 appellate courts1 ,state supreme courts and courts of appeal1 and ,state correctional facilities1 or their equivalents2 and 7iii7 local governments1 including city and county governments1 district attorneys1 and local law enforcement departments1 or their equivalents4 7,b7 ,state and local public health departments ,the term ,state and local public health departments means the following3 7i7 ,state public health departments1 or their equivalents1 including the chief officer of such departments and infectious disease and communicable disease specialists within such departments4 7ii7 ,local public health departments1 or their equivalents1 including city and county public health departments1 the chief officer of such departments1 and infectious disease and communicable disease specialists within such departments4 7iii7 ,public health departments or officials1 or their equivalents1 within ,state or local correctional facilities4 7iv7 ,public health departments or officials1 or their equivalents1 within ,state ,national ,guards4 7v7 ,any other recognized ,state or local public health organization or entity charged with carrying out official ,state or local public health duties4 7,c7 ,eligible nongovernmental organizations ,the term eligible nongovernmental organizations means the following3 7i7 ,nongovernmental organizations1 including trade organizations or associations that represent-- 7,i7 ,state attorneys general1 or their equivalents2 7,,ii7 ,state public health officials1 or their equivalents2 7,,iii7 ,state judicial and court officers1 including judges1 district attorneys1 prosecutors1 defense attorneys1 law enforcement1 and correctional officers2 7,,iv7 ,state ,national ,guards2 7,v7 people living with ,,hiv2 7,,vi7 legal advocacy and ,,hiv service organizations that work with people living with ,,hiv2 and 7,,vii7 nongovernmental health organizations that work on behalf of people living with ,,hiv4 7ii7 ,nongovernmental organizations1 including trade organizations or associations that demonstrate a public-health oriented1 evidence-based1 medically accurate1 and contemporary understanding of-- 7,i7 the multiple factors that lead to ,,hiv transmission2 7,,ii7 the relative risk of ,,hiv transmission routes2 7,,iii7 the current health implications of living with ,,hiv2 7,,iv7 the associated benefits of treatment and support services for people living with ,,hiv2 7,v7 the impact of punitive ,,hiv-specific laws and policies on public health1 on people living with or affected by ,,hiv1 and on their families and communities2 and 7,,vi7 the current science on ,,hiv prevention and treatment1 including pre-exposure prophylaxis 7,pr,e,p71 post-exposure prophylaxis 7,,pep71 and viral suppression4 7#f7 ,authorization of appropriations 7,a7 ,in general ,in addition to amounts otherwise made available1 there are authorized to be appropriated to the ,attorney ,general and the ,secretary of ,health and ,human ,services such sums as may be necessary to carry out this subsection for each of the fiscal years #bjba through #bjbd4 7,b7 ,availability of funds ,amounts appropriated pursuant to the authorizations of appropriations in subparagraph 7,a7 are authorized to remain available until expended4 #gef4 ,expanding support for condoms in prisons 7a7 ,definitions ,in this section3 7#a7 ,community organization ,the term community organization means a public health care facility or a nonprofit organization that provides health- or ,,sti-related services according to established public health standards4 7#b7 ,comprehensive sexuality education ,the term comprehensive sexuality education means sexuality education-- 7,a7 that includes information about abstinence and about the proper use and disposal of sexual barrier protection devices2 and 7,b7 that is-- 7i7 evidence-based2 7ii7 medically accurate2 7iii7 age and developmentally appropriate2 7iv7 gender and identity sensitive2 7v7 culturally and linguistically appropriate2 and 7vi7 structured to promote critical thinking1 self-esteem1 respect for others1 and the development of healthy attitudes and relationships4 7#c7 ,correctional facility ,the term correctional facility means any prison1 penitentiary1 adult detention facility1 juvenile detention facility1 jail1 or other facility to which individuals may be sent after conviction of a crime or act of juvenile delinquency within the ,united ,states4 7#d7 ,incarcerated individual ,the term incarcerated individual means any individual who is serving a sentence in a correctional facility after conviction of a crime4 7#e7 ,sexual barrier protection device ,the term sexual barrier protection device means any physical device approved by the ,food and ,drug ,administration that has not been tampered with and which reduces the probability of ,,sti transmission or infection between sexual partners1 including female condoms1 male condoms1 and dental dams4 7#f7 ,sexually transmitted infection ,the term sexually transmitted infection or ,,sti means any disease or infection that is commonly transmitted through sexual activity1 including ,,hiv1 gonorrhea1 chlamydia1 syphilis1 genital herpes1 viral hepatitis1 and human papillomavirus4 7#g7 ,state ,the term ,state includes the ,district of ,columbia1 ,american ,samoa1 the ,commonwealth of the ,northern ,mariana ,islands1 ,guam1 ,puerto ,rico1 and the ,united ,states ,virgin ,islands4 7b7 ,authority ,to allow community organizations ,to provide ,,sti counseling1 ,,sti prevention education1 and sexual barrier protection devices in ,federal correctional facilities 7#a7 ,directive to attorney general ,not later than #cj days after the date of enactment of this ,act1 the ,attorney ,general shall direct the ,director of the ,bureau of ,prisons to allow community organizations to1 in accordance with all relevant ,federal laws and regulations that govern visitation in correctional facilities-- 7,a7 distribute sexual barrier protection devices in ,federal correctional facilities2 and 7,b7 engage in ,,sti counseling and ,,sti prevention education in ,federal correctional facilities4 7#b7 ,information requirement ,any community organization permitted to distribute sexual barrier protection devices under paragraph 7#a7 shall ensure that the individuals to whom the devices are distributed are informed about the proper use and disposal of sexual barrier protection devices in accordance with established public health practices4 ,any community organization conducting ,,sti counseling or ,,sti prevention education under paragraph 7#a7 shall offer comprehensive sexuality education4 7#c7 ,possession of device protected ,a ,federal correctional facility may not1 because of the possession or use of a sexual barrier protection device-- 7,a7 take adverse action against an incarcerated individual2 or 7,b7 consider possession or use as evidence of prohibited activity for the purpose of any ,federal correctional facility administrative proceeding4 7#d7 ,implementation ,the ,attorney ,general and the ,director of the ,bureau of ,prisons shall implement this section according to established public health practices in a manner that protects the health1 safety1 and privacy of incarcerated individuals and of correctional facility staff4 7c7 ,sense of congress regarding distribution of sexual barrier protection devices in state prison systems ,it is the sense of the ,congress that ,states should allow for the legal distribution of sexual barrier protection devices in ,state correctional facilities to reduce the prevalence and spread of ,s,t,is in those facilities4 7d7 ,survey of and report on correctional facility programs aimed at reducing the spread of ,s,t,is 7#a7 ,survey ,not later than #ahj days after the date of enactment of this ,act1 and annually thereafter for #e years1 the ,attorney ,general1 after consulting with the ,secretary of ,health and ,human ,services1 ,state officials1 and community organizations1 shall1 to the maximum extent practicable1 conduct a survey of all ,federal and ,state correctional facilities1 to determine the following3 7,a7 ,counseling1 treatment1 and supportive services ,whether the correctional facility-- 7i7 requires incarcerated individuals to participate in counseling1 treatment1 and supportive services related to ,s,t,is2 or 7ii7 offers such programs to incarcerated individuals4 7,b7 ,access to sexual barrier protection devices ,whether incarcerated individuals can-- 7i7 possess sexual barrier protection devices2 7ii7 purchase sexual barrier protection devices2 7iii7 purchase sexual barrier protection devices at a reduced cost2 or 7iv7 obtain sexual barrier protection devices without cost4 7,c7 ,incidence of sexual violence ,the incidence of sexual violence and assault committed by incarcerated individuals and by correctional facility staff4 7,d7 ,prevention education offered ,the type of prevention education1 information1 or training offered to incarcerated individuals and correctional facility staff regarding sexual violence and the spread of ,s,t,is1 including whether such education1 information1 or training-- 7i7 constitutes comprehensive sexuality education2 7ii7 is compulsory for new incarcerated individuals and for new staff2 and 7iii7 is offered on an ongoing basis4 7,e7 ,,sti testing ,whether the correctional facility tests incarcerated individuals for ,s,t,is or gives them the option to undergo such testing-- 7i7 at intake2 7ii7 on a regular basis2 and 7iii7 prior to release4 7,f7 ,,sti test results ,the number of incarcerated individuals who are tested for ,s,t,is and the outcome of such tests at each correctional facility1 disaggregated to include results for-- 7i7 the type of sexually transmitted infection tested for2 7ii7 the race and ethnicity of individuals tested2 7iii7 the age of individuals tested2 and 7iv7 the gender of individuals tested4 7,g7 ,prerelease referral policy ,whether incarcerated individuals are informed prior to release about ,,sti-related services or other health services in their communities1 including free and low-cost counseling and treatment options4 7,h7 ,prerelease referrals made ,the number of referrals to community-based organizations or public health facilities offering ,,sti-related or other health services provided to incarcerated individuals prior to release1 and the type of counseling or treatment for which the referral was made4 7,i7 ,reinstatement of medicaid benefits ,whether the correctional facility assists incarcerated individuals that were enrolled in the ,state ,medicaid program prior to their incarceration1 in reinstating their enrollment upon release and whether such individuals receive referrals as provided by subparagraph 7,g7 to entities that accept the ,state ,medicaid program1 including if applicable-- 7i7 the number of such individuals1 including those diagnosed with ,,hiv1 that have been reinstated2 7ii7 a list of obstacles to reinstating enrollment or to making determinations of eligibility for reinstatement1 if any2 and 7iii7 the number of individuals denied enrollment4 7,j7 ,other actions taken ,whether the correctional facility has taken any other action1 in conjunction with community organizations or otherwise1 to reduce the prevalence and spread of ,s,t,is in that facility4 7#b7 ,privacy ,in conducting the survey under paragraph 7#a71 the ,attorney ,general shall not request or retain the identity of any individual who has sought or been offered counseling1 treatment1 testing1 or prevention education information regarding an ,,sti 7including information about sexual barrier protection devices71 or who has tested positive for an ,,sti4 7#c7 ,report 7,a7 ,in general ,the ,attorney ,general shall transmit to ,congress and make publicly available the results of the survey required under paragraph 7#a71 both for the ,united ,states as a whole and disaggregated as to each ,state and each correctional facility4 7,b7 ,deadlines ,to the maximum extent possible1 the ,attorney ,general shall-- 7i7 issue the first report under subparagraph 7,a7 not later than #a year after the date of enactment of this ,act2 and 7ii7 issue reports under subparagraph 7,a7 annually thereafter for #e years4 7e7 ,strategy 7#a7 ,directive to attorney general ,the ,attorney ,general1 in consultation with the ,secretary of ,health and ,human ,services1 ,state officials1 and community organizations1 shall develop and implement a #e-year strategy to reduce the prevalence and spread of ,s,t,is in ,federal and ,state correctional facilities4 ,to the maximum extent possible1 the strategy shall be developed1 transmitted to ,congress1 and made publicly available no later than #ahj days after the transmission of the first report required under subsection 7d77#c74 7#b7 ,contents of strategy ,the strategy developed under paragraph 7#a7 shall include the following3 7,a7 ,prevention education ,a plan for improving prevention education1 information1 and training offered to incarcerated individuals and correctional facility staff1 including information and training on sexual violence and the spread of ,s,t,is1 and comprehensive sexuality education4 7,b7 ,sexual barrier protection device access ,a plan for expanding access to sexual barrier protection devices in correctional facilities4 7,c7 ,sexual violence reduction ,a plan for reducing the incidence of sexual violence among incarcerated individuals and correctional facility staff1 developed in consultation with the ,national ,prison ,rape ,elimination ,commission4 7,d7 ,counseling and supportive services ,a plan for expanding access to counseling and supportive services related to ,s,t,is in correctional facilities4 7,e7 ,testing ,a plan for testing incarcerated individuals for ,s,t,is during intake1 during regular health exams1 and prior to release1 and that-- 7i7 is conducted in accordance with guidelines established by the ,centers for ,disease ,control and ,prevention2 7ii7 includes pretest counseling2 7iii7 requires that incarcerated individuals are notified of their option to decline testing at any time2 7iv7 requires that incarcerated individuals are confidentially notified of their test results in a timely manner2 and 7v7 ensures that incarcerated individuals testing positive for ,s,t,is receive post-test counseling1 care1 treatment1 and supportive services4 7,f7 ,treatment ,a plan for ensuring that correctional facilities have the necessary medicine and equipment to treat and monitor ,s,t,is and for ensuring that incarcerated individuals living with or testing positive for ,s,t,is receive and have access to care and treatment services4 7,g7 ,strategies for demographic groups ,a plan for developing and implementing culturally appropriate1 sensitive1 and specific strategies to reduce the spread of ,s,t,is among demographic groups heavily impacted by ,s,t,is4 7,h7 ,linkages with communities and facilities ,a plan for establishing and strengthening linkages to local communities and health facilities that-- 7i7 provide counseling1 testing1 care1 and treatment services2 7ii7 may receive individuals recently released from incarceration who are living with ,s,t,is2 and 7iii7 accept payment through the ,state ,medicaid program4 7,i7 ,enrollment in ,state ,medicaid programs ,plans to ensure that-- 7i7 incarcerated individuals who were enrolled in their ,state ,medicaid program prior to incarceration in a correctional facility are automatically reenrolled in such program upon their release2 and 7ii7 incarcerated individuals who were not enrolled in their ,state ,medicaid program prior to incarceration1 and who are diagnosed with ,,hiv while incarcerated in a correctional facility1 are automatically enrolled in such program upon their release4 7,j7 ,other plans ,any other plans developed by the ,attorney ,general for reducing the spread of ,s,t,is or improving the quality of health care in correctional facilities4 7,k7 ,monitoring system ,a monitoring system that establishes performance goals related to reducing the prevalence and spread of ,s,t,is in correctional facilities and which1 where feasible1 expresses such goals in quantifiable form4 7,l7 ,monitoring system performance indicators ,performance indicators that measure or assess the achievement of the performance goals described in subparagraph 7,k74 7,m7 ,cost estimate ,a detailed estimate of the funding necessary to implement the strategy at the ,federal and ,state levels for all #e years1 including the amount of funds required by community organizations to implement the parts of the strategy in which they take part4 7#c7 ,report ,not later than #a year after the date of the enactment of this ,act1 and annually thereafter1 the ,attorney ,general shall transmit to ,congress and make publicly available an annual progress report regarding the implementation and effectiveness of the strategy described in paragraph 7#a74 ,the progress report shall include an evaluation of the implementation of the strategy using the monitoring system and performance indicators provided for in subparagraphs 7,k7 and 7,l7 of paragraph 7#b74 7f7 ,authorization of appropriations 7#a7 ,in general ,there are authorized to be appropriated such sums as may be necessary to carry out this section for each of fiscal years #bjba through #bjbe4 7#b7 ,availability of funds ,amounts made available under paragraph 7#a7 are authorized to remain available until expended4 #geg4 ,automatic reinstatement or enrollment in ,medicaid for people who test positive for ,,hiv before reentering communities 7a7 ,in general ,section #aijb7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77 is amended by adding at the end the following3 7#af7 ,enrollment of ex-offenders 7,a7 ,automatic enrollment or reinstatement 7i7 ,in general ,the ,state plan shall provide for the automatic enrollment or reinstatement of enrollment of an eligible individual-- 7,i7 if such individual is scheduled to be released from a public institution due to the completion of sentence1 not less than #cj days prior to the scheduled date of the release2 and 7,,ii7 if such individual is to be released from a public institution on parole or on probation1 as soon as possible after the date on which the determination to release such individual was made1 and before the date such individual is released4 7ii7 ,exception ,if a ,state makes a determination that an individual is not eligible to be enrolled under the ,state plan-- 7,i7 on or before the date by which the individual would be enrolled under clause 7i71 such clause shall not apply to such individual2 or 7,,ii7 after such date1 the ,state may terminate the enrollment of such individual4 7,b7 ,relationship of enrollment to payment for services 7i7 ,in general ,subject to subparagraph 7,a77ii71 an eligible individual who is enrolled1 or whose enrollment is reinstated1 under subparagraph 7,a7 shall be eligible for all services for which medical assistance is provided under the ,state plan after the date that the eligible individual is released from the public institution4 7ii7 ,relationship to payment prohibition for inmates ,no provision of this paragraph may be construed to permit payment for care or services for which payment is excluded under subdivision 7,a7 following paragraph 7#ca7 of section #aije7;a74 7,c7 ,treatment of continuous eligibility 7i7 ,suspension for inmates ,any period of continuous eligibility under this title shall be suspended on the date an individual enrolled under this title becomes an inmate of a public institution 7except as a patient of a medical institution74 7ii7 ,determination of remaining period ,notwithstanding any changes to ,state law related to continuous eligibility during the time that an individual is an inmate of a public institution 7except as a patient of a medical institution71 subject to clause 7iii71 with respect to an eligible individual who was subject to a suspension under clause 7i71 on the date that such individual is released from a public institution the suspension of continuous eligibility under such clause shall be lifted for a period that is equal to the time remaining in the period of continuous eligibility for such individual on the date that such period was suspended under such clause4 7iii7 ,exception ,if a ,state makes a determination that an individual is not eligible to be enrolled under the ,state plan-- 7,i7 on or before the date that the suspension of continuous eligibility is lifted under clause 7ii71 such clause shall not apply to such individual2 or 7,,ii7 after such date1 the ,state may terminate the enrollment of such individual4 7,d7 ,automatic enrollment or reinstatement of enrollment defined ,for purposes of this paragraph1 the term automatic enrollment or reinstatement of enrollment means that the ,state determines eligibility for medical assistance under the ,state plan without a program application from1 or on behalf of1 the eligible individual1 but an individual can only be automatically enrolled in the ,state ,medicaid plan if the individual affirmatively consents to being enrolled through affirmation in writing1 by telephone1 orally1 through electronic signature1 or through any other means specified by the ,secretary4 7,e7 ,eligible individual defined ,for purposes of this paragraph1 the term eligible individual means an individual who is an inmate of a public institution 7except as a patient in a medical institution7-- 7i7 who was enrolled under the ,state plan for medical assistance immediately before becoming an inmate of such an institution2 or 7ii7 who is diagnosed with human immunodeficiency virus4 4 7b7 ,supplemental funding for state implementation of automatic reinstatement of medicaid benefits 7#a7 ,in general ,subject to paragraph 7#c71 with respect to a ,state1 for each of the first #d calendar quarters in which the ,state plan meets the requirements of paragraph 7#af7 of section #aijb7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77 7as added by subsection 7a771 the ,federal matching payments 7including payments based on the ,federal medical assistance percentage7 made to such ,state under section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 for the ,state expenditures described in paragraph 7#b7 shall be increased by #e percentage points4 7#b7 ,expenditures ,the expenditures described in this paragraph are the following3 7,a7 ,expenditures for which payment is available under section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 and which are attributable to strengthening the ,state's enrollment and administrative resources for the purpose of improving processes for enrolling 7or reinstating the enrollment of7 eligible individuals 7as such term is defined in subparagraph 7,e7 of paragraph 7#af7 of section #aijb7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77 7as amended by subsection 7a7774 7,b7 ,expenditures for medical assistance 7as such term is defined in section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a777 provided to such eligible individuals4 7#c7 ,requirements2 limitation 7,a7 ,report ,a ,state is not eligible for an increase in its ,federal matching payments under paragraph 7#a7 unless the ,state agrees to submit to the ,secretary of ,health and ,human ,services1 and make publicly available1 a report that contains the information required under paragraph 7#d7 by the end of the #a-year period during which the ,state receives increased ,federal matching payments in accordance with that paragraph4 7,b7 ,maintenance of eligibility 7i7 ,in general ,subject to clause 7ii71 a ,state is not eligible for an increase in its ,federal matching payments under paragraph 7#a7 if eligibility standards1 methodologies1 or procedures under its ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 or waiver of such a plan1 are more restrictive than the eligibility standards1 methodologies1 or procedures1 respectively1 under such plan or waiver as in effect on the date of enactment of this ,act4 7ii7 ,state reinstatement of eligibility permitted ,a ,state that has restricted eligibility standards1 methodologies1 or procedures under its ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 or a waiver of such plan1 after the date of enactment of this ,act1 is no longer ineligible under clause 7i7 beginning with the first calendar quarter in which the ,state has reinstated eligibility standards1 methodologies1 or procedures that are no more restrictive than the eligibility standards1 methodologies1 or procedures1 respectively1 under such plan 7or waiver7 as in effect on such date4 7,c7 ,limitation of matching payments to #ajj percent ,in no case shall an increase in ,federal matching payments under paragraph 7#a7 result in ,federal matching payments that exceed #ajj percent of ,state expenditures4 7#d7 ,required report information ,the information that is required in the report under paragraph 7#c77;,a7 shall include-- 7,a7 the results of an evaluation of the impact of the implementation of the requirements of paragraph 7#af7 of section #aijb7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77 on improving the ,state's processes for enrolling individuals who are released from public institutions under the ,state ,medicaid plan2 7,b7 the number of individuals who were automatically enrolled 7or whose enrollment was reinstated7 under such paragraph during the #a-year period during which the ,state received increased payments under this subsection2 and 7,c7 any other information that is required by the ,secretary of ,health and ,human ,services4 7c7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 the amendments made by subsection 7a7 shall take effect #ahj days after the date of the enactment of this ,act4 7#b7 ,rule for changes requiring ,state legislation ,in the case of a ,state plan for medical assistance under title ,,xix of the ,social ,security ,act 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 subsection 7a71 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 #geh4 ,stop ,,hiv in prison 7a7 ,short title ,this section may be cited as the ,stop ,,hiv in ,prison ,act4 7b7 ,in general ,the ,director of the ,bureau of ,prisons 7referred to in this section as the ,director7 shall develop a comprehensive policy to provide ,,hiv testing1 treatment1 and prevention for inmates within the correctional setting and upon reentry4 7c7 ,purpose ,the purposes of the policy required to be developed under subsection 7b7 shall be as follows3 7#a7 ,to stop the spread of ,,hiv among inmates4 7#b7 ,to protect prison guards and other personnel from ,,hiv infection4 7#c7 ,to provide comprehensive medical treatment to inmates who are living with ,,hiv4 7#d7 ,to promote ,,hiv awareness and prevention among inmates4 7#e7 ,to encourage inmates to take personal responsibility for their health4 7#f7 ,to reduce the risk that inmates will transmit ,,hiv to other persons in the community following their release from prison4 7d7 ,consultation ,the ,director shall consult with appropriate officials of the ,department of ,health and ,human ,services1 the ,office of ,national ,drug ,control ,policy1 and the ,centers for ,disease ,control and ,prevention regarding the development of the policy required under subsection 7b74 7e7 ,time limit ,not later than #a year after the date of enactment of this ,act1 the ,director shall draft appropriate regulations to implement the policy required to be developed under subsection 7b74 7f7 ,requirements for policy ,the policy required to be developed under subsection 7b7 shall provide for the following3 7#a7 ,testing and counseling upon intake 7,a7 ,health care personnel shall provide routine ,,hiv testing to all inmates as a part of a comprehensive medical examination immediately following admission to a facility4 ,health care personnel need not provide routine ,,hiv testing to an inmate who is transferred to a facility from another facility if the inmate's medical records are transferred with the inmate and indicate that the inmate has been tested previously4 7,b7 ,to all inmates admitted to a facility prior to the effective date of this policy1 health care personnel shall provide routine ,,hiv testing within no more than #f months4 ,,hiv testing for these inmates may be performed in conjunction with other health services provided to these inmates by health care personnel4 7,c7 ,all ,,hiv tests under this paragraph shall comply with the opt-out provision4 7#b7 ,pre-test and post-test counseling ,health care personnel shall provide confidential pre-test and post-test counseling to all inmates who are tested for ,,hiv4 ,counseling may be included with other general health counseling provided to inmates by health care personnel4 7#c7 ,,hiv prevention education 7,a7 ,health care personnel shall improve ,,hiv awareness through frequent educational programs for all inmates4 ,,hiv educational programs may be provided by community-based organizations1 local health departments1 and inmate peer educators4 7,b7 ,,hiv educational materials shall be made available to all inmates at orientation1 at health care clinics1 at regular educational programs1 and prior to release4 ,both written and audiovisual materials shall be made available to all inmates4 7,c7 7i7 ,the ,,hiv educational programs and materials under this paragraph shall include information on-- 7,i7 modes of transmission1 including transmission through tattooing1 sexual contact1 and intravenous drug use2 7,,ii7 prevention methods2 7,,iii7 treatment2 and 7,,iv7 disease progression4 7ii7 ,the programs and materials shall be culturally sensitive1 written or designed for low-literacy levels1 available in a variety of languages1 and present scientifically accurate information in a clear and understandable manner4 7#d7 ,,hiv testing upon request 7,a7 ,health care personnel shall allow inmates to obtain ,,hiv tests upon request once per year or whenever an inmate has a reason to believe the inmate may have been exposed to ,,hiv4 ,health care personnel shall1 both orally and in writing1 inform inmates1 during orientation and periodically throughout incarceration1 of their right to obtain ,,hiv tests4 7,b7 ,health care personnel shall encourage inmates to request ,,hiv tests if the inmate is sexually active1 has been raped1 uses intravenous drugs1 receives a tattoo1 or if the inmate is concerned that the inmate may have been exposed to ,,hiv4 7,c7 ,an inmate's request for an ,,hiv test shall not be considered an indication that the inmate has put him_/herself at risk of infection and_/or committed a violation of prison rules4 7#e7 ,,hiv testing of pregnant woman 7,a7 ,health care personnel shall provide routine ,,hiv testing to all inmates who become pregnant4 7,b7 ,all ,,hiv tests under this paragraph shall comply with the opt-out provision4 7#f7 ,comprehensive treatment 7,a7 ,health care personnel shall provide all inmates who test positive for ,,hiv-- 7i7 timely1 comprehensive medical treatment2 7ii7 confidential counseling on managing their medical condition and preventing its transmission to other persons2 and 7iii7 voluntary partner notification services4 7,b7 ,health care provided under this paragraph shall be consistent with current ,department of ,health and ,human ,services guidelines and standard medical practice4 ,health care personnel shall discuss treatment options1 the importance of adherence to antiretroviral therapy1 and the side effects of medications with inmates receiving treatment4 7,c7 ,health care personnel and pharmacy personnel shall ensure that the facility formulary contains all ,food and ,drug ,administration-approved medications necessary to provide comprehensive treatment for inmates living with ,,hiv1 and that the facility maintains adequate supplies of such medications to meet inmates' medical needs4 ,health care personnel and pharmacy personnel shall also develop and implement automatic renewal systems for these medications to prevent interruptions in care4 7,d7 ,correctional staff1 health care personnel1 and pharmacy personnel shall develop and implement distribution procedures to ensure timely and confidential access to medications4 7#g7 ,protection of confidentiality 7,a7 ,health care personnel shall develop and implement procedures to ensure the confidentiality of inmate tests1 diagnoses1 and treatment4 ,health care personnel and correctional staff shall receive regular training on the implementation of these procedures4 ,penalties for violations of inmate confidentiality by health care personnel or correctional staff shall be specified and strictly enforced4 7,b7 ,,hiv testing1 counseling1 and treatment shall be provided in a confidential setting where other routine health services are provided and in a manner that allows the inmate to request and obtain these services as routine medical services4 7#h7 ,testing1 counseling1 and referral prior to reentry 7,a7 ,health care personnel shall provide routine ,,hiv testing to all inmates not earlier than #c months prior to their release and reentry into the community4 ,inmates who are already known to be infected need not be tested again4 ,this requirement may be waived if an inmate's release occurs without sufficient notice to the ,bureau to allow health care personnel to perform a routine ,,hiv test and notify the inmate of the results4 7,b7 ,all ,,hiv tests under this paragraph shall comply with the opt-out provision4 7,c7 ,to all inmates who test positive for ,,hiv and all inmates who already are known to have ,,hiv1 health care personnel shall provide-- 7i7 confidential prerelease counseling on managing their medical condition in the community1 accessing appropriate treatment and services in the community1 and preventing the transmission of their condition to family members and other persons in the community2 7ii7 referrals to appropriate health care providers and social service agencies in the community that meet the inmate's individual needs1 including voluntary partner notification services and prevention counseling services for people living with ,,hiv2 and 7iii7 a #cj-;day supply of any medically necessary medications the inmate is currently receiving4 7#i7 ,opt-out provision ,inmates shall have the right to refuse routine ,,hiv testing4 ,inmates shall be informed both orally and in writing of this right4 ,oral and written disclosure of this right may be included with other general health information and counseling provided to inmates by health care personnel4 ,if an inmate refuses a routine test for ,,hiv1 health care personnel shall make a note of the inmate's refusal in the inmate's confidential medical records4 ,however1 the inmate's refusal shall not be considered a violation of prison rules or result in disciplinary action4 ,any reference in this section to the opt-out provision shall be deemed a reference to the requirement of this paragraph4 7#aj7 ,exclusion of tests performed under section #djad7;b7 from the definition of routine ,,hiv ,testing ,,hiv testing of an inmate under section #djad7;b7 of title #ah1 ,united ,states ,code1 is not routine ,,hiv testing for the purposes of the opt-out provision4 ,health care personnel shall document the reason for testing under section #djad7;b7 of title #ah1 ,united ,states ,code1 in the inmate's confidential medical records4 7#aa7 ,timely notification of test results ,health care personnel shall provide timely notification to inmates of the results of ,,hiv tests4 7g7 ,changes in existing law 7#a7 ,screening in ,general ,section #djad7;a7 of title #ah1 ,united ,states ,code1 is amended-- 7,a7 by striking for a period of #f months or more2 7,b7 by striking 1 as appropriate12 and 7,c7 by striking if such individual is determined to be at risk for infection with such virus in accordance with the guidelines issued by the ,bureau of ,prisons relating to infectious disease management and inserting unless the individual declines4 ,the ,attorney ,general shall also cause such individual to be so tested before release unless the individual declines44 7#b7 ,inadmissibility of ,,hiv ,test ,results in ,civil and ,criminal ,proceedings ,section #djad7;d7 of title #ah1 ,united ,states ,code1 is amended by inserting or under the ,stop ,,hiv in ,prison ,act after under this section4 7#c7 ,screening as ,part of ,routine ,screening ,section #djad7;e7 of title #ah1 ,united ,states ,code1 is amended by adding at the end the following3 ,such rules shall also provide that the initial test under this section be performed as part of the routine health screening conducted at intake44 7h7 ,reporting requirements 7#a7 ,report on ,hepatitis1 liver1 and ,other ,diseases ,not later than #a year after the date of enactment of this ,act1 the ,director shall provide a report to the ,congress on the policies and procedures of the ,bureau of ,prisons to provide testing1 treatment1 and prevention education programs for hepatitis1 liver failure1 and other liver-related diseases transmitted through sexual activity1 intravenous drug use1 or other means4 ,the ,director shall consult with appropriate officials of the ,department of ,health and ,human ,services1 the ,office of ,national ,drug ,control ,policy1 the ,office of ,national ,,aids ,policy1 and the ,centers for ,disease ,control and ,prevention regarding the development of this report4 7#b7 ,annual ,reports 7,a7 ,generally ,not later than #b years after the date of enactment of this ,act1 and then annually thereafter1 the ,director shall report to ,congress on the incidence among inmates of diseases transmitted through sexual activity and intravenous drug use4 7,b7 ,matters pertaining to various diseases ,each report under paragraph 7#a7 shall discuss-- 7i7 the incidence among inmates of ,,hiv1 hepatitis1 and other diseases transmitted through sexual activity and intravenous drug use2 and 7ii7 updates on the testing1 treatment1 and prevention education programs for these diseases conducted by the ,bureau of ,prisons4 7,c7 ,matters pertaining to ,,hiv only ,each report under paragraph 7#a7 shall also include-- 7i7 the number of inmates who tested positive for ,,hiv upon intake2 7ii7 the number of inmates who tested positive prior to reentry2 7iii7 the number of inmates who were not tested prior to reentry because they were released without sufficient notice2 7iv7 the number of inmates who opted-out of taking the test2 7v7 the number of inmates who were tested under section #djad7;b7 of title #ah1 ,united ,states ,code2 and 7vi7 the number of inmates under treatment for ,,hiv4 7,d7 ,consultation ,the ,director shall consult with appropriate officials of the ,department of ,health and ,human ,services1 the ,office of ,national ,drug ,control ,policy1 and the ,centers for ,disease ,control and ,prevention regarding the development of each report under paragraph 7#a74 #gei4 ,support data system review and indicators for monitoring ,,hiv care ,the ,secretary of ,health and ,human ,services1 in collaboration with the ,assistant ,secretary for ,health1 the ,director of the ,office of ,infectious ,disease and ,,hiv_/,,aids ,policy1 the ,director of the ,centers for ,disease ,control and ,prevention1 the ,assistant ,secretary for ,mental ,health and ,substance ,use1 the ,director of the ,department of ,housing and ,urban ,development1 the ,director of the ,office of ,,aids ,research1 the ,administrator of the ,health ,resources and ,services ,administration1 and the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall expand and coordinate efforts to align metrics across agencies and modify ,federal data systems1 to-- 7#a7 adopt the ,national ,academy of ,medicine's clinical ,,hiv care indicators as the core metrics for monitoring the quality of ,,hiv care1 mental health1 substance abuse1 and supportive services2 7#b7 better enable assessment of the impact of the ,national ,,hiv_/,,aids ,strategy and the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 on improving ,,hiv care and access to supportive services for individuals with ,,hiv2 7#c7 expand the demographic data elements to be captured by ,federal data systems relevant to ,,hiv care to permit calculation of the indicators for subgroups of the population of people with diagnosed ,,hiv infection1 including-- 7,a7 age2 7,b7 race2 7,c7 ethnicity2 7,d7 sex 7assigned at birth72 7,e7 gender identity2 7,f7 sexual orientation2 7,g7 current geographic marker of residence2 7,h7 income or poverty level2 and 7,i7 primary means of reimbursement for medical services 7including a ,state ,medicaid program1 the ,medicare program1 the ,ryan ,white ,,hiv_/,,aids ,program1 private insurance1 health maintenance organizations1 and no coverage72 and 7#d7 streamline data collection and systematically review all existing reporting requirements for federally funded ,,hiv programs to ensure that only essential data are collected4 #gfj4 ,transfer of funds for implementation of ending the ,,hiv epidemic3 a plan for ,america ,title ,,ii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bjb et seq47 is amended by inserting after section #bda the following3 #bda;,a4 ,transfer of funds for implementation of ,national ,,hiv_/,,aids ,strategy 7a7 ,transfer authorization ,of the discretionary appropriations made available to the ,department of ,health and ,human ,services for any fiscal year for programs and activities that1 as determined by the ,secretary1 pertain to ,,hiv1 the ,secretary may transfer up to #a percent of such appropriations to the ,office of the ,assistant ,secretary for ,health for implementation of the ,ending the ,,hiv ,epidemic3 ,a ,plan for ,america4 7b7 ,congressional notification ,not less than #cj days before making any transfer under this section1 the ,secretary shall give notice of the transfer to the ,congress4 7c7 ,definitions ,in this section1 the term ,ending the ,,hiv ,epidemic3 ,a ,plan for ,america means the initiative of the ,department of ,health and ,human ,services that seeks to reduce the number of new ,,hiv infections in the ,united ,states by #ge percent by #bjbe1 and then by at least #ij percent by #bjcj1 for an estimated #bej1jjj total ,,hiv infections averted4 4 ,f ,diabetes #gga4 ,research1 treatment1 and education ,subpart #c of part ,c of title ,,iv of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe;c et seq47 is amended by adding at the end the following new section3 #dcd;,b4 ,diabetes in minority populations 7a7 ,in general ,the ,director of ,,nih shall expand1 intensify1 and support ongoing research and other activities with respect to prediabetes and diabetes1 particularly type #b1 in minority populations4 7b7 ,research 7#a7 ,description ,research under subsection 7a7 shall include investigation into-- 7,a7 the causes of diabetes1 including socioeconomic1 geographic1 clinical1 environmental1 genetic1 and other factors that may contribute to increased rates of diabetes in minority populations2 and 7,b7 the causes of increased incidence of diabetes complications in minority populations1 and possible interventions to decrease such incidence4 7#b7 ,inclusion of minority participants ,in conducting and supporting research described in subsection 7a71 the ,director of ,,nih shall seek to include minority participants as study subjects in clinical trials4 7c7 ,report2 comprehensive plan 7#a7 ,in general ,the ,diabetes ,mellitus ,interagency ,coordinating ,committee shall-- 7,a7 prepare and submit to the ,congress1 not later than #f months after the date of enactment of this section1 a report on ,federal research and public health activities with respect to prediabetes and diabetes in minority populations2 and 7,b7 develop and submit to ,congress1 not later than #a year after the date of enactment of this section1 an effective and comprehensive ,federal plan 7including all appropriate ,federal health programs7 to address prediabetes and diabetes in minority populations4 7#b7 ,contents ,the report under paragraph 7#a77;,a7 shall at minimum address each of the following3 7,a7 ,research on diabetes and prediabetes in minority populations1 including such research on-- 7i7 genetic1 behavioral1 and environmental factors2 and 7ii7 prevention and complications among individuals within these populations who have already developed diabetes4 7,b7 ,surveillance and data collection on diabetes and prediabetes in minority populations1 including with respect to-- 7i7 efforts to better determine the prevalence of diabetes among ,asian-,american and ,pacific ,islander subgroups2 and 7ii7 efforts to coordinate data collection on the ,american ,indian population4 7,c7 ,community-based interventions to address diabetes and prediabetes targeting minority populations1 including-- 7i7 the evidence base for such interventions2 7ii7 the cultural appropriateness of such interventions2 and 7iii7 efforts to educate the public on the causes and consequences of diabetes4 7,d7 ,education and training programs for health professionals 7including community health workers7 on the prevention and management of diabetes and its related complications that is supported by the ,health ,resources and ,services ,administration1 including such programs supported by-- 7i7 the ,national ,health ,service ,corps2 or 7ii7 the community health centers program under section #ccj4 7d7 ,education ,the ,director of ,,nih shall-- 7#a7 through the ,national ,institute on ,minority ,health and ,health ,disparities and the ,national ,diabetes ,education ,program-- 7,a7 make grants to programs funded under section #dfdz-#d for the purpose of establishing a mentoring program for health care professionals to be more involved in weight counseling1 obesity research1 and nutrition2 and 7,b7 provide for the participation of minority health professionals in diabetes-focused research programs2 and 7#b7 make grants for programs to establish a pipeline from high school to professional school that will increase minority representation in diabetes-focused health fields by expanding ,minority ,access to ,research ,careers program internships and mentoring opportunities for recruitment4 7e7 ,definitions ,for purposes of this section3 7#a7 ,diabetes ,mellitus ,interagency ,coordinating ,committee ,the ,diabetes ,mellitus ,interagency ,coordinating ,committee means the ,diabetes ,mellitus ,interagency ,coordinating ,committee established under section #dbi4 7#b7 ,minority population ,the term minority population means a racial and ethnic minority group1 as defined in section #agjg4 4 #ggb4 ,research1 education1 and other activities ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq471 as amended by section #gba1 is further amended by inserting after section #cag,w the following section3 #cag,x4 ,diabetes in minority populations 7a7 ,research and other activities 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall conduct and support research and public health activities with respect to diabetes in minority populations4 7#b7 ,certain activities ,activities under paragraph 7#a7 regarding diabetes in minority populations shall include the following3 7,a7 ,further enhancing the ,national ,health and ,nutrition ,examination ,survey by oversampling ,asian ,americans1 ,native ,hawaiians1 and ,pacific ,islanders in appropriate geographic areas to better determine the prevalence of diabetes in such populations as well as to improve the data collection of diabetes penetration disaggregated into major ethnic groups within such populations4 ,the ,secretary shall ensure that any such oversampling does not reduce the oversampling of other minority populations including ,african-,american and ,latino populations4 7,b7 ,through the ,division of ,diabetes ,translation-- 7i7 providing for prevention research to better understand how to influence health care systems changes to improve quality of care being delivered to such populations2 7ii7 carrying out model demonstration projects to design1 implement1 and evaluate effective diabetes prevention and control interventions for minority populations1 including culturally appropriate community-based interventions2 7iii7 developing and implementing a strategic plan to reduce diabetes in minority populations through applied research to reduce disparities and culturally and linguistically appropriate community-based interventions2 7iv7 supporting1 through the national diabetes prevention program under section #cii,v-#c1 diabetes prevention program sites in underserved regions highly impacted by diabetes2 and 7v7 implementing1 through the national diabetes prevention program under section #cii,v-#c1 a demonstration program developing new metrics measuring health outcomes related to diabetes that can be stratified by specific minority populations4 7b7 ,education ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall direct the ,division of ,diabetes ,translation to conduct and support both programs to educate the public on diabetes in minority populations and programs to educate minority populations about the causes and effects of diabetes4 7c7 ,diabetes2 health promotion1 prevention activities1 and access ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention and the ,national ,diabetes ,education ,program1 shall conduct and support programs to educate specific minority populations through culturally appropriate and linguistically appropriate information campaigns about prevention of1 and managing1 diabetes4 7d7 ,definition ,for purposes of this section1 the term minority population means a racial and ethnic minority group1 as defined in section #agjg4 4 #ggc4 ,programs to educate health providers on the causes and effects of diabetes in minority populations ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq471 as amended by section #gcc1 is further amended by adding at the end the following new section3 #cii,v-#aj4 ,programs to educate health providers on the causes and effects of diabetes in minority populations 7a7 ,in general ,the ,secretary1 acting through the ,director of the ,health ,resources and ,services ,administration1 shall conduct and support programs described in subsection 7b7 to educate health professionals on the causes and effects of diabetes in minority populations4 7b7 ,programs ,programs described in this subsection1 with respect to education on diabetes in minority populations1 shall include the following3 7#a7 ,giving priority1 under the primary care training and enhancement program under section #gdg-- 7,a7 to awarding grants to focus on or address diabetes2 and 7,b7 to adding minority populations to the list of vulnerable populations that should be served by such grants4 7#b7 ,providing additional funds for the ,health ,careers ,opportunity ,program1 the ,centers for ,excellence1 and the ,minority ,faculty ,fellowship ,program to partner with the ,office of ,minority ,health under section #agjg and the ,national ,institutes of ,health to strengthen programs for career opportunities focused on diabetes treatment and care within underserved regions highly impacted by diabetes4 7#c7 ,developing a diabetes focus within1 and providing additional funds for1 the ,national ,health ,service ,corps scholarship program-- 7,a7 to place individuals in areas that are disproportionately affected by diabetes and to provide diabetes treatment and care in such areas2 and 7,b7 to provide such individuals continuing medical education specific to diabetes care4 4 #ggd4 ,research1 education1 and other activities regarding diabetes in ,american ,indian populations ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq471 as amended by section #ggc1 is further amended by adding at the end the following section3 #cii,v-#aa4 ,research1 education1 and other activities regarding diabetes in ,american ,indian populations ,in addition to activities under sections #cag,x1 #cii,v-#aj1 and #dcd;,b1 the ,secretary1 acting through the ,indian ,health ,service and in collaboration with other appropriate ,federal agencies1 shall-- 7#a7 conduct and support research and other activities with respect to diabetes2 and 7#b7 coordinate the collection of data on clinically and culturally appropriate diabetes treatment1 care1 prevention1 and services by health care professionals to the ,american ,indian population4 4 #gge4 ,updated report on health disparities ,the ,secretary of ,health and ,human ,services shall seek to enter into an arrangement with the ,national ,academy of ,medicine under which the ,national ,academy will-- 7#a7 not later than #a year after the date of enactment of this ,act1 submit to ,congress an updated version of the #bjjc report entitled ,unequal ,treatment3 ,confronting ,racial and ,ethnic ,disparities in ,health ,care2 and 7#b7 in such updated version1 address how racial and ethnic health disparities have changed since the publication of the original report4 ,g ,lung ,disease #ggf4 ,expansion of the ,national ,asthma ,education and ,prevention ,program 7a7 ,findings ,congress finds as follows3 7#a7 ,the prevalence of asthma has increased since #aihj and affects more than #bf1jjj1jjj people in the ,united ,states4 7#b7 ,significant disparities in asthma morbidity and mortality exist for both adults and children particularly for low-income and minority populations1 particularly ,african ,americans and ,puerto ,ricans4 7#c7 ,african-,american children are twice as likely to have asthma as ,white children4 7#d7 ,in #bjaf1 almost #d1ejj1jjj non-,hispanic ,african ,americans reported having asthma4 ,african ,americans with asthma are #c times as likely to visit the emergency department and twice as likely to get hospitalized as ,white patients with asthma4 7#e7 ,puerto ,ricans are #c4d times as likely to die from asthma compared with all other ,hispanic or ,latino groups4 ,overall ,hispanic ,americans are #cj percent more likely to be hospitalized for asthma than non-,hispanic ,whites4 7#f7 ,the majority of adults with asthma are women4 7b7 ,in general ,not later than #b years after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall convene a working group comprised of patient groups1 nonprofit organizations1 medical societies1 and other relevant governmental and nongovernmental entities1 including those that participate in the ,national ,asthma ,education and ,prevention ,program1 to develop a report to ,congress that-- 7#a7 catalogs1 with respect to asthma prevention1 management1 and surveillance-- 7,a7 the activities of the ,federal ,government1 including identifying all ,federal programs that carry out asthma-related activities1 as well as assessment of the progress of the ,federal ,government and ,states1 with respect to achieving the goals of ,healthy ,people #bjbj2 and 7,b7 the activities of other entities that participate in the program1 including nonprofit organizations1 patient advocacy groups1 and medical societies2 and 7#b7 makes recommendations for the future direction of asthma activities1 in consultation with researchers from the ,national ,institutes of ,health and other member bodies of the ,national ,asthma ,education and ,prevention ,program who are qualified to review and analyze data and evaluate interventions1 including-- 7,a7 a description of how the ,federal ,government may better coordinate and improve its response to asthma including identifying any barriers that may exist2 7,b7 a description of how the ,federal ,government may continue1 expand1 and improve its private-public partnerships with respect to asthma including identifying any barriers that may exist2 7,c7 identification of steps that may be taken to reduce the-- 7i7 morbidity1 mortality1 and overall prevalence of asthma2 7ii7 financial burden of asthma on society2 7iii7 burden of asthma on disproportionately affected areas1 particularly those in medically underserved populations 7as defined in section #ccj7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c7772 and 7iv7 burden of asthma as a chronic disease2 7,d7 identification of programs and policies that have achieved the steps described in subparagraph 7,c71 and steps that may be taken to expand such programs and policies to benefit larger populations2 and 7,e7 recommendations for future research and interventions4 7c7 ,report to ,congress ,at the end of the #e-year period following the submission of the report under this section1 the ,national ,asthma ,education and ,prevention ,program shall evaluate the analyses and recommendations under such report and determine whether a new report to the ,congress is necessary1 and make appropriate recommendations to the ,congress4 #ggg4 ,asthma-related activities of the ,centers for ,disease ,control and ,prevention ,section #cag;,i of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#aj7 is amended to read as follows3 #cag;,i4 ,asthma-related activities of the centers for disease control and prevention 7a7 ,program for providing information and education to the public ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall collaborate with ,state and local health departments to conduct activities1 including the provision of information and education to the public regarding asthma including-- 7#a7 deterring the harmful consequences of uncontrolled asthma2 and 7#b7 disseminating health education and information regarding prevention of asthma episodes and strategies for managing asthma4 7b7 ,development of ,state asthma plans ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall collaborate with ,state and local health departments to develop ,state plans incorporating public health responses to reduce the burden of asthma1 particularly regarding disproportionately affected populations4 7c7 ,compilation of data ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall1 in cooperation with ,state and local public health officials-- 7#a7 conduct asthma surveillance activities to collect data on the prevalence and severity of asthma1 the effectiveness of public health asthma interventions1 and the quality of asthma management1 including-- 7,a7 collection of household data on the local burden of asthma2 7,b7 surveillance of health care facilities2 and 7,c7 collection of data not containing individually identifiable information from electronic health records or other electronic communications2 7#b7 compile and annually publish data regarding the prevalence and incidence of childhood asthma1 the child mortality rate1 and the number of hospital admissions and emergency department visits by children associated with asthma nationally and in each ,state and at the county level by age1 sex1 race1 and ethnicity1 as well as lifetime and current prevalence2 and 7#c7 compile and annually publish data regarding the prevalence and incidence of adult asthma1 the adult mortality rate1 and the number of hospital admissions and emergency department visits by adults associated with asthma nationally and in each ,state and at the county level by age1 sex1 race1 ethnicity1 industry1 and occupation1 as well as lifetime and current prevalence4 7d7 ,coordination of data collection ,the ,director of the ,centers for ,disease ,control and ,prevention1 in conjunction with ,state and local health departments1 shall coordinate data collection activities under paragraphs 7#b7 and 7#c7 of subsection 7c7 so as to maximize comparability of results4 7e7 ,collaboration ,the ,centers for ,disease ,control and ,prevention are encouraged to collaborate with national1 ,state1 and local nonprofit organizations to provide information and education about asthma1 and to strengthen such collaborations when possible4 7f7 ,additional funding ,in addition to any other authorization of appropriations that is available to the ,centers for ,disease ,control and ,prevention for the purpose of carrying out this section1 there are authorized to be appropriated to such ,centers such sums as may be necessary for each of fiscal years #bjba through #bjbe for the purpose of carrying out this section4 4 #ggh4 ,influenza and pneumonia vaccination campaign 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall-- 7#a7 enhance the annual campaign by the ,department of ,health and ,human ,services to increase the number of people vaccinated each year for influenza and pneumonia2 and 7#b7 include in such campaign the use of written educational materials1 public service announcements1 physician education1 and any other means which the ,secretary deems effective4 7b7 ,materials and announcements ,in carrying out the annual campaign described in subsection 7a71 the ,secretary of ,health and ,human ,services shall ensure that-- 7#a7 educational materials and public service announcements are readily and widely available in communities experiencing disparities in the incidence and mortality rates of influenza and pneumonia2 and 7#b7 the campaign uses targeted1 culturally appropriate messages and messengers to reach underserved communities4 7c7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjba through #bjbe4 #ggi4 ,chronic obstructive pulmonary disease action plan 7a7 ,findings ,congress finds as follows3 7#a7 ,chronic obstructive pulmonary disease 7referred to in this subsection as ,,copd7 refers to chronic bronchitis and emphysema1 incurable diseases that make it difficult to exhale all the air from one's lungs1 and that can cause persistent coughing1 shortness of breath1 and sputum4 7#b7 ,,copd exacerbations--episodes of acute difficulty breathing and moderate to severe fatigue--are dangerous1 and their treatment often requires hospitalization4 7#c7 ,while smoking is the primary risk factor for ,,copd1 other risk factors include air pollution1 occupational exposures1 heredity1 a history of childhood respiratory infections1 and socioeconomic status4 7#d7 ,it is estimated that over #ac1ejj1jjj adults in the ,united ,states have ,,copd4 7#e7 ,,copd is the third-leading cause of death in the ,united ,states1 claiming over #acd1jjj lives in #bjaj4 7#f7 ,since #bjjj1 deaths for women with ,,copd have exceeded deaths in men4 7#g7 ,although ,african ,americans have a lower prevalence of ,,copd in the ,united ,states1 researchers have shown that ,african ,americans may be underdiagnosed4 ,furthermore1 research has shown that ,african ,americans develop ,,copd with less cumulative smoke exposure and at a younger age4 7b7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention shall conduct1 support1 and expand public health strategies1 prevention1 diagnosis1 surveillance1 and public and professional awareness activities regarding chronic obstructive pulmonary disease4 7c7 ,national action plan 7#a7 ,development ,not later than #b years after the date of the enactment of this ,act1 the ,director of the ,national ,heart1 ,lung1 and ,blood ,institute1 in consultation with the ,director of the ,centers for ,disease ,control and ,prevention1 shall develop a national action plan to address chronic obstructive pulmonary disease in the ,united ,states with participation from patients1 caregivers1 health professionals1 patient advocacy organizations1 researchers1 providers1 public health professionals1 and other stakeholders4 7#b7 ,contents ,at a minimum1 such plan shall include recommendations for-- 7,a7 public health interventions for the purpose of implementation of the national plan2 7,b7 biomedical1 health services1 and public health research on chronic obstructive pulmonary disease2 and 7,c7 inclusion of chronic obstructive pulmonary disease in the health data collections of all ,federal agencies4 7#c7 ,consideration ,in developing such plan1 the ,director of the ,national ,heart1 ,lung1 and ,blood ,institute shall consider the recommendations and findings of the ,national ,academy of ,medicine in the report entitled ,a ,nationwide ,framework for ,surveillance of ,cardiovascular and ,chronic ,lung ,diseases 7,july #bb1 #bjaa74 7d7 ,chronic disease prevention programs ,the ,director of the ,national ,heart1 ,lung1 and ,blood ,institute shall carry out the following3 7#a7 ,conduct public education and awareness activities with patient and professional organizations to stimulate earlier diagnosis and improve patient outcomes from treatment of chronic obstructive pulmonary disease4 ,to the extent known and relevant1 such public education and awareness activities shall reflect differences in chronic obstructive pulmonary disease by cause 7tobacco1 environmental1 occupational1 biological1 and genetic7 and include a focus on outreach to undiagnosed and1 as appropriate1 minority populations4 7#b7 ,supplement and expand upon the activities of the ,national ,heart1 ,lung1 and ,blood ,institute by making grants to nonprofit organizations1 ,state and local jurisdictions1 and ,indian tribes for the purpose of reducing the burden of chronic obstructive pulmonary disease1 especially in disproportionately impacted communities1 through public health interventions and related activities4 7#c7 ,coordinate with the ,centers for ,disease ,control and ,prevention1 the ,indian ,health ,service1 the ,health ,resources and ,services ,administration1 and the ,department of ,veterans ,affairs to develop pilot programs to demonstrate best practices for the diagnosis and management of chronic obstructive pulmonary disease4 7#d7 ,develop improved techniques and identify best practices1 in coordination with the ,secretary of ,veterans ,affairs1 for assisting chronic obstructive pulmonary disease patients to successfully stop smoking1 including identification of subpopulations with different needs4 ,initiatives under this paragraph may include research to determine whether successful smoking cessation strategies are different for chronic obstructive pulmonary disease patients compared to such strategies for patients with other chronic diseases4 7e7 ,environmental and occupational health programs ,the ,director of the ,centers for ,disease ,control and ,prevention shall-- 7#a7 support research into the environmental and occupational causes and biological mechanisms that contribute to chronic obstructive pulmonary disease2 and 7#b7 develop and disseminate public health interventions that will lessen the impact of environmental and occupational causes of chronic obstructive pulmonary disease4 7f7 ,data ,collection ,not later than #ahj days after the enactment of this ,act1 the ,director of the ,national ,heart1 ,lung1 and ,blood ,institute and the ,director of the ,centers for ,disease ,control and ,prevention1 acting jointly1 shall assess the depth and quality of information on chronic obstructive pulmonary disease that is collected in surveys and population studies conducted by the ,centers for ,disease ,control and ,prevention1 including whether there are additional opportunities for information to be collected in the ,national ,health and ,nutrition ,examination ,survey1 the ,national ,health ,interview ,survey1 and the ,behavioral ,risk ,factors ,surveillance ,system surveys4 ,the ,director of the ,national ,heart1 ,lung1 and ,blood ,institute shall include the results of such assessment in the national action plan under subsection 7c74 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 ,h ,tuberculosis #gha4 ,elimination of all forms of tuberculosis 7a7 ,short title ,this subtitle may be cited as the ,end ,tuberculosis ,act4 7b7 ,findings ,congress makes the following findings3 7#a7 ,in the ,united ,states1 #i1jbe people were diagnosed with tuberculosis 7referred to in this section as ,,tb7 in #bjah4 7#b7 ,disparities in ,,tb exist and significantly impact minority communities in the ,united ,states4 ,the ,centers for ,disease ,control and ,prevention 7referred to in this section as ,,cdc7 finds that #gj percent of people diagnosed with ,,tb in #bjah self-identified as racial and ethnic minorities4 7#c7 ,african ,americans comprised #bj percent of people diagnosed with ,,tb during #bjah4 ,the population-adjusted rate of ,,tb among ,african ,americans is #a4g times higher than the national total1 and #h4j times higher than among ,whites4 7#d7 ,asian ,americans1 ,native ,hawaiians1 and other ,pacific ,islanders comprised #cg percent of people diagnosed with ,,tb during #bjah4 ,the population-adjusted rate of ,,tb among ,asian ,americans is #f4b times higher than the national total1 and #ca times higher than among ,whites4 ,the population-adjusted rate of ,,tb among ,native ,hawaiians and other ,pacific ,islanders is #d4h times higher than the national total1 and #bc4b times higher than among ,whites4 7#e7 ,hispanics and ,latinos comprised #bf percent of people diagnosed with ,,tb during #bjah4 ,the population-adjusted rate of ,,tb among ,hispanics and ,latinos is #a4f times higher than the national total1 and #h4j times higher than among ,whites4 7#f7 ,,tb is both preventable and curable1 but the current rate of decline of ,,tb in the ,united ,states remains too slow to achieve ,,tb elimination in this century4 7#g7 ,,tb is transmitted through the air when a person who has ,,tb disease in their lungs coughs or sneezes4 ,people who are in close proximity to the person with ,,tb can breathe in the ,,tb bacteria1 and the bacteria will initially settle in their lungs4 ,without proper and timely diagnosis and access to treatment1 the ,,tb bacteria may grow and spread to other parts of their body4 7#h7 ,as many as #ac1jjj1jjj people in the ,united ,states may have latent ,,tb ,infection 7referred to in this section as ,,ltbi74 ,people with ,,ltbi have ,,tb bacteria in their bodies1 but their immune system is containing the bacteria1 and they are not sick1 nor do they have any current risk of spreading ,,tb to others4 ,,ltbi can activate into infectious1 life-threatening ,,tb if not treated4 ,modeling has shown that eliminating ,,tb is not possible without addressing ,,ltbi4 7#i7 ,comorbidities associated with ,,tb include cancer1 diabetes mellitus1 and ,,hiv4 ,people with these medical conditions and compromised immune systems are more likely to develop active ,,tb disease and to have worse outcomes from ,,tb4 7#aj7 ,forms of active ,,tb that do not show drug resistance are classified as drug-susceptible ,,tb 7referred to in this section as ,,ds-,,tb74 ,drug-resistant ,,tb 7referred to in this section as ,,dr-,,tb7 is a rising threat to the public health of the ,united ,states4 ,,dr-,,tb that exhibits resistance to two or more first-line drugs is referred to as multi-drug resistant ,,tb 7referred to in this section as ,,mdr-,,tb74 ,,mdr-,,tb that also is resistant to at least one injectable second-line medication and at least one fluoroquinolone is classified as extensively drug-resistant ,,tb 7referred to in this section as ,,xdr-,,tb74 7#aa7 ,approximately #ig people in the ,united ,states were diagnosed with ,,mdr-,,tb in #bjah4 ,one person was diagnosed with ,,xdr-,,tb in the same year4 7#ab7 ,in the ,united ,states1 #dhj1jjj1jjj was spent in #bjah to treat ,,tb2 direct treatment costs average #ai1jjj to treat a patient with ,,ds-,,tb1 #age1jjj to treat a patient with ,,mdr-,,tb1 and #edd1jjj to treat a patient with ,,xdr-,,tb4 ,when factoring in productivity losses during treatment1 ,,ds-,,tb averages #df1jjj1 ,,mdr-,,tb averages #bid1jjj and ,,xdr-,,tb averages #fid1jjj4 ,treatment is often difficult1 with daily complex multi-pill regimens and injections1 with side-effects ranging from hearing and vision loss to mental health issues4 7#ac7 ,recognizing the public health1 economic and societal costs to the threat of ,,mdr-,,tb1 the ,national ,action ,plan to ,combat ,,mdr-,,tb was developed by the ,white ,house to provide the ,united ,states with a comprehensive three-pronged strategy to address ,,mdr-,,tb by strengthening domestic capacity to combat ,,mdr-,,tb2 improve international capacity and cooperation to combat ,,mdr-,,tb2 accelerate basic and applied research and development for new therapies1 diagnostics and prevention strategies to combat ,,mdr-,,tb4 7#ad7 ,additional ,federal support is necessary to expand ,,tb control efforts in case finding and treatment to address ,,ltbi in a national prevention initiative4 ,key policy and research breakthroughs increase the success of a ,,tb prevention initiative3 the ,u4,s4 ,preventative ,services ,task ,force recommendation's ,b rating1 screening for ,,ltbi among high-risk adults as a covered service increases the likelihood that impacted racial and ethnic minority groups can get tested for ,,tb2 a new1 shorter course treatment regimen reduces the length of treatment for ,,ltbi from every day for #f to #i months to one dose per week for #ab weeks1 increasing likelihood of treatment completion2 and the use of blood-based diagnostic tests1 ,interferon-gamma release assays or ,i,g,r,as1 increases ability to detect ,,ltbi among patients in affected communities4 7#ae7 ,the right to health1 and the right to science as a necessary human right to help achieve the right to health1 is enshrined in ,articles #be and #bg of the ,universal ,declaration of ,human ,rights4 ,these fundamental human rights cannot be achieved when anyone lacks access to ,,tb prevention or treatment1 and when the benefits of scientific innovation are not extended to people with all forms of ,,tb4 #ghb4 ,additional funding for ,states in combating and eliminating tuberculosis ,section #cag;,e7h7 of the ,public ,health ,act 7#db ,u4,s4,c4 #bdg;b-#f7;h77 is amended by adding at the end the following3 7#c7 ,additional funding for ,states in combating and eliminating tuberculosis ,in addition to amounts otherwise authorized to be appropriated to carry out this section1 there are authorized to be appropriated such sums as may be necessary to carry out this section for each of fiscal years #bjbj through #bjba4 4 #ghc4 ,strengthening clinical research funding for tuberculosis 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall expand and intensify support for current and prospective research activities of the ,national ,institutes of ,health1 the ,biomedical ,advanced ,research and ,development ,authority1 and the ,centers for ,disease ,control and ,prevention ,division of ,tuberculosis ,elimination to develop new therapeutics1 diagnostics1 vaccines1 and other prevention modalities in addressing all forms of tuberculosis 7referred to in this section as ,,tb74 7b7 ,included research activities ,research activities under subsection 7a7 shall include-- 7#a7 research and development1 and pathways to approval1 for novel1 safe drugs and drug regimens for the treatment of ,,tb1 including in adolescent and pediatric populations and in pregnant and lactating women2 7#b7 research to develop rapid diagnostic tests for all forms of ,,tb1 including diagnostics that can be used for pediatric populations and people living with ,,hiv1 diagnostics that can detect extra pulmonary ,,tb and drug resistance1 and diagnostics that can be used at the point of care2 7#c7 research to advance basic knowledge of the pathogenesis of ,,tb and its major comorbidities1 including ,,hiv and diabetes mellitus2 7#d7 research to improve knowledge and understandings of the role of latency in ,,tb and the factors that increase the risk of latent ,,tb infection progressing to active1 symptomatic ,,tb disease2 7#e7 awarding grants and contracts to specifically develop new and needed vaccines to address ,,tb2 7#f7 awarding grants and contracts to support the training and development of clinical researchers whose research improves the landscape of tools to combat ,,tb2 and 7#g7 awarding grants and contracts to support capacity-building and develop clinical trial site infrastructure in the ,united ,states and in ,,tb endemic countries to support the aforementioned research activities4 ,i ,osteoarthritis and ,musculoskeletal ,diseases #ghe4 ,findings ,congress finds as follows3 7#a7 ,eighty percent of ,african-,american women and nearly #gd percent of ,hispanic men are either overweight or obese1 speeding the onset and progression of arthritis4 7#b7 ,arthritis affects #df1jjj1jjj people in the ,united ,states1 and that number will rise to #fg1jjj1jjj by the year #bjcj4 7#c7 ,twenty-seven million people in the ,united ,states suffer from osteoarthritis1 the most common form of arthritis1 making it the leading cause of disability in the ,united ,states4 ,osteoarthritis is sometimes referred to as degenerative joint disease4 7#d7 ,obesity accelerates the onset of arthritis3 #gj percent of obese adults with mild osteoarthritis of the knee at age #fj will develop advanced end-stage disease by age #hj4 ,in contrast1 just #dc percent of non-obese adults will have end-stage disease over the same time period4 7#e7 ,arthritis affects #a in #e people in the ,united ,states and is the single greatest cause of chronic pain and disability in the ,united ,states4 7#f7 ,women1 ,african ,americans1 and ,hispanics have more severe arthritis and functional limitations4 ,these same individuals are more likely to be obese1 diabetic1 and have higher incidence of heart disease--medical conditions that can be improved with physical activity4 ,instead of moving1 however1 these groups have an inactivity rate of #dj to #ej percent1 which continues to increase4 7#g7 ,arthritis costs #abh1jjj1jjj1jjj a year1 including #ha1jjj1jjj1jjj in direct costs 7medical7 and #dg1jjj1jjj1jjj in indirect costs 7lost earnings74 ,each year1 #cji1jjj1jjj1jjj in direct and indirect costs is lost due to disparities in osteoarthritis and musculoskeletal diseases4 7#h7 ,obesity and other chronic health conditions exacerbate the debilitating impact of arthritis1 leading to inactivity1 loss of independence1 and a perpetual cycle of comorbid chronic conditions4 7#i7 ,sixty-one percent of arthritis sufferers are women1 and women represent #fd percent of an estimated #dc1jjj1jjj annual visits to physicians' offices and outpatient clinics where arthritis was the primary diagnosis4 ,women also represented #fj percent of approximately #a1jjj1jjj hospitalizations that occurred in #bjjc for which arthritis was the primary diagnosis4 7#aj7 ,women ages #fe and older have up to #b times more disabilities than men of the same age4 ,higher rates of obesity and arthritis among this group explained up to #dh percent of the gender gap in disability1 above all other common chronic health conditions4 7#aa7 ,the primary indication for total knee arthroplasty 7referred to in this section as ,,tka71 also known as knee replacement1 is relief of significant1 disabling pain caused by severe arthritis4 7#ab7 ,knee replacement is surgery for people with severe knee damage4 ,knee replacement can relieve pain and allow an individual to be more active4 ,the process for a total knee replacement involves the surgeon removing damaged cartilage and bone from the surface of the knee joint and replacing the cartilage and bone with a man-made surface of metal and plastic4 ,in a partial knee replacement1 the surgeon only replaces part of the knee joint4 7#ac7 ,total hip replacement1 also called total hip arthroplasty 7referred to in this section as ,,tha71 is used if hip pain interferes with daily activities and more conservative treatments have not helped4 ,arthritis damage is the most common reason to need hip replacement4 7#ad7 ,the odds of a family practice physician recommending ,,tka to a male patient with moderate arthritis are twice that of a female patient1 while the odds of an orthopaedic surgeon recommending ,,tka to a male patient with moderate arthritis are #bb times that of a female patient4 7#ae7 ,african ,americans with doctor-diagnosed arthritis have a higher prevalence of severe pain attributable to arthritis1 compared with ,whites 7#cd4j percent versus #bb4f percent74 ,african ,americans1 compared to ,whites1 report a higher proportion of work limitations 7#ci4e percent versus #bh4j percent7 and a higher prevalence of arthritis-attributable work limitation 7#f4f percent versus #d4f percent74 7#af7 ,hispanics are #ej percent more likely than non-,hispanic ,whites to report needing assistance with at least one instrumental activity of daily living and to have difficulty walking4 7#ag7 ,african ,americans and ,hispanics were #a4c times more likely to have activity limitation1 #a4f times more likely to have work limitations1 and #a4i times more likely to have severe joint pain than ,whites4 7#ah7 ,in #bjjc1 the ,national ,academy of ,medicine reported that the rates of ,,tka and ,,tha among ,african-,american and ,hispanic patients are significantly lower than for ,whites--even for those with equitable health care coverage such as through ,medicare or the ,department of ,veterans ,affairs4 7#ai7 ,according to the ,centers for ,disease ,control and ,prevention1 in #bjjj1 ,african-,american ,medicare enrollees were #cg percent less likely than ,white ,medicare enrollees to undergo total knee replacements4 ,in #bjjf1 the disparity increased to #ci percent4 7#bj7 ,even after adjusting for insurance and health access1 ,hispanics and ,african ,americans are almost #ej percent less likely to undergo total knee replacement than ,whites4 #ghf4 ,osteoarthritis and other musculoskeletal health-related activities of the ,centers for ,disease ,control and ,prevention 7a7 ,education and ,awareness activities ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall direct the ,national ,center for ,chronic ,disease ,prevention and ,health ,promotion to conduct and expand the ,health ,community ,program and ,arthritis ,program to educate the public on-- 7#a7 the causes of1 preventive health actions for1 and effects of arthritis and other musculoskeletal conditions in minority patient populations2 and 7#b7 the effects of such conditions on other comorbidities including obesity1 hypertension1 and cardiovascular disease4 7b7 ,programs on arthritis and musculoskeletal conditions ,education and awareness programs of the ,centers for ,disease ,control and ,prevention on arthritis and other musculoskeletal conditions in minority communities shall-- 7#a7 be culturally and linguistically appropriate to minority patients1 targeting musculoskeletal health promotion and prevention programs of each major ethnic group1 including-- 7,a7 ,native ,americans and ,alaska ,natives2 7,b7 ,asian ,americans2 7,c7 ,african ,americans and ,blacks2 7,d7 ,hispanic and ,latino ,americans2 and 7,e7 ,native ,hawaiians and ,pacific ,islanders2 and 7#b7 include public awareness campaigns directed toward these patient populations that emphasize the importance of musculoskeletal health1 physical activity1 diet and healthy lifestyle1 and weight reduction for overweight and obese patients4 7c7 ,authorization of ,appropriations ,to carry out this section1 there are authorized to be appropriated such sums as are necessary for fiscal year #bjba and each subsequent fiscal year4 #ghg4 ,grants for comprehensive osteoarthritis and musculoskeletal disease health education within health professions schools 7a7 ,program authorized ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary71 in coordination with the ,secretary of ,education1 shall award grants1 on a competitive basis1 to academic health science centers1 health professions schools1 and institutions of higher education to enable such centers1 schools1 and institutions to provide people with comprehensive education on arthritis and musculoskeletal health1 particularly-- 7#a7 obesity-related musculoskeletal diseases2 7#b7 arthritis and osteoarthritis2 7#c7 arthritis and musculoskeletal health disparities2 and 7#d7 the relationship between arthritis and musculoskeletal diseases and metabolic activity1 psychological health1 and comorbidities such as diabetes1 cardiovascular disease1 and hypertension4 7b7 ,duration ,grants awarded under this section shall be for a period of #e years4 7c7 ,applications ,an academic health science center1 health professions school1 or institution of higher education seeking a grant under this section shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7d7 ,priority ,in awarding grants under this section1 the ,secretary shall give priority to an institution of higher education that-- 7#a7 has an enrollment of needy students1 as defined in section #cah7;b7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajei;e7b772 7#b7 is a ,hispanic-serving institution1 as defined in section #ejb7;a7 of such ,act 7#bj ,u4,s4,c4 #aaja;a7a772 7#c7 is a ,tribal ,college or ,university1 as defined in section #caf7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;c7b772 7#d7 is an ,alaska ,native-serving institution1 as defined in section #cag7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7#e7 is a ,native ,hawaiian-serving institution1 as defined in section #cag7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7#f7 is a ,predominately ,black ,institution1 as defined in section #cah7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;e7b772 7#g7 is a ,native ,american-serving1 non-,tribal institution1 as defined in section #cai7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;f7b772 7#h7 is an ,asian ,american and ,native ,american ,pacific ,islander-serving institution1 as defined in section #cbj7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;g7b772 or 7#i7 is a minority institution1 as defined in section #cfe of such ,act 7#bj ,u4,s4,c4 #ajfgk71 with an enrollment of needy students1 as defined in section #cab of such ,act 7#bj ,u4,s4,c4 #ajeh74 7e7 ,uses of funds ,an academic health science center1 health professions school1 or institution of higher education receiving a grant under this section may use grant funds to integrate issues relating to comprehensive arthritis and musculoskeletal health into the academic or support sectors of the center1 school1 or institution in order to reach a large number of students1 by carrying out #a or more of the following activities3 7#a7 ,developing educational content for issues relating to comprehensive arthritis and musculoskeletal health education that will be incorporated into first-year orientation or core courses4 7#b7 ,creating innovative technology-based approaches to deliver arthritis and musculoskeletal health education to students1 faculty1 and staff4 7#c7 ,developing and employing peer-outreach and education programs to generate discussion1 educate1 and raise awareness among students about issues relating to arthritis and musculoskeletal health disorders1 and their relationship to diabetes1 hypertension1 cardiovascular disease1 psychological health1 and other comorbid conditions4 7f7 ,report to congress 7#a7 ,in general ,not later than #a year after the date of the enactment of this ,act1 and annually thereafter for a period of #e years1 the ,secretary shall prepare and submit to the appropriate committees of ,congress a report on the activities to provide health professions students with comprehensive arthritis and musculoskeletal health education funded under this section4 7#b7 ,report elements ,the report described in paragraph 7#a7 shall include information about-- 7,a7 the number of entities that are receiving grant funds2 7,b7 the specific activities supported by grant funds2 7,c7 the number of students served by grant programs2 and 7,d7 the status of program evaluations4 7g7 ,definition of institution of higher education ,in this section1 the term institution of higher education has the meaning given such term in section #aja7;b7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja7;b774 ,j ,sleep and ,circadian ,rhythm ,disorders #gia4 ,short title2 findings 7a7 ,short title ,this subtitle may be cited as the ,sleep and ,circadian ,rhythm ,disorders ,health ,disparities ,act4 7b7 ,findings ,congress finds the following3 7#a7 ,decrements in sleep health such as sleep apnea1 insufficient sleep time1 and insomnia1 affect #ej1jjj1jjj to #gj1jjj1jjj adults in the ,united ,states4 ,twelve to eighteen million ,united ,states adults have sleep apnea1 a chronic disorder characterized by one or more pauses in breathing which can last from a few seconds to minutes4 ,they may occur #cj times or more an hour1 disrupting sleep and resulting in excessive daytime sleepiness and loss in productivity4 7#b7 ,seventy percent of high school students are not getting enough sleep on school nights1 while #cc percent of people in the ,united ,states get fewer than #g hours of sleep per night1 and roughly #f1jjj fatal motor vehicle crashes are caused by drowsy drivers4 7#c7 ,insufficient sleep and insomnia are more prevalent in women4 ,women who are pregnant and have sleep apnea are at an increased risk of cardiovascular complications during pregnancy4 ,the impact of disparities in sleep health is associated with a growing number of health problems1 including the following3 7,a7 ,hypertension4 7,b7 ,cancer4 7,c7 ,stroke4 7,d7 ,cardiac arrhythmia4 7,e7 ,chronic heart failure and heart disease4 7,f7 ,diabetes4 7,g7 ,cognitive functioning and behavior4 7,h7 ,depression and bipolar disorder4 7,i7 ,substance abuse4 7#d7 ,a sleep disparity exists in that poor sleep quality is strongly associated with poverty and race4 ,factors such as employment1 education1 and health status1 amongst others1 significantly mediated this effect only in poor subjects1 suggesting a differential vulnerability to these factors in poor relative to nonpoor individuals in the context of sleep quality4 7#e7 ,african ,americans sleep worse than ,caucasian ,americans4 ,african ,americans take longer to fall asleep1 report poorer sleep quality1 have more light and less deep sleep1 and nap more often and longer4 7#f7 ,african ,americans and individuals in lower socioeconomic status groups may be at an increased risk for sleep disturbances and associated health consequences4 7#g7 ,among young ,african ,americans1 the likelihood of having sleep disordered breathing and exhibiting risk factors for poor sleep is twice that in young ,caucasians4 ,frequent snoring is more common among ,african-,american and ,hispanic women and ,hispanic men compared to non-,hispanic ,caucasians1 independent of other factors including obesity4 7#h7 ,african ,americans with sleep-disordered breathing develop symptoms at a younger age than ,caucasians but appear less likely to be diagnosed and treated in a timely manner4 ,this delay may at least in part be due to reduced access to care4 7#i7 ,sleep loss contributes to increased risk for chronic conditions such as obesity1 diabetes1 and hypertension1 all of which have increased prevalence in underserved1 underrepresented minorities4 ,racial and ethnic disparities related to obesity may also contribute to disparities in health outcomes related to sleep-disordered breathing4 7#aj7 ,non-,caucasian adults report an insomnia rate of #ab4i percent compared to only #f4f percent for ,caucasians4 7#aa7 ,african-,american women have a higher incidence of insomnia than ,african-,american men1 perhaps related in part to higher risk for chronic persisting symptoms4 #gib4 ,sleep and circadian rhythm disorders research activities of the ,national ,institutes of ,health 7a7 ,in general ,the ,director of the ,national ,institutes of ,health1 acting through the ,director of the ,national ,heart1 ,lung1 and ,blood ,institute1 shall-- 7#a7 continue to expand research activities addressing sleep health disparities2 and 7#b7 continue implementation of the ,,nih ,sleep ,disorders ,research ,plan across all institutes and centers of the ,national ,institutes of ,health to improve treatment and prevention of sleep health disparities4 7b7 ,required research activities ,in conducting or supporting research relating to sleep and circadian rhythm1 the ,director of the ,national ,heart1 ,lung1 and ,blood ,institute shall-- 7#a7 advance epidemiology and clinical research to achieve a more complete understanding of disparities in domains of sleep health and across population subgroups for which cardiovascular and metabolic health disparities exist1 including-- 7,a7 prevalence and severity of sleep apnea2 7,b7 habitual sleep duration2 7,c7 sleep timing and regularity2 and 7,d7 insomnia2 7#b7 develop study designs and analytical approaches to explain and predict multilevel and life-course determinants of sleep health and to elucidate the sleep-related causes of cardiovascular and metabolic health disparities across the age spectrum1 including such determinants and causes that are-- 7,a7 environmental2 7,b7 biological or genetic2 7,c7 psychosocial2 7,d7 societal2 7,e7 political2 or 7,f7 economic2 7#c7 determine the contribution of sleep impairments such as sleep apnea1 insufficient sleep duration1 irregular sleep schedules1 and insomnia to unexplained disparities in cardiovascular and metabolic risk and disease outcomes2 7#d7 develop study designs1 data sampling and collection tools1 and analytical approaches to optimize understanding of mediating and moderating factors1 and feedback mechanisms coupling sleep to cardiovascular and metabolic health disparities2 7#e7 advance research to understand cultural and linguistic barriers 7on the person1 provider1 or system level7 to access to care1 medical diagnosis1 and treatment of sleep disorders in diverse population groups2 7#f7 develop and test multilevel interventions 7including sleep health education in diverse communities7 to reduce disparities in sleep health that will impact ability to improve disparities in cardiovascular and metabolic risk or disease2 7#g7 create opportunities to integrate sleep and health disparity science by strategically utilizing resources 7existing or anticipated cohorts71 exchanging scientific data and ideas 7cross-over into scientific meetings71 and develop multidisciplinary investigator-initiated grant applications2 and 7#h7 enhance the diversity and foster career development of young investigators involved in sleep and health disparities science4 7c7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal year #bjba and each subsequent fiscal year4 #gic4 ,sleep and circadian rhythm health disparities-related activities of the ,centers for ,disease ,control and ,prevention 7a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention shall conduct1 support1 and expand public health strategies and prevention1 diagnosis1 surveillance1 and public and professional awareness activities regarding sleep and circadian rhythm disorders4 7b7 ,findings ,congress finds as follows3 7#a7 ,sleep disorders and sleep deficiency unrelated to a primary sleep disorder are underdiagnosed and are increasingly detrimental to health status4 7#b7 ,the consequences to society include additional diseases1 motor vehicle accidents1 decreased longevity1 elevated direct medical costs1 and indirect costs related to work absenteeism and property damage4 7c7 ,required surveillance and education awareness activities ,in conducting or supporting research relating to sleep and circadian rhythm disorders surveillance and education awareness activities1 the ,director of the ,centers for ,disease ,control and ,prevention shall-- 7#a7 ensure that such activities are culturally and linguistically appropriate to minority patients1 targeting sleep and circadian rhythm health promotion and prevention programs of each major ethnic group1 including-- 7,a7 ,native ,americans and ,alaska ,natives2 7,b7 ,asian ,americans2 7,c7 ,african ,americans and ,blacks2 7,d7 ,hispanic and ,latino-,americans2 and 7,e7 ,native ,hawaiians and ,pacific ,islanders2 7#b7 collect and compile national and ,state surveillance data on sleep disorders health disparities2 7#c7 continue to develop and implement new sleep questions in public health surveillance systems to increase public awareness of sleep health and sleep disorders and their impact on health2 7#d7 publish monthly reports highlighting geographic1 racial1 and ethnic disparities in sleep health1 as well as relationships between insufficient sleep and chronic disease1 health risk behaviors1 and other outcomes as determined necessary by the ,director2 and 7#e7 include public awareness campaigns that inform patient populations from major ethnic groups about the prevalence of sleep and circadian rhythm disorders and emphasize the importance of sleep health4 7d7 ,authorization of ,appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal year #bjba and each subsequent fiscal year4 #gid4 ,grants for comprehensive sleep and circadian health education within health professions schools 7a7 ,program authorized ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 in coordination with the ,secretary of ,education1 shall award grants1 on a competitive basis1 to academic health science centers1 health professions schools1 and institutions of higher education to enable such centers1 schools1 and institutions to provide people with comprehensive education on sleep and circadian health1 particularly-- 7#a7 poor sleep health2 7#b7 sleep disorders2 7#c7 sleep health disparities2 and 7#d7 the relationship between sleep and circadian health on metabolic activity1 neurological activity1 comorbidities1 and other diseases4 7b7 ,duration ,grants awarded under this section shall be for a period of #e years4 7c7 ,applications ,an academic health science center1 health professions school1 or institution of higher education seeking a grant under this section shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7d7 ,priority ,in awarding grants under this section1 the ,secretary shall give priority to an institution of higher education that-- 7#a7 has an enrollment of needy students1 as defined in section #cah7;b7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajei;e7b772 7#b7 is a ,hispanic-serving institution1 as defined in section #ejb7;a7 of such ,act 7#bj ,u4,s4,c4 #aaja;a7a772 7#c7 is a ,tribal ,college or ,university1 as defined in section #caf7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;c7b772 7#d7 is an ,alaska ,native-serving institution1 as defined in section #cag7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7#e7 is a ,native ,hawaiian-serving institution1 as defined in section #cag7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7#f7 is a ,predominately ,black ,institution1 as defined in section #cah7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;e7b772 7#g7 is a ,native ,american-serving1 nontribal institution1 as defined in section #cai7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;f7b772 7#h7 is an ,asian ,american and ,native ,american ,pacific ,islander-serving institution1 as defined in section #cbj7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;g7b772 or 7#i7 is a minority institution1 as defined in section #cfe of such ,act 7#bj ,u4,s4,c4 #ajfgk71 with an enrollment of needy students1 as defined in section #cab of such ,act 7#bj ,u4,s4,c4 #ajeh74 7e7 ,uses of funds ,an academic health science center1 health professions school1 or institution of higher education receiving a grant under this section may use the grant funds to integrate issues relating to comprehensive sleep and circadian health into the academic or support sectors of the center1 school1 or institution1 in order to reach a large number of students1 by carrying out #a or more of the following activities3 7#a7 ,developing educational content for issues relating to comprehensive sleep and circadian health education that will be incorporated into first-year orientation or core courses4 7#b7 ,creating innovative technology-based approaches to deliver sleep health education to students1 faculty1 and staff4 7#c7 ,developing and employing peer-outreach and education programs to generate discussion1 educate1 and raise awareness among students about issues relating to poor quality sleep1 sleep and circadian disorders1 and the role sleep health plays in other diseases and comorbidities4 7f7 ,report to congress 7#a7 ,in general ,not later than #a year after the date of the enactment of this ,act1 and annually thereafter for a period of #e years1 the ,secretary shall prepare and submit to the appropriate committees of ,congress a report on the activities to provide health professions students with comprehensive sleep and circadian health education funded under this section4 7#b7 ,report elements ,the report described in paragraph 7#a7 shall include information about-- 7,a7 the number of entities that are receiving grant funds2 7,b7 the specific activities supported by grant funds2 7,c7 the number of students served by grant programs2 and 7,d7 the status of program evaluations4 7g7 ,definition of institution of higher education ,in this section1 the term institution of higher education has the meaning given such term in section #aja7;b7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja7;b774 #gie4 ,report on impact of sleep and circadian health disorders in vulnerable and racial_/ethnic populations 7a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall submit to ,congress and the ,president a report on the impact of sleep and circadian health disorders for racial and ethnic minority communities and other vulnerable populations4 7b7 ,contents ,the report under subsection 7a7 shall include information on the-- 7#a7 progress that has been made in reducing the impact of sleep and circadian health disorders in such communities and populations2 7#b7 opportunities that exist to make additional progress in reducing the impact of sleep and circadian health disorders in such communities and populations2 7#c7 challenges that may impede such additional progress2 and 7#d7 ,federal funding necessary to achieve substantial reductions in sleep and circadian health disorders in racial and ethnic minority communities4 ,k ,kidney ,disease ,research1 ,surveillance1 ,prevention1 and ,treatment #gig4 ,kidney disease1 research1 surveillance1 prevention1 and treatment 7a7 ,short title ,this section may be cited as the ,kidney ,disease ,research1 ,surveillance1 ,prevention and ,treatment ,improvement ,act of #bjbj4 7b7 ,findings ,congress makes the following findings3 7#a7 ,kidney diseases impact #cg1jjj1jjj individuals in the ,united ,states4 7#b7 ,african ,americans comprise just #ac percent of the ,united ,states population1 but #cc percent of the ,united ,states dialysis patient population4 ,compared to ,caucasians1 kidney failure prevalence is about #c4g times greater in ,african ,americans1 #a4d times greater in ,native ,americans1 and #a4e times greater in ,asian ,americans4 7#c7 ,peritoneal dialysis and home hemodialysis use is #dj-ej percent lower among ,african ,americans and ,hispanics4 7#d7 ,every racial and ethnic minority group in the ,united ,states is significantly less likely to be treated with home dialysis than ,whites1 and demographic and clinical characteristics are insufficient to explain this differential use4 7#e7 ,african ,americans on dialysis1 irrespective of dialysis modality1 and ,hispanics undergoing ,,pd or in-center ,,hd1 are significantly less likely than their ,white counterparts to receive a kidney transplant4 7#f7 ,african ,americans1 ,hispanics1 and ,asian ,americans are less likely to receive living donor kidney transplants than ,whites4 ,efforts to reduce disparities in live donor kidney transplantation for ,african-,american1 ,hispanic1 and ,asian patients with kidney failure have been unsuccessful4 7#g7 ,medicare and ,medicaid patients are less likely to receive a preemptive transplant from a deceased donor compared to private insurance patients 7#e percent and #aa percent versus #bd percent71 and ,black and ,hispanic patients are less likely to receive a preemptive transplant from a deceased donor compared with ,white patients even after changes to the kidney allocation system 7#e percent of ,black patients and #e percent of ,hispanic patients compared with #ah percent of ,white patients74 7#h7 ,low-income populations are significantly more likely to progress to kidney failure4 7#i7 ,low socioeconomic status is associated with increased incidence of chronic kidney disease1 progression to kidney failure1 inadequate dialysis treatment1 and reduced access to kidney transplantation4 7#aj7 ,the #c goals of ,executive ,order #achgi of ,july #aj1 #bjai 7#hd ,fed4 ,reg4 #cchag2 relating to ,advancing ,american ,kidney ,health71 recognizes the need for more transplants1 better prevention and education1 and improved access to treatment modalities4 #gih4 ,kidney disease research in minority populations 7a7 ,in general ,the ,director of the ,national ,institutes of ,health shall expand1 intensify1 and support ongoing research and other activities with respect to kidney disease in minority populations4 7b7 ,research 7#a7 ,description ,research under subsection 7a7 shall include investigation into-- 7,a7 the causes of kidney disease1 including socioeconomic1 geographic1 clinical1 environmental1 genetic1 and other factors that may contribute to increased rates of kidney disease in minority populations2 and 7,b7 the causes of increased incidence of kidney disease complications in minority populations1 and possible interventions to decrease such incidence4 7#b7 ,inclusion of minority participants ,in conducting and supporting research described in subsection 7a71 the ,director of the ,national ,institutes of ,health shall seek to include minority participants as study subjects in clinical trials4 7c7 ,report2 comprehensive plan 7#a7 ,in general ,the ,secretary of ,health and ,human ,services shall-- 7,a7 prepare and submit to the ,congress1 not later than #f months after the date of enactment of this section1 a report on ,federal research and public health activities with respect to kidney disease in minority populations2 and 7,b7 develop and submit to ,congress1 not later than #a year after the date of enactment of this section1 an effective and comprehensive ,federal plan 7including all appropriate ,federal health programs7 to address kidney disease in minority populations4 7#b7 ,contents ,the report under paragraph 7#a77;,a7 shall at minimum address each of the following3 7,a7 ,research on kidney disease in minority populations1 including such research on-- 7i7 genetic1 behavioral1 and environmental factors2 and 7ii7 prevention and complications among individuals within these populations who have already developed kidney disease4 7,b7 ,surveillance and data collection on kidney disease in minority populations1 including with respect to-- 7i7 efforts to better determine the prevalence of kidney disease among ,asian-,american and ,pacific ,islander subgroups2 and 7ii7 efforts to coordinate data collection on the ,american ,indian population4 7,c7 ,community-based interventions to address kidney disease targeting minority populations1 including-- 7i7 the evidence base for such interventions2 7ii7 the cultural appropriateness of such interventions2 and 7iii7 efforts to educate the public on the causes and consequences of kidney disease4 7,d7 ,education and training programs for health professionals 7including community health workers7 on the prevention and management of kidney disease and its related complications that are supported by the ,health ,resources and ,services ,administration1 including such programs supported by the ,bureau of ,health ,workforce1 the ,bureau of ,primary ,health ,care1 and the ,healthcare ,systems ,bureau4 #gii4 ,kidney disease action plan 7a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention shall conduct1 support1 and expand public health strategies1 prevention1 diagnosis1 surveillance1 and public and professional awareness activities regarding kidney disease4 7b7 ,national action plan 7#a7 ,development ,not later than #b years after the date of the enactment of this ,act1 the ,director of the ,national ,institute of ,diabetes and ,digestive and ,kidney ,diseases1 in consultation with the ,director of the ,centers for ,disease ,control and ,prevention1 shall develop a national action plan to address kidney disease in the ,united ,states with participation from patients1 caregivers1 health professionals1 patient advocacy organizations1 researchers1 providers1 public health professionals1 and other stakeholders4 7#b7 ,contents ,at a minimum1 such plan shall include recommendations for-- 7,a7 public health interventions for the purpose of implementation of the national plan2 7,b7 biomedical1 health services1 and public health research on kidney disease2 and 7,c7 inclusion of kidney disease in the health data collections of all ,federal agencies4 7c7 ,kidney disease prevention programs ,the ,director of the ,national ,institute of ,diabetes and ,digestive and ,kidney ,diseases shall carry out the following3 7#a7 ,conduct public education and awareness activities with patient and professional organizations to stimulate earlier diagnosis and improve patient outcomes from treatment of kidney disease4 ,to the extent known and relevant1 such public education and awareness activities shall reflect differences in kidney disease by cause 7such as hypertension1 diabetes1 and polycystic kidney disease7 and include a focus on outreach to undiagnosed and1 as appropriate1 minority populations4 7#b7 ,supplement and expand upon the activities of the ,national ,institute of ,diabetes and ,digestive and ,kidney ,diseases by making grants to nonprofit organizations1 ,state and local jurisdictions1 and ,indian tribes for the purpose of reducing the burden of kidney disease1 especially in disproportionately impacted communities1 through public health interventions and related activities4 7#c7 ,coordinate with the ,centers for ,disease ,control and ,prevention1 the ,indian ,health ,service1 the ,health ,resources and ,services ,administration1 and the ,department of ,veterans ,affairs to develop pilot programs to demonstrate best practices for the diagnosis and management of kidney disease4 7#d7 ,develop improved techniques and identify best practices1 in coordination with the ,secretary of ,veterans ,affairs1 for assisting kidney disease patients4 7d7 ,data collection ,not later than #ahj days after the date of enactment of this ,act1 the ,director of the ,national ,institute of ,diabetes and ,digestive and ,kidney ,diseases and the ,director of the ,centers for ,disease ,control and ,prevention1 acting jointly1 shall assess the depth and quality of information on kidney disease that is collected in surveys and population studies conducted by the ,centers for ,disease ,control and ,prevention1 including whether there are additional opportunities for information to be collected in the ,national ,health and ,nutrition ,examination ,survey1 the ,national ,health ,interview ,survey1 and the ,behavioral ,risk ,factor ,surveillance ,system surveys4 ,the ,director of the ,national ,institute of ,diabetes and ,digestive and ,kidney ,diseases shall include the results of such assessment in the national action plan under subsection 7b74 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #a1jjj1jjj for fiscal year #bjba1 #a1jjj1jjj for fiscal year #bjbb1 #a1jjj1jjj for fiscal year #bjbc1 #a1jjj1jjj for fiscal year #bjbd1 and #a1jjj1jjj for fiscal year #bjbe4 #gii;,a4 ,home dialysis and increasing end-stage renal disease treatment modalities in minority communities action plan 7a7 ,national action plan 7#a7 ,development ,not later than #b years after the date of the enactment of this ,act1 the ,director of the ,national ,institute of ,diabetes and ,digestive and ,kidney ,diseases1 in consultation with the ,director of the ,centers for ,disease ,control and ,prevention1 shall develop a national action plan to increase the number of home dialyzers and choice in dialysis treatment modality in the ,united ,states with participation from patients1 caregivers1 health professionals1 patient advocacy organizations1 researchers1 providers1 public health professionals1 and other stakeholders in minority communities4 7#b7 ,contents ,at a minimum1 such plan shall include recommendations for-- 7,a7 public health officials for the purpose of implementation of the national plan2 7,b7 biomedical1 health services1 and public health research on home dialysis and modalities in minority communities2 and 7,c7 inclusion of dialysis location and modality in the health data collections of all ,federal agencies4 7b7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #a1jjj1jjj for fiscal year #bjba1 #a1jjj1jjj for fiscal year #bjbb1 #a1jjj1jjj for fiscal year #bjbc1 #a1jjj1jjj for fiscal year #bjbd1 and #a1jjj1jjj for fiscal year #bjbe4 #gii;,b4 ,increasing kidney transplants in minority populations 7a7 ,in general ,the ,director of the ,national ,institutes of ,health shall expand1 intensify1 and support ongoing research and other activities with respect to kidney transplants in minority populations4 7b7 ,research ,research under subsection 7a7 shall include investigation into-- 7#a7 the causes of lower rates of kidney transplants in minority populations1 including socioeconomic1 geographic1 clinical1 environmental1 genetic1 and other factors that may contribute to lower rates of kidney transplants in minority populations2 and 7#b7 possible interventions to increase kidney transplants4 7c7 ,report2 comprehensive plan 7#a7 ,in general ,the ,secretary of ,health and ,human ,services shall-- 7,a7 prepare and submit to the ,congress1 not later than #f months after the date of enactment of this section1 a report on ,federal research and public health activities with respect to kidney transplants as a treatment for end-stage renal disease in minority populations2 and 7,b7 develop and submit to the ,congress1 not later than #a year after the date of enactment of this section1 an effective and comprehensive ,federal plan 7including all appropriate ,federal health programs7 to increase the number of kidney transplants in minority populations4 7#b7 ,contents ,the report under paragraph 7#a77;,a7 shall at a minimum address each of the following3 7,a7 ,research on kidney transplants in minority populations1 including such research on financial1 insurance coverage1 genetic1 behavioral1 and environmental factors4 7,b7 ,surveillance and data collection on kidney transplants in minority populations1 including with respect to-- 7i7 efforts to increase kidney transplants among ,asian-,american and ,pacific ,islander subgroups with end-stage renal disease2 and 7ii7 efforts to increase kidney transplants in the ,american ,indian population4 7,c7 ,community-based efforts to increase kidney transplants targeting minority populations1 including-- 7i7 the evidence base for such increases2 7ii7 the cultural appropriateness of such increases2 and 7iii7 efforts to educate the public on kidney transplants4 7,d7 ,education and training programs for health professionals 7including community health workers7 on the kidney transplants that are supported by the ,health ,resources and ,services ,administration1 including such programs supported by the ,bureau of ,health ,workforce1 the ,bureau of ,primary ,health ,care1 and the ,healthcare ,systems ,bureau4 #gii;,c4 ,environmental and occupational health programs ,the ,director of the ,centers for ,disease ,control and ,prevention shall-- 7#a7 support research into the environmental and occupational causes and biological mechanisms that contribute to kidney disease2 and 7#b7 develop and disseminate public health interventions that will lessen the impact of environmental and occupational causes of kidney disease4 #gii;,d4 ,understanding the treatment patterns associated with providing care and treatment of kidney failure in minority populations 7a7 ,study ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall conduct a study on treatment patterns associated with providing care1 under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 the ,medicaid program under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq471 and through private health insurance1 to minority populations that are disproportionately affected by kidney failure4 7b7 ,report ,not later than #a year after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report on the study conducted under subsection 7a71 together with such recommendations as the ,secretary determines to be appropriate4 #gii;,e4 ,improving access in underserved areas 7a7 ,definition of primary care services ,section #cca7;a77#c77;,d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;d7a77#c77;,d77 is amended by inserting renal dialysis1 after dentistry14 7b7 ,national health service corps scholarship program ,section #cch;,a7a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedl7a77#b77 is amended by inserting 1 which may include nephrology health professionals before the period at the end4 7c7 ,national health service corps loan repayment program ,section #cch;,b7a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedl-#a7;a77#b77 is amended by inserting 1 which may include nephrology health professionals before the period at the end4 ,,viii ,health ,information ,technology #hjj4 ,definitions ,in this title3 7#a7 ,certified electronic health record technology ,the term certified ,,ehr technology has the meaning given such term in section #cjjj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj74 7#b7 ,,ehr ,the term ,,ehr means an electronic health record4 7#c7 ,interoperability ,the term interoperability has the meaning given such term in section #cjjj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj74 ,evaluation and measurement of interoperability shall consider exchange of electronic health information1 usability of exchanged electronic health information1 effective application and use of the exchanged electronic health information1 and impact on outcomes of interoperability4 7#d7 ,access ,the term access1 with respect to health information1 means access described in section #afd4ebd of title #de1 ,code of ,federal ,regulations 7or any successor regulations74 7#e7 ,certified electronic health record technology2 ,,ehr ,the terms certified electronic health record technology and ,,ehr include the health information infrastructure for interoperability1 access1 exchange1 and use of electronic health information required under title ,,xxx of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj et seq471 and are not limited to electronic health records maintained by doctors4 ,a ,reducing ,health ,disparities ,through ,health ,,it #hja4 ,,hrsa assistance to health centers for promotion of ,health ,,it ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall expand and intensify the programs and activities of the ,administration 7directly or through grants or contracts7 to provide technical assistance and resources to health centers 7as defined in section #ccj7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7a777 to adopt and meaningfully use certified ,,ehr technology for the management of chronic diseases and health conditions and reduction of health disparities4 #hjb4 ,assessment of impact of ,health ,,it on racial and ethnic minority communities2 outreach and adoption of ,health ,,it in such communities 7a7 ,national ,coordinator for ,health ,information ,technology 7#a7 ,in general ,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-- 7i7 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 7ii7 have received incentive payments or incentive payment adjustments under ,medicare and ,medicaid ,electronic ,health ,records ,incentive ,programs 7as defined in subsection 7c77#b772 7iii7 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 7iv7 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 and 7,b7 publish the results of such evaluation including the race and ethnicity of such providers and the populations served by such providers4 7#b7 ,certification criterion ,not later than #a year after the date of enactment of this ,act1 the ,national ,coordinator shall-- 7,a7 promulgate a certification criterion and module of certified ,,ehr technology that stratifies quality measures for purposes of the ,merit-,based ,incentive ,payment ,system by disparity characteristics1 including race1 ethnicity1 language1 gender1 gender identity1 sexual orientation1 socio-economic status1 and disability status1 as such characteristics are defined for purposes of certified ,,ehr technology2 and 7,b7 report to the ,centers for ,medicare ,medicaid ,services the quality measures stratified by race and at least #b other disparity characteristics4 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 ,health ,equity and ,accountability ,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 #hjc4 ,nondiscrimination and health equity in health information technology 7a7 ,in general ,covered entities shall ensure that electronic and information technology in their health programs or activities does not exclude individuals from participation in1 deny individuals the benefits of1 or subject individuals to discrimination under any health program or activity on the basis of race1 color1 national origin1 sex1 age1 or disability4 7b7 ,covered entities ,in this section1 the term covered entity means-- 7#a7 an entity that operates a health program or activity1 any part of which receives ,federal financial assistance2 7#b7 an entity established under title ,i of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aad-adh7 that administers a health program or activity2 or 7#c7 the ,department of ,health and ,human ,services4 #hjd4 ,language access in health information technology ,the ,national ,coordinator shall-- 7#a7 not later than #ah months after the date of enactment of this ,act1 propose a rule for providing access to patients1 through certified ,,ehr technology1 to their personal health information in a computable format1 including using patient portals or third-party applications 7as described in section #cjji7;e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ai7;e7771 in the #aj most common non-,english languages2 7#b7 hold a public hearing to identify best practices for carrying out paragraph 7#a72 and 7#c7 not later than #f months after the public hearing under paragraph 7#b71 promulgate a final regulation with respect to paragraph 7#a74 ,b ,modifications ,to ,achieve ,parity in ,existing ,programs #haa4 ,extending funding to strengthen the ,health ,,it infrastructure in racial and ethnic minority communities ,section #cjaa of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ca7 is amended-- 7#a7 in subsection 7a71 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 #hab4 ,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 #hac4 ,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 ,c ,additional ,research and ,studies #hba4 ,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 #hbb4 ,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 #hbc4 ,assessment of use and misuse of de-identified health data 7a7 ,in general ,not later than #ah months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall-- 7#a7 enter into an agreement with the ,office of the ,national ,coordinator to conduct a study1 in consultation with relevant stakeholders1 on the impact of digital health technology on medically underserved areas 7as described in section #hbb7;c772 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 examine the overall prevalence1 and historical and existing practices and their respective prevalence1 of use and misuse of de-identified protected health information1 as defined in section #afj4ajc1 title #de1 ,code of ,federal ,regulations 7or any successor regulations71 to discriminate against or benefit medically underserved areas2 7#b7 identify best practices and tools to leverage the benefits and prevent misuse of de-identified protected health information to discriminate against medically underserved areas2 7#c7 examine the overall prevalence1 and historical and existing practices and their respective prevalence1 of use and misuse of de-identified personal health information other than protected health information1 as defined in section #afj4ajc1 title #de1 ,code of ,federal ,regulations 7or any successor regulations71 to discriminate against or benefit medically underserved areas2 and 7#d7 identify best practices and tools to leverage the benefits and prevent misuse of de-identified personal health information other than protected health information to discriminate against medically underserved areas4 ,d ,closing ,gaps in ,funding ,to ,adopt ,certified ,e,h,rs #hca4 ,extending ,medicaid ,,ehr incentive payments to rehabilitation facilities1 long-term care facilities1 and home health agencies 7a7 ,in general ,section #aijc7t77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7t77#b77;,b77 is amended-- 7#a7 in clause 7i71 by striking 1 or and inserting a semicolon2 7#b7 in clause 7ii71 by striking the period at the end and inserting a semicolon2 and 7#c7 by inserting after clause 7ii7 the following new clauses3 7iii7 a rehabilitation facility 7as defined in section #ahhf7;j77#a77 that furnishes acute or subacute rehabilitation services2 7iv7 a long-term care hospital 7as defined in section #ahhf7;d77#a77;,b77iv772 or 7v7 a home health agency 7as defined in section #ahfa7o774 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply with respect to amounts expended under section #aijc7;a77#c77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#c77;,f77 for calendar quarters beginning on or after the date of the enactment of this ,act4 #hcb4 ,extending physician assistant eligibility for ,medicaid electronic health record incentive payments 7a7 ,in general ,section #aijc7t77#c77;,b77v7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7t77#c77;,b77v77 is amended to read as follows3 7v7 physician assistant4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply with respect to amounts expended under section #aijc7;a77#c77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#c77;,f77 for calendar quarters beginning on or after the date of the enactment of this ,act4 ,,ix ,accountability and ,evaluation #ija4 ,prohibition on discrimination in ,federal assisted health care services and research programs on the basis of sex 7including sex orientation1 gender identity1 and pregnancy1 including termination of pregnancy71 race1 color1 national origin1 marital status1 familial status1 sexual orientation1 gender identity1 or disability status 7a7 ,in general ,no person in the ,united ,states shall1 on the basis of sex 7including sex orientation1 gender identity1 and pregnancy1 including termination of pregnancy71 race1 color1 national origin1 marital status1 familial status1 sexual orientation1 gender identity1 or disability status1 be excluded from participation in1 be denied the benefits of1 or be subjected to discrimination under any health program or activity1 including any health research program or activity1 receiving ,federal financial assistance1 including credits1 subsidies1 or contracts of insurance or any health program or activity that is administered by an executive agency4 7b7 ,definition ,in this section1 the term familial status means1 with respect to one or more individuals-- 7#a7 being domiciled with any individual related by blood or affinity whose close association with the individual is the equivalent of a family relationship2 7#b7 being in the process of securing legal custody of any individual2 or 7#c7 being pregnant4 #ijb4 ,treatment of ,medicare payments under title ,,vi of the ,civil ,rights ,act of #aifd ,a payment to a provider of services1 physician1 or other supplier under part ,b1 ,c1 or ,d of title ,,xviii of the ,social ,security ,act shall be deemed a grant1 and not a contract of insurance or guaranty1 for the purposes of title ,,vi of the ,civil ,rights ,act of #aifd4 #ijc4 ,accountability and transparency within the ,department of ,health and ,human ,services ,title ,,xxxiv of the ,public ,health ,service ,act1 as amended by titles ,i1 ,,ii1 and ,,iii of this ,act1 is further amended by inserting after subtitle ,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 #ijd4 ,united ,states ,commission on ,civil ,rights 7a7 ,coordination within ,department of ,justice of activities regarding ,health disparities ,section #c7;a7 of the ,civil ,rights ,commission ,act of #aihc 7#db ,u4,s4,c4 #aige;a7a77 is amended-- 7#a7 in paragraph 7#a71 by striking and at the end2 7#b7 in paragraph 7#b71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following3 7#c7 shall1 with respect to activities carried out in health care and correctional facilities toward the goal of eliminating health disparities between the general population and members of minority groups based on race or color1 promote coordination of such activities of-- 7,a7 the ,office for ,civil ,rights within the ,office of ,justice ,programs of the ,department of ,justice2 7,b7 the ,office of ,justice ,programs within the ,department of ,justice2 7,c7 the ,office for ,civil ,rights within the ,department of ,health and ,human ,services2 and 7,d7 the ,office of ,minority ,health within the ,department of ,health and ,human ,services 7headed by the ,deputy ,assistant ,secretary for ,minority ,health74 4 7b7 ,authorization of appropriations ,section #e of the ,civil ,rights ,commission ,act of #aihc 7#db ,u4,s4,c4 #aige;c7 is amended by striking the first sentence and inserting the following3 ,for the purpose of carrying out this ,act1 there are authorized to be appropriated #cj1jjj1jjj for fiscal year #bjba1 and such sums as may be necessary for each of the fiscal years #bjbb through #bjbf44 #ije4 ,sense of ,congress concerning full funding of activities to eliminate racial and ethnic health disparities 7a7 ,findings ,congress makes the following findings3 7#a7 ,the health status of the population of the ,united ,states is declining and the ,united ,states currently ranks below most industrialized nations in health status measured by longevity1 sickness1 and mortality4 7#b7 ,racial and ethnic minority populations tend to have the poorest health status and face substantial cultural1 social1 and economic barriers to obtaining quality health care4 7#c7 ,lesbian1 gay1 bisexual1 transgender1 queer1 and questioning populations experience significant personal and structural barriers to obtaining high-quality health care4 7#d7 ,efforts to improve minority health have been limited by inadequate resources 7funding1 staffing1 and stewardship7 and lack of accountability4 7b7 ,sense of ,congress ,it is the sense of ,congress that-- 7#a7 health disparities negatively impact outcomes for health and human security of the ,nation2 7#b7 reducing racial1 ethnic1 sexual1 and gender disparities in prevention and treatment are unique civil and human rights challenges and1 as such1 ,federal agencies and health care entities and systems receiving ,federal funds should be accountable for their role in causing disparities and inequity2 7#c7 funding for the ,national ,institute on ,minority ,health and ,health ,disparities1 the ,office of ,civil ,rights in the ,department of ,health and ,human ,services1 the ,national ,institute of ,nursing ,research1 and the ,office of ,minority ,health should be doubled by fiscal year #bjbb2 7#d7 adequate funding by fiscal year #bjbb1 and subsequent funding increases1 should be provided for health and human service professions training programs1 the ,racial and ,ethnic ,approaches to ,community ,health ,initiative at the ,centers for ,disease ,control and ,prevention1 the ,minority ,,hiv_/,,aids ,initiative1 and the ,excellence ,centers to ,eliminate ,ethnic_/,racial ,disparities ,program at the ,agency for ,healthcare ,research and ,quality2 7#e7 funding should be fully restored to the ,racial and ,ethnic ,approaches to ,community ,health ,initiative at the ,centers for ,disease ,control and ,prevention1 which has been a successful program at the community health level1 and efforts should continue to place a strong emphasis on building community capacity to secure financial resources and technical assistance to eliminate health disparities2 7#f7 adequate funding for fiscal year #bjbb and increased funding for future years should be provided for the ,racial and ,ethnic ,approaches to ,community ,health ,initiative's ,united ,states ,risk ,factor ,survey to ensure adequate data collection to track health disparities1 and there should be appropriate avenues provided to disseminate findings to the general public2 7#g7 current and newly created health disparity elimination incentives1 programs1 agencies1 and departments under this ,act 7and the amendments made by this ,act7 should receive adequate staffing and funding by fiscal year #bjbb2 and 7#h7 stewardship and accountability should be provided to the ,congress and the ,president for measurable and sustainable progress toward health disparity elimination4 #ijf4 ,,gao and ,,nih reports 7a7 ,,gao report on ,,nih grant racial and ethnic diversity 7#a7 ,in general ,the ,comptroller ,general of the ,united ,states shall conduct a study on the racial and ethnic diversity among the following groups3 7,a7 ,all applicants for grants1 contracts1 and cooperative agreements awarded by the ,national ,institutes of ,health during the period beginning on ,january #a1 #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 7b7 ,,nih report on certain authority of ,national ,institute on ,minority ,health and ,health ,disparities ,not later than #f months after the date of the enactment of this ,act1 and biennially thereafter1 the ,director of the ,national ,institutes of ,health1 in collaboration with the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities1 shall submit to ,congress a report that details and evaluates-- 7#a7 the steps taken during the applicable report period by the ,director of the ,national ,institutes of ,health to enforce the expanded planning1 coordination1 review1 and evaluation authority provided the ,national ,institute on ,minority ,health and ,health ,disparities under section #dfdz-#c7;h7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe7;h77 over all minority health and health disparity research that is conducted or supported by the ,institutes and ,centers at the ,national ,institutes of ,health2 and 7#b7 the outcomes of such steps4 7c7 ,,gao report related to recipients of ,,ppaca funding ,not later than one year after the date of the enactment of this ,act and biennially thereafter until #bjbd1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report that identifies-- 7#a7 the racial and ethnic diversity of community-based organizations that applied for ,federal enrollment funding provided pursuant to the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 7including the amendments made by such ,act72 7#b7 the percentage of such organizations that were awarded such funding2 and 7#c7 the impact of such community-based organizations' enrollment efforts on the insurance status of their communities4 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 ,x ,addressing ,social ,determinants and ,improving ,environmental ,justice ,a ,in ,general #ajja4 ,definitions ,in this title3 7#a7 ,determinants of health ,the term determinants of health-- 7,a7 means the range of personal1 social1 economic1 and environmental factors that influence health status2 and 7,b7 includes social determinants of health 7which are sometimes referred to as social and economic determinants of health1 socioeconomic determinants of health1 environmental determinants of health1 social drivers of inequality1 or personal determinants of health74 7#b7 ,environmental determinants of health ,the term environmental determinants of health means the broad physical 7including manmade and natural71 psychological1 social1 spiritual1 cultural1 and aesthetic environment4 7#c7 ,built environment ,the term built environment means the components of the environment1 and the location of these components in a geographically defined space1 that are created or modified by individuals to form the physical and social characteristics of a community or enhance quality of human life1 including-- 7,a7 homes1 schools1 and places of work and worship2 7,b7 parks1 recreation areas1 and greenways2 7,c7 transportation systems2 7,d7 business1 industry1 and agriculture2 and 7,e7 land-use plans1 projects1 and policies that impact the physical or social characteristics of a community1 including access to services and amenities4 7#d7 ,personal determinants of health ,the term personal determinants of health means an individual's behavior1 biology1 and genetics4 7#e7 ,social determinants of health ,the term social determinants of health means a subset of determinants of the health of individuals and environments 7such as communities1 neighborhoods1 and societies7 that describe an individual's or group of people's social identity1 describe the social and economic resources to which such individual or group has access1 and describe the conditions in which an individual or group of people works1 lives1 and plays4 7#f7 ,economic determinants of health ,the term economic determinants of health refers to income and social status4 ,higher income and socioeconomic status are linked to decreased rates of morbidity and mortality1 with higher socioeconomic status correlated with better health and longer life1 and lower socioeconomic status correlated with an increased risk of illness and death4 #ajjb4 ,findings ,congress finds as follows3 7#a7 ,social determinants of health are the greatest predictors of health outcomes4 7#b7 ,social determinants of health1 including health-related behaviors1 social and economic factors1 and physical environment factors account for #hj percent of health outcomes1 whereas clinical care accounts for #bj percent of improved health outcomes4 ,yet1 in #bjag1 public health spending represented only #b4e percent of all health spending in the ,united ,states4 7#c7 ,there are more opportunities to improve health for everyone when we understand that health starts1 first1 not in a medical setting1 but in our families1 in our schools and workplaces1 in our neighborhoods1 in the air we breathe1 and in the water we drink4 7#d7 7,a7 ,healthy ,people #bjbj identifies health and health care quality as a function of not only access to health care1 but also the social determinants of health1 categorized into the following3 neighborhoods and the built environment2 social and community context2 education2 and economic stability4 7,b7 ,the following examples illustrate the nexus between the unequal distribution of the social determinants of health and health disparities3 7i7 ,the built environment influences residents' level of physical activity4 ,neighborhoods with high levels of poverty are significantly less likely to have places where children can be physically active1 such as parks1 green spaces1 and bike paths and lanes4 ,neighborhoods and communities can provide opportunities for physical activity and support active lifestyles through accessible and safe parks and open spaces and through land use policy1 zoning1 and healthy community design4 7ii7 ,emotional and physical health and well-being are directly impacted by perceived levels of safety1 such as unlit streets at night4 ,community members have expressed that safety is not only a barrier to accessing programs and services that increase quality of life but they are also not able to access physical activity in their community through the built environment4 7iii7 ,historical and institutional racism in the ,united ,states has shaped the way in which social and economic resources and exposure to health promoting environments are distributed4 ,income1 education1 occupation1 neighborhood conditions1 schools1 workplaces1 the use of health and social services1 and experiences with the criminal justice system are all highly patterned by race1 with people of color experiencing more that is health harming4 ,finding ways to uncouple the link between race and access to resources and healthy environments is a principal means of reducing health disparities4 ,additionally1 the anticipation of racism itself causes higher psychological and cardiovascular stress levels that are linked to poor health outcomes4 ,remedying discriminatory practices at the individual and systemic levels will likely reduce health disparities caused by this unequal distribution of stress4 7iv7 ,poor health among ,native ,americans has largely been driven by post-colonial oppression and historical trauma4 ,the expropriation of native lands and territories to the ,american state had severe consequences on ,native ,american health4 ,this resulted in the deprivation of traditional food sources--and nutrients--for ,native ,americans and also the destruction of traditional economies and community organization4 ,today1 ,native ,americans have twice the rate of diabetes of non-,hispanic ,whites4 ,recognition of the origins of the diabetes as having a social and community context1 rather than just individual responsibility and genetic predisposition1 will shape better policy to provide food security4 7v7 ,in the context of prisons1 overcrowding has led to the deterioration of the physical and mental health of individuals after they leave prison4 ,in particular1 the mass incarceration of ,african-,american males as a result of unequal contact with and treatment in the criminal justice system has contributed to an overburdening of certain infectious diseases within the ,african-,american community4 ,as a social institution1 incarceration amplifies existing adverse health conditions by concentrating diseases and harmful health behaviors such as tobacco use1 drug use1 and violence4 7vi7 ,educational attainment is the strongest predictor of adult mortality4 ,it is a basic component of socioeconomic status that shapes earning potential to access resources that promote health4 ,people with more education are less likely to report that they are in poor health1 and are also less likely to have diabetes and other chronic diseases4 7vii7 ,individuals with lower levels of educational attainment are much more likely to report to be current smokers4 ,in #bjag1 smoking prevalence was #cf4h percent among adults with a ,,ged diploma1 #bc4a percent with less than a high school diploma1 and #ah4g percent with a high school diploma1 while dropping significantly to #g4a percent among adults with an undergraduate college degree and #d4a percent with a postgraduate college degree4 7viii7 ,income inequality differences account for a large part of health disparities44 ,for example1 children living in poverty experience poorer housing conditions1 increased exposure to indoor allergens and toxins 7such as pesticides1 lead1 mercury1 radon1 air pollution1 and carcinogens71 increased food insecurity1 and more psychological stress4 ,these experiences culminate in worse adult health as compared with children with higher socioeconomic status4 ,specifically1 children living in lower socioeconomic neighborhoods have higher rates of asthma due to higher rates of psychological stress resulting from higher rates of violence4 ,food insecurity is associated with obesity and racial and ethnic minorities have higher rates of food insecurity4 7ix7 ,lesbian1 gay1 bisexual1 transgender1 queer or questioning1 intersex1 and asexual or allied 7referred to in this section as ,,lgbtqia7 individuals face health disparities linked to societal stigma1 discrimination1 and denial of their civil and human rights4 ,discrimination against ,,lgbtqia individuals has been associated with high rates of psychiatric disorders1 substance abuse1 and suicide4 ,experiences of violence and victimization are frequent for ,,lgbtqia individuals1 and have long-lasting effects on the individual and the community4 ,personal1 family1 and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of ,,lgbtqia individuals4 7x7 ,individuals in older and cheaper housing are at higher risks to be exposed to lead1 particularly in housing built prior to #aifj4 ,the threat of lead poisoning disproportionally affects vulnerable populations1 with children living in poverty 7#e4f percent7 and ,black children 7#e4f7 experiencing the highest rates4 ,according to the ,department of ,housing and ,urban ,development1 about #c1fjj1jjj homes nationwide that house young children have lead hazards such as contaminated drinking water1 peeling paint1 contaminated dust1 or toxic soil4 ,the combined cost of medical treatment and special education for lead poisoned children averages about #e1fjj per child per year1 and lead poisoning costs the ,united ,states an estimated #ej1jjj1jjj1jjj annually4 7xi7 ,according to the report ,healthy ,people #bjbj1 individuals with disabilities1 as a group1 experience health disparities in routine public health arenas such as health behaviors1 clinical preventive services1 and chronic conditions4 ,compared with individuals without disabilities1 individuals with disabilities are-- 7,i7 less likely to receive recommended preventive health care services1 such as routine teeth cleanings and cancer screenings2 7,,ii7 at a high risk for poor health outcomes such as obesity1 hypertension1 falls-related injuries1 and mood disorders such as depression2 and 7,,iii7 more likely to engage in unhealthy behaviors that put their health at risk1 such as cigarette smoking and inadequate physical activity4 7#e7 ,laws and regulations that improve opportunities to live in safe neighborhoods with more social cohesion1 attain higher education1 sustain stable employment1 and bridge class differences help foster the health and safety of individuals4 7#f7 ,the global public health community has reached consensus through the ,rio ,political ,declaration of ,social ,determinants of ,health adopted by the ,world ,health ,organization in ,october #bjaa that collaboration in coordinated and intersectoral policy actions has proven to be effective4 ,health in ,all ,policies1 an initiative of the ,american ,public ,health ,association1 together with intersectoral cooperation and action1 is one promising approach to enhance accountability in other sectors of health1 as well as the promotion of health equity and more inclusive and productive societies44 #ajjc4 ,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 decision-making processes2 and 7#c7 build stronger1 healthier communities through the use of ,health ,impact ,assessments4 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 #gdd1 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 ,health ,equity and ,accountability ,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 decision-making 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 disease4 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 emergency2 7,,ii7 the probability that the proposed activity will result in a significant increase in tourism1 economic development1 or employment in the jurisdiction of the eligible entity2 7,,iii7 any other significant potential hazard or enhancement to human health1 as determined by the eligible entity2 or 7,,iv7 whether the evaluation of a proposed activity would duplicate another analysis or study being undertaken in conjunction with the proposed activity4 7,c7 ,factors for consideration ,in evaluating a proposed activity under subparagraph 7,a71 an eligible entity may take into consideration any reasonable1 direct1 indirect1 or cumulative effect that can be clearly related to potential health effects and that is related to the proposed activity1 including the effect of any action that is-- 7i7 included in the long-range plan relating to the proposed activity2 7ii7 likely to be carried out in coordination with the proposed activity2 7iii7 dependent on the occurrence of the proposed activity2 or 7iv7 likely to have a disproportionate impact on high-risk or vulnerable populations4 7#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 ,health ,equity and ,accountability ,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 7#aj7 transportation options2 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 #ajjd4 ,implementation of recommendations by ,environmental ,protection ,agency 7a7 ,inspector general recommendations ,the ,administrator of the ,environmental ,protection ,agency 7referred to in this section as the ,administrator7 shall1 as promptly as practicable1 carry out each of the following recommendations of the ,inspector ,general of the ,environmental ,protection ,agency as described in the report entitled ,,epa ,needs to ,conduct ,environmental ,justice ,reviews of ,its ,programs1 ,policies and ,activities 7,report ,no4 #bjjf-,p-#jjjcd73 7#a7 ,the recommendation that the program and regional offices of the ,environmental ,protection ,agency identify which programs1 policies1 and activities need environmental justice reviews and the ,administrator require those offices to establish a plan to complete the necessary reviews4 7#b7 ,the recommendation that the ,administrator ensure that the reviews described in paragraph 7#a7 determine whether the programs1 policies1 and activities may have a disproportionately high and adverse health or environmental impact on minority and low-income populations4 7#c7 ,the recommendation that each program and regional office of the ,environmental ,protection ,agency develop specific environmental justice review guidance for conducting environmental justice reviews4 7#d7 ,the recommendation that the ,administrator designate a responsible office to compile results of environmental justice reviews and recommend appropriate actions4 7b7 ,,gao recommendations ,in promulgating regulations of the ,environmental ,protection ,agency1 the ,administrator shall1 as promptly as practicable1 carry out each of the following recommendations of the ,comptroller ,general of the ,united ,states as described in the report entitled ,,epa ,should ,devote ,more ,attention to ,environmental ,justice when ,developing ,clean ,air ,rules 7,,gao-#je-bhi73 7#a7 ,the recommendation that the ,administrator ensure that workgroups involved in developing a rule devote attention to environmental justice while drafting and finalizing the rule4 7#b7 ,the recommendation that the ,administrator enhance the ability of the workgroups described in paragraph 7#a7 to identify potential environmental justice issues through steps such as-- 7,a7 providing workgroup members with guidance and training to help those members identify potential environmental justice problems2 and 7,b7 involving environmental justice coordinators in the workgroups if appropriate4 7#c7 ,the recommendation that the ,administrator improve assessments of potential environmental justice impacts in economic reviews by identifying the data and developing the modeling techniques needed to assess those impacts4 7#d7 ,the recommendation that the ,administrator direct appropriate officers and employees of the ,environmental ,protection ,agency1 if feasible1 to respond fully to public comments on environmental justice1 including by-- 7,a7 improving the explanation by the ,administrator of the basis for any conclusions relating to environmental justice2 and 7,b7 including in an explanation under subparagraph 7,a7 supporting data4 7c7 #bjjd ,inspector ,general report 7#a7 ,in general ,the ,administrator shall1 as promptly as practicable1 carry out each of the following recommendations of the ,inspector ,general of the ,environmental ,protection ,agency as described in the report entitled ,,epa ,needs to ,consistently ,implement the ,intent of the ,executive ,order on ,environmental ,justice 7,report ,no4 #bjjd-,p-#jjjjg73 7,a7 ,the recommendation that the ,administrator clearly define the mission of the ,office of ,environmental ,justice and provide ,environmental ,protection ,agency staff with an understanding of the roles and responsibilities of that ,office4 7,b7 ,the recommendation that the ,administrator-- 7i7 establish1 through the issuance of guidance or a policy statement1 specific timeframes for the development of definitions1 goals1 and measurements regarding environmental justice2 and 7ii7 provide the regions and program offices a standard and consistent definition for a minority and low-income community1 with instructions on how the ,environmental ,protection ,agency will implement and put into operation environmental justice in the daily activities of the ,environmental ,protection ,agency4 7,c7 ,the recommendation that the ,administrator ensure that the comprehensive training program that was under development 7as of the date of the report7 includes standard and consistent definitions of the key environmental justice concepts1 such as low-income1 minority1 and disproportionately impacted1 and instructions for implementation of those concepts4 7#b7 ,reports 7,a7 ,initial report ,not later than #ahj days after the date of enactment of this ,act1 the ,administrator shall submit to ,congress an initial report on the strategy of the ,administrator for implementing the recommendations described in subparagraphs 7,a71 7,b71 and 7,c7 of paragraph 7#a74 7,b7 ,subsequent reports ,after submitting the initial report under subparagraph 7,a71 the ,administrator shall submit to ,congress semiannual reports on the progress of the ,administrator in-- 7i7 implementing the recommendations referred to in subparagraph 7,a72 and 7ii7 modifying the emergency management procedures of the ,administrator to incorporate environmental justice in the ,incident ,command ,structure of the ,environmental ,protection ,agency1 in accordance with the ,december #ah1 #bjjf1 letter from the ,deputy ,administrator to the ,acting ,inspector ,general of the ,environmental ,protection ,agency4 7d7 ,federal action plan for saving lives1 protecting people and their families from radon 7#a7 ,findings ,congress finds that radon is a naturally occurring radioactive gas that is-- 7,a7 recognized as the leading cause of lung cancer among nonsmokers2 and 7,b7 a particular environmental threat for low-income and minority individuals because of the lack of information about radon levels in the homes of those individuals4 7#b7 ,implementation ,not later than #ahj days after the date of enactment of this ,act1 the ,administrator shall implement the action plan entitled ,protecting ,people and ,families from ,radon3 ,a ,federal ,action ,plan for ,saving ,lives 7,june #bj1 #bjaa71 in consultation with the ,director of the ,centers for ,disease ,control and ,prevention and any other ,federal agencies referred to in the action plan4 7#c7 ,specific steps ,in carrying out paragraph 7#b71 the ,administrator shall ensure that-- 7,a7 the workgroup comprised of the ,federal agencies participating in the development of the action plan referred to in paragraph 7#b7 implements specific steps within the existing authority and activities of each ,federal agency to reduce exposure to radon2 and 7,b7 not later than the date that is #a year after the date on which the ,administrator begins implementation of the action plan described in paragraph 7#b71 the workgroup described in subparagraph 7,a7 meets to assess and recognize achievements of the plan4 7#d7 ,report ,after the progress meeting of the workgroup under paragraph 7#c77;,b71 the ,administrator shall submit to ,congress a report on the implementation of the action plan described in paragraph 7#b71 including the challenges remaining and the progress in reducing radon exposure1 particularly for low-income and minority families4 7e7 ,federal action plan for preventing childhood lead poisoning 7#a7 ,findings ,congress finds that-- 7,a7 the effects of lead poisoning are irreversible and cost the ,united ,states millions annually in medical and education costs2 7,b7 the cognitive effects suffered by children exposed to lead result in a lifetime of health and behavioral problems1 which makes prevention efforts more critical2 and 7,c7 the risk is especially high for vulnerable minority populations who are more likely to live in older homes1 where lead-based paint is more likely to be present4 7#b7 ,action plan ,not later than #ahj days after the date of enactment of this ,act1 the ,administrator1 in consultation with the ,director of the ,centers for ,disease ,control and ,prevention and other relevant ,federal agencies1 shall develop an action plan to reduce exposure to lead4 7#c7 ,specific steps ,in carrying out paragraph 7#b71 the ,administrator shall-- 7,a7 establish a working group1 comprised of representatives of the ,federal agencies participating in the development of the action plan described in paragraph 7#b71 to make recommendations for the implementation of specific steps within the existing authority and activities of each ,federal agency to reduce exposure to lead2 and 7,b7 assist other ,federal agencies in the development of materials on the hazards of lead-based paint for the purpose of educating tenants and landlords1 how to recognize potential sources of exposure1 and how to remediate those sources4 #ajje4 ,grant program to conduct environmental health improvement activities and to improve social determinants of health 7a7 ,definitions ,in this section3 7#a7 ,director ,the term ,director means the ,director of the ,centers for ,disease ,control and ,prevention1 acting in collaboration with the ,administrator of the ,environmental ,protection ,agency and the ,director of the ,national ,institute of ,environmental ,health ,sciences4 7#b7 ,eligible entity ,the term eligible entity means a ,state or local community that-- 7,a7 bears a disproportionate burden of exposure to environmental health hazards2 7,b7 bears a disproportionate burden of exposure to unhealthy living conditions1 low standard housing conditions1 low socioeconomic status1 poor nutrition1 less opportunity for educational attainment1 disproportionately high unemployment rates1 or lower literacy levels and access to information2 7,c7 has established a coalition-- 7i7 with not less than #a community-based organization or demonstration program2 and 7ii7 with not less than #a-- 7,i7 public health entity2 7,,ii7 health care provider organization2 7,,iii7 academic institution1 including any minority-serving institution 7including a ,hispanic-serving institution1 a historically ,black college or university1 or a ,tribal ,college or ,university72 7,,iv7 child-serving institution2 or 7,v7 landlord or housing provider working on lead remediation2 7,d7 ensures planned activities and funding streams are coordinated to improve community health2 and 7,e7 submits an application in accordance with subsection 7c74 7b7 ,establishment ,the ,director shall establish a grant program under which eligible entities shall receive grants to conduct environmental health improvement activities and to improve social determinants of health4 7c7 ,application ,to receive a grant under this section1 an eligible entity shall submit an application to the ,director at such time1 in such manner1 and accompanied by such information as the ,director may require4 7d7 ,use of grant funds ,an eligible entity may use a grant under this section-- 7#a7 to promote environmental health2 7#b7 to address environmental health disparities among all populations1 including children2 and 7#c7 to address racial and ethnic disparities in social determinants of health4 7e7 ,amount of cooperative agreement ,the ,director shall award grants to eligible entities at the following #c funding levels3 7#a7 ,level #a cooperative agreements 7,a7 ,in general ,an eligible entity awarded a grant under this paragraph shall use the funds to identify environmental health problems and solutions by-- 7i7 establishing a planning and prioritizing council in accordance with subparagraph 7,b72 and 7ii7 conducting an environmental health assessment in accordance with subparagraph 7,c74 7,b7 ,planning and prioritizing council 7i7 ,in general ,a prioritizing and planning council established under subparagraph 7,a77i7 7referred to in this paragraph as a ,,ppc7 shall assist the environmental health assessment process and environmental health promotion activities of the eligible entity4 7ii7 ,membership ,membership of a ,,ppc shall consist of representatives from various organizations within public health1 planning1 development1 and environmental services and shall include stakeholders from vulnerable groups such as children1 the elderly1 disabled1 and minority ethnic groups that are often not actively involved in democratic or decision-making processes4 7iii7 ,duties ,a ,,ppc shall-- 7,i7 identify key stakeholders and engage and coordinate potential partners in the planning process2 7,,ii7 establish a formal advisory group to plan for the establishment of services2 7,,iii7 conduct an in-depth review of the nature and extent of the need for an environmental health assessment1 including a local epidemiological profile1 an evaluation of the service provider capacity of the community1 and a profile of any target populations2 and 7,,iv7 define the components of care and form essential programmatic linkages with related providers in the community4 7,c7 ,environmental health assessment 7i7 ,in general ,a ,,ppc shall carry out an environmental health assessment to identify environmental health concerns4 7ii7 ,assessment process ,the ,,ppc shall-- 7,i7 define the goals of the assessment2 7,,ii7 generate the environmental health issue list2 7,,iii7 analyze issues with a systems framework2 7,,iv7 develop appropriate community environmental health indicators2 7,v7 rank the environmental health issues2 7,,vi7 set priorities for action2 7,,vii7 develop an action plan2 7,,viii7 implement the plan2 and 7,,ix7 evaluate progress and planning for the future4 7,d7 ,evaluation ,each eligible entity that receives a grant under this paragraph shall evaluate1 report1 and disseminate program findings and outcomes4 7,e7 ,technical assistance ,the ,director may provide such technical and other non-financial assistance to eligible entities as the ,director determines to be necessary4 7#b7 ,level #b cooperative agreements 7,a7 ,eligibility 7i7 ,in general ,the ,director shall award grants under this paragraph to eligible entities that have already-- 7,i7 established broad-based collaborative partnerships2 and 7,,ii7 completed environmental assessments4 7ii7 ,no level #a requirement ,to be eligible to receive a grant under this paragraph1 an eligible entity is not required to have successfully completed a ,level #a ,cooperative ,agreement 7as described in paragraph 7#a774 7,b7 ,use of grant funds ,an eligible entity awarded a grant under this paragraph shall use the funds to further activities to carry out environmental health improvement activities1 including-- 7i7 addressing community environmental health priorities in accordance with paragraph 7#a77;,c77ii71 including-- 7,i7 geography2 7,,ii7 the built environment2 7,,iii7 air quality2 7,,iv7 water quality2 7,v7 land use2 7,,vi7 solid waste2 7,,vii7 housing2 7,,viii7 violence2 7,,ix7 socioeconomic status2 7,x7 ethnicity1 social construct and language preference2 7,,xi7 educational attainment2 7,,xii7 employment2 7,,xiii7 food safety1 accessibility1 and affordability2 7,,xiv7 nutrition2 7,,xv7 health care services2 and 7,,xvi7 injuries2 7ii7 building partnerships between planning1 public health1 and other sectors1 including child-serving institutions1 to address how the built environment impacts food availability and access and physical activity to promote healthy behaviors and lifestyles and reduce overweight and obesity1 musculoskeletal diseases1 respiratory conditions1 dental1 oral and mental health conditions1 poverty1 and related co-morbidities2 7iii7 establishing programs to address-- 7,i7 how environmental and social conditions of work and living choices influence physical activity and dietary intake2 or 7,,ii7 how the conditions described in subclause 7,i7 influence the concerns and needs of people who have impaired mobility and use assistance devices1 including wheelchairs1 lower limb prostheses1 and hip1 knee1 and other joint replacements2 and 7iv7 convening intervention and demonstration programs that examine the role of the social environment in connection with the physical and chemical environment in-- 7,i7 determining access to nutritional food2 7,,ii7 improving physical activity to reduce overweight1 obesity1 and co-morbidities and increase quality of life2 and 7,,iii7 location and access to medical facilities4 7#c7 ,level #c cooperative agreements 7,a7 ,in general ,an eligible entity awarded a grant under this paragraph shall use the funds to identify and address racial and ethnic disparities in social determinants of health by creating demonstration programs that assess the feasibility of establishing a federally funded comprehensive program and describe key outcomes that address racial and ethnic disparities in social determinants of health4 7,b7 ,program ,design 7i7 ,evaluation ,no later than #a year after enactment of this ,act1 the ,director shall evaluate the best practices of existing programs from the private1 public1 community based1 and academically supported initiatives focused on reducing disparities in the social determinants of health for racial and ethnic populations4 7ii7 ,demonstration projects ,not later than two years after the date of enactment of this ,act1 the ,director shall implement at least ten demonstration projects including at least one project for each major racial and ethnic minority group1 each of which is unique to the cultural and linguistic needs of each of the following groups3 7,i7 ,native ,americans and ,alaska ,natives4 7,,ii7 ,asian ,americans4 7,,iii7 ,african ,americans_/,blacks4 7,,iv7 ,hispanic_/,latino-,americans4 7,v7 ,native ,hawaiians and ,pacific ,islanders4 7iii7 ,report to ,congress ,no later than #b years after the implementation of the initial demonstration projects1 the ,director shall submit to ,congress a report which includes-- 7,i7 a description of each demonstration project and design2 7,,ii7 an evaluation of the cost-effectiveness of each project's prevention and treatment efforts2 7,,iii7 an evaluation of the cultural and linguistic appropriateness of each project by racial and ethnic group2 and 7,,iv7 an evaluation of the beneficiary's health status improvement under the demonstration project4 7iv7 ,any other information deemed appropriate by the ,director ,the ,director shall require eligible entities awarded a grant under this paragraph to report any other information the ,director determines appropriate to be shared by or developed by such entity1 including the following3 7,i7 ,developing models and evaluating methods that improve the cultural and linguistically appropriate services provided through the ,centers for ,disease ,control and ,prevention to target individuals impacted by health disparities based on their race1 ethnicity1 and gender4 7,,ii7 ,promoting the collaboration between primary and specialty care health care providers and patients1 to ensure patients impacted by health disparities based on race1 ethnicity1 and gender are receiving comprehensive and organized treatment and care4 7,,iii7 ,educating health care professionals on the causes and effects of disparities in the social determinants of health as it relates to minority and racial and ethnic communities and the need for culturally and linguistically appropriate care in the prevention and treatment of high-impact diseases4 7,,iv7 ,encouraging collaboration among community and patient-based organizations which work to address disparities in the social determinants of health as it relates to high-impact diseases in minority and racial and ethnic populations4 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section-- 7#a7 #be1jjj1jjj for fiscal year #bjba2 and 7#b7 such sums as may be necessary for fiscal years #bjbb through #bjbd4 #ajjf4 ,additional research on the relationship between the built environment and the health of community residents 7a7 ,definition of eligible institution ,in this section1 the term eligible institution means a public or private nonprofit institution that submits to the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 and the ,administrator of the ,environmental ,protection ,agency 7in this section referred to as the ,administrator7 an application for a grant under the grant program authorized under subsection 7b77#b7 at such time1 in such manner1 and containing such agreements1 assurances1 and information as the ,secretary and ,administrator may require4 7b7 ,research grant program 7#a7 ,definition of health ,in this section1 the term health includes-- 7,a7 levels of physical activity2 7,b7 degree of mobility due to factors such as musculoskeletal diseases1 arthritis1 and obesity2 7,c7 consumption of nutritional foods2 7,d7 rates of crime2 7,e7 air1 water1 and soil quality2 7,f7 risk of injury2 7,g7 accessibility to health care services2 7,h7 levels of educational attainment2 and 7,i7 other indicators as determined appropriate by the ,secretary4 7#b7 ,grants ,the ,secretary1 in collaboration with the ,administrator1 shall provide grants to eligible institutions to conduct and coordinate research on the built environment and its influence on individual and population-based health4 7#c7 ,research ,the ,secretary shall support research that-- 7,a7 investigates and defines the causal links between all aspects of the built environment and the health of residents2 7,b7 examines-- 7i7 the extent of the impact of the built environment 7including the various characteristics of the built environment7 on the health of residents2 7ii7 the variance in the health of residents by-- 7,i7 location 7such as inner cities1 inner suburbs1 and outer suburbs72 and 7,,ii7 population subgroup 7including children1 the elderly1 the disadvantaged72 or 7iii7 the importance of the built environment to the total health of residents1 which is the primary variable of interest from a public health perspective2 7,c7 is used to develop-- 7i7 measures to address health and the connection of health to the built environment2 and 7ii7 efforts to link the measures to travel and health databases2 7,d7 distinguishes carefully between personal attitudes and choices and external influences on observed behavior to determine how much an observed association between the built environment and the health of residents1 versus the lifestyle preferences of the people that choose to live in the neighborhood1 reflects the physical characteristics of the neighborhood2 and 7,e7 7i7 identifies or develops effective intervention strategies to promote better health among residents with a focus on behavioral interventions and enhancements of the built environment that promote increased use by residents2 and 7ii7 in developing the intervention strategies under clause 7i71 ensures that the intervention strategies will reach out to high-risk populations1 including racial and ethnic minorities1 low-income urban and rural communities1 and children4 7#d7 ,priority ,in providing assistance under the grant program authorized under paragraph 7#b71 the ,secretary and the ,administrator shall give priority to research that incorporates-- 7,a7 minority-serving institutions as grantees2 7,b7 interdisciplinary approaches2 or 7,c7 the expertise of the public health1 physical activity1 nutrition and health care 7including child health71 urban planning1 and transportation research communities in the ,united ,states and abroad4 #ajjg4 ,environment and public health restoration 7a7 ,findings ,congress finds that-- 7#a7 humans share an environment with a wide variety of habitats and ecosystems that nurture and sustain a diversity of species2 7#b7 the abundance of natural resources in the environment forms the basis for the economy and has greatly contributed to human development throughout history2 7#c7 the accelerated pace of human development over the last several hundred years has significantly impacted-- 7,a7 the natural environment and its resources2 7,b7 the health and diversity of plant and animal life2 7,c7 the availability of critical habitats2 7,d7 the quality of the air and water2 and 7,e7 the global climate2 7#d7 the intervention of the ,federal ,government is necessary to minimize and mitigate human impact on the environment-- 7,a7 for the benefit of public health2 7,b7 to maintain air quality and water quality2 7,c7 to sustain the diversity of plants and animals2 7,d7 to combat global climate change2 and 7,e7 to protect the environment2 7#e7 laws and regulations in the ,united ,states have been enacted and promulgated to minimize and mitigate human impact on the environment for the benefit of public health1 to maintain air quality and water quality1 to sustain wildlife1 and to protect the environment2 and 7#f7 attempts to repeal or weaken key environmental safeguards pose dangers to the public health1 air quality1 water quality1 wildlife1 and the environment4 7b7 ,statement of policy ,it is the policy of the ,federal ,government to work in conjunction with ,states1 territories1 ,tribal governments1 international organizations1 and foreign governments as a steward of the environment for the benefit of public health1 to maintain air quality and water quality1 to sustain the diversity of plant and animal species1 to combat global climate change1 and to protect the environment for future generations4 7c7 ,study and report on public health or environmental impact of revised rules1 regulations1 laws1 or other agency decisions 7#a7 ,study ,not later than #cj days after the date of enactment of this ,act1 the ,president shall seek to enter into an arrangement under which the ,national ,academy of ,sciences shall conduct a study to determine the impact on public health1 air quality1 water quality1 wildlife1 and the environment of the following regulations1 laws1 and other agency decisions3 7,a7 ,clean water 7i7 ,the final rule of the ,environmental ,protection ,agency and the ,corps of ,engineers entitled ,final ,revisions to the ,clean ,water ,act ,regulatory ,definitions of ,fill ,material and ,discharge of ,fill ,material 7#fg ,fed4 ,reg4 #caabi 7,may #i1 #bjjb774 7ii7 ,the final rule of the ,environmental ,protection ,agency entitled ,national ,pollutant ,discharge ,elimination ,system ,permit ,regulation for ,concentrated ,animal ,feeding ,operations3 ,removal of ,vacated ,elements in ,response to #bjaa ,court ,decision 7#gg ,fed4 ,reg4 #dddid 7,july #cj1 #bjab774 7iii7 ,the final rule entitled ,withdrawal of ,revisions to the ,water ,quality ,planning and ,management ,regulation and ,revisions to the ,national ,pollutant ,discharge ,elimination ,system ,program in ,support of ,revisions to the ,water ,quality ,planning and ,management ,regulation 7#fh ,fed4 ,reg4 #acfjh 7,march #ai1 #bjjc774 7iv7 ,the final rule of the ,environmental ,protection ,agency entitled ,consolidated ,permit ,regulations3 ,,rcra ,hazardous ,waste2 ,,sdwa ,underground ,injection ,control2 ,,cwa ,national ,pollutant ,discharge ,elimination ,system2 ,,cwa ,section #djd ,dredge or ,fill ,programs2 and ,,caa ,prevention of ,significant ,deterioration 7#de ,fed4 ,reg4 #ccbij 7,may #ai1 #aihj771 with respect to the definition of the waters of the ,united ,states4 7v7 ,the final rule of the ,corps of ,engineers and the ,environmental ,protection ,agency entitled ,definition of ,waters of the ,united ,states--,recodification of ,pre-,existing ,rules 7#hd ,fed4 ,reg4 #effbf 7,october #bb1 #bjai774 7vi7 ,the final rule of the ,corps of ,engineers and the ,environmental ,protection ,agency entitled ,the ,navigable ,waters ,protection ,rule3 ,definition of ,waters of the ,united ,states 7#he ,fed4 ,reg4 #bbbej 7,april #ba1 #bjbj774 7,b7 ,forests and land management 7i7 ,the ,healthy ,forests ,restoration ,act of #bjjc 7#af ,u4,s4,c4 #feja et seq474 7ii7 ,the application of section #eec7;e7 of title #e1 ,united ,states ,code1 such that a ,state may petition for a special rule for the ,national ,forest ,system inventoried roadless areas within the ,state4 7iii7 ,the final rules entitled ,national ,forest ,system ,land ,management ,planning 7#gg ,fed4 ,reg4 #baafb 7,april #i1 #bjab77 and ,national ,forest ,system ,land ,management ,planning 7#ha ,fed4 ,reg4 #ijgbc 7,december #ae1 #bjaf774 7iv7 ,the final rule entitled ,oil ,shale ,management--,general 7#gc ,fed4 ,reg4 #fidad 7,november #ah1 #bjjh774 7v7 ,the record of decision described in the notice of availability entitled ,notice of ,availability of ,approved ,land ,use ,plan ,amendments_/,record of ,decision for ,allocation of ,oil ,shale and ,tar ,sands ,resources on ,lands ,administered by the ,bureau of ,land ,management in ,colorado1 ,utah1 and ,wyoming and ,final ,programmatic ,environmental ,impact ,statement 7#gh ,fed4 ,reg4 #aieah 7,april #a1 #bjac774 7,c7 ,scientific review ,the final rule entitled ,interagency ,cooperation ,under the ,endangered ,species ,act 7#gc ,fed4 ,reg4 #gfbgb 7,december #af1 #bjjh771 as amended by the final rule entitled ,endangered and ,threatened ,wildlife and ,plants2 ,regulations for ,interagency ,cooperation 7#hd ,fed4 ,reg4 #ddigf 7,august #bg1 #bjai774 7#b7 ,method ,in conducting the study under paragraph 7#a71 the ,national ,academy of ,sciences may use and compare existing scientific studies regarding the regulations1 laws1 and other agency decisions described in paragraph 7#a74 7#c7 ,report ,not later than #bgj days after the date on which the ,president enters into the arrangement under paragraph 7#a71 the ,national ,academy of ,sciences shall make publicly available and shall submit to ,congress and to the head of each department and agency of the ,federal ,government that issued1 implements1 or would implement a regulation1 law1 or other agency decision described in paragraph 7#a71 a report that includes-- 7,a7 a description of the impact of each regulation1 law1 or other agency decision described in paragraph 7#a7 on public health1 air quality1 water quality1 wildlife1 and the environment1 compared to the impact of preexisting regulations1 laws1 or other agency decisions in effect1 as applicable1 including-- 7i7 any negative impacts to air quality or water quality2 7ii7 any negative impacts to wildlife2 7iii7 any delays in hazardous waste cleanup that are projected to be hazardous to public health2 and 7iv7 any other negative impact on public health or the environment2 and 7,b7 any recommendations that the ,national ,academy of ,sciences considers appropriate to maintain1 restore1 or improve in whole or in part protections for public health1 air quality1 water quality1 wildlife1 and the environment for each of the regulations1 laws1 and other agency decisions described in paragraph 7#a71 which may include recommendations for the adoption of any regulation or law in place or proposed prior to ,january #a1 #bjja4 7d7 ,department and agency revision of existing rules1 regulations1 or laws ,not later than #ahj days after the date on which the report is submitted pursuant to subsection 7c77#c71 the head of each department or agency that has issued or implemented a regulation1 law1 or other agency decision described in subsection 7c77#a7 shall submit to ,congress a plan describing the steps the department or agency will take1 or has taken1 to restore or improve protections for public health and the environment in whole or in part that were in existence prior to the issuance of the applicable regulation1 law1 or other agency decision4 #ajjh4 ,,gao report on health effects of ,deepwater ,horizon oil rig explosion in the ,gulf ,coast 7a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study on the type and scope of health care services administered through the ,department of ,health and ,human ,services addressing the provision of health care to racial and ethnic minorities1 including residents1 cleanup workers1 and volunteers1 affected by the blowout and explosion of the mobile offshore drilling unit ,deepwater ,horizon that occurred on ,april #bj1 #bjaj1 and resulting hydrocarbon releases into the environment4 7b7 ,specific components ,in carrying out subsection 7a71 the ,comptroller ,general of the ,united ,states shall-- 7#a7 assess the type1 size1 and scope of programs administered by the ,secretary of ,health and ,human ,services that focus on the provision of health care to communities on the ,gulf ,coast2 7#b7 identify the merits and disadvantages associated with each of the programs2 7#c7 perform an analysis of the costs and benefits of the programs2 and 7#d7 determine whether there is any duplication of programs4 7c7 ,report ,not later than #ahj days after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report that includes-- 7#a7 the findings of the study conducted under subsection 7a72 and 7#b7 recommendations for improving access to health care for racial and ethnic minorities4 #ajji4 ,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 outcomes 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 section 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 section as the ,secretary71 in coordination with the ,administrator of the ,centers for ,medicare ,medicaid ,services 7referred to in this section as the ,administrator71 shall establish an interagency council1 to be known as the ,social ,determinants ,accelerator ,interagency ,council 7referred to in this section as the ,council7 to achieve the purposes listed in subsection 7b77#b74 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 #c 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 ,federal ,government-wide 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 section 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 subsection1 for the development of social determinants accelerator plans1 as described in this subsection4 7#b7 ,eligible applicant ,an eligible applicant described in this subsection 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 subsection4 7#d7 ,application ,an eligible applicant seeking a grant under this subsection 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 section4 7#e7 ,use of funds ,a recipient of a grant under this subsection 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 subsection 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 section #be1jjj1jjj to remain available for obligation until the date that is #e years after the date of enactment of this section4 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 subsection 7d7 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 section 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 #ajaj4 ,correcting hurtful and alienating names in government expression 7,,change7 7a7 ,short title ,this section may be cited as the ,correcting ,hurtful and ,alienating ,names in ,government ,expression 7,,change7 ,act4 7b7 ,definitions ,in this section3 7#a7 ,employee ,the term employee has the meaning given the term in section #baje of title #e1 ,united ,states ,code4 7#b7 ,executive agency ,the term ,executive agency has the meaning given the term in section #aje of title #e1 ,united ,states ,code4 7#c7 ,officer ,the term officer has the meaning given the term in section #bajd of title #e1 ,united ,states ,code4 7#d7 ,prohibited term ,the term prohibited term means-- 7,a7 the term alien1 when used to refer to an individual who is not a citizen or national of the ,united ,states2 and 7,b7 the term illegal alien1 when used to refer to an individual who-- 7i7 is unlawfully present in the ,united ,states2 or 7ii7 lacks a lawful immigration status in the ,united ,states4 7c7 ,modernization of language referring to individuals who are not citizens or nationals of the ,united ,states 7#a7 ,in general ,except as provided in paragraph 7#b71 on and after the date of enactment of this ,act1 an ,executive agency may not use a prohibited term in any proposed or final rule1 regulation1 interpretation1 publication1 other document1 display1 or sign issued by the ,executive agency4 7#b7 ,exception ,an ,executive agency may use a prohibited term under paragraph 7#a7 if the ,executive agency uses the prohibited term while quoting or reproducing text written by a source that is not an officer or employee of the ,executive agency4 7d7 ,uniform definition 7#a7 ,in general ,chapter #a of title #a1 ,united ,states ,code1 is amended by adding at the end the following3 #i4 ,definition of foreign national ,in determining the meaning of any ,act of ,congress or any ruling1 regulation1 or interpretation of an administrative bureau or agency of the ,united ,states1 the term foreign national means any individual that is not an individual who-- 7#a7 is a citizen of the ,united ,states2 or 7#b7 though not a citizen of the ,united ,states1 owes permanent allegiance to the ,united ,states4 4 7#b7 ,technical amendment ,the table of sections for chapter #a of title #a1 ,united ,states ,code1 is amended by adding at the end the following3 #i4 ,definition of foreign national4 4 7e7 ,references 7#a7 ,in general ,any reference in any ,federal statute1 rule1 regulation1 ,executive order1 publication1 or other document of the ,united ,states-- 7,a7 to the term alien1 when used to refer to an individual who is not a citizen or national of the ,united ,states1 is deemed to refer to the term foreign national2 and 7,b7 to the term illegal alien is deemed to refer to the term undocumented foreign national1 when used to refer to an individual who-- 7i7 is unlawfully present in the ,united ,states2 or 7ii7 lacks a lawful immigration status in the ,united ,states4 7#b7 ,conforming amendments 7,a7 ,section #dba7e77;,a77ii77,,ii7 of the ,congressional ,budget and ,impoundment ,control ,act of #aigd 7#b ,u4,s4,c4 #feh7e77;,a77ii77,,ii77 is amended-- 7i7 by striking illegal1 deportable1 and excludable aliens and inserting undocumented foreign nationals and deportable and excludable foreign nationals2 and 7ii7 by striking illegal aliens each place it appears and inserting undocumented foreign nationals4 7,b7 ,section #dcb7;e7 of the ,homeland ,security ,act of #bjjb 7#f ,u4,s4,c4 #bdj7;e77 is amended by striking illegal alien and inserting undocumented foreign national4 7,c7 ,section #dci of the ,antiterrorism and ,effective ,death ,penalty ,act of #aiif 7#h ,u4,s4,c4 #abeb;c7 is amended in the section heading by striking illegal aliens and inserting undocumented foreign nationals4 7,d7 ,section #bhj7;b77#c77;,a77iii7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #accj7;b77#c77;,a77iii77 is amended by striking illegal aliens and inserting undocumented foreign nationals4 7,e7 ,section #bhf7r77#c77;ii7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #acef7r77#c77;ii77 is amended by striking illegal aliens and inserting undocumented foreign nationals4 7,f7 ,title ,v of the ,immigration ,reform and ,control ,act of #aihf 7,public ,law #ii-fjc2 #ajj ,stat4 #cddc7 is amended-- 7i7 in the title heading1 by striking illegal aliens and inserting undocumented foreign nationals2 and 7ii7 in section #eja 7#h ,u4,s4,c4 #acfe7-- 7,i7 in the section heading1 by striking illegal aliens and inserting undocumented foreign nationals2 7,,ii7 in subsection 7b71 in the subsection heading1 by striking ,illegal aliens and inserting ,undocumented foreign nationals2 and 7,,iii7 by striking illegal alien each place such term appears and inserting undocumented foreign national4 7,g7 ,section #ccb of the ,omnibus ,consolidated ,appropriations ,act1 #aiig 7#h ,u4,s4,c4 #acff7 is amended by striking illegal aliens each place it appears and inserting undocumented foreign nationals4 7,h7 ,section #daa7;d7 of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afba7;d77 is amended in the subsection heading by striking illegal aliens and inserting undocumented foreign nationals4 7,i7 ,section #djabe7;a77#b7 of title #di1 ,united ,states ,code1 is amended by striking illegal aliens and inserting undocumented foreign nationals4 ,b ,gun ,violence #ajaa4 ,findings ,congress finds as follows3 7#a7 ,on average1 #hf ,americans are killed by guns each day4 7#b7 ,an estimated #ci1ggc people were killed by guns in #bjag1 of which two-thirds committed suicide4 7#c7 ,gun violence disproportionately affects communities of color1 especially ,african ,americans 7who comprise around #ad percent of the ,united ,states population but account for more than half the country's gun homicide victims74 7#d7 ,on average1 there is more than one mass shooting each day in the ,united ,states4 #ajab4 ,reaffirming research authority of the ,centers for ,disease ,control and ,prevention 7a7 ,in general ,section #cia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;b7 is amended-- 7#a7 in subsection 7a77#a71 by striking research relating to the causes1 mechanisms1 prevention1 diagnosis1 treatment of injuries1 and rehabilitation from injuries2 and inserting the following3 research1 including data collection1 relating to-- 7,a7 the causes1 mechanisms1 prevention1 diagnosis1 and treatment of injuries1 including with respect to gun violence2 and 7,b7 rehabilitation from such injuries2 2 and 7#b7 by adding at the end the following new subsection3 7c7 ,no advocacy or promotion of gun control ,nothing in this section shall be construed to-- 7#a7 authorize the ,secretary to give assistance1 make grants1 or enter into cooperative agreements or contracts for the purpose of advocating or promoting gun control2 or 7#b7 permit a recipient of any assistance1 grant1 cooperative agreement1 or contract under this section to use such assistance1 grant1 agreement1 or contract for the purpose of advocating or promoting gun control4 4 #ajac4 ,national ,violent ,death ,reporting ,system ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall improve1 particularly through the inclusion of additional ,states1 the ,national ,violent ,death ,reporting ,system1 as authorized by sections #cja7;a7 and #cia7;a7 of the ,public ,service ,health ,act 7#db ,u4,s4,c4 #bda7;a71 #bhj7;b774 ,participation in the system by the ,states shall be voluntary4 #ajad4 ,report on effects of gun violence on public health ,not later than one year after the date of the enactment of this ,act1 and annually thereafter1 the ,surgeon ,general shall submit to ,congress a report on the effects on public health1 including mental health1 of gun violence in the ,united ,states during the preceding year1 and the status of actions taken to address such effects4 #ajae4 ,report on effects of gun violence on mental health in minority communities ,not later than one year after the date of the enactment of this ,act1 the ,deputy ,assistant ,secretary for ,minority ,health in the ,office of the ,secretary of ,health and ,human ,services shall submit to the ,congress a report on the effects of gun violence on public health1 including mental health1 in minority communities in the ,united ,states1 and the status of actions taken to address such effects4