,,ii #aaf? ,,congress #b;d ,session ,s4 #dhai ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,octob] #bj 7legislative day1 ,octob] #ai71 #bjbj,ms4 ,hirono 7= h]self1 ,mrs4 ,gillibr&1 ,mr4 ,m]kley1 ,ms4 ,duckwor?1 ,mr4 ,blum5?al1 ,mr4 ,s&]s1 ,mr4 ,book]1 ,mr4 ,c>d91 & ,mr4 ,ka9e7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to improve ! heal? ( m9ority individuals1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,heal? ,equity & ,acc\ntability ,act ( #bjbj4 #b4 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title4,sec4 #b4 ,table ( cont5ts4,sec4 #c4 ,f9d+s4,,title ,i--,data collection & reporting,sec4 #aja4 ,am5dm5t to ! ,public ,heal? ,s]vice ,act4,sec4 #ajb4 ,elim9ation ( pr]equisite ( direct appropriations = data collection & analysis4,sec4 #ajc4 ,collection ( data = ! ,m$ic>e program4,sec4 #ajd4 ,revision ( ,,hipaa claims /&>ds4,sec4 #aje4 ,national ,c5t] = ,heal? ,/ati/ics4,sec4 #ajf4 ,disp>ities data collect$ by ! ,f$]al ,gov]nm5t4,sec4 #ajg4 ,data collection & analysis grants to m9ority-s]v+ in/itutions4,sec4 #ajh4 ,/&>ds = measur+ sexual ori5tation1 g5d] id5tity1 & socioeconomic /atus 9 collection ( heal? data4,sec4 #aji4 ,safety & effectiv5ess ( drugs ) respect to racial & e?nic backgr\nd4,sec4 #aaj4 ,improv+ heal? data reg>d+ ,native ,hawaiians & o!r ,pacific ,isl&]s4,sec4 #aaa4 ,cl>ification ( simplifi$ adm9i/rative report+ requirem5t4,,title ,,ii--,culturally & l+ui/ically appropriate heal? & heal? care,sec4 #bja4 ,def9itions2 f9d+s4,sec4 #bjb4 ,improv+ access to s]vices = individuals ) limit$ ,engli% pr(ici5cy4,sec4 #bjc4 ,ensur+ /&>ds = culturally & l+ui/ically appropriate s]vices 9 heal? c>e4,sec4 #bjd4 ,culturally & l+ui/ically appropriate heal? c>e 9 ! ,public ,heal? ,s]vice ,act4,sec4 #bje4 ,pilot program = improvem5t & developm5t ( ,/ate m$ical int]pret+ s]vices4,sec4 #bjf4 ,tra9+ tomorr['s doctors = culturally & l+ui/ically appropriate c>e3 graduate m$ical education4,sec4 #bjg4 ,f$]al reimbursem5t = culturally & l+ui/ically appropriate s]vices "u ! ,m$ic>e1 ,m$icaid1 & ,/ate ,*ildr5's ,heal? ,insurance ,programs4,sec4 #bjh4 ,increas+ und]/&+ ( & improv+ heal? lit]acy4,sec4 #bji4 ,requirem5ts = heal? programs or activities receiv+ ,f$]al funds4,sec4 #baj4 ,report on ,f$]al ef=ts to provide culturally & l+ui/ically appropriate heal? c>e s]vices4,sec4 #baa4 ,engli% = speak]s ( o!r languages4,sec4 #bab4 ,implem5tation4,sec4 #bac4 ,language access s]vices4,sec4 #bad4 ,m$ically und]s]v$ populations4,,title ,,iii--,heal? work=ce diversity,sec4 #cja4 ,am5dm5t to ! ,public ,heal? ,s]vice ,act4,sec4 #cjb4 ,hispanic-s]v+ in/itutions1 hi/orically black colleges & univ]sities1 ,asian ,am]ican & ,native ,am]ican ,pacific ,isl&]-s]v+ in/itutions1 ,tribal colleges1 regional community-bas$ organizations1 & national m9ority m$ical associations4,sec4 #cjc4 ,loan repaym5t program ( ,c5t]s = ,disease ,control & ,prev5tion4,sec4 #cjd4 ,coop]ative agreem5ts = onl9e degree programs at s*ools ( public heal? & s*ools ( alli$ heal?4,sec4 #cje4 ,s5se ( ,congress on ! mission ( ! ,national ,heal? ,c>e ,work=ce ,commission4,sec4 #cjf4 ,s*ol>%ip & fell[%ip programs4,sec4 #cjg4 ,mc,nair ,po/baccalaureate ,a*ievem5t ,program4,sec4 #cjh4 ,rules = det]m9ation ( full-"t equival5t resid5ts = co/-report+ p]iods4,sec4 #cji4 ,develop+ & implem5t+ /rategies = local heal? equity4,sec4 #caj4 ,loan =giv5ess = m5tal & behavioral heal? social work]s4,sec4 #caa4 ,heal? ,pr(essions ,work=ce ,fund4,sec4 #cab4 ,f9d+s2 s5se ( ,congress relat+ to graduate m$ical education4,sec4 #cac4 ,c>e] support = skill$1 int]nationally educat$ heal? pr(essionals4,sec4 #cad4 ,/udy & report on /rategies = increas+ div]sity4,sec4 #cae4 ,conrad ,/ate #cj program2 physician ret5tion4,,title ,,iv--,improv+ ,heal? ,c>e ,access & ,quality,subtitle ,a--,improvem5t ( ,coverage,sec4 #dja4 ,repeal ( requirem5t = docum5tation evid5c+ citiz5%ip or nationality "u ! ,m$icaid program4,sec4 #djb4 ,remov+ citiz5%ip & immigration b>ri]s to access to af=dable heal? c>e "u ,,aca4,sec4 #djc4 ,/udy on ! un9sur$4,sec4 #djd4 ,m$icaid 9 ! t]ritories4,sec4 #dje4 ,ext5sion ( ,m$ic>e second>y pay]4,sec4 #djf4 ,indian def9$ 9 title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act4,sec4 #djg4 ,remov+ ,m$ic>e b>ri] to heal? c>e4,sec4 #djh4 #ajj p]c5t ,,fmap = m$ical assi/ance provid$ by urban ,indian heal? c5t]s4,sec4 #dji4 #ajj p]c5t ,,fmap = m$ical assi/ance provid$ to a ,native ,hawaiian ?r\gh a f$]ally qualifi$ heal? c5t] or a ,native ,hawaiian heal? c>e sy/em "u ! ,m$icaid program4,sec4 #daj4 ,m$icaid cov]age = citiz5s ( freely associat$ /ates4,subtitle ,b--,expansion ( ,access ,sec4 #dab4 ,am5dm5t to ! ,public ,heal? ,s]vice ,act4,sec4 #dac4 ,protect+ s5sitive locations4,sec4 #dad4 ,grants = racial & e?nic approa*es to community heal?4,sec4 #dae4 ,bord] heal? grants4,sec4 #daf4 ,critical access hospital improvem5ts4,sec4 #dag4 ,e/abli%m5t ( ,rural ,community ,hospital 7,,r*7 ,program4,sec4 #dah4 ,m$ic>e remote monitor+ pilot projects4,sec4 #dai4 ,rural ,heal? ,quality ,advisory ,commission & demon/ration projects4,sec4 #dbj4 ,rural heal? c>e s]vices4,sec4 #dba4 ,community heal? c5t] collaborative access expansion4,sec4 #dbb4 ,facilitat+ ! provision ( teleheal? s]vices across ,/ate l9es4,sec4 #dbc4 ,scor+ ( prev5tive heal? sav+s4,sec4 #dbd4 ,s5se ( ,congress on ,ma9t5ance ( ,ef=t ,provisions ,reg>d+ ,*ildr5's ,heal?4,sec4 #dbe4 ,protection ( ! ,,hhs ,(fices ( ,m9ority ,heal?4,sec4 #dbf4 ,(fice ( ,m9ority ,heal? 9 ,vet]ans ,heal? ,adm9i/ration ( ,dep>tm5t ( ,vet]ans ,affairs4,sec4 #dbg4 ,/udy ( ,,d% paym5ts to ensure hospital access = l[-income pati5ts4,sec4 #dbh4 ,assi/ant ,secret>y ( ! ,indian ,heal? ,s]vice4,sec4 #dbi4 ,reau?orization ( ! ,native ,hawaiian ,heal? ,c>e ,improvem5t ,act4,sec4 #dcj4 ,availability ( non-,engli% language speak+ provid]s4,sec4 #dca4 ,access to ess5tial community provid]s4,sec4 #dcb4 ,provid] network adequacy 9 communities ( color4,sec4 #dcc4 ,improv+ access to d5tal c>e4,sec4 #dcd4 ,provid+ = a special enrollm5t p]iod = pregnant individuals4,sec4 #dce4 ,cov]age ( mat]nity c>e = dep5d5t *ildr54,sec4 #dcf4 ,f$]al ,employee ,heal? ,b5efit ,plans4,sec4 #dcg4 ,cont9uation ( ,m$icaid income eligibility /&>d = pregnant individuals & infants4,subtitle ,c--,advanc+ ,heal? ,equity ,?r\gh ,paym5t & ,deliv]y ,re=m ,sec4 #dda4 ,s5se ( ,congress4,sec4 #ddb4 ,c5t]s = ,m$ic>e ,m$icaid ,s]vices report+ & value bas$ programs4,sec4 #ddc4 ,developm5t & te/+ ( disp>ity r$uc+ deliv]y & paym5t models4,sec4 #ddd4 ,div]sity 9 ,c5t]s = ,m$ic>e & ,m$icaid consultation4,sec4 #dde4 ,support+ safety net & community-bas$ provid]s to compete 9 value-bas$ paym5t sy/ems4,subtitle ,d--,heal? ,emp[]m5t ,zones ,sec4 #dea4 ,%ort title4,sec4 #deb4 ,f9d+s4,sec4 #dec4 ,designation ( heal? emp[]m5t zones4,sec4 #ded4 ,assi/ance to ^? seek+ designation4,sec4 #dee4 ,b5efits ( designation4,sec4 #def4 ,def9ition ( ,secret>y4,sec4 #deg4 ,au?orization ( appropriations4,,title ,v--,,improv+ ,,heal? ,,outcomes ,,= ,,wom51 ,,*ildr51 ,,& ,f,a,m,i,l,i,e,s,subtitle ,a--,9 ,general,sec4 #eja4 ,grants to promote heal? = und]s]v$ communities4,sec4 #ejb4 ,remov+ b>ri]s to heal? c>e & nutrition assi/ance = *ildr51 pregnant p]sons1 & lawfully pres5t individuals4,sec4 #ejc4 ,repeal ( d5ial ( ,,snap b5efits4,sec4 #ejd4 ,bir? defects prev5tion1 risk r$uction1 & aw>5ess4,sec4 #eje4 ,,momma's ,act4,sec4 #ejf4 ,rural mat]nal & ob/etric mod]nization ( s]vices4,sec4 #ejg4 ,decreas+ ! risk factors = sudd5 unexpect$ infant dea? & sudd5 unexpla9$ dea? 9 *ildhood4,sec4 #ejh4 ,r$uc+ un9t5d$ te5age pregnancies4,sec4 #eji4 ,ge/ational diabetes4,sec4 #eaj4 ,em]g5cy contraception education & in=mation programs4,sec4 #eaa4 ,compreh5sive sex education programs4,sec4 #eab4 ,compassionate assi/ance = rape em]g5cies4,sec4 #eac4 ,access to bir? control duties ( ph>macies to ensure provision ( ,,fda-approv$ contraception4,sec4 #ead4 ,additional focus area = ! ,(fice on ,wom5's ,heal?4,sec4 #eae4 ,int]ag5cy ,coord9at+ ,committee on ! ,promotion ( ,optimal ,mat]nity ,outcomes4,sec4 #eaf4 ,consum] education campaign4,sec4 #eag4 ,bibliographic database ( sy/ematic reviews = c>e ( *ildbe>+ individuals & newborns4,sec4 #eah4 ,expansion ( ,,cdc ,prev5tion ,rese>* ,c5t]s ,program to include ,c5t]s on ,optimal ,mat]nity ,outcomes4,sec4 #eai4 ,exp&+ models all[$ to be te/$ by ,c5t] = ,m$ic>e ,m$icaid ,innovation to include mat]nity c>e models4,sec4 #ebj4 ,developm5t ( int]pr(essional mat]nity c>e educational models & tools4,sec4 #eba4 ,includ+ s]vices furni%$ by c]ta9 /ud5ts1 int]ns1 & resid5ts sup]vis$ by c]tifi$ nurse midwives )9 inpati5t hospital s]vices "u ,m$ic>e4,sec4 #ebb4 ,grants to pr(essional organizations to increase div]sity 9 mat]nal1 reproductive1 & sexual heal? pr(essionals4,sec4 #ebc4 ,int]ag5cy update to ! quality family plann+ guidel9es4,sec4 #ebd4 ,dissem9ation ( ! quality family plann+ guidel9es4,subtitle ,b--,pregnancy ,screening,sec4 #eca4 ,pregnancy int5tion scre5+ initiative demon/ration program4,,title ,,vi--,m5tal health,sec4 #fja4 ,m5tal heal? f9d+s4,sec4 #fjb4 ,cov]age ( m>riage & family !rapi/ s]vices1 m5tal heal? c\nselor s]vices1 sub/ance abuse c\nselor s]vices1 & pe] support speciali/ s]vices "u "p ,b ( ! ,m$ic>e program4,sec4 #fjc4 ,integrat$ ,heal? ,c>e ,demon/ration ,program4,sec4 #fjd4 ,address+ racial & e?nic m5tal heal? disp>ities rese>* gaps4,sec4 #fje4 ,heal? pr(essions compet5cies to address racial & e?nic m5tal heal? disp>ities4,sec4 #fjf4 ,geoaccess /udy4,sec4 #fjg4 ,asian ,am]ican1 ,native ,hawaiian1 ,pacific ,isl&]1 & ,hispanic & ,lat9o behavioral & m5tal heal? outrea* & education /rategies4,sec4 #fjh4 ,m5tal heal? 9 s*ools4,sec4 #fji4 ,build+ an effective work=ce 9 m5tal heal?4,sec4 #faj4 ,m5tal heal? at ! bord]4,,title ,,vii--,address+ high impact m9ority diseases ,subtitle ,a--,cancer,sec4 #gja4 ,lung canc] mortality r$uction4,sec4 #gjb4 ,exp&+ pro/ate canc] rese>*1 outrea*1 scre5+1 te/+1 access1 & treatm5t effectiv5ess4,sec4 #gjc4 ,pro/ate rese>*1 imag+1 & m5's education 7,,prime74,sec4 #gjd4 ,pro/ate canc] detection rese>* & education4,sec4 #gje4 ,national ,pro/ate ,canc] ,c\ncil4,sec4 #gjf4 ,improv$ ,m$icaid cov]age = c]ta9 brea/ & c]vical canc] pati5ts 9 ! t]ritories4,sec4 #gjg4 ,canc] prev5tion & treatm5t demon/ration = e?nic & racial m9orities4,sec4 #gjh4 ,r$uc+ canc] disp>ities )9 ,m$ic>e4,sec4 #gji4 ,canc] cl9ical trials4,subtitle ,b--,viral ,hepatitis & ,liv] ,canc] ,control & ,prevention,sec4 #gaa4 ,viral hepatitis & liv] canc] control & prev5tion4,subtitle ,c--,acquir$ ,bone ,m>r[ ,failure ,diseases,sec4 #gba4 ,acquir$ bone m>r[ failure diseases4,subtitle ,d--,c>diovascul> ,disease1 ,*ronic ,disease1 ,obesity1 & ,o!r ,disease ,issues,sec4 #gca4 ,guidel9es = disease scre5+ = m9ority pati5ts4,sec4 #gcb4 ,,cdc ,wisewoman ,scre5+ ,program4,sec4 #gcc4 ,report on c>diovascul> c>e = wom5 & m9orities4,sec4 #gcd4 ,cov]age ( compreh5sive tobacco cessation s]vices 9 ,m$icaid & private heal? insurance4,sec4 #gce4 ,cl9ical rese>* fund+ = oral heal?4,sec4 #gcf4 ,p>ticipation by ,m$icaid b5efici>ies 9 approv$ cl9ical trials4,sec4 #gcg4 ,guide on evid5ce-bas$ /rategies = public heal? dep>tm5t obesity prev5tion programs4,subtitle ,e--,,hiv_/,a,i,d,s,sec4 #gda4 ,/atem5t ( policy4,sec4 #gdb4 ,f9d+s4,sec4 #gdc4 ,additional fund+ = ,,aids drug assi/ance program treatm5ts4,sec4 #gdd4 ,enhanc+ ! national ,,hiv surveillance sy/em4,sec4 #gde4 ,evid5ce-bas$ /rategies = improv+ l9kage to & ret5tion 9 appropriate c>e4,sec4 #gdf4 ,improv+ entry into & ret5tion 9 c>e & antiretroviral adh]5ce = p]sons ) ,,hiv4,sec4 #gdg4 ,s]vices to r$uce ,,hiv_/,,aids 9 racial & e?nic m9ority communities4,sec4 #gdh4 ,m9ority ,,aids initiative4,sec4 #gdi4 ,heal? c>e pr(essionals treat+ individuals ) ,,hiv4,sec4 #gej4 ,,hiv_/,,aids provid] loan repaym5t program4,sec4 #gea4 ,d5tal education loan repaym5t program4,sec4 #geb4 ,r$uc+ new ,,hiv infections among inject+ drug us]s4,sec4 #gec4 ,report on impact ( ,,hiv_/,,aids 9 vuln]able populations4,sec4 #ged4 ,national ,,hiv_/,,aids obs]vance days4,sec4 #gee4 ,review ( all ,f$]al & ,/ate laws1 policies1 & regulations reg>d+ ! crim9al prosecution ( individuals = ,,hiv-relat$ (f5ses4,sec4 #gef4 ,exp&+ support = condoms 9 prisons4,sec4 #geg4 ,automatic re9/atem5t or enrollm5t 9 ,m$icaid = p :o te/ positive = ,,hiv be=e re5t]+ communities4,sec4 #geh4 ,/op ,,hiv 9 prison4,sec4 #gei4 ,support data sy/em review & indicators = monitor+ ,,hiv c>e4,sec4 #gfj4 ,transf] ( funds = implem5tation ( end+ ! ,,hiv epidemic3 a plan = ,am]ica4,subtitle ,f--,diabetes,sec4 #gga4 ,rese>*1 treatm5t1 & education4,sec4 #ggb4 ,rese>*1 education1 & o!r activities4,sec4 #ggc4 ,programs to educate heal? provid]s on ! causes & effects ( diabetes 9 m9ority populations4,sec4 #ggd4 ,rese>*1 education1 & o!r activities reg>d+ diabetes 9 ,am]ican ,indian populations4,sec4 #gge4 ,updat$ report on heal? disp>ities4,subtitle ,g--,lung ,disease ,sec4 #ggf4 ,expansion ( ! ,national ,a/hma ,education & ,prev5tion ,program4,sec4 #ggg4 ,a/hma-relat$ activities ( ! ,c5t]s = ,disease ,control & ,prev5tion4,sec4 #ggh4 ,influ5za & pneumonia vacc9ation campaign4,sec4 #ggi4 ,*ronic ob/ructive pulmon>y disease action plan4,subtitle ,h--,tuberculosis,sec4 #gha4 ,elim9ation ( all =ms ( tub]culosis4,sec4 #ghb4 ,additional fund+ = ,/ates 9 combat+ & elim9at+ tub]culosis4,sec4 #ghc4 ,/r5g!n+ cl9ical rese>* fund+ = tub]culosis4,subtitle ,i--,o/eo>?ritis & ,musculoskeletal ,diseases,sec4 #ghe4 ,f9d+s4,sec4 #ghf4 ,o/eo>?ritis & o!r musculoskeletal heal?-relat$ activities ( ! ,c5t]s = ,disease ,control & ,prev5tion4,sec4 #ghg4 ,grants = compreh5sive o/eo>?ritis & musculoskeletal disease heal? education )9 heal? pr(essions s*ools4,subtitle ,j--,sleep & ,circadian ,rhy?m ,disorders,sec4 #gia4 ,%ort title2 f9d+s4,sec4 #gib4 ,sleep & circadian rhy?m disord]s rese>* activities ( ! ,national ,in/itutes ( ,heal?4,sec4 #gic4 ,sleep & circadian rhy?m heal? disp>ities-relat$ activities ( ! ,c5t]s = ,disease ,control & ,prev5tion4,sec4 #gid4 ,grants = compreh5sive sleep & circadian heal? education )9 heal? pr(essions s*ools4,sec4 #gie4 ,report on impact ( sleep & circadian heal? disord]s 9 vuln]able & racial_/e?nic populations4,subtitle ,k--,kidney ,disease ,rese>*1 ,surveillance1 ,prev5tion1 & ,treatment,sec4 #gig4 ,kidney disease1 rese>*1 surveillance1 prev5tion1 & treatm5t4,sec4 #gih4 ,kidney disease rese>* 9 m9ority populations4,sec4 #gii4 ,kidney disease action plan4,sec4 #gii;,a4 ,home dialysis & increas+ end-/age r5al disease treatm5t modalities 9 m9ority communities action plan4,sec4 #gii;,b4 ,increas+ kidney transplants 9 m9ority populations4,sec4 #gii;,c4 ,environm5tal & occupational heal? programs4,sec4 #gii;,d4 ,und]/&+ ! treatm5t patt]ns associat$ ) provid+ c>e & treatm5t ( kidney failure 9 m9ority populations4,sec4 #gii;,e4 ,improv+ access 9 und]s]v$ areas4,,title ,,viii--,heal? ,in=mation ,technology,sec4 #hjj4 ,def9itions4,subtitle ,a--,r$uc+ ,heal? ,disp>ities ,?r\gh ,heal? ,i,t,sec4 #hja4 ,,hrsa assi/ance to heal? c5t]s = promotion ( ,heal? ,,x4,sec4 #hjb4 ,assessm5t ( impact ( ,heal? ,,x on racial & e?nic m9ority communities2 outrea* & adoption ( ,heal? ,,x 9 su* communities4,sec4 #hjc4 ,nondiscrim9ation & heal? equity 9 heal? in=mation te*nology4,sec4 #hjd4 ,language access 9 heal? in=mation te*nology4,subtitle ,b--,modifications ,to ,a*ieve ,p>ity 9 ,exi/+ ,programs,sec4 #haa4 ,ext5d+ fund+ to /r5g!n ! ,heal? ,,x infra/ructure 9 racial & e?nic m9ority communities4,sec4 #hab4 ,ext5d+ competitive grants = ! developm5t ( loan programs to facilitate adoption ( c]tifi$ ,,ehr te*nology by provid]s s]v+ racial & e?nic m9ority gr\ps4,sec4 #hac4 ,au?orization ( appropriations4,subtitle ,c--,additional ,rese>* & ,/udies ,sec4 #hba4 ,data collection & assessm5ts conduct$ 9 coord9ation ) m9ority-s]v+ in/itutions4,sec4 #hbb4 ,/udy ( heal? in=mation te*nology 9 m$ically und]s]v$ communities4,sec4 #hbc4 ,assessm5t ( use & misuse ( de-id5tifi$ heal? data4,subtitle ,d--,clos+ ,gaps 9 ,fund+ ,to ,adopt ,c]tifi$ ,e,h,rs,sec4 #hca4 ,ext5d+ ,m$icaid ,,ehr inc5tive paym5ts to rehabilitation facilities1 long-t]m c>e facilities1 & home heal? ag5cies4,sec4 #hcb4 ,ext5d+ physician assi/ant eligibility = ,m$icaid electronic heal? record inc5tive paym5ts4,,title ,,ix--,acc\ntability & ,evaluation,sec4 #ija4 ,prohibition on discrim9ation 9 ,f$]al assi/$ heal? c>e s]vices & rese>* programs on ! basis ( sex 7includ+ sex ori5tation1 g5d] id5tity1 & pregnancy1 includ+ t]m9ation ( pregnancy71 race1 color1 national orig91 m>ital /atus1 familial /atus1 sexual ori5tation1 g5d] id5tity1 or disability /atus4,sec4 #ijb4 ,treatm5t ( ,m$ic>e paym5ts "u title ,,vi ( ! ,civil ,rights ,act ( #aifd4,sec4 #ijc4 ,acc\ntability & transp>5cy )9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices4,sec4 #ijd4 ,unit$ ,/ates ,commission on ,civil ,rights4,sec4 #ije4 ,s5se ( ,congress conc]n+ full fund+ ( activities to elim9ate racial & e?nic heal? disp>ities4,sec4 #ijf4 ,,gao & ,,nih reports4,,title ,x--,address+ ,social ,det]m9ants & ,improv+ ,environm5tal ,justice,subtitle ,a--,9 ,general,sec4 #ajja4 ,def9itions4,sec4 #ajjb4 ,f9d+s4,sec4 #ajjc4 ,heal? impact assessm5ts4,sec4 #ajjd4 ,implem5tation ( recomm5dations by ,environm5tal ,protection ,ag5cy4,sec4 #ajje4 ,grant program to conduct environm5tal heal? improvem5t activities & to improve social det]m9ants ( heal?4,sec4 #ajjf4 ,additional rese>* on ! relation%ip betwe5 ! built environm5t & ! heal? ( community resid5ts4,sec4 #ajjg4 ,environm5t & public heal? re/oration4,sec4 #ajjh4 ,,gao report on heal? effects ( ,deepwat] ,horizon oil rig explosion 9 ! ,gulf ,coa/4,sec4 #ajji4 ,e/abli% an int]ag5cy c\nsel & grant programs on social det]m9ants ( heal?4,sec4 #ajaj4 ,correct+ hurtful & ali5at+ names 9 gov]nm5t expression 7,,*ange74,subtitle ,b--,gun ,violence,sec4 #ajaa4 ,f9d+s4,sec4 #ajab4 ,reaffirm+ rese>* au?ority ( ! ,c5t]s = ,disease ,control & ,prev5tion4,sec4 #ajac4 ,national ,viol5t ,dea? ,report+ ,sy/em4,sec4 #ajad4 ,report on effects ( gun viol5ce on public heal?4,sec4 #ajae4 ,report on effects ( gun viol5ce on m5tal heal? 9 m9ority communities4 #c4 ,f9d+s ,! ,congress f9ds z foll[s3 7#a7 ,! population ( racial & e?nic m9orities is expect$ to increase ov] ! next few decades1 yet racial & e?nic m9orities h ! poore/ heal? /atus & face sub/antial cultural1 social1 & economic b>ri]s to obta9+ quality heal? c>e4 7#b7 ,heal? disp>ities are a function ( n only access to heal? c>e1 b also ! social det]m9ants ( heal?--includ+ ! environm5t1 ! physical /ructure ( communities1 nutrition & food options1 educational atta9m5t1 employm5t1 race1 e?nicity1 sex1 geography1 language pref]5ce1 immigrant or citiz5%ip /atus1 sexual ori5tation1 g5d] id5tity1 socioeconomic /atus1 or disability /atus--t directly & indirectly affect ! heal?1 heal? c>e1 & wellness ( individuals & communities4 7#c7 ,ov] ! next few decades1 ! ,unit$ ,/ates w face a %ortage ( heal? c>e provid]s & alli$ heal? work]s4 7#d7 ,all ef=ts to r$uce heal? disp>ities & b>ri]s to quality heal? s]vices require bett] & m consi/5t data & bett] & m consi/5t collection ( & access to data4 7#e7 ,a full range ( culturally & l+ui/ically appropriate heal? c>e & public heal? s]vices mu/ be available & accessible 9 e community4 7#f7 ,racial & e?nic m9orities & und]s]v$ populations mu/ be includ$ e>ly & equitably 9 heal? re=m innovations4 7#g7 ,ef=ts to improve m9ority heal? h be5 limit$ by inadequate res\rces 9 fund+1 /aff+1 /ew>d%ip1 & acc\ntability4 ,t>get$ inve/m5ts t are focus$ on disp>ities elim9ation mu/ be made 9 provid+ c>e & s]vices t are community-bas$1 includ+ prev5tion & policies address+ social det]m9ants ( heal?4 7#h7 ,9 #bjaa1 ! ,dep>tm5t ( ,heal? & ,human ,s]vices develop$ ! ,,hhs ,action ,plan to ,r$uce ,racial & ,e?nic ,heal? ,disp>ities & ! ,national ,/akehold] ,/rategy = ,a*iev+ ,heal? ,equity1 :i* are #b /rategic plans t repres5t ! fir/ coord9at$ roadmap 9 ! ,unit$ ,/ates to r$uc+ heal? disp>ities4 ,^! compreh5sive plans1 along ) ! ,national ,prev5tion ,/rategy issu$ by ! ,national ,prev5tion ,c\ncil ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 ,heal?y ,p #bjcj1 & ! ,national ,quality ,/rategy ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 z well z critical res\rces su* z ! #bjab ,national ,heal?c>e ,quality & ,disp>ities ,reports1 w "w to increase ! numb] ( p 9 ! ,unit$ ,/ates :o are heal?y at e /age ( life4 7#i7 ,! ,secret>y ( ,heal? & ,human ,s]vices has also review$ & advanc$ updat$ cl9ical guidel9es & develop$ o!r /rategic plann+ docum5ts to combat heal? disp>ities ) a high impact on m9ority populations & to provide high-quality family plann+ s]vices4 ,su* guidel9es & docum5ts include ! ,national ,,hiv_/,,aids ,/rategy1 ! ,action ,plan = ! ,prev5tion1 ,c>e1 & ,treatm5t ( ,viral ,hepatitis1 & recomm5dations ( ! ,c5t]s = ,disease ,control & ,prev5tion & ! ,(fice ( ,population ,affairs4 7#aj7 ,! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh71 z am5d$ by ! ,heal? ,c>e & ,education ,reconciliation ,act 7,public ,law #aaa-aeb71 repres5ts ! bigge/ advancem5t = m9ority heal? 9 ! #dj ye>s imm$iately prec$+ ! enactm5t ( ?is ,act4 7#aa7 ,! ,heal? ,in=mation ,te*nology = ,economic & ,cl9ical ,heal? ,act ( #bjji1 "p ( ! ,am]ican ,recov]y & ,re9ve/m5t ,act ( #bjji 7,public ,law #aaa-e71 provides t ! nationwide heal? in=mation ex*ange infra/ructure be develop$ & us$ to r$uce heal? disp>ities1 among o!r purposes4 ,i ,data collection & report+ #aja4 ,am5dm5t to ! ,public ,heal? ,s]vice ,act 7a7 ,purpose ,x is ! purpose ( ! am5dm5t made by ?is section to promote data collection1 analysis1 & report+ by race1 e?nicity1 sex1 prim>y language1 sexual ori5tation1 disability /atus1 g5d] id5tity1 age1 & socioeconomic /atus among f$]ally support$ heal? programs4 7b7 ,am5dm5t ,title ,,xxxiv ( ! ,public ,heal? ,s]vice ,act1 z add$ by titles ,,ii & ,,iii ( ?is ,act1 is fur!r am5d$ by ins]t+ aft] subtitle ,b ! foll[+3 ,c ,/r5g!n+ data collection1 improv+ data analysis1 & exp&+ data report+ #cdca4 ,heal? disp>ity data 7a7 ,requirem5ts 7#a7 ,9 g5]al ,ea* heal?-relat$ program %all-- 7,a7 require ! collection1 by ! ag5cy or program involv$1 ( data on ! race1 e?nicity1 sex1 prim>y language1 sexual ori5tation1 disability /atus1 g5d] id5tity1 age1 & socioeconomic /atus ( ea* applicant = & recipi5t ( heal?-relat$ assi/ance "u su* program1 includ+-- 7i7 us+1 at a m9imum1 /&>ds = data collection on race1 e?nicity1 sex1 prim>y language1 sexual ori5tation1 g5d] id5tity1 age1 socioeconomic /atus1 & disability /atus z ea* are develop$ "u section #caja2 7ii7 collect+ data = additional population gr\ps if su* gr\ps c be aggregat$ into ! race & e?nicity categories outl9$ by /&>ds develop$ "u section #caja2 7iii7 us+1 :]e practicable1 ! /&>ds develop$ by ! ,heal? & ,m$ic9e ,division ( ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e 7=m]ly kn[n z ! ,in/itute ( ,m$ic9e7 9 ! #bjji publication1 entitl$ ,race1 ,e?nicity1 & ,language ,data3 ,/&>dization = ,heal? ,c>e ,quality ,improvem5t2 & 7iv7 :]e practicable1 collect+ su* data ?r\gh self-report+2 7,b7 ) respect to ! collection ( ! data describ$ 9 subp>agraph 7,a71 = applicants & recipi5ts :o are m9ors1 require communication assi/ance 9 spee* or writ+1 & = applicants & recipi5ts :o are o!rwise legally incapacitat$1 require t-- 7i7 su* data be collect$ f ! p>5t or legal gu>dian ( su* an applicant or recipi5t2 & 7ii7 ! prim>y language ( ! p>5t or legal gu>dian ( su* an applicant or recipi5t be collect$2 7,c7 sy/ematically analyze su* data us+ ! smalle/ appropriate units ( analysis feasible to detect racial & e?nic disp>ities1 z well z disp>ities along ! l9es ( prim>y language1 sex1 disability /atus1 sexual ori5tation1 g5d] id5tity1 age1 & socioeconomic /atus 9 heal? & heal? c>e1 & report ! results ( su* analysis to ! ,secret>y1 ! ,director ( ! ,(fice = ,civil ,rights1 ea* ag5cy li/$ 9 section #caja7;c77#a71 ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions & ! ,committee on ,f9ance ( ! ,s5ate1 & ! ,committee on ,en]gy & ,comm]ce & ! ,committee on ,ways & ,means ( ! ,h\se ( ,repres5tatives2 7,d7 provide su* data to ! ,secret>y on at lea/ an annual basis2 & 7,e7 ensure t ! provision ( assi/ance to an applicant or recipi5t ( assi/ance is n d5i$ or o!rwise adv]sely affect$ because ( ! failure ( ! applicant or recipi5t to provide race1 e?nicity1 prim>y language1 sex1 sexual ori5tation1 disability /atus1 g5d] id5tity1 age1 & socioeconomic /atus data4 7#b7 ,rules ( con/ruction ,no?+ 9 ?is subsection %all be con/ru$ to-- 7,a7 p]mit ! use ( in=mation collect$ "u ?is subsection 9 a mann] t w\ld adv]sely affect any individual provid+ any su* in=mation2 or 7,b7 dim9i% any requirem5ts1 includ+ su* requirem5ts 9 effect on or aft] ! date ( enactm5t ( ?is section1 on heal? c>e provid]s to collect data4 7#c7 ,no compell$ disclosure ( data ,?is title does n au?orize any heal? c>e provid]1 ,f$]al (ficial1 or o!r entity to compel ! disclosure ( any data collect$ "u ?is title4 ,! disclosure ( any su* data by an individual pursuant to ?is title %all be /rictly volunt>y4 7b7 ,protection ( data ,! ,secret>y %all ensure 7?r\gh ! promulgation ( regulations or o!rwise7 t all data collect$ pursuant to subsection 7a7 are protect$-- 7#a7 "u ! same privacy protections z ! ,secret>y applies to o!r heal? data "u ! regulations promulgat$ "u section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif relat+ to ! privacy ( individually id5tifiable heal? in=mation & o!r protections2 & 7#b7 f all inappropriate int]nal use by any entity t collects1 /ores1 or receives ! data1 includ+ use ( su* data 9 det]m9ations ( eligibility 7or cont9u$ eligibility7 9 heal? plans1 & f o!r inappropriate uses1 z def9$ by ! ,secret>y4 7c7 ,national plan ( ! data ,c\ncil ,! ,secret>y %all develop & implem5t a national plan to ensure ! collection ( data 9 a culturally & l+ui/ically appropriate mann]1 to improve ! collection1 analysis1 & report+ ( racial1 e?nic1 sex1 prim>y language1 sexual ori5tation1 disability /atus1 g5d] id5tity1 age1 & socioeconomic /atus data at ! ,f$]al1 ,/ate1 t]ritorial1 ,tribal1 & local levels1 includ+ data to be collect$ "u subsection 7a71 & to ensure t data collection activities c>ri$ out "u ?is section are 9 compliance ) /&>ds develop$ "u section #caja4 ,! ,data ,c\ncil ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 9 consultation ) ! ,national ,committee on ,vital ,heal? ,/ati/ics1 ! ,(fice ( ,m9ority ,heal?1 ,(fice on ,wom5's ,heal?1 & o!r appropriate public & private entities1 %all make recomm5dations to ! ,secret>y conc]n+ ! developm5t1 implem5tation1 & revision ( ! national plan4 ,su* plan %all include recomm5dations on h[ to-- 7#a7 implem5t subsection 7a7 :ile m9imiz+ ! co/ & adm9i/rative burd5s ( data collection & report+2 7#b7 exp& k among ,f$]al ag5cies1 ,/ates1 t]ritories1 ,indian ,tribes1 c\nties1 municipalities1 heal? provid]s1 heal? plans1 & ! g5]al public t data collection1 analysis1 & report+ by race1 e?nicity1 sex1 prim>y language1 sexual ori5tation1 g5d] id5tity1 age1 socioeconomic /atus1 & disability /atus is legal & necess>y to assure equity & nondiscrim9ation 9 ! quality ( heal? c>e s]vices2 7#c7 ensure t future pati5t record sy/ems foll[ ,f$]al /&>ds promulgat$ "u ! ,heal? ,in=mation ,te*nology = ,economic & ,cl9ical ,heal? ,act = ! collection & mean+ful use ( electronic heal? data on race1 e?nicity1 sex1 prim>y language1 sexual ori5tation1 g5d] id5tity1 age1 socioeconomic /atus1 & disability /atus2 7#d7 improve heal? & heal? c>e data collection & analysis = m population gr\ps if su* gr\ps c be aggregat$ into ! m9imum race & e?nicity categories1 includ+ explor+ ! feasibility ( enhanc+ collection ef=ts 9 ,/ates1 c\nties1 & municipalities = racial & e?nic gr\ps t comprise a significant proportion ( ! population ( ! ,/ate1 c\nty1 or municipality2 7#e7 provide rese>*]s ) great] access to racial1 e?nic1 prim>y language1 sex1 sexual ori5tation1 g5d] id5tity1 age1 socioeconomic /atus data1 & disability /atus data1 subject to all applicable privacy & confid5tiality requirem5ts1 includ+ ,,hipaa privacy & security law z def9$ 9 section #cjji2 & 7#f7 safegu>d & prev5t ! misuse ( data collect$ "u subsection 7a74 7d7 ,compliance ) ,/&>ds ,data collect$ "u subsection 7a7 %all be obta9$1 ma9ta9$1 & pres5t$ 7includ+ = report+ purposes7 9 accordance ) /&>ds develop$ "u section #caja4 7e7 ,analysis ( heal? disp>ity data ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality & 9 coord9ation ) ! ,assi/ant ,secret>y = ,plann+ & ,evaluation1 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 ! ,director ( ! ,national ,c5t] = ,heal? ,/ati/ics1 & ! ,director ( ! ,national ,in/itutes ( ,heal?1 %all provide te*nical assi/ance to ag5cies ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices 9 meet+ ,f$]al /&>ds = heal? disp>ity data collection & = analysis ( racial1 e?nic1 & o!r disp>ities 9 heal? & heal? c>e 9 programs conduct$ or support$ by su* ag5cies by-- 7#a7 id5tify+ appropriate quality assurance me*anisms to monitor = heal? disp>ities2 7#b7 specify+ ! cl9ical1 diagno/ic1 or !rapeutic measures :i* %\ld be monitor$2 7#c7 develop+ new quality measures relat+ to racial & e?nic disp>ities & _! ov]lap ) o!r disp>ity factors 9 heal? & heal? c>e2 7#d7 id5tify+ ! level at :i* data analysis %\ld be conduct$2 & 7#e7 %>+ data ) ext]nal organizations = rese>* & quality improvem5t purposes4 7f7 ,def9ition ( heal?-,relat$ program ,9 ?is section1 ! t]m heal?-relat$ program means a program t is op]at$ by ! ,secret>y1 or t receives fund+ or reimbursem5t1 9 :ole or 9 "p1 ei!r directly or indirectly f ! ,secret>y-- 7#a7 = activities "u ! ,social ,security ,act = heal? c>e s]vices2 or 7#b7 = provid+ ,f$]al f9ancial assi/ance = heal? c>e1 biom$ical rese>*1 or heal? s]vices rese>* or = o!rwise improv+ ! heal? ( ! public4 7g7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #cdcb4 ,e/abli%+ grants = data collection improvem5t activities 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality & 9 consultation ) ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 ! ,director ( ! ,national ,in/itutes ( ,heal?1 ! ,assi/ant ,secret>y = ,plann+ & ,evaluation1 & ! ,director ( ! ,national ,c5t] = ,heal? ,/ati/ics1 %all e/abli% a te*nical assi/ance program "u :i* ! ,secret>y provides grants to eligible entities to assi/ su* entities 9 comply+ ) section #cdca4 7b7 ,types ( assi/ance ,a grant provid$ "u ?is section may be us$ to-- 7#a7 enhance or upgrade comput] te*nology t w facilitate collection1 analysis1 & report+ ( racial1 e?nic1 prim>y language1 sexual ori5tation1 sex1 g5d] id5tity1 socioeconomic /atus1 & disability /atus data2 7#b7 improve me?ods = heal? data collection & analysis1 includ+ additional population gr\ps if su* gr\ps c be aggregat$ into ! race & e?nicity categories outl9$ by /&>ds develop$ "u section #caja2 7#c7 develop me*anisms = submitt+ collect$ data subject to any applicable privacy & confid5tiality regulations2 & 7#d7 develop educational programs to in=m heal? plans1 heal? provid]s1 heal?-relat$ ag5cies1 & ! g5]al public t data collection & report+ by race1 e?nicity1 prim>y language1 sexual ori5tation1 sex1 g5d] id5tity1 disability /atus1 & socioeconomic /atus are legal & ess5tial = elim9at+ heal? & heal? c>e disp>ities4 7c7 ,eligible entity ,to be eligible = grants "u ?is section1 an entity %all be a ,/ate1 t]ritory1 ,indian ,tribe1 municipality1 c\nty1 heal? provid]1 heal? c>e organization1 or heal? plan mak+ a demon/rat$ ef=t to br+ data collections into compliance ) section #cdca4 7d7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #cdcc4 ,ov]sampl+ ( und]repres5t$ gr\ps 9 ,f$]al heal? surveys 7a7 ,national /rategy 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,national ,c5t] = ,heal? ,/ati/ics ( ! ,c5t]s = ,disease ,control & ,prev5tion1 & o!r ag5cies )9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices z ! ,secret>y det]m9es appropriate1 %all develop & implem5t an ongo+ & su/a9able national /rategy = ov]sampl+ und]repres5t$ populations )9 ! categories ( race1 e?nicity1 sex1 prim>y language1 sexual ori5tation1 disability /atus1 g5d] id5tity1 & socioeconomic /atus z det]m9$ appropriate by ! ,secret>y 9 ,f$]al heal? surveys & program data collections4 ,su* national /rategy %all include a /rategy = ov]sampl+ ( ,asian ,am]icans1 ,native ,hawaiians1 & ,pacific ,isl&]s4 7#b7 ,consultation ,9 develop+ & implem5t+ a national /rategy1 z describ$ 9 p>agraph 7#a71 n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is section1 ! ,secret>y %all-- 7,a7 consult ) repres5tatives ( community gr\ps1 nonpr(it organizations1 nongov]nm5tal organizations1 & gov]nm5t ag5cies work+ ) und]repres5t$ populations2 7,b7 solicit ! p>ticipation ( repres5tatives f o!r ,f$]al dep>tm5ts & ag5cies1 includ+ subag5cies ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices2 & 7,c7 consult on1 & use z models1 ! #bjad ,national ,heal? ,int]view ,survey ov]sample ( ,native ,hawaiian & ,pacific ,isl&] populations & ! #bjag ,behavioral ,risk ,factor ,surveillance ,sy/em ov]sample ( ,am]ican ,indian & ,alaska ,native communities4 7b7 ,progress report ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is section1 ! ,secret>y %all submit to ! ,congress a progress report1 :i* %all include ! national /rategy describ$ 9 subsection 7a77#a74 7c7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y = fiscal ye>s #bjba ?r\gh #bjbe4 4 #ajb4 ,elim9ation ( pr]equisite ( direct appropriations = data collection & analysis ,section #caja ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjjkk7 is am5d$-- 7#a7 by /rik+ subsection 7h72 & 7#b7 by r$esignat+ subsection 7i7 z subsection 7h74 #ajc4 ,collection ( data = ! ,m$ic>e program ,"p ,a ( title ,,xi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq47 is am5d$ by add+ at ! end ! foll[+3 #aaej;,c4 ,collection ( data = ! ,m$ic>e program 7a7 ,requirem5t 7#a7 ,9 g5]al ,! ,commission] ( ,social ,security1 9 consultation ) ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 %all collect data on ! race1 e?nicity1 sex1 prim>y language1 sexual ori5tation1 g5d] id5tity1 socioeconomic /atus1 & disability /atus ( all applicants = ,social ,security b5efits "u title ,,ii or ,m$ic>e b5efits "u title ,,xviii4 7#b7 ,data collection /&>ds ,9 collect+ data "u p>agraph 7#a71 ! ,commission] ( ,social ,security %all at lea/ use ! /&>ds = data collection develop$ "u section #caja ( ! ,public ,heal? ,s]vice ,act or ! /&>ds develop$ by ! ,(fice ( ,managem5t & ,budget1 :i*ev] is m disaggregat$4 ,9 ! ev5t !re are no /&>ds = ! demographic gr\ps li/$ "u p>agraph 7#a71 ! ,commission] %all consult ) /akehold] gr\ps repres5t+ ! v>i\s id5tities z well z ) ! ,(fice ( ,m9ority ,heal? )9 ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices to develop appropriate /&>ds4 7#c7 ,data = additional population gr\ps ,:]e practicable1 ! in=mation collect$ by ! ,commission] ( ,social ,security "u p>agraph 7#a7 %all include data = additional population gr\ps if su* gr\ps c be aggregat$ into ! race & e?nicity categories outl9$ by ! data collection /&>ds describ$ 9 p>agraph 7#b74 7#d7 ,collection ( data = m9ors & legally incapacitat$ individuals ,) respect to ! collection ( ! data describ$ 9 p>agraph 7#a7 ( applicants :o are "u #ah ye>s ( age or o!rwise legally incapacitat$1 ! ,commission] ( ,social ,security %all require t-- 7,a7 su* data be collect$ f ! p>5t or legal gu>dian ( su* an applicant2 & 7,b7 ! prim>y language ( ! p>5t or legal gu>dian ( su* an applicant or recipi5t be us$ 9 collect+ ! data4 7#e7 ,quality ( data ,! ,commission] ( ,social ,security %all p]iodically review ! quality & complet5ess ( ! data collect$ "u p>agraph 7#a7 & make adju/m5ts z necess>y to improve bo?4 7#f7 ,transmission ( data ,^u an individual's entitlem5t to1 or enrollm5t =1 b5efits "u title ,,xviii1 ! ,commission] ( ,social ,security %all transmit ! demographic data ( ! individual z collect$ "u p>agraph 7#a7 to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 7#g7 ,analysis & report+ ( data ,) respect to data transmitt$ "u p>agraph 7#f71 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 9 consultation ) ! ,commission] ( ,social ,security %all-- 7,a7 require t su* data be uni=mly analyz$ & t su* analysis be report$ at lea/ annually to ,congress2 7,b7 incorporate su* data 9 o!r analysis & report+ on heal? disp>ities z appropriate2 7,c7 make su* data available to rese>*]s1 "u ! protections outl9$ 9 p>agraph 7#h72 7,d7 provide opportunities to individuals entitl$ to1 or enroll$ =1 b5efits "u title ,,xviii to submit updat$ data2 & 7,e7 ensure t ! provision ( assi/ance or b5efits to an applicant is n d5i$ or o!rwise adv]sely affect$ because ( ! failure ( ! applicant to provide any ( ! data collect$ "u p>agraph 7#a74 7#h7 ,protection ( data ,! ,commission] ( ,social ,security %all ensure 7?r\gh ! promulgation ( regulations or o!rwise7 t all data collect$ pursuant to ?is subsection is protect$-- 7,a7 "u ! same privacy protections z ! ,secret>y applies to heal? data "u ! regulations promulgat$ "u section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif 7relat+ to ! privacy ( individually id5tifiable heal? in=mation & o!r protections72 & 7,b7 f all inappropriate int]nal use by any entity t collects1 /ores1 or receives ! data1 includ+ use ( su* data 9 det]m9ations ( eligibility 7or cont9u$ eligibility7 9 heal? plans1 & f o!r inappropriate uses1 z def9$ by ! ,secret>y4 7b7 ,rule ( con/ruction ,no?+ 9 ?is section %all be con/ru$ to p]mit ! use ( in=mation collect$ "u ?is section 9 a mann] t w\ld adv]sely affect any individual provid+ any su* in=mation4 7c7 ,te*nical assi/ance ,! ,secret>y may1 ei!r directly or by grant or contract1 provide te*nical assi/ance to enable any entity to comply ) ! requirem5ts ( ?is section or ) regulations implem5t+ ?is section4 7d7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section #ejj1jjj1jjj = fiscal ye> #bjba & #ajj1jjj1jjj = ea* fiscal ye> !reaft]4 4 #ajd4 ,revision ( ,,hipaa claims /&>ds 7a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all revise ! regulations promulgat$ "u "p ,c ( title ,,xi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;d et seq471 relat+ to ! collection ( data on race1 e?nicity1 & prim>y language 9 a heal?-relat$ transaction1 to require-- 7#a7 ! use1 at a m9imum1 ( /&>ds = data collection on race1 e?nicity1 prim>y language1 disability1 sex1 sexual ori5tation1 g5d] id5tity1 & socioeconomic /atus develop$ "u section #caja ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjjkk72 & 7#b7 9 consultation ) ! ,(fice ( ! ,national ,coord9ator = ,heal? ,in=mation ,te*nology1 ! designation ( ! appropriate racial1 e?nic1 prim>y language1 disability1 sex1 & o!r code sets z requir$ = claims & enrollm5t data4 7b7 ,dissem9ation ,! ,secret>y ( ,heal? & ,human ,s]vices %all dissem9ate ! new /&>ds develop$ "u subsection 7a7 to all entities t are subject to ! regulations describ$ 9 su* subsection & provide te*nical assi/ance ) respect to ! collection ( ! data involv$4 7c7 ,compliance ,! ,secret>y ( ,heal? & ,human ,s]vices %all require t entities comply ) ! new /&>ds develop$ "u subsection 7a7 n lat] ?an #b ye>s aft] ! f9al promulgation ( su* /&>ds4 #aje4 ,national ,c5t] = ,heal? ,/ati/ics ,section #cjf7n7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdbk7n77 is am5d$-- 7#a7 9 p>agraph 7#a71 by /rik+ #bjjc & ins]t+ #bjbb2 7#b7 9 p>agraph 7#b71 9 ! fir/ s5t5ce1 by /rik+ #bjjc & ins]t+ #bjbb2 & 7#c7 9 p>agraph 7#c71 by /rik+ #bjjb & ins]t+ #bjbb4 #ajf4 ,disp>ities data collect$ by ! ,f$]al ,gov]nm5t 7a7 ,repository ( ,gov]nm5t data ,! ,secret>y ( ,heal? & ,human ,s]vices1 9 coord9ation ) ! dep>tm5ts1 ag5cies1 or (fices describ$ 9 subsection 7b71 %all e/abli% a c5traliz$ electronic repository ( ,gov]nm5t data on factors relat$ to ! heal? & well-be+ ( ! population ( ! ,unit$ ,/ates4 7b7 ,collection2 submission ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 & ,janu>y #ca ( ea* ye> !reaft]1 ea* dep>tm5t1 ag5cy1 & (fice ( ! ,f$]al ,gov]nm5t t has collect$ data on race1 e?nicity1 sex1 prim>y language1 sexual ori5tation1 disability /atus1 g5d] id5tity1 age1 or socioeconomic /atus dur+ ! prec$+ cal5d> ye> %all submit su* data to ! repository ( ,gov]nm5t data e/abli%$ "u subsection 7a74 7c7 ,analysis2 public availability2 report+ ,n lat] ?an ,april #cj1 #bjba1 & ,april #cj ( ea* ye> !reaft]1 ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,assi/ant ,secret>y = ,plann+ & ,evaluation1 ! ,assi/ant ,secret>y = ,heal?1 ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 ! ,director ( ! ,national ,c5t] = ,heal? ,/ati/ics1 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 ! ,director ( ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities1 & ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 %all-- 7#a7 prep>e & make available datasets = public use t relate to disp>ities 9 heal? /atus1 heal? c>e access1 heal? c>e quality1 heal? outcomes1 public heal?1 & o!r areas ( heal? & well-be+ by factors t include race1 e?nicity1 sex1 prim>y language1 sexual ori5tation1 disability /atus1 g5d] id5tity1 & socioeconomic /atus2 7#b7 ensure t ^! datasets are publicly id5tifi$ on ! repository e/abli%$ "u subsection 7a7 z disp>ities data2 & 7#c7 submit a report to ! ,congress on ! availability & use ( su* data by public /akehold]s4 #ajg4 ,data collection & analysis grants to m9ority-s]v+ in/itutions 7a7 ,au?ority ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities & ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 %all aw>d grants to eligible entities to access & analyze racial & e?nic data on disp>ities 9 heal? & heal? c>e1 & :]e possible o!r data on disp>ities 9 heal? & heal? c>e1 to monitor & report on progress to r$uce & elim9ate disp>ities 9 heal? & heal? c>e4 7b7 ,eligible entity ,9 ?is section1 ! t]m eligible entity means an entity t has an accr$it$ public heal?1 heal? policy1 or heal? s]vices rese>* program & is any ( ! foll[+3 7#a7 ,a "p ,b in/itution1 z def9$ 9 section #cbb ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajfa74 7#b7 ,a ,hispanic-s]v+ in/itution1 z def9$ 9 section #ejb ( su* ,act 7#bj ,u4,s4,c4 #aaja;a74 7#c7 ,a ,tribal ,college or ,univ]sity1 z def9$ 9 section #caf ( su* ,act 7#bj ,u4,s4,c4 #ajei;c74 7#d7 ,an ,asian ,am]ican & ,native ,am]ican ,pacific ,isl&]-s]v+ in/itution1 z def9$ 9 section #cga7;c7 ( su* ,act 7#bj ,u4,s4,c4 #ajfgq7c774 7c7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y = fiscal ye>s #bjba ?r\gh #bjbe4 #ajh4 ,/&>ds = measur+ sexual ori5tation1 g5d] id5tity1 & socioeconomic /atus 9 collection ( heal? data ,section #caja7;a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjjkk7a77 is am5d$-- 7#a7 9 p>agraph 7#a77;,a71 by ins]t+ sexual ori5tation1 g5d] id5tity1 socioeconomic /atus1 be=e & disability /atus2 7#b7 9 p>agraph 7#a77;,c71 by ins]t+ sexual ori5tation1 g5d] id5tity1 socioeconomic /atus1 be=e & disability /atus2 & 7#c7 9 p>agraph 7#b77;,b71 by ins]t+ sexual ori5tation1 g5d] id5tity1 socioeconomic /atus1 be=e & disability /atus4 #aji4 ,safety & effectiv5ess ( drugs ) respect to racial & e?nic backgr\nd 7a7 ,9 g5]al ,*apt] ,v ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act 7#ba ,u4,s4,c4 #cea et seq47 is am5d$ by add+ aft] section #eje;,g ! foll[+3 #eje;,h4 ,safety & effectiv5ess ( drugs ) respect to racial & e?nic backgr\nd 7a7 ,preapproval /udies ,if !re is evid5ce t !re may be a disp>ity on ! basis ( racial or e?nic backgr\nd z to ! safety or effectiv5ess ( a drug or biological product1 !n-- 7#a7 7,a7 9 ! case ( a drug1 ! inve/igations requir$ "u section #eje7;b77#a77;,a7 %all include adequate & well-controll$ inve/igations ( ! disp>ity2 or 7,b7 9 ! case ( a biological product1 ! evid5ce requir$ "u section #cea7;a7 ( ! ,public ,heal? ,s]vice ,act = approval ( a biologics lic5se application = ! biological product %all include adequate & well-controll$ inve/igations ( ! disp>ity2 & 7#b7 if ! inve/igations describ$ 9 subp>agraph 7,a7 or 7,b7 ( p>agraph 7#a7 confirm t !re is su* a disp>ity1 ! label+ ( ! drug or biological product %all include appropriate in=mation ab\t ! disp>ity4 7b7 ,po/m>ket /udies 7#a7 ,9 g5]al ,if !re is evid5ce t !re may be a disp>ity on ! basis ( racial or e?nic backgr\nd z to ! safety or effectiv5ess ( a drug = :i* !re is an approv$ application "u section #eje ( ?is ,act or ( a biological product = :i* !re is an approv$ lic5se "u section #cea ( ! ,public ,heal? ,s]vice ,act1 ! ,secret>y may by ord] require ! hold] ( ! approv$ application or lic5se to conduct1 by a date specifi$ by ! ,secret>y1 po/m>ket /udies to inve/igate ! disp>ity4 7#b7 ,label+ ,if ! ,secret>y det]m9es t ! po/m>ket /udies confirm t !re is a disp>ity describ$ 9 p>agraph 7#a71 ! label+ ( ! drug or biological product %all include appropriate in=mation ab\t ! disp>ity4 7#c7 ,/udy design ,! ,secret>y may1 9 an ord] "u p>agraph 7#a71 specify all aspects ( ! design ( ! po/m>ket /udies requir$ "u su* p>agraph = a drug or biological product1 includ+ ! numb] ( /udies & /udy p>ticipants1 & ! o!r demographic *>act]i/ics ( ! /udy p>ticipants4 7#d7 ,modifications ( /udy design ,! ,secret>y may1 by ord] & z necess>y1 modify any aspect ( ! design ( a po/m>ket /udy requir$ 9 an ord] "u p>agraph 7#a7 aft] issu+ su* ord]4 7#e7 ,/udy results ,! results f a /udy requir$ "u p>agraph 7#a7 %all be submitt$ to ! ,secret>y z a supplem5t to ! drug application or biologics lic5se application4 7c7 ,applications "u section #eje7;j7 7#a7 ,9 g5]al ,a drug = :i* an application has be5 submitt$ or approv$ "u section #eje7;j7 %all n be consid]$ ineligible = approval "u t section or misbr&$ "u section #ejb on ! basis t ! label+ ( ! drug omits in=mation relat+ to a disp>ity on ! basis ( racial or e?nic backgr\nd z to ! safety or effectiv5ess ( ! drug1 :e!r d]iv$ f inve/igations or /udies requir$ "u ?is section or d]iv$ f o!r s\rces1 :5 ! omitt$ in=mation is protect$ by pat5t or by exclusivity "u section #eje7;j77#e77;,f74 7#b7 ,label+ ,not)/&+ p>agraph 7#a71 ! ,secret>y may require t ! label+ ( a drug approv$ "u section #eje7;j7 t omits in=mation relat+ to a disp>ity on ! basis ( racial or e?nic backgr\nd z to ! safety or effectiv5ess ( ! drug include a /atem5t ( any appropriate contra9dications1 w>n+s1 or precautions relat$ to ! disp>ity t ! ,secret>y consid]s necess>y4 7d7 ,def9ition ,! t]m evid5ce t !re may be a disp>ity on ! basis ( racial or e?nic backgr\nd z to ! safety or effectiv5ess1 ) respect to a drug or biological product1 includes-- 7#a7 evid5ce t !re is a disp>ity on ! basis ( racial or e?nic backgr\nd z to safety or effectiv5ess ( a drug or biological product 9 ! same *emical class z ! drug or biological product2 7#b7 evid5ce t !re is a disp>ity on ! basis ( racial or e?nic backgr\nd 9 ! way ! drug or biological product is metaboliz$2 & 7#c7 o!r evid5ce z ! ,secret>y may det]m9e appropriate4 4 7b7 ,en=cem5t ,section #ejb ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act 7#ba ,u4,s4,c4 #ceb7 is am5d$ by add+ at ! end ! foll[+3 7gg7 ,if x is a drug & ! hold] ( ! approv$ application "u section #eje or lic5se "u section #cea ( ! ,public ,heal? ,s]vice ,act = ! drug has fail$ to complete ! inve/igations or /udies1 or comply ) any o!r requirem5t1 ( section #eje;,h4 4 7c7 ,drug fees ,section #gcf7;a77#a77;,a77ii7 ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act 7#ba ,u4,s4,c4 #cgi;h7a77#a77;,a77ii77 is am5d$ by ins]t+ aft] are n requir$ ! foll[+3 1 includ+ po/m>ket /udies requir$ "u section #eje;,h4 #aaj4 ,improv+ heal? data reg>d+ ,native ,hawaiians & o!r ,pacific ,isl&]s ,"p ,b ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdc et seq47 is am5d$ by ins]t+ aft] section #cag,u ! foll[+3 #cag,v4 ,native ,hawaiian & o!r ,pacific ,isl&] heal? data 7a7 ,def9itions ,9 ?is section3 7#a7 ,community gr\p ,! t]m community gr\p means a gr\p ( ,,nhopi :o are organiz$ at ! community level1 & may include a *ur* gr\p1 social s]vice gr\p1 national advocacy organization1 or cultural gr\p4 7#b7 ,nonpr(it1 nongov]nm5tal organization ,! t]m nonpr(it1 nongov]nm5tal organization means a gr\p ( ,,nhopi ) a demon/rat$ hi/ory ( address+ ,,nhopi issues1 includ+ a ,,nhopi coalition4 7#c7 ,designat$ organization ,! t]m designat$ organization means an entity e/abli%$ to repres5t ,,nhopi populations & :i* has /atutory responsibilities to provide1 or has community support = provid+1 heal? c>e4 7#d7 ,gov]nm5t repres5tatives ( ,,nhopi populations ,! t]m gov]nm5t repres5tatives ( ,,nhopi populations means repres5tatives f ,hawaii1 ,am]ican ,samoa1 ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 ! ,f$]at$ ,/ates ( ,micronesia1 ,guam1 ! ,republic ( ,palau1 & ! ,republic ( ! ,m>%all ,isl&s4 7#e7 ,native ,hawaiians & o!r ,pacific ,isl&]s 7,,nhopi7 ,! t]m ,native ,hawaiians & ,o!r ,pacific ,isl&]s or ,,nhopi means p hav+ orig9s 9 any ( ! orig9al peoples ( ,am]ican ,samoa1 ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 ! ,f$]at$ ,/ates ( ,micronesia1 ,guam1 ,hawaii1 ! ,republic ( ! ,m>%all ,isl&s1 ! ,republic ( ,palau1 or any o!r ,pacific ,isl&4 7#f7 ,insul> area ,! t]m insul> area means ,guam1 ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 ,am]ican ,samoa1 ! ,unit$ ,/ates ,virg9 ,isl&s1 ! ,f$]at$ ,/ates ( ,micronesia1 ! ,republic ( ,palau1 or ! ,republic ( ! ,m>%all ,isl&s4 7b7 ,national /rategy 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,national ,c5t] = ,heal? ,/ati/ics 7ref]r$ to 9 ?is section z ,,n*s7 ( ! ,c5t]s = ,disease ,control & ,prev5tion1 & o!r ag5cies )9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices z ! ,secret>y det]m9es appropriate1 %all develop & implem5t an ongo+ & su/a9able national /rategy = id5tify+ & evaluat+ ! heal? /atus & heal? c>e ne$s ( ,,nhopi populations liv+ 9 ! cont95tal ,unit$ ,/ates1 ,hawaii1 ,am]ican ,samoa1 ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 ! ,f$]at$ ,/ates ( ,micronesia1 ,guam1 ! ,republic ( ,palau1 & ! ,republic ( ! ,m>%all ,isl&s4 7#b7 ,consultation ,9 develop+ & implem5t+ a national /rategy1 z describ$ 9 p>agraph 7#a71 n lat] ?an #ahj days aft] ! date ( enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbj1 ! ,secret>y-- 7,a7 %all consult ) repres5tatives ( community gr\ps1 designat$ organizations1 & nonpr(it1 nongov]nm5tal organizations & ) gov]nm5t repres5tatives ( ,,nhopi populations2 & 7,b7 may solicit ! p>ticipation ( repres5tatives f o!r ,f$]al dep>tm5ts4 7c7 ,prelim9>y heal? survey 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ,,n*s1 %all conduct a prelim9>y heal? survey 9 ord] to id5tify ! major areas & regions 9 ! cont95tal ,unit$ ,/ates1 ,hawaii1 ,am]ican ,samoa1 ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 ! ,f$]at$ ,/ates ( ,micronesia1 ,guam1 ! ,republic ( ,palau1 & ! ,republic ( ! ,m>%all ,isl&s 9 :i* ,,nhopi p reside4 7#b7 ,cont5ts ,! heal? survey describ$ 9 p>agraph 7#a7 %all include heal? data & any o!r data ! ,secret>y det]m9es to be-- 7,a7 useful 9 det]m9+ heal? /atus & heal? c>e ne$s2 or 7,b7 requir$ = develop+ or implem5t+ a national /rategy4 7#c7 ,me?odology ,me?odology = ! heal? survey describ$ 9 p>agraph 7#a71 includ+ plans = design+ que/ions1 implem5tation1 sampl+1 & analysis1 %all be develop$ 9 consultation ) community gr\ps1 designat$ organizations1 nonpr(it1 nongov]nm5tal organizations1 & gov]nm5t repres5tatives ( ,,nhopi populations1 z det]m9$ by ! ,secret>y4 7#d7 ,timeframe ,! survey requir$ "u ?is subsection %all be complet$ n lat] ?an #ah mon?s aft] ! date ( enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbj4 7d7 ,progress report ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbj1 ! ,secret>y %all submit to ,congress a progress report1 :i* %all include ! national /rategy describ$ 9 subsection 7b77#a74 7e7 ,/udy & report by ! ,heal? & ,m$ic9e ,division 7#a7 ,9 g5]al ,! ,secret>y %all seek to ent] into an agreem5t ) ! ,heal? & ,m$ic9e ,division ( ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e to conduct a /udy1 ) input f /akehold]s 9 insul> areas1 on ea* ( ! foll[+3 7,a7 ,! /&>ds & def9itions ( heal? c>e appli$ to heal? c>e sy/ems 9 insul> areas & ! appropriat5ess ( su* /&>ds & def9itions4 7,b7 ,! /atus & p]=mance ( heal? c>e sy/ems 9 insul> areas1 evaluat$ bas$ ^u /&>ds & def9itions1 z ! ,secret>y det]m9es appropriate4 7,c7 ,! effectiv5ess ( donor aid 9 address+ heal? c>e ne$s & priorities 9 insul> areas4 7,d7 ,! progress t[>d implem5tation ( recomm5dations ( ! ,committee on ,heal? ,c>e ,s]vices 9 ! ,unit$ ,/ates--,associat$ ,pacific ,bas9 t are set =? 9 ! #aiih report entitl$ ,pacific ,p>tn]%ips = ,heal?3 ,*>t+ a ,new ,c\rse4 7#b7 ,report ,an agreem5t describ$ 9 p>agraph 7#a7 %all require ! ,heal? & ,m$ic9e ,division to submit to ! ,secret>y & to ,congress1 n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbj1 a report conta9+ a description ( ! results ( ! /udy conduct$ "u p>agraph 7#a71 includ+ ! conclusions & recomm5dations ( ! ,heal? & ,m$ic9e ,division = ea* ( ! items describ$ 9 subp>agraphs 7,a7 ?r\gh 7,d7 ( su* p>agraph4 7f7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y = fiscal ye>s #bjba ?r\gh #bjbe4 4 #aaa4 ,cl>ification ( simplifi$ adm9i/rative report+ requirem5t ,section #aa7;a7 ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjbj7;a77 is am5d$ by add+ at ! end ! foll[+3 7#e7 ,simplifi$ adm9i/rative report+ requirem5t ,) respect to any obligation ( a ,/ate ag5cy c>ry+ out ! supplem5tal nutrition assi/ance program to comply ) ! notification requirem5t "u p>agraph 7#b7 ( section #dba7;e7 ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#h ,u4,s4,c4 #afca7;e771 not)/&+ ! requirem5t to include 9 t notification ! names ( ! sponsor & ! sponsor$ ali5 involv$1 ! ,/ate ag5cy %all be consid]$ to h compli$ ) ! notification requirem5t if ! ,/ate ag5cy submits to ! ,attorney ,g5]al a report t includes ! aggregate numb] ( exceptions grant$ by ! ,/ate ag5cy "u p>agraph 7#a7 ( t section4 4 ,,ii ,culturally & l+ui/ically appropriate heal? & heal? c>e #bja4 ,def9itions2 f9d+s 7a7 ,def9itions ,9 ?is title1 ! def9itions 9 section #cdjj ( ! ,public ,heal? ,s]vice ,act1 z add$ by section #bjd1 %all apply4 7b7 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,effective communication is ess5tial to mean+ful access to quality physical & m5tal heal? c>e4 7#b7 ,rese>* indicates t ! lack ( appropriate language s]vices creates language b>ri]s t result 9 increas$ risk ( misdiagnosis1 ineffective treatm5t plans1 & poor heal? outcomes = individuals ) limit$ ,engli% pr(ici5cy & individuals ) communication disabilities su* z cognitive1 he>+1 vision1 or pr9t impairm5ts4 7#c7 ,! numb] ( limit$ ,engli%-speak+ resid5ts 9 ! ,unit$ ,/ates :o speak ,engli% less ?an v well &1 !re=e1 _c effectively communicate ) heal? & social s]vice provid]s cont9ues to increase significantly4 7#d7 ,! responsibility to fund language s]vices 9 ! provision ( heal? c>e & heal?-c>e-relat$ s]vices to individuals ) limit$ ,engli% pr(ici5cy & individuals ) communication disabilities su* z cognitive he>+1 vision1 or pr9t impairm5ts is a societal "o t _c fairly be plac$ solely ^u ! heal? c>e1 public heal?1 or social s]vices community4 7#e7 ,title ,,vi ( ! ,civil ,rights ,act ( #aifd 7#db ,u4,s4,c4 #bjjj;d et seq47 prohibits discrim9ation bas$ on ! gr\nds ( race1 color1 or national orig9 by any entity receiv+ ,f$]al f9ancial assi/ance4 ,9 ord] to avoid discrim9ation on ! gr\nds ( national orig91 all programs or activities adm9i/]$ by ! ,f$]al ,gov]nm5t mu/ take adequate /eps to ensure t _! policies & proc$ures d n d5y or h ! effect ( d5y+ individuals ) limit$ ,engli% pr(ici5cy ) equal access to b5efits & s]vices = :i* su* p]sons qualify4 7#f7 ,bo? ! ,am]icans ) ,disabilities ,act ( #aiij 7#db ,u4,s4,c4 #abaja et seq47 & ! ,rehabilitation ,act ( #aigc 7#bi ,u4,s4,c4 #gja et seq47 prohibit discrim9ation on ! basis ( disability & require ! provision ( appropriate auxili>y aids & s]vices necess>y to ensure effective communication ) individuals ) disabilities4 ,! type ( auxili>y aid or s]vice necess>y to ensure effective communication w v>y 9 accordance ) ! me?od ( communication us$ by ! individual2 ! nature1 l5g?1 & complexity ( ! communication involv$2 & ! context 9 :i* ! communication is tak+ place4 ,a public accommodation %\ld consult ) individuals ) disabilities :5ev] possible to det]m9e :at type ( auxili>y aid is ne$$ to ensure effective communication4 ,! public accommodation %\ld use ! individual's pref]r$ me?od ( communication :5ev] possible1 unless x w\ld be an undue burd5 to ! public accommodation & an alt]native w\ld provide an equally effective means ( communication4 ,! ultimate decision z to :at measures to take re/s ) ! public accommodation1 provid$ t ! me?od *os5 results 9 effective communication4 7#g7 ,section #aeeg ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahaaf7 builds on title ,,vi ( ! ,civil ,rights ,act ( #aifd 7#db ,u4,s4,c4 #bjjj;d et seq47 & section #ejd ( ! ,rehabilitation ,act ( #aigc 7#bi ,u4,s4,c4 #gid71 prohibits discrim9ation on ! basis ( race1 color1 national orig91 disability1 sex1 & age1 requires ! provision ( language s]vices to ensure effective communication ) individuals ) limit$ ,engli% pr(ici5cy1 & requires ! provision ( appropriate auxili>y aids & s]vices necess>y to ensure effective communication ) individuals ) disabilities4 7#h7 ,l+ui/ic div]sity 9 ! heal? c>e & heal?-c>e-relat$ s]vices work=ce is important = provid+ all pati5ts ! environm5t mo/ conducive to positive heal? outcomes4 7#i7 ,all memb]s ( ! heal? c>e & heal?-c>e-relat$ s]vices community %\ld cont9ue to educate _! /aff & con/itu5ts ab\t limit$ ,engli%-pr(ici5t & disability communication issues & help !m id5tify res\rces to improve access to quality c>e = individuals ) limit$ ,engli% pr(ici5cy & individuals ) communication disabilities su* z cognitive1 he>+1 vision1 or pr9t impairm5ts4 7#aj7 ,access to ,engli% z a second language1 =eign language1 & sign language int]pret]s1 translat$ & alt]native =mat docum5ts1 read]s1 & o!r auxili>y aids & s]vices1 are ess5tial to ensure effective communication & elim9ate ! language b>ri]s t imp$e access to heal? c>e4 7#aa7 ,compet5t language s]vices 9 heal? c>e sett+s %\ld be available z a matt] ( c\rse4 #bjb4 ,improv+ access to s]vices = individuals ) limit$ ,engli% pr(ici5cy 7a7 ,purpose ,consi/5t ) ! goals provid$ 9 ,executive ,ord] #acaff 7#db ,u4,s4,c4 #bjjj;d-#a note2 relat+ to improv+ access to s]vices = p]sons ) limit$ ,engli% pr(ici5cy71 x is ! purpose ( ?is section-- 7#a7 to improve ,f$]al ag5cy p]=mance reg>d+ access to f$]ally conduct$ & f$]ally assi/$ programs & activities = individuals ) limit$ ,engli% pr(ici5cy2 7#b7 to require ea* ,f$]al ag5cy to exam9e ! s]vices x provides & develop & implem5t a sy/em by :i* individuals ) limit$ ,engli% pr(ici5cy c obta9 culturally compet5ce s]vices & mean+ful access to ^? s]vices consi/5t )1 & )\t sub/antially burd5+1 ! fundam5tal mission ( ! ag5cy2 7#c7 to require ea* ,f$]al ag5cy to ensure t recipi5ts ( ,f$]al f9ancial assi/ance provide culturally compet5ce s]vices & mean+ful access to applicants & b5efici>ies t are individuals ) limit$ ,engli% pr(ici5cy2 7#d7 to ensure t recipi5ts ( ,f$]al f9ancial assi/ance take reasonable /eps1 consi/5t ) ! guidel9es set =? 9 ! ,guidance to ,f$]al ,f9ancial ,assi/ance ,recipi5ts ,reg>d+ ,title ,,vi ,prohibition ,aga9/ ,national ,orig9 ,discrim9ation ,affect+ ,limit$ ,engli% ,pr(ici5t ,p]sons 7#fg ,f$4 ,reg4 #dadee 7,june #ah1 #bjjb771 to ensure culturally & l+ui/ically appropriate access to _! programs & activities by individuals ) limit$ ,engli% pr(ici5cy2 & 7#e7 to ensure compliance ) title ,,vi ( ! ,civil ,rights ,act ( #aifd 7#db ,u4,s4,c4 #bjjj;d et seq47 & section #aeeg ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahaaf7 z publi%$ 9 ! ,f$]al ,regi/] on ,may #ah1 #bjaf1 t heal? c>e provid]s & organizations d n discrim9ate 9 ! provision ( s]vices4 7b7 ,f$]ally ,conduct$ programs & activities 7#a7 ,9 g5]al ,n lat] ?an #abj days aft] ! date ( enactm5t ( ?is ,act1 ea* ,f$]al ag5cy provid+ f9ancial assi/ance to1 or adm9i/]+1 a heal? program or activity describ$ 9 section #bjc7;a7 %all prep>e a plan or update a plan to improve culturally & l+ui/ically appropriate access to su* program or activity ) respect to individuals ) limit$ ,engli% pr(ici5cy4 ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ea* su* ,f$]al ag5cy %all ensure t su* plan is fully implem5t$4 7#b7 ,plan requirem5t ,ea* plan "u p>agraph 7#a7 %all include-- 7,a7 ! /eps ! ag5cy w take to ensure t individuals ) limit$ ,engli% pr(ici5cy h access to ea* heal? program or activity support$ or adm9i/]$ by ! ag5cy2 7,b7 ! policies & proc$ures = id5tify+1 assess+1 & meet+ ! culturally & l+ui/ically appropriate language ne$s ( its b5efici>ies t are individuals ) limit$ ,engli% pr(ici5cy s]v$ by su* program or activity2 7,c7 ! /eps ! ag5cy w take = su* program or activity to be culturally & l+ui/ically appropriate by provid+ a range ( language assi/ance options1 notice to individuals ) limit$ ,engli% pr(ici5cy ( ! "r to compet5t language s]vices1 p]iodic tra9+ ( /aff1 monitor+ & quality assessm5t ( ! language s]vices &1 9 appropriate circum/ances1 ! translation ( writt5 mat]ials2 7,d7 ! /eps ! ag5cy w take = su* program or activity to provide reasonable accommodations necess>y = individuals ) limit$ ,engli% pr(ici5cy1 includ+ ^? individuals ) a communication disability1 to und]/& communications f ! ag5cy2 7,e7 ! /eps ! ag5cy w take to ensure t applications1 =ms1 & o!r relevant docum5ts = su* program or activity are compet5tly translat$ into ! prim>y language ( a cli5t t is an individual ) limit$ ,engli% pr(ici5cy :]e su* mat]ials are ne$$ to improve access ( su* cli5t to su* program or activity2 7,f7 ! res\rces ! ag5cy w provide to improve cultural & l+ui/ic appropriat5ess to assi/ recipi5ts ( ,f$]al funds to improve access to heal? c>e relat$ programs & activities = individuals ) limit$ ,engli% pr(ici5cy2 7,g7 ! res\rces ! ag5cy w provide to ensure t compet5t language assi/ance is provid$ to pati5ts t are individuals ) limit$ ,engli% pr(ici5cy by int]pret]s or tra9$ bil+ual /aff2 & 7,h7 ! res\rces ! ag5cy w provide to ensure t family1 p>ticul>ly m9or *ildr51 & fri5ds are n us$ to provide int]pretation s]vices1 except z p]mitt$ "u regulations implem5t+ section #aeeg ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahaaf7 z publi%$ 9 ! ,f$]al ,regi/] on ,may #ah1 #bjaf4 7#c7 ,submission ( plan to ,,doj ,ea* ag5cy t is requir$ to prep>e a plan "u p>agraph 7#a7 %all s5d a copy ( su* plan to ! ,attorney ,g5]al1 :i* %all s]ve z ! c5tral repository ( all su* plans4 #bjc4 ,ensur+ /&>ds = culturally & l+ui/ically appropriate s]vices 9 heal? c>e 7a7 ,applicability ,?is section %all apply to any heal? program or activity1 any "p ( :i* is receiv+ ,f$]al f9ancial assi/ance1 includ+ cr$its1 subsidies1 or contracts ( insurance1 or any program or activity t is adm9i/]$ by an executive ag5cy or any entity e/abli%$ "u title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjja et seq47 7or am5dm5ts made !reby74 7b7 ,/&>ds ,ea* program or activity describ$ 9 subsection 7a7-- 7#a7 %all implem5t /rategies to recruit1 reta91 & promote individuals at all levels to ma9ta9 a div]se /aff & lead]%ip t c provide culturally & l+ui/ically appropriate heal? c>e to pati5t populations ( ! s]vice area ( ! program or activity2 7#b7 %all educate & tra9 gov]nance1 lead]%ip1 & work=ce at all levels & across all discipl9es ( ! program or activity 9 culturally & l+ui/ically appropriate policies & practices on an ongo+ basis at lea/ annually2 7#c7 %all (f] & provide language assi/ance1 includ+ tra9$ & compet5t bil+ual /aff & int]pret] s]vices1 to individuals ) limit$ ,engli% pr(ici5cy or :o h o!r communication ne$s1 at no co/ to ! individual at all po9ts ( contact1 & dur+ all h\rs ( op]ation1 to facilitate timely access to heal? c>e s]vices & heal?-c>e-relat$ s]vices2 7#d7 %all = ea* language gr\p consi/+ ( individuals ) limit$ ,engli% pr(ici5cy t con/itutes #e p]c5t or #ejj individuals1 :i*ev] is less1 ( ! population ( p]sons eligible to be s]v$ or likely to be affect$ or enc\nt]$ 9 ! s]vice area ( ! program or activity1 make available at a fif? grade read+ level-- 7,a7 easily und]/ood pati5t-relat$ mat]ials1 includ+ pr9t & multim$ia mat]ials1 9 ! language ( su* language gr\p2 7,b7 in=mation or notices ab\t t]m9ation ( b5efits 9 su* language2 7,c7 signage2 & 7,d7 any o!r docum5ts or types ( docum5ts designat$ by ! ,secret>y2 7#e7 %all develop & implem5t cle> goals1 policies1 op]ational plans1 & managem5t1 acc\ntability1 & ov]sight me*anisms to provide culturally & l+ui/ically appropriate s]vices & infuse !m ?r\gh\t ! plann+ & op]ations ( ! program or activity2 7#f7 %all conduct initial & ongo+1 at lea/ annually1 organizational assessm5ts ( culturally & l+ui/ically appropriate s]vices-relat$ activities & integrate valid l+ui/ic1 compet5ce-relat$ ,national ,/&>ds = ,culturally & ,l+ui/ically ,appropriate ,s]vices 7,,clas7 measures into ! int]nal audits1 p]=mance improvem5t programs1 pati5t satisfaction assessm5ts1 cont9u\s quality improvem5t activities1 & outcomes-bas$ evaluations ( ! program or activity & develop ways to /&>dize ! assessm5ts2 7#g7 %all ensure t1 consi/5t ) ! privacy protections provid$ = "u ! regulations promulgat$ "u section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif 7#db ,u4,s4,c4 #acbj-b note71 data on an individual requir$ to be collect$ pursuant to section #caja1 includ+ ! individual's alt]native =mat pref]5ces & policy modification ne$s1 are-- 7,a7 collect$ 9 heal? records2 7,b7 integrat$ into ! managem5t in=mation sy/ems ( ! program or activity2 & 7,c7 p]iodically updat$2 7#h7 %all ma9ta9 a curr5t demographic1 cultural1 & epidemiological pr(ile ( ! community1 conduct regul> assessm5ts ( community heal? assets & ne$s1 & use ! results ( su* assessm5ts to accurately plan = & implem5t s]vices t respond to ! cultural & l+ui/ic *>act]i/ics ( ! s]vice area ( ! program or activity2 7#i7 %all develop p>ticipatory1 collaborative p>tn]%ips ) communities & utilize a v>iety ( =mal & in=mal me*anisms to facilitate community & pati5t involvem5t 9 design+1 implem5t+1 & evaluat+ policies & practices to ensure culturally & l+ui/ically appropriate s]vice-relat$ activities2 7#aj7 %all ensure t conflict & grievance resolution processes are culturally & l+ui/ically appropriate & capable ( id5tify+1 prev5t+1 & resolv+ cross-cultural conflicts or compla9ts by pati5ts2 7#aa7 %all regul>ly make available to ! public in=mation ab\t _! progress & successful innovations 9 implem5t+ ! /&>ds "u ?is section & provide public notice 9 _! communities ab\t ! availability ( ?is in=mation2 & 7#ab7 %all1 if reque/$1 regul>ly make available to ! head ( ea* ,f$]al entity f :i* ,f$]al funds are provid$1 in=mation ab\t ! progress & successful innovations ( ! program or activity 9 implem5t+ ! /&>ds "u ?is section z requir$ by ! head ( su* entity4 7c7 ,comm5ts accept$ ?r\gh notice & comm5t rulemak+ ,an ag5cy c>ry+ out a program describ$ 9 subsection 7a7-- 7#a7 %all ensure t comm5ts ) respect to su* program t are accept$ ?r\gh notice & comm5t rulemak+ are accept$ 9 all languages2 7#b7 may n require su* comm5ts to be submitt$ only 9 ,engli%2 & 7#c7 %all ensure t any su* comm5ts t are n submitt$ 9 ,engli% are consid]$1 dur+ ! ag5cy's review ( su* comm5ts1 equally z su* comm5ts t are submitt$ 9 ,engli%4 #bjd4 ,culturally & l+ui/ically appropriate heal? c>e 9 ! ,public ,heal? ,s]vice ,act ,! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bja et seq47 is am5d$ by add+ at ! end ! foll[+3 ,,xxxiv ,,culturally ,,& ,,l+ui/ically ,,appropriate ,,heal? ,,c>e #cdjj4 ,def9itions 7a7 ,9 g5]al ,9 ?is title3 7#a7 ,bil+ual ,! t]m bil+ual1 ) respect to an individual1 means an individual :o has suffici5t degree ( pr(ici5cy 9 #b languages4 7#b7 ,cultural ,! t]m cultural means relat+ to integrat$ patt]ns ( human behavior t include ! language1 ?\ghts1 communications1 actions1 cu/oms1 beliefs1 values1 & in/itutions ( racial1 e?nic1 religi\s1 or social gr\ps1 includ+ lesbian1 gay1 bisexual1 transg5d]1 que]1 & que/ion+ individuals1 & individuals ) physical & m5tal disabilities4 7#c7 ,culturally & l+ui/ically appropriate ,! t]m culturally & l+ui/ically appropriate means be+ respectful ( & responsive to ! cultural & l+ui/ic ne$s ( all individuals4 7#d7 ,effective communication ,! t]m effective communication means an ex*ange ( in=mation betwe5 ! provid] ( heal? c>e or heal?-c>e-relat$ s]vices & ! recipi5t ( su* s]vices :o is limit$ 9 ,engli% pr(ici5cy1 or has a communication impairm5t su* z a he>+1 vision1 speak+1 or le>n+ impairm5t1 t enables access to1 und]/&+ (1 & b5efit f heal? c>e or heal?-c>e-relat$ s]vices1 & full p>ticipation 9 ! developm5t ( _! treatm5t plan4 7#e7 ,grievance resolution process ,! t]m grievance resolution process means all aspects ( dispute resolution includ+ fil+ compla9ts1 grievance & appeal proc$ures1 & c\rt action4 7#f7 ,heal? c>e gr\p ,! t]m heal? c>e gr\p means a gr\p ( physicians organiz$1 at lea/ 9 "p1 = ! purposes ( provid+ physician s]vices "u ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act1 ! ,/ate ,*ildr5's ,heal? ,insurance ,program "u title ,,xxi ( su* ,act1 or ! ,m$ic>e program "u title ,,xviii ( su* ,act & may include a hospital & any o!r individual or entity furni%+ s]vices cov]$ "u any su* program t is affiliat$ ) ! heal? c>e gr\p4 7#g7 ,heal? c>e s]vices ,! t]m heal? c>e s]vices means s]vices t address physical z well z m5tal heal? conditions 9 all c>e sett+s4 7#h7 ,heal?-c>e-relat$ s]vices ,! t]m heal?-c>e-relat$ s]vices means human or social s]vices programs or activities t provide access1 ref]rals1 or l9ks to heal? c>e4 7#i7 ,heal? educator ,! t]m heal? educator includes a pr(essional ) a baccalaureate degree :o is responsible = design+1 implem5t+1 & evaluat+ individual & population heal? promotion & *ronic disease prev5tion programs4 7#aj7 ,indian2 indian tribe ,! t]ms ,indian & ,indian ,tribe h ! mean+s giv5 su* t]ms 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act4 7#aa7 ,individual ) a disability ,! t]m individual ) a disability means any individual :o has a disability z def9$ = ! purpose ( section #ejd ( ! ,rehabilitation ,act ( #aigc4 7#ab7 ,individual ) limit$ ,engli% pr(ici5cy ,! t]m individual ) limit$ ,engli% pr(ici5cy means an individual ^: prim>y language = communication is n ,engli% & :o has a limit$ ability to read1 write1 speak1 or und]/& ,engli%4 7#ac7 ,integrat$ heal? c>e deliv]y sy/em ,! t]m integrat$ heal? c>e deliv]y sy/em means an int]discipl9>y sy/em t br+s toge!r provid]s f ! prim>y heal?1 m5tal heal?1 sub/ance use disord]1 & relat$ discipl9es to improve ! heal? outcomes ( an individual4 ,su* provid]s may include hospitals1 heal?1 m5tal heal?1 or sub/ance use disord] cl9ics & provid]s1 home heal? ag5cies1 ambulatory surg]y c5t]s1 skill$ nurs+ facilities1 rehabilitation c5t]s1 & employ$1 indep5d5t1 or contract$ physicians4 7#ad7 ,int]pret+2 int]pretation ,! t]ms int]pret+ & int]pretation mean ! transmission ( a spok51 writt51 or sign$ message f "o language or =mat into ano!r1 fai?fully1 accurately1 & objectively4 7#ae7 ,language access ,! t]m language access means ! provision ( language s]vices to an individual ) limit$ ,engli% pr(ici5cy or an individual ) communication disabilities design$ to enhance t individual's access to1 und]/&+ (1 or b5efit f heal? c>e s]vices or heal?-c>e-relat$ s]vices4 7#af7 ,language assi/ance s]vices ,! t]m language assi/ance s]vices includes-- 7,a7 oral language assi/ance1 includ+ int]pretation 9 non-,engli% languages provid$ 9-p]son or remotely by a qualifi$ int]pret] = an individual ) limit$ ,engli% pr(ici5cy1 & ! use ( qualifi$ bil+ual or multil+ual /aff to communicate directly ) individuals ) limit$ ,engli% pr(ici5cy2 7,b7 writt5 translation1 p]=m$ by a qualifi$ translator1 ( writt5 cont5t 9 pap] or electronic =m into languages o!r ?an ,engli%2 & 7,c7 tagl9es4 7#ag7 ,m9ority 7,a7 ,9 g5]al ,! t]ms m9ority & m9orities ref] to individuals f a m9ority gr\p4 7,b7 ,populations ,! t]m m9ority1 ) respect to populations1 ref]s to racial & e?nic m9ority gr\ps1 memb]s ( sexual & g5d] m9ority gr\ps1 & individuals ) a disability4 7#ah7 ,m9ority gr\p ,! t]m m9ority gr\p has ! mean+ giv5 ! t]m racial & e?nic m9ority gr\p4 7#ai7 ,onsite int]pretation ,! t]m onsite int]pretation means a me?od ( int]pret+ or int]pretation = :i* ! int]pret] is 9 ! physical pres5ce ( ! provid] ( heal? c>e s]vices or heal?-c>e-relat$ s]vices & ! recipi5t ( su* s]vices :o is limit$ 9 ,engli% pr(ici5cy or has a communication impairm5t su* z an impairm5t 9 he>+1 vision1 or le>n+4 7#bj7 ,qualifi$ individual ) a disability ,! t]m qualifi$ individual ) a disability means1 ) respect to a heal? program or activity1 an individual ) a disability :o1 ) or )\t reasonable modifications to policies1 practices1 or proc$ures1 ! removal ( ar*itectural1 communication1 or transportation b>ri]s1 or ! provision ( auxili>y aids & s]vices1 meets ! ess5tial eligibility requirem5ts = ! receipt ( aids1 b5efits1 or s]vices (f]$ or provid$ by ! heal? program or activity4 7#ba7 ,qualifi$ int]pret] = an individual ) a disability ,! t]m qualifi$ int]pret] = an individual ) a disability1 ) respect to an individual ) a disability-- 7,a7 means an int]pret] = su* individual :o by means ( a remote int]pret+ s]vice or an onsite appe>ance2 7i7 adh]es to g5]ally accept$ int]pret] e?ics pr9ciples1 includ+ cli5t confid5tiality2 & 7ii7 is able to int]pret effectively1 accurately1 & imp>tially1 bo? receptively & expressively1 us+ any necess>y specializ$ vocabul>y1 t]m9ology1 & phraseology2 & 7,b7 may include-- 7i7 sign language int]pret]s2 7ii7 oral translit]ators1 :i* are individuals :o repres5t or spell 9 ! *>act]s ( ano!r alphabet2 & 7iii7 cu$ language translit]ators1 :i* are individuals :o repres5t or spell by us+ a small numb] ( h&%apes4 7#bb7 ,qualifi$ int]pret] = an individual ) limit$ ,engli% pr(ici5cy ,! t]m qualifi$ int]pret] = an individual ) limit$ ,engli% pr(ici5cy means an int]pret] :o by means ( a remote int]pret+ s]vice or an onsite appe>ance-- 7,a7 adh]es to g5]ally accept$ int]pret] e?ics pr9ciples1 includ+ cli5t confid5tiality2 7,b7 has demon/rat$ pr(ici5cy 9 speak+ & und]/&+ bo? spok5 ,engli% & "o or m o!r spok5 languages2 & 7,c7 is able to int]pret effectively1 accurately1 & imp>tially1 bo? receptively & expressly1 to & f su* languages & ,engli%1 us+ any necess>y specializ$ vocabul>y1 t]m9ology1 & phraseology4 7#bc7 ,qualifi$ translator ,! t]m qualifi$ translator means a translator :o-- 7,a7 adh]es to g5]ally accept$ translator e?ics pr9ciples1 includ+ cli5t confid5tiality2 7,b7 has demon/rat$ pr(ici5cy 9 writ+ & und]/&+ bo? writt5 ,engli% & "o or m o!r writt5 non-,engli% languages2 & 7,c7 is able to translate effectively1 accurately1 & imp>tially to & f su* languages & ,engli%1 us+ any necess>y specializ$ vocabul>y1 t]m9ology1 & phraseology4 7#bd7 ,racial & e?nic m9ority gr\p ,! t]m racial & e?nic m9ority gr\p means ,indians & ,alaska ,natives1 ,african ,am]icans 7includ+ ,c>ibbean ,blacks1 ,africans1 & o!r ,blacks71 ,asian ,am]icans1 ,hispanics 7includ+ ,lat9os71 & ,native ,hawaiians & o!r ,pacific ,isl&]s4 7#be7 ,sexual & g5d] m9ority gr\p ,! t]m sexual & g5d] m9ority gr\p encompasses lesbian1 gay1 bisexual1 & transg5d] populations1 z well z ^? ^: sexual ori5tation1 g5d] id5tity & expression1 or reproductive developm5t v>ies f traditional1 societal1 cultural1 or physiological norms4 7#bf7 ,sight translation ,! t]m sight translation means ! transmission ( a writt5 message 9 "o language into a spok5 or sign$ message 9 ano!r language1 or an alt]native =mat 9 ,engli% or ano!r language4 7#bg7 ,/ate ,not)/&+ section #b1 ! t]m ,/ate means ea* ( ! sev]al ,/ates1 ! ,di/rict ( ,columbia1 ! ,commonweal? ( ,pu]to ,rico1 ! ,unit$ ,/ates ,virg9 ,isl&s1 ,guam1 ,am]ican ,samoa1 & ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s4 7#bh7 ,telephonic int]pretation ,! t]m telephonic int]pretation 7also kn[n z ov] ! phone int]pretation or ,,opi7 means1 ) respect to int]pretation = an individual ) limit$ ,engli% pr(ici5cy1 a me?od ( int]pretation 9 :i* ! int]pret] is n 9 ! physical pres5ce ( ! provid] ( heal? c>e s]vices or heal?-c>e-relat$ s]vices & su* individual receiv+ su* s]vices1 b ! int]pret] is connect$ via telephone4 7#bi7 ,translation ,! t]m translation means ! transmission ( a writt5 message 9 "o language into a writt5 or sign$ message 9 ano!r language1 & includes translation into ano!r language or alt]native =mat1 su* z l>ge pr9t font1 ,braille1 audio record+1 or ,,cd4 7#cj7 ,video remote int]pret+ s]vices ,! t]m video remote int]pret+ s]vices means ! provision1 9 heal? c>e s]vices or heal?-c>e-relat$ s]vices1 ?r\gh a qualifi$ int]pret] = an individual ) limit$ ,engli% pr(ici5cy1 ( video remote int]pret+ s]vices t are-- 7,a7 9 real-"t1 full-motion video1 & audio ov] a d$icat$ high-spe$1 wide-b&wid? video connection or wireless connection t deliv]s high quality video images t d n produce lags1 *oppy1 blurry1 or gra9y images1 or irregul> pauses 9 communication2 & 7,b7 9 a %>ply del9eat$ image t is l>ge en\gh to display4 7#ca7 ,vital docum5t ,! t]m vital docum5t includes applications = gov]nm5t programs t provide heal? c>e s]vices1 m$ical or f9ancial cons5t =ms1 f9ancial assi/ance docum5ts1 lett]s conta9+ important in=mation reg>d+ pati5t in/ructions 7su* z prescriptions1 ref]rals to o!r provid]s1 & dis*>ge plans7 & p>ticipation 9 a program 7su* z a ,m$icaid manag$ c>e program71 notices p]ta9+ to ! r$uction1 d5ial1 or t]m9ation ( s]vices or b5efits1 notices ( ! "r to appeal su* actions1 & notices advis+ individuals ) limit$ ,engli% pr(ici5cy ) communication disabilities ( ! availability ( free language s]vices1 alt]native =mats1 & o!r outrea* mat]ials4 7b7 ,ref]5ce ,9 any ref]5ce 9 ?is title to a regulatory provision applicable to a h&icapp$ individual1 ! t]m h&icapp$ individual 9 su* provision %all h ! same mean+ z ! t]m individual ) a disability z def9$ 9 subsection 7a74 ,a ,res\rces & innovation = culturally & l+ui/ically appropriate heal? c>e #cdja4 ,rob]t ,t4 ,matsui ,c5t] = ,culturally & ,l+ui/ically ,appropriate ,heal? ,c>e 7a7 ,e/abli%m5t ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 %all e/abli% & support a c5t] to be kn[n z ! ,rob]t ,t4 ,matsui ,c5t] = ,culturally & ,l+ui/ically ,appropriate ,heal? ,c>e 7ref]r$ to 9 ?is section z ! ,c5t]7 to c>ry out ea* ( ! foll[+ activities3 7#a7 ,int]pretation s]vices ,! ,c5t] %all provide res\rces via ! int]net to id5tify & l9k heal? c>e provid]s to compet5t int]pret] & translation s]vices4 7#b7 ,translation ( writt5 mat]ial 7,a7 ,vital docum5ts ,! ,c5t] %all provide1 directly or ?r\gh contract1 vital docum5ts f compet5t translation s]vices = provid]s ( heal? c>e s]vices & heal?-c>e-relat$ s]vices at no co/ to su* provid]s4 ,su* docum5ts may be submitt$ by cov]$ entities 7z def9$ 9 section #ib4d ( title #de1 ,code ( ,f$]al ,regulations1 z 9 effect on ,may #ah1 #bjaf7 = translation into non-,engli% languages or alt]native =mats at a fif?-grade read+ level4 ,su* translation s]vices %all be provid$ 9 a timely & reasonable mann]4 ,! quality ( su* translation s]vices %all be monitor$ & report$ publicly4 7,b7 ,=ms ,= ea* =m develop$ or revis$ by ! ,secret>y t w be us$ by individuals ) limit$ ,engli% pr(ici5cy 9 heal? c>e or heal?-c>e-relat$ sett+s1 ! ,c5t] %all translate ! =m1 at a m9imum1 into ! top #ae non-,engli% languages 9 ! ,unit$ ,/ates accord+ to ! mo/ rec5t data f ! ,am]ican ,community ,survey or its replacem5t4 ,! translation %all be complet$ )9 #de cal5d> days ( ! ,secret>y receiv+ f9al approval ( ! =m f ! ,(fice ( ,managem5t & ,budget4 ,! ,c5t] %all po/ all translat$ =ms on its website s t o!r entities may use ! same translations4 7#c7 ,toll-free cu/om] s]vice telephone numb] ,! ,c5t] %all provide1 ?r\gh a toll-free numb]1 a cu/om] s]vice l9e = individuals ) limit$ ,engli% pr(ici5cy-- 7,a7 to obta9 in=mation ab\t f$]ally conduct$ or fund$ heal? programs1 includ+ ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act1 ! ,m$icaid program "u title ,,xix ( su* ,act1 & ! ,/ate ,*ildr5's ,heal? ,insurance ,program "u title ,,xxi ( su* ,act1 & cov]age available ?r\gh an ,ex*ange e/abli%$ "u title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act1 & o!r s\rces ( free or r$uc$ c>e includ+ ?r\gh f$]ally qualifi$ heal? c5t]s1 entities receiv+ assi/ance "u title ,x1 & public heal? dep>tm5ts2 7,b7 to obta9 assi/ance ) apply+ = or access+ ^! programs & und]/&+ ,f$]al notices writt5 9 ,engli%2 & 7,c7 to le>n h[ to access language s]vices4 7#d7 ,heal? in=mation cle>+h\se 7,a7 ,9 g5]al ,! ,c5t] %all develop & ma9ta9 an in=mation cle>+h\se to facilitate ! provision ( language s]vices by provid]s ( heal? c>e s]vices & heal?-c>e-relat$ s]vices to r$uce m$ical errors1 improve m$ical outcomes1 improve cultural compet5ce1 r$uce heal? c>e co/s caus$ by miscommunication ) individuals ) limit$ ,engli% pr(ici5cy1 & r$uce or elim9ate ! duplication ( ef=ts to translate mat]ials4 ,! cle>+h\se %all include ! in=mation describ$ 9 subp>agraphs 7,b7 ?r\gh 7,f7 & make su* in=mation available on ! int]net & 9 pr9t4 7,b7 ,docum5t templates ,! ,c5t] %all collect & evaluate = accuracy1 develop1 & make available templates = /&>d docum5ts t are necess>y = pati5ts & consum]s to access & make educat$ decisions ab\t _! heal? c>e1 includ+ templates = ea* ( ! foll[+3 7i7 ,adm9i/rative & legal docum5ts1 includ+-- 7,i7 intake =ms2 7,,ii7 =ms relat$ to ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act1 ! ,m$icaid program "u title ,,xix ( su* ,act1 & ! ,/ate ,*ildr5's ,heal? ,insurance ,program "u title ,,xxi ( su* ,act1 includ+ eligibility in=mation = su* programs2 7,,iii7 =ms in=m+ pati5ts ( ! compliance & cons5t requirem5ts pursuant to ! regulations "u section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif 7#db ,u4,s4,c4 #acbj-b note72 & 7,,iv7 docum5ts conc]n+ in=m$ cons5t1 advanc$ directives1 & waiv]s ( rights4 7ii7 ,cl9ical in=mation1 su* z h[ to take m$ications1 h[ to prev5t transmission ( a contagi\s disease1 & o!r prev5tion & treatm5t in/ructions4 7iii7 ,public heal?1 pati5t education1 & outrea* mat]ials1 su* z immunization notices1 heal? w>n+s1 or scre5+ notices4 7iv7 ,additional heal? or heal?-c>e-relat$ mat]ials z det]m9$ appropriate by ! ,director ( ! ,c5t]4 7,c7 ,/ructure ( =ms ,9 op]at+ ! cle>+h\se1 ! ,c5t] %all-- 7i7 ensure t ! docum5ts po/$ 9 ,engli% & non-,engli% languages are culturally & l+ui/ically appropriate2 7ii7 all[ public review ( ! docum5ts be=e dissem9ation 9 ord] to ensure t ! docum5ts are und]/&able & culturally & l+ui/ically appropriate = ! t>get populations2 7iii7 all[ heal? c>e provid]s to cu/omize ! docum5ts = _! use2 7iv7 facilitate access to ^! docum5ts2 7v7 provide te*nical assi/ance ) respect to ! access & use ( su* in=mation2 & 7vi7 c>ry out any o!r activities ! ,secret>y det]m9es to be useful to fulfill ! purposes ( ! cle>+h\se4 7,d7 ,language assi/ance programs ,! ,c5t] %all provide = ! collection & dissem9ation ( in=mation on curr5t examples ( language assi/ance programs & /rategies to improve language s]vices = individuals ) limit$ ,engli% pr(ici5cy1 includ+ case /udies us+ de-id5tifi$ pati5t in=mation1 program summ>ies1 & program evaluations4 7,e7 ,culturally & l+ui/ically appropriate mat]ials ,! ,c5t] %all provide in=mation relat+ to culturally & l+ui/ically appropriate heal? c>e = m9ority populations resid+ 9 ! ,unit$ ,/ates to all heal? c>e provid]s & heal?-c>e-relat$ s]vices at no co/4 ,su* in=mation %all include-- 7i7 t5ets ( culturally & l+ui/ically appropriate c>e2 7ii7 culturally & l+ui/ically appropriate self-assessm5t tools2 7iii7 culturally & l+ui/ically appropriate tra9+ tools2 7iv7 /rategic plans to increase cultural & l+ui/ic appropriat5ess 9 diff]5t types ( provid]s ( heal? c>e s]vices & heal?-c>e-relat$ s]vices1 includ+ regional collaborations among heal? c>e organizations2 & 7v7 culturally & l+ui/ically appropriate in=mation = educators1 practition]s1 & rese>*]s4 7,f7 ,translation ,gloss>ies ,! ,c5t] %all-- 7i7 develop & publi% on its website translation gloss>ies t provide /&>diz$ translations ( commonly us$ t]ms & phrases utiliz$ 9 docum5ts translat$ by ! ,c5t]2 & 7ii7 make ^! gloss>ies available-- 7,i7 free ( *>ge2 7,,ii7 9 ea* language 9 :i* ! ,c5t] translates =ms "u p>agraph 7#b77;,b72 & 7,,iii7 9 alt]native =mats 9 accordance ) ! ,am]icans ) ,disabilities ,act ( #aiij 7#db ,u4,s4,c4 #abaja et seq474 7,g7 ,in=mation ab\t progress ,! ,c5t] %all regul>ly collect & make publicly available in=mation ab\t ! progress ( entities receiv+ grants "u section #cdjb reg>d+ successful innovations 9 implem5t+ ! obligations "u ?is subsection & provide public notice 9 ! entities' communities ab\t ! availability ( ?is in=mation4 7b7 ,director ,! ,c5t] %all be head$ by a ,director :o %all be appo9t$ by1 & :o %all report to1 ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality4 7c7 ,availability ( language access ,! ,director %all collaborate ) ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 & ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration to notify heal? c>e provid]s & heal? c>e organizations ab\t ! availability ( language access s]vices by ! ,c5t]4 7d7 ,education ,! ,secret>y1 directly or ?r\gh contract1 %all und]take a national education campaign to in=m provid]s1 individuals ) limit$ ,engli% pr(ici5cy1 individuals ) he>+ or vision impairm5ts1 heal? pr(essionals1 graduate s*ools1 & community heal? c5t]s ab\t-- 7#a7 ,f$]al & ,/ate laws & guidel9es gov]n+ access to language s]vices2 7#b7 ! value ( us+ tra9$ & compet5t int]pret]s & ! risks associat$ ) us+ family memb]s1 fri5ds1 m9ors1 & untra9$ bil+ual /aff2 7#c7 fund+ s\rces = develop+ & implem5t+ language s]vices2 & 7#d7 promis+ practices to effectively provide language s]vices4 7e7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section #e1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #cdjb4 ,innovations 9 culturally & l+ui/ically appropriate heal? c>e grants 7a7 ,9 g5]al 7#a7 ,grants ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 %all aw>d grants to eligible entities to enable su* entities to design1 implem5t1 & evaluate innovative1 co/-effective programs to improve culturally & l+ui/ically appropriate access to heal? c>e s]vices = individuals ) limit$ ,engli% pr(ici5cy4 7#b7 ,coord9ation ,! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality %all coord9ate )1 & ensure ! p>ticipation (1 o!r ag5cies includ+ ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities at ! ,national ,in/itutes ( ,heal?1 & ! ,(fice ( ,m9ority ,heal?1 reg>d+ ! design & evaluation ( ! grants program4 7b7 ,eligibility ,to be eligible to receive a grant "u subsection 7a71 an entity %all-- 7#a7 be-- 7,a7 a city1 c\nty1 ,indian ,tribe1 ,/ate1 or subdivision !re(2 7,b7 an organization describ$ 9 section #eja7;c77#c7 ( ! ,int]nal ,rev5ue ,code ( #aihf & exempt f tax "u section #eja7;a7 ( su* ,code2 7,c7 a community heal?1 m5tal heal?1 or sub/ance use disord] c5t] or cl9ic2 7,d7 a solo or gr\p physician practice2 7,e7 an integrat$ heal? c>e deliv]y sy/em2 7,f7 a public hospital2 7,g7 a heal? c>e gr\p1 univ]sity1 or college2 or 7,h7 any o!r entity designat$ by ! ,secret>y2 & 7#b7 prep>e & submit to ! ,secret>y an application1 at su* "t1 9 su* mann]1 & conta9+ su* additional in=mation z ! ,secret>y may reasonably require4 7c7 ,use ( funds ,an entity %all use funds receiv$ ?r\gh a grant "u ?is section to-- 7#a7 develop1 implem5t1 & evaluate models ( provid+ compet5t int]pretation s]vices ?r\gh onsite int]pretation1 telephonic int]pretation1 or video remote int]pret+ s]vices2 7#b7 implem5t /rategies to recruit1 reta91 & promote individuals at all levels ( ! organization to ma9ta9 a div]se /aff & lead]%ip t c promote & provide language s]vices to pati5t populations ( ! s]vice area ( ! entity2 7#c7 develop & ma9ta9 a ne$s assessm5t t id5tifies ! curr5t demographic1 cultural1 & epidemiological pr(ile ( ! community to accurately plan = & implem5t language s]vices ne$$ 9 ! s]vice area ( ! entity2 7#d7 develop a /rategic plan to implem5t language s]vices2 7#e7 develop p>ticipatory1 collaborative p>tn]%ips ) communities encompass+ ! pati5t populations ( individuals ) limit$ ,engli% pr(ici5cy s]v$ by ! grant to ga9 input 9 design+ & implem5t+ language s]vices2 7#f7 develop & implem5t grievance resolution processes t are culturally & l+ui/ically appropriate & capable ( id5tify+1 prev5t+1 & resolv+ compla9ts by individuals ) limit$ ,engli% pr(ici5cy2 7#g7 develop %ort-t]m m$ical & m5tal heal? int]pretation tra9+ c\rses & inc5tives = bil+ual heal? c>e /aff :o are ask$ to provide int]pretation s]vices 9 ! workplace2 7#h7 develop =mal tra9+ programs1 includ+ cont9u$ pr(essional developm5t & education programs z well z sup]vision1 = individuals int]e/$ 9 becom+ d$icat$ heal? c>e int]pret]s & culturally & l+ui/ically appropriate provid]s2 7#i7 provide /aff language tra9+ in/ruction1 :i* %all include in=mation on ! practical limitations ( su* in/ruction = nonnative speak]s2 7#aj7 develop policies t address comp5sation 9 sal>y = /aff :o receive tra9+ to become ei!r a /aff int]pret] or bil+ual provid]2 7#aa7 develop o!r language assi/ance s]vices z det]m9$ appropriate by ! ,secret>y2 7#ab7 develop1 implem5t1 & evaluate models ( improv+ cultural compet5ce1 includ+ cultural compet5ce programs = community heal? work]s2 & 7#ac7 ensure t1 consi/5t ) ! privacy protections provid$ = "u ! regulations promulgat$ "u section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif & any applicable ,/ate privacy laws1 data on ! individual pati5t or recipi5t's race1 e?nicity1 & prim>y language are collect$ 7& p]iodically updat$7 9 heal? records & integrat$ into ! organization's in=mation managem5t sy/ems or any simil> sy/em us$ to /ore & retrieve data4 7d7 ,priority ,9 aw>d+ grants "u ?is section1 ! ,secret>y %all give priority to entities t prim>ily engage 9 provid+ direct c>e & t h develop$ p>tn]%ips ) community organizations or ) ag5cies ) exp]i5ce 9 improv+ language access4 7e7 ,evaluation 7#a7 ,by grantees ,an entity t receives a grant "u ?is section %all submit to ! ,secret>y an evaluation t describes1 9 ! mann] & to ! ext5t requir$ by ! ,secret>y1 ! activities c>ri$ out ) funds receiv$ "u ! grant1 & h[ su* activities improv$ access to heal? c>e s]vices & heal?-c>e-relat$ s]vices & ! quality ( heal? c>e = individuals ) limit$ ,engli% pr(ici5cy4 ,su* evaluation %all be collect$ & dissem9at$ ?r\gh ! ,rob]t ,t4 ,matsui ,c5t] = ,culturally & ,l+ui/ically ,appropriate ,heal? ,c>e e/abli%$ "u section #cdja4 ,! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality %all notify grantees ( ! availability ( te*nical assi/ance = ! evaluation & provide su* assi/ance ^u reque/4 7#b7 ,by ,secret>y ,! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality %all evaluate or arrange ) o!r individuals or organizations to evaluate projects fund$ "u ?is section4 7f7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section1 #e1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #cdjc4 ,rese>* on cultural & language compet5ce 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 %all exp& rese>* conc]n+ language access 9 ! provision ( heal? c>e s]vices4 7b7 ,eligibility ,! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality may conduct ! rese>* describ$ 9 subsection 7a7 or ent] into contracts ) o!r individuals or organizations to conduct su* rese>*4 7c7 ,use ( funds ,rese>* conduct$ "u ?is section %all be design$ to d "o or m ( ! foll[+3 7#a7 ,to id5tify ! b>ri]s to m5tal & behavioral s]vices t are fac$ by individuals ) limit$ ,engli% pr(ici5cy4 7#b7 ,to id5tify heal? c>e provid]s' & heal? adm9i/rators' attitudes1 k1 & aw>5ess ( ! b>ri]s to quality heal? c>e s]vices t are fac$ by individuals ) limit$ ,engli% pr(ici5cy4 7#c7 ,to id5tify optimal approa*es = deliv]+ language access4 7#d7 ,to id5tify be/ practices = data collection1 includ+-- 7,a7 ! collection by provid]s ( heal? c>e s]vices & heal?-c>e-relat$ s]vices ( data on ! race1 e?nicity1 & prim>y language ( recipi5ts ( su* s]vices1 tak+ into acc\nt exi/+ rese>* conduct$ by ! ,gov]nm5t or private sector2 7,b7 ! developm5t & implem5tation ( data collection & report+ sy/ems2 & 7,c7 effective privacy safegu>ds = collect$ data4 7#e7 ,to develop a m9imum data collection set = prim>y language4 7#f7 ,to evaluate ! mo/ effective ways 9 :i* ! ,secret>y c create or coord9ate1 & subsidize or o!rwise fund1 telephonic int]pretation s]vices = heal? c>e provid]s1 tak+ into consid]ation1 among o!r factors1 ! flexibility necess>y = su* a sy/em to accommodate v>iations 9-- 7,a7 provid] type2 7,b7 languages ne$$ & _! frequ5cy ( use2 7,c7 type ( enc\nt]2 7,d7 "t ( enc\nt]1 includ+ regul> bus9ess h\rs & aft] h\rs2 & 7,e7 location ( enc\nt]4 7d7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section #e1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 4 #bje4 ,pilot program = improvem5t & developm5t ( ,/ate m$ical int]pret+ s]vices 7a7 ,grants au?oriz$ ,! ,secret>y ( ,heal? & ,human ,s]vices %all aw>d #a grant 9 accordance ) ?is section to ea* ( #c ,/ates 7to be select$ by ! ,secret>y7 to assi/ ea* su* ,/ate 9 design+1 implem5t+1 & evaluat+ a /atewide program to provide onsite int]pret] s]vices "u ! ,/ate ,m$icaid plan4 7b7 ,grant p]iod ,a grant aw>d$ "u ?is section is au?oriz$ = ! p]iod ( #c fiscal ye>s beg9n+ on ,octob] #a1 #bjba1 & end+ on ,septemb] #cj1 #bjbd4 7c7 ,pref]5ce ,9 aw>d+ a grant "u ?is section1 ! ,secret>y %all give pref]5ce to a ,/ate-- 7#a7 t has a high proportion ( qualifi$ ,,lep enrollees1 z det]m9$ by ! ,secret>y2 7#b7 t has a l>ge numb] ( qualifi$ ,,lep enrollees1 z det]m9$ by ! ,secret>y2 7#c7 t has a high gr[? rate ( ! population ( individuals ) limit$ ,engli% pr(ici5cy1 z det]m9$ by ! ,secret>y2 & 7#d7 t has a population ( qualifi$ ,,lep enrollees t is l+ui/ically div]se1 requir+ int]pret] s]vices 9 at lea/ #bjj non-,engli% languages4 7d7 ,use ( funds ,a ,/ate receiv+ a grant "u ?is section %all use ! grant funds to-- 7#a7 ensure t all heal? c>e provid]s 9 ! ,/ate p>ticipat+ 9 ! ,/ate ,m$icaid plan h access to onsite int]pret] s]vices1 = ! purpose ( enabl+ effective communication betwe5 su* provid]s & qualifi$ ,,lep enrollees dur+ ! furni%+ ( items & s]vices & adm9i/rative int]actions2 7#b7 e/abli%1 exp&1 procure1 or contract =-- 7,a7 a /atewide heal? c>e in=mation te*nology sy/em t is design$ to a*ieve effici5cies & economies ( scale ) respect to onsite int]pret] s]vices provid$ to heal? c>e provid]s 9 ! ,/ate p>ticipat+ 9 ! ,/ate ,m$icaid plan2 & 7,b7 an entity to adm9i/] su* sy/em1 ! duties ( :i* %all include-- 7i7 procur+ & s*$ul+ int]pret] s]vices = qualifi$ ,,lep enrollees2 7ii7 procur+ & s*$ul+ int]pret] s]vices = individuals ) limit$ ,engli% pr(ici5cy seek+ to enroll 9 ! ,/ate ,m$icaid plan2 7iii7 ensur+ t int]pret]s receive paym5t = int]pret] s]vices r5d]$ "u ! sy/em2 & 7iv7 consult+ regul>ly ) organizations repres5t+ consum]s1 int]pret]s1 & heal? c>e provid]s2 & 7#c7 develop me*anisms to e/abli%1 improve1 & /r5g!n ! compet5cy ( ! m$ical int]pretation work=ce t s]ves qualifi$ ,,lep enrollees 9 ! ,/ate1 includ+ a national c]tification process t is valid1 cr$ible1 & v5dor-neutral4 7e7 ,application ,to receive a grant "u ?is section1 a ,/ate %all submit an application at su* "t & conta9+ su* in=mation z ! ,secret>y may require1 :i* %all include ! foll[+3 7#a7 ,a description ( ! language access ne$s ( individuals 9 ! ,/ate enroll$ 9 ! ,/ate ,m$icaid plan4 7#b7 ,a description ( ! ext5t to :i* ! program w-- 7,a7 use ! grant funds = ! purposes describ$ 9 subsection 7d72 7,b7 meet ! heal? c>e ne$s ( rural populations ( ! ,/ate2 & 7,c7 collect in=mation t accurately tracks ! language s]vices reque/$ by consum]s z comp>$ to ! language s]vices provid$ by heal? c>e provid]s 9 ! ,/ate p>ticipat+ 9 ! ,/ate ,m$icaid plan4 7#c7 ,a description ( h[ ! program w be evaluat$1 includ+ a proposal = collaboration ) organizations repres5t+ int]pret]s1 consum]s1 & individuals ) limit$ ,engli% pr(ici5cy4 7f7 ,def9itions ,9 ?is section3 7#a7 ,qualifi$ ,,lep enrollee ,! t]m qualifi$ ,,lep enrollee means an individual-- 7,a7 :o is limit$ ,engli% pr(ici5t2 & 7,b7 :o is enroll$ 9 a ,/ate ,m$icaid plan4 7#b7 ,/ate ,! t]m ,/ate has ! mean+ giv5 ! t]m 9 section #aaja7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acja7;a77#a771 = purposes ( title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq474 7#c7 ,/ate ,m$icaid plan ,! t]m ,/ate ,m$icaid plan means a ,/ate plan "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 or a waiv] ( su* a plan4 7#d7 ,unit$ ,/ates ,! t]m ,unit$ ,/ates has ! mean+ giv5 ! t]m 9 section #aaja7;a77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acja7;a77#b771 = purposes ( title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq474 7g7 ,cont9uation pa/ demon/ration ,any ,/ate receiv+ a grant "u ?is section mu/ agree to directly pay = language s]vices 9 ,m$icaid = all ,m$icaid provid]s by ! end ( ! grant p]iod4 7h7 ,fund+ 7#a7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ #e1jjj1jjj to c>ry out ?is section4 7#b7 ,availability ( funds ,am\nts appropriat$ pursuant to ! au?orization 9 p>agraph 7#a7 are au?oriz$ to rema9 available )\t fiscal ye> limitation4 7#c7 ,increas$ ,f$]al f9ancial p>ticipation ,section #aijc7;a77#b77;,e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#b77;,e77 is am5d$ by ins]t+ 7or1 9 ! case ( a ,/ate t 0 aw>d$ a grant "u section #bje ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbj1 #ajj p]c5t = ea* qu>t] occurr+ dur+ ! grant p]iod specifi$ 9 subsection 7b7 ( su* section7 aft] #ge p]c5t4 7i7 ,limitation ,no ,f$]al funds aw>d$ "u ?is section may be us$ to provide int]pret] s]vices f a location outside ! ,unit$ ,/ates4 #bjf4 ,tra9+ tomorr['s doctors = culturally & l+ui/ically appropriate c>e3 graduate m$ical education 7a7 ,direct graduate m$ical education ,section #ahhf7;h77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77#d77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,l7 ,treatm5t ( culturally & l+ui/ically appropriate tra9+ ,9 det]m9+ a hospital's numb] ( full-"t equival5t resid5ts = purposes ( ?is subsection1 all ! "t t is sp5t by an int]n or resid5t 9 an approv$ m$ical resid5cy tra9+ program = education & tra9+ 9 culturally & l+ui/ically appropriate s]vice deliv]y1 :i* %all include all div]se populations includ+ p ) disabilities & ! ,lesbian1 gay1 bisexual1 transg5d]1 que]1 que/ion+1 que/ion+ & int]sex 7,,lgbtqia7 community1 %all be c\nt$ t[>d ! det]m9ation ( full-"t equival5cy4 4 7b7 ,indirect m$ical education ,section #ahhf7;d77#e77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77 is am5d$-- 7#a7 by r$esignat+ ! clause 7x7 add$ by section #eeje7;b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act z clause 7xi7 & mov+ ! left m>g9 ( su* clause & ea* subclause & item !re9 #b ems to ! left2 & 7#b7 by add+ at ! end ! foll[+ new clause3 7xii7 ,! provisions ( subp>agraph 7,l7 ( subsection 7h77#d7 %all apply "u ?is subp>agraph 9 ! same mann] z !y apply "u su* subsection4 4 7c7 ,effective date ,! am5dm5ts made by subsections 7a7 & 7b7 %all apply ) respect to paym5ts made to hospitals on or aft] ! date t is "o ye> aft] ! date ( ! enactm5t ( ?is ,act4 #bjg4 ,f$]al reimbursem5t = culturally & l+ui/ically appropriate s]vices "u ! ,m$ic>e1 ,m$icaid1 & ,/ate ,*ildr5's ,heal? ,insurance ,programs 7a7 ,language ,access grants = ,m$ic>e ,provid]s 7#a7 ,e/abli%m5t 7,a7 ,9 g5]al ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices & 9 consultation ) ! ,c5t] = ,m$ic>e & ,m$icaid ,innovation 7z ref]r$ to 9 section #aaae;,a ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae;a771 %all e/abli% a demon/ration program "u :i* ! ,secret>y %all aw>d grants to eligible ,m$ic>e s]vice provid]s to improve communication betwe5 su* provid]s & ,m$ic>e b5efici>ies :o are limit$ ,engli% pr(ici5t1 includ+ b5efici>ies :o live 9 div]se & und]s]v$ communities4 7,b7 ,application ( innovation rules ,! demon/ration project "u subp>agraph 7,a7 %all be conduct$ 9 a mann] t is consi/5t ) ! applicable provisions ( subsections 7b71 7c71 & 7d7 ( section #aaae;,a ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae;a74 7,c7 ,numb] ( grants ,to ! ext5t practicable1 ! ,secret>y %all aw>d n less ?an #bd grants "u ?is subsection4 7,d7 ,grant p]iod ,except z provid$ "u p>agraph 7#b77;,d71 ea* grant aw>d$ "u ?is subsection %all be = a #c-ye> p]iod4 7#b7 ,eligibility requirem5ts ,to be eligible = a grant "u ?is subsection1 an entity mu/ meet ! foll[+ requirem5ts3 7,a7 ,m$ic>e provid] ,! entity mu/ be-- 7i7 a provid] ( s]vices "u "p ,a ( title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq472 7ii7 a provid] ( s]vices "u "p ,b ( su* title 7#db ,u4,s4,c4 #acie;j et seq472 7iii7 a ,m$ic>e ,advantage organization (f]+ a ,m$ic>e ,advantage plan "u "p ,c ( su* title 7#db ,u4,s4,c4 #aciew-#ba et seq472 or 7iv7 a ,,pdp sponsor (f]+ a prescription drug plan "u "p ,d ( su* title 7#db ,u4,s4,c4 #aciew-#aja et seq474 7,b7 ,und]s]v$ communities ,! entity mu/ s]ve a community t1 ) respect to necess>y language s]vices = improv+ access & utilization ( heal? c>e among ,engli% le>n]s1 is disproportionally und]s]v$4 7,c7 ,application ,! entity mu/ prep>e & submit to ! ,secret>y an application1 at su* "t1 9 su* mann]1 & accompani$ by su* additional in=mation z ! ,secret>y may require4 7,d7 ,report+ ,9 ! case ( a grantee t receiv$ a grant "u ?is subsection 9 a previ\s ye>1 su* grantee is only eligible = cont9u$ paym5ts "u a grant "u ?is subsection if ! grantee met ! report+ requirem5ts "u p>agraph 7#i7 = su* ye>4 ,if a grantee fails to meet ! requirem5t ( su* p>agraph = ! fir/ ye> ( a grant1 ! ,secret>y may t]m9ate ! grant & solicit applications f new grantees to p>ticipate 9 ! demon/ration program4 7#c7 ,di/ribution ,to ! ext5t feasible1 ! ,secret>y %all aw>d-- 7,a7 at lea/ #f grants to provid]s ( s]vices describ$ 9 p>agraph 7#b77;,a77i72 7,b7 at lea/ #f grants to s]vice provid]s describ$ 9 p>agraph 7#b77;,a77ii72 7,c7 at lea/ #f grants to organizations describ$ 9 p>agraph 7#b77;,a77iii72 & 7,d7 at lea/ #f grants to sponsors describ$ 9 p>agraph 7#b77;,a77iv74 7#d7 ,consid]ations 9 aw>d+ grants 7,a7 ,v>iation 9 grantees ,9 aw>d+ grants "u ?is subsection1 ! ,secret>y %all select grantees to ensure ! foll[+3 7i7 ,! grantees provide _m diff]5t types ( language s]vices4 7ii7 ,! grantees s]ve ,m$ic>e b5efici>ies :o speak diff]5t languages1 & :o1 z a population1 h diff]+ ne$s = language s]vices4 7iii7 ,! grantees s]ve ,m$ic>e b5efici>ies 9 bo? urban & rural sett+s4 7iv7 ,! grantees s]ve ,m$ic>e b5efici>ies 9 at lea/ two geographic regions1 z def9$ by ! ,secret>y4 7v7 ,! grantees s]ve ,m$ic>e b5efici>ies 9 at lea/ two l>ge metropolitan /ati/ical areas ) racial1 e?nic1 sexual1 g5d]1 disability1 & economically div]se populations4 7,b7 ,priority = p>tn]%ips ) community organizations & ag5cies ,9 aw>d+ grants "u ?is subsection1 ! ,secret>y %all give priority to eligible entities t h a p>tn]%ip )-- 7i7 a community organization2 or 7ii7 a consortia ( community organizations1 ,/ate ag5cies1 & local ag5cies1 t has exp]i5ce 9 provid+ language s]vices4 7#e7 ,use ( funds = compet5t language s]vices 7,a7 ,9 g5]al ,subject to subp>agraph 7,e71 a grantee may only use grant funds receiv$ "u ?is subsection to pay = ! provision ( compet5t language s]vices to ,m$ic>e b5efici>ies :o are ,engli% le>n]s4 7,b7 ,compet5t language s]vices def9$ ,= purposes ( ?is subsection1 ! t]m compet5t language s]vices means-- 7i7 int]pret] & translation s]vices t-- 7,i7 subject to ! exceptions "u subp>agraph 7,c7-- 7aa7 if ! grantee op]ates 9 a ,/ate t has /atewide heal? c>e int]pret] /&>ds1 meet ! ,/ate /&>ds curr5tly 9 effect2 or 7bb7 if ! grantee op]ates 9 a ,/ate t does n h /atewide heal? c>e int]pret] /&>ds1 utilizes compet5t int]pret]s :o foll[ ! ,national ,c\ncil on ,int]pret+ 9 ,heal? ,c>e's ,code ( ,e?ics & ,/&>ds ( ,practice & comply ) ! requirem5ts ( section #aeeg ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahaaf7 z publi%$ 9 ! ,f$]al ,regi/] on ,may #ah1 #bjaf2 & 7,,ii7 t1 9 ! case ( int]pret] s]vices1 are provid$ ?r\gh-- 7aa7 onsite int]pretation2 7bb7 telephonic int]pretation2 or 7cc7 video int]pretation2 & 7ii7 ! direct provision ( heal? c>e or heal?-c>e-relat$ s]vices by a compet5t bil+ual heal? c>e provid]4 7,c7 ,exceptions ,! requirem5ts ( subp>agraph 7,b77i77,i7 d n apply1 ) respect to int]pret] & translation s]vices & a grantee-- 7i7 9 ! case ( a ,m$ic>e b5efici>y :o is an ,engli% le>n] if-- 7,i7 su* b5efici>y has be5 in=m$1 9 ! b5efici>y's prim>y language1 ( ! availability ( free int]pret] & translation s]vices & ! b5efici>y in/ead reque/s t a family memb]1 fri5d1 or o!r p]son provide su* s]vices2 & 7,,ii7 ! grantee docum5ts su* reque/ 9 ! b5efici>y's m$ical record2 or 7ii7 9 ! case ( a m$ical em]g5cy :]e ! delay directly associat$ ) obta9+ a compet5t int]pret] or translation s]vices w\ld jeop>dize ! heal? ( ! pati5t4 ,clause 7ii7 %all n be con/ru$ to exempt em]g5cy rooms or simil> entities t regul>ly provide heal? c>e s]vices 9 m$ical em]g5cies to pati5ts :o are ,engli% le>n]s f any applicable legal or regulatory requirem5ts relat$ to provid+ compet5t int]pret] & translation s]vices )\t undue delay4 7,d7 ,m$ic>e advantage organizations & ,,pdp sponsors ,if a grantee is a ,m$ic>e ,advantage organization (f]+ a ,m$ic>e ,advantage plan "u "p ,c ( title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba et seq47 or a ,,pdp sponsor (f]+ a prescription drug plan "u "p ,d ( su* title 7#db ,u4,s4,c4 #aciew-#aja et seq471 su* entity mu/ provide at lea/ #ej p]c5t ( ! grant funds t ! entity receives "u ?is subsection directly to ! entity's network provid]s 7includ+ all heal? provid]s & ph>maci/s7 = ! purpose ( provid+ support = su* provid]s to provide compet5t language s]vices to ,m$ic>e b5efici>ies :o are ,engli% le>n]s4 7,e7 ,adm9i/rative & report+ co/s ,a grantee may use up to #aj p]c5t ( ! grant funds to pay = adm9i/rative co/s associat$ ) ! provision ( compet5t language s]vices & = report+ requir$ "u p>agraph 7#i74 7#f7 ,det]m9ation ( am\nt ( grant paym5ts 7,a7 ,9 g5]al ,paym5ts to grantees "u ?is subsection %all be calculat$ bas$ on ! e/imat$ numb]s ( ,m$ic>e b5efici>ies :o are ,engli% le>n]s 9 a grantee's s]vice area utiliz+-- 7i7 data on ! numb]s ( ,engli% le>n]s :o speak ,engli% less ?an v well f ! mo/ rec5tly available data f ! ,bureau ( ! ,c5sus or o!r ,/ate-bas$ /udy ! ,secret>y det]m9es likely to yield accurate data reg>d+ ! numb] ( su* individuals 9 su* s]vice area2 or 7ii7 data provid$ by ! grantee1 if ! grantee r\t9ely collects data on ! prim>y language ( ! ,m$ic>e b5efici>ies t ! grantee s]ves & ! ,secret>y det]m9es t ! data is accurate & %[s a great] numb] ( ,engli% le>n]s ?an w\ld be e/imat$ us+ ! data "u clause 7i74 7,b7 ,discretion ( ,secret>y ,subject to subp>agraph 7,c71 ! am\nt ( paym5t made to a grantee "u ?is subsection may be modifi$ annually at ! discretion ( ! ,secret>y1 bas$ on *anges 9 ! data "u subp>agraph 7,a7 ) respect to ! s]vice area ( a grantee = ! ye>4 7,c7 ,limitation on am\nt ,! am\nt ( a grant made "u ?is subsection to a grantee may n exce$ #ejj1jjj = ! p]iod "u p>agraph 7#a77;,d74 7#g7 ,assurances ,grantees "u ?is subsection %all1 z a condition ( receiv+ a grant "u ?is subsection-- 7,a7 ensure t cl9ical & support /aff receive appropriate ongo+ education & tra9+ 9 l+ui/ically appropriate s]vice deliv]y2 7,b7 ensure ! l+ui/ic compet5ce ( bil+ual provid]s2 7,c7 (f] & provide appropriate language s]vices at no additional *>ge to ea* pati5t :o is an ,engli% le>n] = all po9ts ( contact betwe5 ! pati5t & ! grantee1 9 a timely mann] dur+ all h\rs ( op]ation2 7,d7 notify ,m$ic>e b5efici>ies ( _! "r to receive language s]vices 9 _! prim>y language2 7,e7 po/ signage 9 ! prim>y languages commonly us$ by ! pati5t population 9 ! s]vice area ( ! organization2 & 7,f7 ensure t-- 7i7 prim>y language data are collect$ = recipi5ts ( language s]vices & su* data are consi/5t ) /&>ds develop$ "u title ,,xxxiv ( ! ,public ,heal? ,s]vice ,act1 z add$ by section #bjb ( ?is ,act1 to ! ext5t su* /&>ds are available ^u ! initiation ( ! demon/ration program2 & 7ii7 consi/5t ) ! privacy protections provid$ "u ! regulations promulgat$ pursuant to section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif 7#db ,u4,s4,c4 #acbj;d-#b note71 if ! recipi5t ( language s]vices is a m9or or is incapacitat$1 prim>y language data are collect$ on ! p>5t or legal gu>dian ( su* recipi5t4 7#h7 ,no ,co/ ,%>+ ,m$ic>e b5efici>ies :o are ,engli% le>n]s %all n h to pay co/ %>+ or co-paym5ts = compet5t language s]vices provid$ "u ?is demon/ration program4 7#i7 ,report+ ,requirem5ts = grantees ,n lat] ?an ! end ( ea* cal5d> ye>1 a grantee t receives funds "u ?is subsection 9 su* ye> %all submit to ! ,secret>y a report t includes ! foll[+ in=mation3 7,a7 ,! numb] ( ,m$ic>e b5efici>ies to :om compet5t language s]vices are provid$4 7,b7 ,! prim>y languages ( ^? ,m$ic>e b5efici>ies4 7,c7 ,! types ( language s]vices provid$ to su* b5efici>ies4 7,d7 ,:e!r su* language s]vices 7 provid$ by employees ( ! grantee or ?r\gh a contract ) ext]nal contractors or ag5cies4 7,e7 ,! types ( int]pretation s]vices provid$ to su* b5efici>ies1 & ! approximate l5g? ( "t su* s]vice is provid$ to su* b5efici>ies4 7,f7 ,! co/s ( provid+ compet5t language s]vices4 7,g7 ,an acc\nt ( ! tra9+ or accr$itation ( bil+ual /aff1 int]pret]s1 & translators provid+ s]vices fund$ by ! grant "u ?is subsection4 7#aj7 ,evaluation & report to ,congress ,n lat] ?an #a ye> aft] ! completion ( a #c-ye> grant "u ?is subsection1 ! ,secret>y %all conduct an evaluation ( ! demon/ration program "u ?is subsection & %all submit to ! ,congress a report t includes ! foll[+3 7,a7 ,an analysis ( ! pati5t outcomes & ! co/s ( furni%+ c>e to ! ,m$ic>e b5efici>ies :o are ,engli% le>n]s p>ticipat+ 9 ! project z comp>$ to su* outcomes & co/s = su* ,m$ic>e b5efici>ies n p>ticipat+1 bas$ on ! data provid$ "u p>agraph 7#i7 & any o!r in=mation available to ! ,secret>y4 7,b7 ,! effect ( deliv]+ language s]vices on-- 7i7 ,m$ic>e b5efici>y access to c>e & utilization ( s]vices2 7ii7 ! effici5cy & co/ effectiv5ess ( heal? c>e deliv]y2 7iii7 pati5t satisfaction2 7iv7 heal? outcomes2 & 7v7 ! provision ( culturally appropriate s]vices provid$ to su* b5efici>ies4 7,c7 ,! ext5t to :i* bil+ual /aff1 int]pret]s1 & translators provid+ s]vices "u su* demon/ration 7 tra9$ or accr$it$ & ! nature ( accr$itation or tra9+ ne$$ by type ( provid]1 s]vice1 or o!r category z det]m9$ by ! ,secret>y to ensure ! provision ( high-quality int]pretation1 translation1 or o!r language s]vices to ,m$ic>e b5efici>ies if su* s]vices are exp&$ pursuant to section #aaae;,a7c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7c774 7,d7 ,recomm5dations1 if any1 reg>d+ ! ext5sion ( su* project to ! entire ,m$ic>e ,program1 subject to ! provisions ( su* section #aaae;,a7c74 7#aa7 ,appropriations ,!re is appropriat$ to c>ry out ?is subsection1 9 equal p>ts f ! ,f$]al ,hospital ,insurance ,tru/ ,fund "u section #ahag ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;i7 & ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund "u section #ahda ( su* ,act 7#db ,u4,s4,c4 #aciet71 #af1jjj1jjj = ea* fiscal ye> ( ! demon/ration program4 7#ab7 ,engli% le>n] def9$ ,9 ?is subsection1 ! t]m ,engli% le>n] has ! mean+ giv5 su* t]m 9 section #haja7bj7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife1 except t subp>agraphs 7,a71 7,b71 & 7,d7 ( su* section %all n apply4 7b7 ,language assi/ance s]vices "u ! ,m$ic>e program 7#a7 ,inclusion z rural heal? cl9ic s]vices ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is am5d$-- 7,a7 9 subsection 7aa77#a7-- 7i7 9 subp>agraph 7,b71 by /rik+ & at ! end2 7ii7 by add+ & at ! end ( subp>agraph 7,c72 & 7iii7 by ins]t+ aft] subp>agraph 7,c7 ! foll[+ new subp>agraph3 7,d7 language assi/ance s]vices z def9$ 9 subsection 7kkk77#a71 2 & 7,b7 by add+ at ! end ! foll[+ new subsection3 7kkk7 ,language assi/ance s]vices & relat$ t]ms 7#a7 ,! t]m language assi/ance s]vices means language access or language assi/ance s]vices 7z ^? t]ms are def9$ 9 section #cdjj ( ! ,public ,heal? ,s]vice ,act7 furni%$ by a qualifi$ int]pret] = an individual ) limit$ ,engli% pr(ici5cy or a qualifi$ translator 7z ^? t]ms are def9$ 9 su* section #cdjj7 to an individual ) limit$ ,engli% pr(ici5cy 7z def9$ 9 su* section #cdjj7 or an ,engli% le>n] 7z def9$ 9 p>agraph 7#b774 7#b7 ,! t]m ,engli% le>n] has ! mean+ giv5 t t]m 9 section #haja7bj7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife1 except t subp>agraphs 7,a71 7,b71 & 7,d7 ( su* section %all n apply4 4 7#b7 ,cov]age ,section #ahcb7;a77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciek7a77#b77 is am5d$-- 7,a7 by /rik+ & at ! end ( subp>agraph 7,i72 7,b7 by /rik+ ! p]iod at ! end ( subp>agraph 7,j7 & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,k7 language assi/ance s]vices 7z def9$ 9 section #ahfa7kkk77#a774 4 7#c7 ,paym5t ,section #ahcc7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77 is am5d$-- 7,a7 by /rik+ & at ! end ( p>agraph 7#h72 7,b7 by /rik+ ! p]iod at ! end ( p>agraph 7#i7 & ins]t+ 2 &2 & 7,c7 by ins]t+ aft] p>agraph 7#i7 ! foll[+ new p>agraph3 7#aj7 9 ! case ( language assi/ance s]vices 7z def9$ 9 section #ahfa7kkk77#a771 #ajj p]c5t ( ! reasonable *>ges = su* s]vices1 z det]m9$ 9 consultation ) ! ,m$ic>e ,paym5t ,advisory ,commission4 4 7#d7 ,waiv] ( budget neutrality ,= ! #c-ye> p]iod beg9n+ on ! date ( enactm5t ( ?is section1 ! budget neutrality provision ( section #ahdh7;c77#b77;,b77ii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77;,b77ii77 %all n apply ) respect to language assi/ance s]vices 7z def9$ 9 section #ahfa7kkk77#a7 ( su* ,act74 7c7 ,m$ic>e p>ts ,c & ,d 7#a7 ,9 g5]al ,m$ic>e ,advantage plans "u "p ,c ( title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba et seq47 & prescription drug plans "u "p ,d ( su* title 7#db ,u4,s4,c4 #acieq-#aja7 %all comply ) title ,,vi ( ! ,civil ,rights ,act ( #aifd 7#db ,u4,s4,c4 #bjjj;d et seq47 & section #aeeg ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahaaf7 to provide effective language s]vices to enrollees ( su* plans4 7#b7 ,m$ic>e ,advantage plans & prescription drug plans report+ requirem5t ,section #aheg7;e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7;e77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#f7 ,report+ requirem5ts relat+ to effective language s]vices ,a contract "u ?is "p %all require a ,m$ic>e ,advantage organization 7&1 ?r\gh application ( section #ahfj;,d-#ab7;b77#c77;,d71 a contract "u section #ahfj;,d-#ab %all require a ,,pdp sponsor7 to annually submit 7= ea* ye> ( ! contract7 a report t conta9s in=mation on ! int]nal policies & proc$ures ( ! organization 7or sponsor7 relat$ to recruitm5t & ret5tion ef=ts direct$ to work=ce div]sity & l+ui/ically & culturally appropriate provision ( s]vices 9 ea* ( ! foll[+ contexts3 7,a7 ,! collection ( data 9 a mann] t meets ! requirem5ts ( title ,i ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbj1 reg>d+ ! enrollee population4 7,b7 ,education ( /aff & contractors :o h r\t9e contact ) enrollees reg>d+ ! v>i\s ne$s ( ! div]se enrollee population4 7,c7 ,evaluation ( ! language s]vices programs & s]vices (f]$ by ! organization 7or sponsor7 ) respect to ! enrollee population1 su* z ?r\gh analysis ( compla9ts or satisfaction survey results4 7,d7 ,me?ods by :i* ! plan provides to ! ,secret>y in=mation reg>d+ ! e?nic div]sity ( ! enrollee population4 7,e7 ,! p]iodic provision ( educational in=mation to plan enrollees on ! language s]vices & programs (f]$ by ! organization 7or sponsor74 4 7d7 ,improv+ language s]vices 9 ,m$icaid & ,,*ip 7#a7 ,paym5ts to ,/ates ,section #aijc7;a77#b77;,e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#b77;,e771 z am5d$ by section #bje7;h77#c71 is fur!r am5d$ by-- 7,a7 /rik+ #ge & ins]t+ #ie2 7,b7 /rik+ translation or int]pretation s]vices & ins]t+ language assi/ance s]vices2 & 7,c7 /rik+ *ildr5 ( families & ins]t+ individuals4 7#b7 ,/ate plan requirem5ts ,section #aijb7;a77#aj77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77 is am5d$ by /rik+ & 7#bi7 & ins]t+ 7#bi71 & 7#cj74 7#c7 ,def9ition ( m$ical assi/ance ,section #aije7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is am5d$-- 7,a7 9 p>agraph 7#bi71 by /rik+ & at ! end2 7,b7 by r$esignat+ p>agraph 7#cj7 z p>agraph 7#ca72 & 7,c7 by ins]t+ aft] p>agraph 7#bi7 ! foll[+ new p>agraph3 7#cj7 language assi/ance s]vices1 z su* t]m is def9$ 9 section #ahfa7kkk77#a71 provid$ 9 a timely mann] to individuals ) limit$ ,engli% pr(ici5cy z def9$ 9 section #cdjj ( ! ,public ,heal? ,s]vice ,act2 & 4 7#d7 ,use ( d$uctions & co/ %>+ ,section #aiaf7;a77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifo7a77#b77 is am5d$-- 7,a7 by /rik+ or at ! end ( subp>agraph 7,f72 7,b7 by /rik+ 2 & at ! end ( subp>agraph 7,g7 & ins]t+ 1 or2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,h7 language assi/ance s]vices describ$ 9 section #aije7;a77#cj72 & 4 7#e7 ,,*ip cov]age requirem5ts ,section #bajc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7 is am5d$-- 7,a7 9 subsection 7a71 9 ! matt] be=e p>agraph 7#a71 by /rik+ 7#g7 & 7#h7 & ins]t+ 7#g71 7#aj71 & 7#aa72 7,b7 9 subsection 7c71 by add+ at ! end ! foll[+ new p>agraph3 7#aa7 ,language assi/ance s]vices ,! *ild heal? assi/ance provid$ to a t>get$ l[-income *ild %all include cov]age ( language assi/ance s]vices1 z su* t]m is def9$ 9 section #ahfa7kkk77#a71 provid$ 9 a timely mann] to individuals ) limit$ ,engli% pr(ici5cy 7z def9$ 9 section #cdjj ( ! ,public ,heal? ,s]vice ,act74 2 & 7,c7 9 subsection 7e77#b7-- 7i7 9 ! head+1 by /rik+ prev5tive & ins]t+ c]ta92 & 7ii7 by ins]t+ language assi/ance s]vices describ$ 9 subsection 7c77#aa71 be=e visits describ$ 94 7#f7 ,def9ition ( *ild heal? assi/ance ,section #baaj7;a77#bg7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;jj7a77#bg77 is am5d$ by /rik+ translation & ins]t+ language assi/ance s]vices z describ$ 9 section #bajc7;c77#aa74 7#g7 ,/ate data collection ,pursuant to ! report+ requirem5t describ$ 9 section #bajg7;b77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7b77#a771 ! ,secret>y ( ,heal? & ,human ,s]vices %all require t ,/ates collect data on-- 7,a7 ! prim>y language ( individuals receiv+ *ild heal? assi/ance "u title ,,xxi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq472 & 7,b7 9 ! case ( su* individuals :o are m9ors or incapacitat$1 ! prim>y language ( ! individual's p>5t or gu>dian4 7#h7 ,,*ip paym5ts to ,/ates ,section #baje ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7 is am5d$-- 7,a7 9 subsection 7a77#a7-- 7i7 9 ! matt] prec$+ subp>agraph 7,a71 by /rik+ #ge & ins]t+ #ie2 & 7ii7 9 subp>agraph 7,d77iv71 by /rik+ translation or int]pretation s]vices & ins]t+ language assi/ance s]vices2 & 7,b7 9 subsection 7c77#b77;,a71 by ins]t+ be=e ! p]iod at ! end ! foll[+3 1 except t exp5ditures pursuant to clause 7iv7 ( subp>agraph 7,d7 ( su* p>agraph %all n c\nt t[>ds ?is total4 7e7 ,fund+ language assi/ance s]vices furni%$ by provid]s ( heal? c>e & heal?-,c>e-,relat$ s]vices t s]ve high rates ( un9sur$ ,,lep individuals 7#a7 ,paym5t ( co/s 7,a7 ,9 g5]al ,subject to subp>agraph 7,b71 ! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is subsection z ! ,secret>y7 %all make paym5ts 7on a qu>t]ly basis7 directly to eligible entities to support ! provision ( language assi/ance s]vices to ,engli% le>n]s 9 an am\nt equal to an eligible entity's eligible co/s = provid+ su* s]vices = ! qu>t]4 7,b7 ,fund+ ,out ( any funds 9 ! ,treasury n o!rwise appropriat$1 !re are appropriat$ to ! ,secret>y ( ,heal? & ,human ,s]vices su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 7,c7 ,relation to ,m$icaid ,,d% ,paym5ts "u ?is subsection %all n (fset or r$uce paym5ts "u section #aibc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d71 nor %all paym5ts "u su* section be consid]$ :5 det]m9+ uncomp5sat$ co/s associat$ ) ! provision ( language assi/ance s]vices = ! purposes ( ?is section4 7#b7 ,me?odology = paym5t ( claims 7,a7 ,9 g5]al ,! ,secret>y %all e/abli% a me?odology to det]m9e ! av]age p] p]son co/ ( language assi/ance s]vices4 7,b7 ,diff]5t entities ,9 e/abli%+ su* me?odology1 ! ,secret>y may e/abli% diff]5t me?odologies = diff]5t types ( eligible entities4 7,c7 ,no individual claims ,! ,secret>y may n require eligible entities to submit individual claims = language assi/ance s]vices = individual pati5ts z a requirem5t = paym5t "u ?is subsection4 7#c7 ,data collection in/rum5t ,= purposes ( ?is subsection1 ! ,secret>y %all create a /&>d data collection in/rum5t t is consi/5t ) any exi/+ report+ requirem5ts by ! ,secret>y or relevant accr$it+ organizations reg>d+ ! numb] ( individuals to :om language access are provid$4 7#d7 ,guidel9es ,n lat] ?an #f mon?s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all e/abli% & di/ribute guidel9es conc]n+ ! implem5tation ( ?is subsection4 7#e7 ,report+ requirem5ts 7,a7 ,report to ,secret>y ,entities receiv+ paym5t "u ?is subsection %all provide ! ,secret>y ) a qu>t]ly report on h[ ! entity us$ su* funds4 ,su* report %all conta9 aggregate 7& may n conta9 individualiz$7 data collect$ us+ ! in/rum5t "u p>agraph 7#c7 & %all o!rwise be 9 a =m & mann] det]m9$ by ! ,secret>y4 7,b7 ,report to ,congress ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 & e #b ye>s !reaft]1 ! ,secret>y %all submit a report to ,congress conc]n+ ! implem5tation ( ?is subsection4 7#f7 ,def9itions ,9 ?is subsection3 7,a7 ,eligible co/s ,! t]m eligible co/s means1 ) respect to an eligible entity t provides language assi/ance s]vices to ,engli% le>n]s1 ! product (-- 7i7 ! av]age p] p]son co/ ( language assi/ance s]vices1 det]m9$ accord+ to ! me?odology devis$ "u p>agraph 7#b72 & 7ii7 ! numb] ( ,engli% le>n]s :o are provid$ language assi/ance s]vices by ! entity & = :om no reimbursem5t is available = su* s]vices "u ! am5dm5ts made by subsection 7a71 7b71 7c71 or 7d7 or by private heal? insurance4 7,b7 ,eligible entity ,! t]m eligible entity means an entity t-- 7i7 is a ,m$icaid provid] t is-- 7,i7 a physician2 7,,ii7 a hospital ) a l[-income utilization rate 7z def9$ 9 section #aibc7;b77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;b77#c777 ( great] ?an #be p]c5t2 or 7,,iii7 a f$]ally qualifi$ heal? c5t] 7z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7772 7ii7 n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is ,act1 provides language assi/ance s]vices to n less ?an #h p]c5t ( ! entity's total numb] ( pati5ts2 & 7iii7 prep>es & submits an application to ! ,secret>y1 at su* "t1 9 su* mann]1 & accompani$ by su* in=mation z ! ,secret>y may require1 to asc]ta9 ! entity's eligibility = fund+ "u ?is subsection4 7,c7 ,engli% le>n] ,! t]m ,engli% le>n] has ! mean+ giv5 su* t]m 9 section #haja7bj7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #ghja7bj771 except t subp>agraphs 7,a71 7,b71 & 7,d7 ( su* section %all n apply4 7,d7 ,language assi/ance s]vices ,! t]m language assi/ance s]vices has ! mean+ giv5 su* t]m 9 section #ahfa7kkk77#a7 ( ! ,social ,security ,act1 z add$ by subsection 7b74 7f7 ,application ( ,civil ,rights ,act ( #aifd1 section #aeeg ( ! ,af=dable ,c>e ,act1 & o!r laws ,no?+ 9 ?is section %all be con/ru$ to limit o!rwise exi/+ obligations ( recipi5ts ( ,f$]al f9ancial assi/ance "u title ,,vi ( ! ,civil ,rights ,act ( #aifd 7#db ,u4,s4,c4 #bjjj;d et seq471 section #aeeg ( ! ,af=dable ,c>e ,act1 or o!r laws t protect ! civil rights ( individuals4 7g7 ,effective date 7#a7 ,9 g5]al ,except z o!rwise provid$ & subject to p>agraph 7#b71 ! am5dm5ts made by ?is section %all take effect on ,janu>y #a1 #bjba4 7#b7 ,exception if ,/ate legislation requir$ ,9 ! case ( a ,/ate plan = m$ical assi/ance "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 or a ,/ate plan = *ild heal? assi/ance "u title ,,xxi ( su* ,act 7#db ,u4,s4,c4 #acig;aa et seq47 :i* ! ,secret>y ( ,heal? & ,human ,s]vices det]m9es requires ,/ate legislation 7o!r ?an legislation appropriat+ funds7 9 ord] = ! plan to meet ! additional requirem5t impos$ by ! am5dm5ts made by ?is section1 su* ,/ate plan %all n be reg>d$ z fail+ to comply ) ! requirem5ts ( su* title solely on ! basis ( its failure to meet ?is additional requirem5t be=e ! fir/ day ( ! fir/ cal5d> qu>t] beg9n+ aft] ! close ( ! fir/ regul> session ( ! ,/ate legislature t beg9s aft] ! date ( ! enactm5t ( ?is ,act4 ,= purposes ( ! previ\s s5t5ce1 9 ! case ( a ,/ate t has a #b-ye> legislative session1 ea* ye> ( su* session %all be deem$ to be a sep>ate regul> session ( ! ,/ate legislature4 #bjh4 ,increas+ und]/&+ ( & improv+ heal? lit]acy 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality ) respect to grants "u subsection 7c77#a7 & ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration ) respect to grants "u subsection 7c77#b71 9 consultation ) ! ,director ( ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities & ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 %all aw>d grants to eligible entities to improve heal? c>e = pati5t populations t h l[ functional heal? lit]acy4 7b7 ,eligibility ,to be eligible to receive a grant "u subsection 7a71 an entity %all-- 7#a7 be a hospital1 heal? c5t] or cl9ic1 heal? plan1 or o!r heal? entity 7includ+ a nonpr(it m9ority heal? organization or association72 & 7#b7 prep>e & submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may reasonably require4 7c7 ,use ( funds 7#a7 ,ag5cy = heal?c>e rese>* & quality ,a grant aw>d$ "u subsection 7a7 ?r\gh ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality %all be us$-- 7,a7 to def9e & increase ! und]/&+ ( heal? lit]acy2 7,b7 to inve/igate ! correlation betwe5 l[ heal? lit]acy & heal? & heal? c>e2 7,c7 to cl>ify :i* aspects ( heal? lit]acy h an effect on heal? outcomes2 & 7,d7 = any o!r activity det]m9$ appropriate by ! ,director4 7#b7 ,heal? res\rces & s]vices adm9i/ration ,a grant aw>d$ "u subsection 7a7 ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration %all be us$ to conduct demon/ration projects = int]v5tions = pati5ts ) l[ heal? lit]acy t may include-- 7,a7 ! developm5t ( new disease managem5t programs = pati5ts ) l[ heal? lit]acy2 7,b7 ! tailor+ ( disease managem5t programs address+ m5tal1 physical1 oral1 & behavioral heal? conditions = pati5ts ) l[ heal? lit]acy2 7,c7 ! translation ( writt5 heal? mat]ials = pati5ts ) l[ heal? lit]acy2 7,d7 ! id5tification1 implem5tation1 & te/+ ( l[ heal? lit]acy scre5+ tools2 7,e7 ! conduct ( educational campaigns = pati5ts & provid]s ab\t l[ heal? lit]acy2 7,f7 ! conduct ( educational campaigns conc]n+ heal? direct$ specifically at pati5ts ) m5tal disabilities1 includ+ ^? ) cognitive & intellectual disabilities1 design$ to r$uce ! incid5ce ( l[ heal? lit]acy among ^! populations1 :i* %all h in/ructional mat]ials 9 ! pla9 language /&>ds promulgat$ "u ! ,pla9 ,writ+ ,act ( #bjaj 7#e ,u4,s4,c4 #cja note7 = ,f$]al ag5cies2 & 7,g7 o!r activities det]m9$ appropriate by ! ,adm9i/rator4 7d7 ,def9itions ,9 ?is section1 ! t]m l[ heal? lit]acy means ! inability ( an individual to obta91 process1 & und]/& basic heal? in=mation & s]vices ne$$ to make appropriate heal? decisions4 7e7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section1 su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #bji4 ,requirem5ts = heal? programs or activities receiv+ ,f$]al funds 7a7 ,cov]$ entity2 cov]$ program or activity ,9 ?is section-- 7#a7 ! t]m cov]$ entity has ! mean+ giv5 su* t]m 9 section #ib4d ( title #de1 ,code ( ,f$]al ,regulations1 z 9 effect on ,may #ah1 #bjaf 7#ha ,f$4 ,reg4 #cadff 7,may #ah1 #bjaf772 & 7#b7 ! t]m heal? program or activity has ! mean+ giv5 su* t]m 9 section #ib4d ( title #de1 ,code ( ,f$]al ,regulations1 z 9 effect on ,may #ah1 #bjaf 7#ha ,f$4 ,reg4 #cadff 7,may #ah1 #bjaf774 7b7 ,requirem5ts ,a cov]$ entity1 9 ord] to ensure ! "r ( individuals ) limit$ ,engli% pr(ici5cy to receive access to high-quality heal? c>e ?r\gh ! cov]$ program or activity1 %all-- 7#a7 ensure t appropriate cl9ical & support /aff receive ongo+ education & tra9+ 9 culturally & l+ui/ically appropriate s]vice deliv]y2 7#b7 (f] & provide appropriate language assi/ance s]vices at no additional *>ge to ea* pati5t t is an individual ) limit$ ,engli% pr(ici5cy at all po9ts ( contact1 9 a timely mann] dur+ all h\rs ( op]ation2 7#c7 notify pati5ts ( _! "r to receive language s]vices 9 _! prim>y language2 & 7#d7 utilize only qualifi$ int]pret]s = an individual ) limit$ ,engli% pr(ici5cy or qualifi$ translators1 except z provid$ 9 subsection 7c74 7c7 ,exemptions ,! requirem5ts ( subsection 7b77#d7 %all n apply z foll[s3 7#a7 ,:5 a pati5t reque/s ! use ( family1 fri5ds1 or o!r p]sons untra9$ 9 int]pretation or translation if ea* ( ! foll[+ conditions are met3 7,a7 ,! int]pret] reque/$ by ! pati5t is ov] ! age ( #ah4 7,b7 ,! cov]$ entity in=ms ! pati5t 9 ! prim>y language ( ! pati5t t he or %e has ! option ( hav+ ! entity provide to ! pati5t an int]pret] & translation s]vices )\t *>ge4 7,c7 ,! cov]$ entity in=ms ! pati5t t ! entity may n require an individual ) a limit$ ,engli% pr(ici5cy to use a family memb] or fri5d z an int]pret]4 7,d7 ,! cov]$ entity evaluates :e!r ! p]son ! pati5t wi%es to use z an int]pret] is compet5t4 ,if ! cov]$ entity has reason to believe t su* p]son is n compet5t z an int]pret]1 ! entity provides its own int]pret] to protect ! cov]$ entity f liability if ! pati5t's int]pret] is lat] f\nd n compet5t4 7,e7 ,if ! cov]$ entity has reason to believe t !re is a conflict ( int]e/ betwe5 ! int]pret] & pati5t1 ! cov]$ entity may n use ! pati5t's int]pret]4 7,f7 ,! cov]$ entity has ! pati5t sign a waiv]1 witness$ by at lea/ #a individual n relat$ to ! pati5t1 t includes ! in=mation /at$ 9 subp>agraphs 7,a7 ?r\gh 7,e7 & is translat$ into ! pati5t's prim>y language4 7#b7 ,:5 a m$ical em]g5cy exi/s & ! delay directly associat$ ) obta9+ compet5t int]pret] or translation s]vices w\ld jeop>dize ! heal? ( ! pati5t1 b only until a compet5t int]pret] or translation s]vice is available4 7d7 ,rule ( con/ruction ,subsection 7c77#b7 %all n be con/ru$ to mean t em]g5cy rooms or simil> entities t regul>ly provide heal? c>e s]vices 9 m$ical em]g5cies are exempt f legal or regulatory requirem5ts relat$ to compet5t int]pret] s]vices4 #baj4 ,report on ,f$]al ef=ts to provide culturally & l+ui/ically appropriate heal? c>e s]vices 7a7 ,report ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act & annually !reaft]1 ! ,secret>y ( ,heal? & ,human ,s]vices %all ent] into a contract ) ! ,national ,academy ( ,m$ic9e = ! prep>ation & publication ( a report t describes ,f$]al ef=ts to ensure t all individuals ) limit$ ,engli% pr(ici5cy h mean+ful access to heal? c>e s]vices & heal?-c>e-relat$ s]vices t are culturally & l+ui/ically appropriate4 ,su* report %all include-- 7#a7 a description & evaluation ( ! activities c>ri$ out "u ?is ,act2 7#b7 a description & analysis ( be/ practices1 model programs1 guidel9es1 & o!r effective /rategies = provid+ access to culturally & l+ui/ically appropriate heal? c>e s]vices2 7#c7 recomm5dations on ! developm5t & implem5tation ( policies & practices by provid]s ( heal? c>e s]vices & heal?-c>e-relat$ s]vices = individuals ) limit$ ,engli% pr(ici5cy1 includ+ p ) cognitive1 he>+1 vision1 or pr9t impairm5ts2 7#d7 recomm5d guidel9es or /&>ds = heal? lit]acy & pla9 language1 in=m$ cons5t1 dis*>ge in/ructions1 & writt5 communications1 & = improvem5t ( heal? c>e access2 7#e7 a description ( ! effect ( provid+ language s]vices on quality ( heal? c>e & access to c>e2 & 7#f7 a description ( ! co/s associat$ ) or sav+s relat$ to ! provision ( language s]vices4 7b7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #baa4 ,engli% = speak]s ( o!r languages 7a7 ,grants au?oriz$ ,! ,secret>y ( ,education is au?oriz$ to provide grants to eligible entities = ! provision ( ,engli% z a second language 79 ?is section ref]r$ to ,,esl7 in/ruction & %all det]m9e1 aft] consultation ) appropriate /akehold]s1 ! me*anism = adm9i/]+ & di/ribut+ su* grants4 7b7 ,eligible entity def9$ ,9 ?is section1 ! t]m eligible entity means a ,/ate or community-bas$ organization t employs & s]ves m9ority populations4 7c7 ,application ,an eligible entity may apply = a grant "u ?is section by submitt+ su* in=mation z ! ,secret>y ( ,education may require & 9 su* =m & mann] z ! ,secret>y may require4 7d7 ,use ( grant ,z a condition ( receiv+ a grant "u ?is section1 an eligible entity %all-- 7#a7 develop & implem5t a plan = assur+ ! availability ( ,,esl in/ruction t effectively integrates in=mation ab\t ! nature ( ! ,unit$ ,/ates heal? c>e sy/em1 h[ to access c>e1 & any special language skills t may be requir$ = individuals to access & regul>ly negotiate ! sy/em effectively2 7#b7 develop a plan1 includ+1 :]e appropriate1 public-private p>tn]%ips1 = mak+ ,,esl in/ruction progressively available to all individuals seek+ in/ruction2 & 7#c7 ma9ta9 curr5t ,,esl in/ruction ef=ts by us+ funds available "u ?is section to supplem5t r ?an supplant any funds exp5d$ = ,,esl in/ruction 9 ! ,/ate z ( ,janu>y #a1 #bjbj4 7e7 ,additional duties ( ! secret>y ,! ,secret>y ( ,education %all-- 7#a7 collect & publicize annual data on h[ mu* ,f$]al1 ,/ate1 & local gov]nm5ts sp5d on ,,esl in/ruction2 7#b7 collect data f ,/ate & local gov]nm5ts to id5tify ! unmet ne$s ( ,engli% language le>n]s = appropriate ,,esl in/ruction1 includ+-- 7,a7 ! pref]r$ writt5 & spok5 language ( su* ,engli% language le>n]s2 7,b7 ! ext5t ( wait+ li/s = ,,esl in/ruction1 includ+ h[ _m programs ma9ta9 wait+ li/s &1 = programs t d n h wait+ li/s1 ! reasons :y n2 7,c7 ! availability ( programs to geographically isolat$ communities2 7,d7 ! impact ( c\rse enrollm5t policies1 includ+ op5 enrollm5t1 on ! availability ( ,,esl in/ruction2 7,e7 ! numb] ( individuals 9 ! ,/ate & ea* p>ticipat+ locality2 7,f7 ! effectiv5ess ( ! in/ruction 9 meet+ ! ne$s ( individuals receiv+ in/ruction & individuals ne$+ in/ruction2 7,g7 an assessm5t ( ! ne$ = programs t integrate job tra9+ & ,,esl in/ruction1 to assi/ individuals to obta9 bett] jobs2 & 7,h7 ! availability ( ,,esl slots by ,/ate & locality2 7#c7 det]m9e ! co/ & mo/ appropriate me?ods ( mak+ ,,esl in/ruction available to all ,engli% language le>n]s seek+ in/ruction2 & 7#d7 n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 issue a report to ,congress t assesses ! in=mation collect$ 9 p>agraphs 7#a71 7#b71 & 7#c7 & makes recomm5dations on /eps t %\ld be tak5 to progressively realize ! goal ( mak+ ,,esl in/ruction available to all ,engli% language le>n]s seek+ in/ruction4 7f7 ,au?orization ( ,appropriations ,!re are au?oriz$ to be appropriat$ to ! ,secret>y ( ,education #bej1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbd to c>ry out ?is section4 #bab4 ,implem5tation 7a7 ,g5]al provisions 7#a7 ,immunity ,a ,/ate %all n be immune "u ! #aa? ,am5dm5t to ! ,con/itution ( ! ,unit$ ,/ates f suit 9 ,f$]al c\rt = a violation ( ?is title 7includ+ an am5dm5t made by ?is title74 7#b7 ,rem$ies ,9 a suit aga9/ a ,/ate = a violation ( ?is title 7includ+ an am5dm5t made by ?is title71 rem$ies 7includ+ rem$ies bo? at law & 9 equity7 are available = su* a violation to ! same ext5t z su* rem$ies are available = su* a violation 9 a suit aga9/ any public or private entity o!r ?an a ,/ate4 7b7 ,rule ( con/ruction ,no?+ 9 ?is title %all be con/ru$ to limit o!rwise exi/+ obligations ( recipi5ts ( ,f$]al f9ancial assi/ance "u title ,,vi ( ! ,civil ,rights ,act ( #aifd 7#db ,u4,s4,c4 #bjjj;d et seq47 or any o!r ,f$]al /atute4 #bac4 ,language access s]vices 7a7 ,ess5tial b5efits ,section #acjb7;b77#a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjbb7;b77#a77 is am5d$ by add+ at ! end ! foll[+3 7,k7 ,language access s]vices1 includ+ oral int]pretation & writt5 translations4 4 7b7 ,employ]-,sponsor$ m9imum ess5tial cov]age 7#a7 ,9 g5]al ,section #cf;,b7c77#b77;,c7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by r$esignat+ clauses 7iii7 & 7iv7 z clauses 7iv7 & 7v71 respectively1 & by ins]t+ aft] clause 7ii7 ! foll[+ new clause3 7iii7 ,cov]age mu/ include language access & s]vices ,except z provid$ 9 clause 7iv71 an employee %all n be treat$ z eligible = m9imum ess5tial cov]age if su* cov]age consi/s ( an eligible employ]-sponsor$ plan 7z def9$ 9 section #ejjj;,a7f77#b77 & ! plan does n provide cov]age = language access s]vices1 includ+ oral int]pretation & writt5 translations4 4 7#b7 ,con=m+ am5dm5ts 7,a7 ,section #cf;,b7c77#b77;,c7 ( su* ,code is am5d$ by /rik+ clause 7iii7 ea* place x appe>s 9 clauses 7i7 & 7ii7 & ins]t+ clause 7iv74 7,b7 ,section #cf;,b7c77#b77;,c77iv7 ( su* ,code1 z r$esignat$ by ?is subsection1 is am5d$ by /rik+ 7i7 & 7ii7 & ins]t+ 7i71 7ii71 & 7iii74 7c7 ,quality ,report+ ,section #bgag7;a77#a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ag7;a77#a77 is am5d$-- 7#a7 by /rik+ & at ! end ( subp>agraph 7,c72 7#b7 by /rik+ ! p]iod at ! end ( subp>agraph 7,d7 & ins]t+ 2 &2 & 7#c7 by add+ at ! end ! foll[+ new subp>agraph3 7,e7 r$uce heal? disp>ities ?r\gh ! provision ( language access s]vices1 includ+ oral int]pretation & writt5 translations4 4 7d7 ,regulations reg>d+ int]nal claims & appeals & ext]nal review processes = heal? plans & heal? insurance issu]s ,! ,secret>y ( ! ,treasury1 ! ,secret>y ( ,labor1 & ! ,secret>y ( ,heal? & ,human ,s]vices %all am5d ! regulations 9 section #ed4ihae-bgai7;e7 ( title #bf1 ,code ( ,f$]al ,regulations1 section #beij4gae- #bgai7;e7 ( title #bi1 ,code ( ,f$]al ,regulations1 & section #adg4acf7;e7 ( title #de1 ,code ( ,f$]al ,regulations 7or a successor regulation71 respectively1 to require gr\p heal? plans & heal? insurance issu]s (f]+ gr\p or individual heal? insurance cov]age to :i* su* sections apply-- 7#a7 to provide oral int]pretation s]vices )\t any ?re%old requirem5ts2 7#b7 to provide 9 ! ,engli% v]sions ( all notices a /atem5t prom95tly display$ 9 n less ?an #ae non-,engli% languages cle>ly indicat+ h[ to access ! language s]vices provid$ by ! plan or issu]2 & 7#c7 ) respect to ! requirem5ts = provid+ relevant notices 9 a culturally & l+ui/ically appropriate mann] 9 ! applicable non-,engli% languages1 to apply a ?re%old t #e p]c5t ( ! population1 or n less ?an #ejj individuals1 9 ! c\nty is lit]ate only 9 ! same non-,engli% language 9 ord] = ! language to be consid]$ an applicable non-,engli% language4 7e7 ,data collection & report+ ,! ,secret>y ( ,heal? & ,human ,s]vices %all-- 7#a7 am5d ! s+le /reaml9$ application =m develop$ pursuant to section #adac ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjhc7 to collect ! pref]r$ spok5 & writt5 language = ea* h\sehold memb] apply+ = cov]age "u a qualifi$ heal? plan ?r\gh an ,ex*ange "u title ,i ( su* ,act 7#db ,u4,s4,c4 #ahjja et seq472 7#b7 require navigators1 c]tifi$ application c\nselors1 & o!r individuals assi/+ ) enrollm5t to collect & report reque/s = language assi/ance2 & 7#c7 require ! toll-free telephone hotl9es e/abli%$ pursuant to section #acaa7;d77#d77;,b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7;d77#d77;,b77 to submit an annual report docum5t+ ! numb] ( language assi/ance reque/s1 ! types ( languages reque/$1 ! range & av]age wait "t = a consum] to speak ) an int]pret]1 & any /eps ! hotl9e1 & any entity contract+ ) ! ,secret>y to provide language s]vices1 h tak5 to actively address "s ( ! consum] compla9ts4 7f7 ,effective date ,! am5dm5ts made by ?is section %all n apply to plans beg9n+ prior to ! date ( ! enactm5t ( ?is ,act4 #bad4 ,m$ically und]s]v$ populations ,section #ccj7;b77#c77;,a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;b7b77#c77;,a77 is am5d$ to read z foll[s3 7,a7 ,9 g5]al ,! t]m m$ically und]s]v$1 ) respect to a population1 means-- 7i7 ! population ( an urban or rural area designat$ by ! ,secret>y z-- 7,i7 an area ) a %ortage ( p]sonal heal? s]vices2 or 7,,ii7 a population gr\p hav+ a %ortage ( su* s]vices2 or 7ii7 a population ( individuals1 n conf9$ to a p>ticul> urban or rural area1 :o are designat$ by ! ,secret>y z hav+ a %ortage ( p]sonal heal? s]vices due to a specific demographic trait4 4 ,,iii ,heal? work=ce div]sity #cja4 ,am5dm5t to ! ,public ,heal? ,s]vice ,act ,title ,,xxxiv ( ! ,public ,heal? ,s]vice ,act1 z add$ by section #bjd1 is am5d$ by add+ at ! end ! foll[+3 ,b ,div]sify+ ! ,heal? ,c>e ,workplace #cdaa4 ,national ,work+ ,gr\p on ,work=ce ,div]sity 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,bureau ( ,heal? ,work=ce ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all aw>d a grant to an entity det]m9$ appropriate by ! ,secret>y = ! e/abli%m5t ( a national work+ gr\p on work=ce div]sity4 7b7 ,repres5tation ,9 e/abli%+ ! national work+ gr\p "u subsection 7a73 7#a7 ,! grantee %all ensure t ! gr\p has repres5tatives ( ea* ( ! foll[+3 7,a7 ,! ,heal? ,res\rces & ,s]vices ,adm9i/ration4 7,b7 ,! ,dep>tm5t ( ,heal? & ,human ,s]vices ,data ,c\ncil4 7,c7 ,! ,(fice ( ,m9ority ,heal? ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7,d7 ,! ,sub/ance ,abuse & ,m5tal ,heal? ,s]vices ,adm9i/ration4 7,e7 ,! ,bureau ( ,labor ,/ati/ics ( ! ,dep>tm5t ( ,labor4 7,f7 ,! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities4 7,g7 ,! ,ag5cy = ,heal?c>e ,rese>* & ,quality4 7,h7 ,! ,in/itute ( ,m$ic9e ,/udy ,committee = ! #bjjd work=ce div]sity report4 7,i7 ,! ,indian ,heal? ,s]vice4 7,j7 ,! ,dep>tm5t ( ,education4 7,k7 ,m9ority-s]v+ academic in/itutions4 7,l7 ,consum] organizations4 7,m7 ,heal? pr(essional associations1 includ+ ^? t repres5t und]repres5t$ m9ority populations4 7,n7 ,rese>*]s 9 ! area ( heal? work=ce4 7,o7 ,heal? work=ce accr$itation entities4 7,p7 ,private 7includ+ nonpr(it7 f\ndations t h sponsor$ work=ce div]sity initiatives4 7,q7 ,local & ,/ate heal? dep>tm5ts4 7,r7 ,repres5tatives ( community memb]s to be includ$ on admissions committees = heal? pr(ession s*ools pursuant to subsection 7c77#i74 7,s7 ,national community-bas$ organizations t s]ve z a national int]m$i>y to _! urban affiliate memb]s & h demon/rat$ capacity to tra9 heal? c>e pr(essionals4 7,t7 ,! ,vet]ans ,heal? ,adm9i/ration4 7,u7 ,o!r entities det]m9$ appropriate by ! ,secret>y4 7#b7 ,! grantee %all ensure t1 9 addition to ! repres5tatives "u p>agraph 7#a71 ! work+ gr\p has n less ?an #e heal? pr(essions /ud5ts repres5t+ v>i\s heal? pr(ession fields & levels ( tra9+4 7c7 ,activities ,! work+ gr\p e/abli%$ "u subsection 7a7 %all conv5e at lea/ twice ea* ye> to complete ! foll[+ activities3 7#a7 ,review public & private heal? work=ce div]sity initiatives4 7#b7 ,id5tify successful heal? work=ce div]sity programs & practices4 7#c7 ,exam9e *all5ges relat+ to ! developm5t & implem5tation ( heal? work=ce div]sity initiatives4 7#d7 ,draft a national /rategic "w plan = heal? work=ce div]sity1 includ+ recomm5dations = public & private sector initiatives4 7#e7 ,develop a framework & me?ods = ! evaluation ( curr5t & future heal? work=ce div]sity initiatives4 7#f7 ,develop recomm5d$ /&>ds = work=ce div]sity t c\ld be applicable to all heal? pr(essions programs & programs fund$ "u ?is ,act4 7#g7 ,develop guidel9es to tra9 heal? pr(essionals to c>e = a div]se population4 7#h7 ,develop a work=ce data collection or track+ sy/em to id5tify :]e racial & e?nic m9ority heal? pr(essionals practice4 7#i7 ,develop a /rategy = ! inclusion ( community memb]s on admissions committees = heal? pr(ession s*ools4 7#aj7 ,help ) monitor+ & implem5tation ( /&>ds = div]sity1 equity1 & inclusion4 7#aa7 ,o!r activities det]m9$ appropriate by ! ,secret>y4 7d7 ,annual report ,n lat] ?an #a ye> aft] ! e/abli%m5t ( ! work+ gr\p "u subsection 7a71 & annually !reaft]1 ! work+ gr\p %all prep>e & make available to ! g5]al public = comm5t1 an annual report on ! activities ( ! work+ gr\p4 ,su* report %all include ! recomm5dations ( ! work+ gr\p = improv+ heal? work=ce div]sity4 7e7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #cdab4 ,te*nical ,cle>+h\se = ,heal? work=ce ,div]sity 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 & 9 collaboration ) ! ,bureau ( ,heal? ,work=ce )9 ! ,heal? ,res\rces & ,s]vices ,adm9i/ration & ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities1 %all e/abli% a te*nical cle>+h\se on heal? work=ce div]sity )9 ! ,(fice ( ,m9ority ,heal? & coord9ate curr5t & future cle>+h\ses relat$ to heal? work=ce div]sity4 7b7 ,in=mation & s]vices ,! cle>+h\se e/abli%$ "u subsection 7a7 %all (f] ! foll[+ in=mation & s]vices3 7#a7 ,in=mation on ! importance ( heal? work=ce div]sity4 7#b7 ,/ati/ical in=mation relat+ to und]repres5t$ m9ority repres5tation 9 heal? & alli$ heal? pr(essions & occupations4 7#c7 ,model heal? work=ce div]sity practices & programs1 includ+ integrat$ models ( c>e4 7#d7 ,admissions policies t promote heal? work=ce div]sity & are 9 compliance ) ,f$]al & ,/ate laws4 7#e7 ,reta9m5t policies t promote completion ( heal? pr(ession degrees = und]s]v$ populations4 7#f7 ,li/s ( s*ol>%ip1 loan repaym5t1 & loan cancellation grants z well z fell[%ip in=mation = und]s]v$ populations = heal? pr(essions s*ools4 7#g7 ,f\ndation & o!r l>ge organizational initiatives relat+ to heal? work=ce div]sity4 7c7 ,consultation ,9 c>ry+ out ?is section1 ! ,secret>y %all consult ) non-,f$]al entities :i* may include m9ority heal? pr(essional associations & m9ority sections ( major heal? pr(essional associations to ensure ! adequacy & accuracy ( in=mation4 7d7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #cdac4 ,support = ,in/itutions committ$ to work=ce div]sity1 equity1 & inclusion 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration & ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all aw>d grants to eligible entities t demon/rate a commitm5t to heal? work=ce div]sity4 7b7 ,eligibility ,to be eligible to receive a grant "u subsection 7a71 an entity %all-- 7#a7 be an educational in/itution or entity t hi/orically produces or tra9s mean+ful numb]s ( und]repres5t$ m9ority heal? pr(essionals1 includ+-- 7,a7 "p ,b in/itutions1 z def9$ 9 section #cbb ( ! ,high] ,education ,act ( #aife2 7,b7 ,hispanic-s]v+ heal? pr(essions s*ools2 7,c7 ,hispanic-s]v+ in/itutions1 z def9$ 9 section #ejb ( su* ,act2 7,d7 ,tribal colleges or univ]sities1 z def9$ 9 section #caf ( su* ,act2 7,e7 ,asian ,am]ican & ,native ,am]ican ,pacific ,isl&]-s]v+ in/itutions1 z def9$ 9 section #cga7;c7 ( su* ,act2 7,f7 in/itutions t h programs to recruit & reta9 und]repres5t$ m9ority heal? pr(essionals1 9 :i* a significant numb] ( ! enroll$ p>ticipants are und]repres5t$ m9orities2 7,g7 heal? pr(essional associations1 :i* may include und]repres5t$ m9ority heal? pr(essional associations2 & 7,h7 in/itutions1 includ+ national & regional community-bas$ organizations ) demon/rat$ commitm5t to a div]sifi$ work=ce-- 7i7 locat$ 9 communities ) pr$om9antly und]repres5t$ m9ority populations2 7ii7 ) :om p>tn]%ips h be5 =m$ = ! purpose ( increas+ work=ce div]sity2 & 7iii7 9 :i* at lea/ #bj p]c5t ( ! enroll$ p>ticipants are und]repres5t$ m9orities2 & 7#b7 submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7c7 ,use ( funds ,am\nts receiv$ "u a grant "u subsection 7a7 %all be us$ to exp& exi/+ work=ce div]sity programs1 implem5t new work=ce div]sity programs1 or evaluate exi/+ or new work=ce div]sity programs1 includ+ ) respect to m5tal heal? c>e pr(essions4 ,su* programs %all enhance div]sity by consid]+ m9ority /atus z "p ( an individualiz$ consid]ation ( qualifications4 ,possible activities may include-- 7#a7 educational outrea* programs relat+ to opportunities 9 ! heal? pr(essions2 7#b7 s*ol>%ip1 fell[%ip1 grant1 loan repaym5t1 & loan cancellation programs2 7#c7 po/baccalaureate programs2 7#d7 academic enri*m5t programs1 p>ticul>ly t>get+ ^? :o w\ld n be competitive = heal? pr(essions s*ools2 7#e7 support+ work=ce div]sity 9 k9d]g>t5 ?r\gh #ab? grade & o!r heal? pipel9e programs2 7#f7 m5tor+ programs2 7#g7 int]n%ip or rotation programs involv+ hospitals1 heal? sy/ems1 heal? plans1 & o!r heal? entities2 7#h7 community p>tn]%ip developm5t = purposes relat+ to work=ce div]sity2 or 7#i7 lead]%ip tra9+4 7d7 ,reports ,n lat] ?an #a ye> aft] receiv+ a grant "u ?is section1 & annually = ! t]m ( ! grant1 a grantee %all submit to ! ,secret>y a report t summ>izes & evaluates all activities conduct$ "u ! grant4 7e7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section1 su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #cdad4 ,c>e] developm5t = sci5ti/s & rese>*]s 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,national ,in/itutes ( ,heal?1 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 ! ,commission] ( ,food & ,drugs1 ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 & ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all aw>d grants t exp& exi/+ opportunities = sci5ti/s & rese>*]s & promote ! inclusion ( und]repres5t$ m9orities 9 ! heal? pr(essions4 7b7 ,rese>* fund+ ,! head ( ea* ag5cy li/$ 9 subsection 7a7 %all e/abli% or exp& exi/+ programs to provide rese>* fund+ to sci5ti/s & rese>*]s 9 tra9+4 ,"u su* programs1 ! head ( ea* su* entity %all give priority 9 allocat+ rese>* fund+ to support heal? rese>* 9 traditionally und]s]v$ communities1 includ+ und]repres5t$ m9ority communities1 & rese>* classifi$ z community or p>ticipatory4 7c7 ,data collection ,! head ( ea* ag5cy li/$ 9 subsection 7a7 %all collect data on ! numb] 7express$ z an absolute numb] & a p]c5tage7 ( und]repres5t$ m9ority & nonm9ority applicants :o receive & are d5i$ ag5cy fund+ at e /age ( review4 ,su* data %all be report$ annually to ! ,secret>y & ! appropriate committees ( ,congress4 7d7 ,/ud5t loan reimbursem5t ,! ,secret>y %all e/abli% a /ud5t loan reimbursem5t program to provide /ud5t loan reimbursem5t assi/ance to rese>*]s :o focus on racial & e?nic disp>ities 9 heal?4 ,! ,secret>y %all promulgate regulations to def9e ! scope & proc$ures = ! program "u ?is subsection4 7e7 ,/ud5t loan cancellation ,! ,secret>y %all e/abli% a /ud5t loan cancellation program to provide /ud5t loan cancellation assi/ance to rese>*]s :o focus on racial & e?nic disp>ities 9 heal?4 ,/ud5ts p>ticipat+ 9 ! program %all make a m9imum #e-ye> commitm5t to "w at an accr$it$ heal? pr(ession s*ool4 ,! ,secret>y %all promulgate additional regulations to def9e ! scope & proc$ures = ! program "u ?is subsection4 7f7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section1 su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #cdae4 ,c>e] support = nonrese>* ,heal? pr(essionals 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 ! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use1 ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 & ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 %all e/abli% a program to aw>d grants to eligible individuals = c>e] support 9 nonrese>*-relat$ heal? & wellness pr(essions4 7b7 ,eligibility ,to be eligible to receive a grant "u subsection 7a71 an individual %all-- 7#a7 be a /ud5t 9 a heal? pr(essions s*ool1 a graduate ( su* a s*ool :o is work+ 9 a heal? pr(ession1 an individual work+ 9 a heal? or wellness pr(ession 7includ+ m5tal & behavioral heal?71 or a faculty memb] ( su* a s*ool2 & 7#b7 submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7c7 ,use ( funds ,an individual %all use am\nts receiv$ "u a grant "u ?is section to-- 7#a7 support ! individual's heal? activities or projects t involve und]s]v$ communities1 includ+ racial & e?nic m9ority communities2 7#b7 support heal?-relat$ c>e] advancem5t activities2 7#c7 pay1 or z reimbursem5t = paym5ts (1 /ud5t loans or tra9+ or cr$5tial+ co/s = individuals :o are heal? pr(essionals & are focus$ on heal? issues affect+ und]s]v$ communities1 includ+ racial & e?nic m9ority communities2 & 7#d7 e/abli% & promote lead]%ip tra9+ programs to decrease heal? disp>ities & to increase cultural compet5ce ) ! goal ( increas+ div]sity 9 lead]%ip positions4 7d7 ,def9ition ,9 ?is section1 ! t]m c>e] 9 nonrese>*-relat$ heal? & wellness pr(essions means employm5t or int5d$ employm5t 9 ! field ( public heal?1 heal? policy1 heal? managem5t1 heal? adm9i/ration1 m$ic9e1 nurs+1 ph>macy1 psy*ology1 social "w1 psy*iatry1 o!r m5tal & behavioral heal?1 alli$ heal?1 community heal?1 social "w1 or o!r fields det]m9$ appropriate by ! ,secret>y1 o!r ?an 9 a position t involves rese>*4 7e7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #cdaf4 ,rese>* on ! effect ( work=ce ,div]sity on quality 7a7 ,9 g5]al ,! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 9 collaboration ) ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal? & ! ,director ( ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities1 %all aw>d grants to eligible entities to exp& rese>* on ! l9k betwe5 heal? work=ce div]sity & quality heal? c>e4 7b7 ,eligibility ,to be eligible to receive a grant "u subsection 7a71 an entity %all-- 7#a7 be a cl9ical1 public heal?1 or heal? s]vices rese>* entity or o!r entity det]m9$ appropriate by ! ,director2 & 7#b7 submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7c7 ,use ( funds ,am\nts receiv$ "u a grant aw>d$ "u subsection 7a7 %all be us$ to support rese>* t inve/igates ! effect ( heal? work=ce div]sity on-- 7#a7 language access2 7#b7 cultural compet5ce2 7#c7 pati5t satisfaction2 7#d7 timel9ess ( c>e2 7#e7 safety ( c>e2 7#f7 effectiv5ess ( c>e2 7#g7 effici5cy ( c>e2 7#h7 pati5t outcomes2 7#i7 community engagem5t2 7#aj7 res\rce allocation2 7#aa7 organizational /ructure2 7#ab7 compliance ( c>e2 or 7#ac7 o!r topics det]m9$ appropriate by ! ,director4 7d7 ,priority ,9 aw>d+ grants "u subsection 7a71 ! ,director %all give individualiz$ consid]ation to all relevant aspects ( ! applicant's backgr\nd4 ,consid]ation ( prior rese>* exp]i5ce involv+ ! heal? ( und]s]v$ communities %all be su* a factor4 7e7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #cdag4 ,heal? disp>ities education program 7a7 ,e/abli%m5t ,! ,secret>y1 act+ ?r\gh ! ,(fice ( ,m9ority ,heal?1 9 collaboration ) ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities1 ! ,(fice = ,civil ,rights1 ! ,c5t]s = ,disease ,control & ,prev5tion1 ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 & o!r appropriate public & private entities1 %all e/abli% & coord9ate a heal? & heal? c>e disp>ities education program to support1 develop1 & implem5t educational initiatives & outrea* /rategies t in=m heal? c>e pr(essionals & ! public ab\t ! exi/5ce ( & me?ods to r$uce racial & e?nic disp>ities 9 heal? & heal? c>e4 7b7 ,activities ,! ,secret>y1 ?r\gh ! education program e/abli%$ "u subsection 7a71 %all1 ?r\gh ! use ( public aw>5ess & outrea* campaigns t>get+ ! g5]al public & ! m$ical community at l>ge-- 7#a7 dissem9ate sci5tific evid5ce = ! exi/5ce & ext5t ( racial & e?nic disp>ities 9 heal? c>e1 includ+ disp>ities t are n o!rwise attributable to kn[n factors su* z access to c>e1 pati5t pref]5ces1 or appropriat5ess ( int]v5tion1 z describ$ 9 ! #bjjb ,in/itute ( ,m$ic9e ,report entitl$ ,unequal ,treatm5t3 ,confront+ ,racial & ,e?nic ,disp>ities 9 ,heal? ,c>e1 z well z ! impact ( disp>ities relat$ to age1 disability /atus1 socioeconomic /atus1 sex1 g5d] id5tity1 & sexual ori5tation on racial & e?nic m9orities2 7#b7 dissem9ate new rese>* f9d+s to heal? c>e provid]s & pati5ts to assi/ !m 9 und]/&+1 r$uc+1 & elim9at+ heal? & heal? c>e disp>ities2 7#c7 dissem9ate in=mation ab\t ! impact ( l+ui/ic & cultural b>ri]s on heal? c>e quality & ! obligation ( heal? provid]s :o receive ,f$]al f9ancial assi/ance to ensure t individuals ) limit$ ,engli% pr(ici5cy h access to language access s]vices2 7#d7 dissem9ate in=mation ab\t ! importance & legality ( racial1 e?nic1 disability /atus1 socioeconomic /atus1 sex1 g5d] id5tity1 & sexual ori5tation1 & prim>y language data collection1 analysis1 & report+2 7#e7 design & implem5t specific educational initiatives to heal? c>e provid]s relat+ to heal? & heal? c>e disp>ities2 7#f7 assess ! impact ( ! programs e/abli%$ "u ?is section 9 rais+ aw>5ess ( heal? & heal? c>e disp>ities & provid+ in=mation on available res\rces2 & 7#g7 design & implem5t specific educational initiatives to educate ! heal? c>e work=ce relat+ to unconsci\s bias4 7c7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 4 #cjb4 ,hispanic-s]v+ in/itutions1 hi/orically black colleges & univ]sities1 ,asian ,am]ican & ,native ,am]ican ,pacific ,isl&]-s]v+ in/itutions1 ,tribal colleges1 regional community-bas$ organizations1 & national m9ority m$ical associations 7a7 ,9 g5]al ,"p ,b ( title ,,vii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bic et seq47 is am5d$ by add+ at ! end ! foll[+3 #gdb4 ,hispanic-s]v+ in/itutions1 hi/orically black colleges & univ]sities1 ,asian ,am]ican & ,native ,am]ican ,pacific ,isl&]-s]v+ in/itutions1 & ,tribal colleges 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration & 9 consultation ) ! ,secret>y ( ,education1 %all aw>d grants to ,hispanic-s]v+ in/itutions1 hi/orically black colleges & univ]sities1 ,asian ,am]ican & ,native ,am]ican ,pacific ,isl&]-s]v+ in/itutions1 ,tribal ,colleges or ,univ]sities1 regional community-bas$ organizations1 & national m9ority m$ical associations1 = c\nsel+1 m5tor+1 & provid+ in=mation on f9ancial assi/ance to prep>e und]repres5t$ m9ority individuals to enroll 9 & graduate f heal? pr(essional s*ools & to increase s]vices = und]repres5t$ m9ority /ud5ts includ+-- 7#a7 m5tor+ ) und]repres5t$ heal? pr(essionals2 & 7#b7 provid+ f9ancial assi/ance in=mation = cont9u$ education & applications to heal? pr(essional s*ools4 7b7 ,def9itions ,9 ?is section3 7#a7 ,asian ,am]ican & ,native ,am]ican ,pacific ,isl&]-s]v+ in/itution ,! t]m ,asian ,am]ican & ,native ,am]ican ,pacific ,isl&]-s]v+ in/itution has ! mean+ giv5 su* t]m 9 section #cbj7;b7 ( ! ,high] ,education ,act ( #aife4 7#b7 ,hispanic-s]v+ in/itution ,! t]m ,hispanic-s]v+ in/itution means an entity t-- 7,a7 is a s*ool or program = :i* !re is a def9ition "u section #gii;,b2 7,b7 has an enrollm5t ( full-"t equival5t /ud5ts t is made up ( at lea/ #i p]c5t ,hispanic /ud5ts2 7,c7 has be5 effective 9 c>ry+ out programs to recruit ,hispanic individuals to enroll 9 & graduate f ! s*ool2 7,d7 has be5 effective 9 recruit+ & reta9+ ,hispanic faculty memb]s2 7,e7 has a significant numb] ( graduates :o are provid+ heal? s]vices to m$ically und]s]v$ populations or to individuals 9 heal? pr(essional %ortage areas2 & 7,f7 is a ,hispanic ,c5t] ( ,excell5ce 9 ,heal? ,pr(essions ,education designat$ "u section #gcf7;d77#b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bic7;d77#b774 7#c7 ,hi/orically black colleges & univ]sity ,! t]m hi/orically black college & univ]sity has ! mean+ giv5 ! t]m "p ,b in/itution z def9$ 9 section #cbb ( ! ,high] ,education ,act ( #aife4 7#d7 ,tribal college or univ]sity ,! t]m ,tribal ,college or ,univ]sity has ! mean+ giv5 su* t]m 9 section #caf7;b7 ( ! ,high] ,education ,act ( #aife4 7c7 ,c]ta9 loan repaym5t programs ,9 c>ry+ out ! ,national ,heal? ,s]vice ,corps ,loan ,repaym5t ,program e/abli%$ "u subp>t ,,iii ( "p ,d ( title ,,iii & ! loan repaym5t program "u section #cag;,f1 ! ,secret>y %all ensure1 not)/&+ su* subp>t or section1 t loan repaym5ts ( n less ?an #ej1jjj p] ye> p] p]son are aw>d$ = repaym5t ( loans incurr$ = enrollm5t or p>ticipation ( und]repres5t$ m9ority individuals 9 heal? pr(essional s*ools & o!r heal? programs describ$ 9 ?is section4 7d7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbf4 4 #cjc4 ,loan repaym5t program ( ,c5t]s = ,disease ,control & ,prev5tion ,section #cag;,f7c77#a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdg;b-#g7;c77#a77 is am5d$-- 7#a7 by /rik+ & aft] #aiid12 & 7#b7 by ins]t+ be=e ! p]iod at ! end ! foll[+3 1 #gej1jjj = fiscal ye> #bjba1 & su* sums z may be necess>y = ea* ( ! fiscal ye>s #bjbb ?r\gh #bjbf4 #cjd4 ,coop]ative agreem5ts = onl9e degree programs at s*ools ( public heal? & s*ools ( alli$ heal? ,"p ,b ( title ,,vii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bic et seq471 z am5d$ by section #cjb1 is fur!r am5d$ by add+ at ! end ! foll[+3 #gdc4 ,coop]ative agreem5ts = onl9e degree programs 7a7 ,coop]ative agreem5ts ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 9 consultation ) ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 & ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 %all ent] into coop]ative agreem5ts ) s*ools ( public heal? & s*ools ( alli$ heal? to design & implem5t onl9e degree programs4 7b7 ,priority ,9 ent]+ into coop]ative agreem5ts "u ?is section1 ! ,secret>y %all give priority to any s*ool ( public heal? or s*ool ( alli$ heal? t has an e/abli%$ track record ( s]v+ m$ically und]s]v$ communities4 7c7 ,requirem5ts ,z a condition ( ent]+ into a coop]ative agreem5t ) ! ,secret>y "u ?is section1 a s*ool ( public heal? or s*ool ( alli$ heal? %all agree to design & implem5t an onl9e degree program t meets ! foll[+ re/rictions3 7#a7 ,enrollm5t ( individuals :o h obta9$ a second>y s*ool diploma or its recogniz$ equival5t4 7#b7 ,ma9ta9+ a significant enrollm5t ( und]repres5t$ m9ority or disadvantag$ /ud5ts4 7#c7 ,a*iev+ a high completion rate ( enroll$ und]repres5t$ m9ority or disadvantag$ /ud5ts4 7d7 ,p]iod ( coop]ative agreem5ts ,! p]iod dur+ :i* paym5ts are made ?r\gh a coop]ative agreem5t ent]$ into "u ?is section may n exce$ #c ye>s4 7e7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 4 #cje4 ,s5se ( ,congress on ! mission ( ! ,national ,heal? ,c>e ,work=ce ,commission ,x is ! s5se ( ,congress t ! ,national ,heal? ,c>e ,work=ce ,commission e/abli%$ by section #eaja ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #bidq7 %\ld1 9 c>ry+ out its assign$ duties "u t section1 give att5tion to ! ne$s ( racial & e?nic m9orities1 individuals ) l[] socioeconomic /atus1 individuals ) m5tal1 developm5tal1 & physical disabilities1 lesbian1 gay1 bisexual1 transg5d]1 que]1 & que/ion+ populations1 & individuals :o are memb]s ( multiple m9ority or special population gr\ps4 #cjf4 ,s*ol>%ip & fell[%ip programs ,subtitle ,b ( title ,,xxxiv ( ! ,public ,heal? ,s]vice ,act1 z add$ by section #cja1 is fur!r am5d$ by ins]t+ aft] section #cdag ! foll[+3 #cdah4 ,david ,sat*] ,public ,heal? & ,heal? ,s]vices ,corps 7a7 ,9 g5]al ,! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 9 collaboration ) ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration & ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 %all aw>d grants to eligible entities to increase aw>5ess among second>y & po/second>y /ud5ts ( c>e] opportunities 9 ! heal? pr(essions4 7b7 ,eligibility ,to be eligible to receive a grant "u subsection 7a71 an entity %all-- 7#a7 be a cl9ical1 public heal?1 or heal? s]vices organization1 community-bas$ or nonpr(it entity1 or o!r entity det]m9$ appropriate by ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion2 7#b7 s]ve a heal? pr(essional %ortage area1 z det]m9$ by ! ,secret>y2 7#c7 "w ) /ud5ts1 includ+ ^? f racial & e?nic m9ority backgr\nds1 t h express$ an int]e/ 9 ! heal? pr(essions2 & 7#d7 submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7c7 ,use ( funds ,grant aw>ds "u subsection 7a7 %all be us$ to support int]n%ips t w increase aw>5ess among /ud5ts ( non-rese>*-bas$1 c>e] opportunities 9 ! foll[+ heal? pr(essions3 7#a7 ,m$ic9e4 7#b7 ,nurs+4 7#c7 ,public heal?4 7#d7 ,ph>macy4 7#e7 ,heal? adm9i/ration & managem5t4 7#f7 ,heal? policy4 7#g7 ,psy*ology4 7#h7 ,d5ti/ry4 7#i7 ,int]national heal?4 7#aj7 ,social "w4 7#aa7 ,alli$ heal?4 7#ab7 ,psy*iatry4 7#ac7 ,hospice c>e4 7#ad7 ,community heal?1 pati5t navigation1 & pe] support4 7#ae7 ,o!r pr(essions det]m9$ appropriate by ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion4 7d7 ,priority ,9 aw>d+ grants "u subsection 7a71 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion %all give priority to ^? entities t-- 7#a7 s]ve a high proportion ( individuals f disadvantag$ backgr\nds2 7#b7 h exp]i5ce 9 heal? disp>ity elim9ation programs2 7#c7 facilitate ! entry ( disadvantag$ individuals into in/itutions ( high] education2 & 7#d7 provide c\nsel+ or o!r s]vices design$ to assi/ disadvantag$ individuals 9 successfully complet+ _! education at ! po/second>y level4 7e7 ,/ip5ds 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 an entity receiv+ a grant "u ?is section may use ! funds made available ?r\gh su* grant to aw>d /ip5ds = educational & liv+ exp5ses to /ud5ts p>ticipat+ 9 ! int]n%ip support$ by ! grant4 7#b7 ,limitations ,a /ip5d aw>d$ "u p>agraph 7#a7 to an individual-- 7,a7 may n be provid$ = a p]iod t exce$s #f mon?s2 & 7,b7 may n exce$ #bj p] day = an individual 7not)/&+ any o!r provision ( law reg>d+ ! am\nt ( a /ip5d74 7f7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbf4 #cdai4 ,l\is ,/okes ,public ,heal? ,s*ol>s ,program 7a7 ,9 g5]al ,! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 9 collaboration ) ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 %all aw>d s*ol>%ips to eligible individuals "u subsection 7b7 :o seek a c>e] 9 public heal?4 7b7 ,eligibility ,to be eligible to receive a s*ol>%ip "u subsection 7a71 an individual %all-- 7#a7 h int]e/1 k1 or skill 9 public heal? rese>* or public heal? practice1 or o!r heal? pr(essions z det]m9$ appropriate by ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion2 7#b7 reside 9 a heal? pr(essional %ortage area z det]m9$ by ! ,secret>y2 7#c7 demon/rate promise = becom+ a lead] 9 public heal?2 7#d7 secure admission to a #d-ye> in/itution ( high] education2 & 7#e7 submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7c7 ,use ( funds ,am\nts receiv$ "u an aw>d "u subsection 7a7 %all be us$ to support opportunities = /ud5ts to become public heal? pr(essionals4 7d7 ,priority ,9 aw>d+ grants "u subsection 7a71 ! ,director %all give priority to ^? /ud5ts t-- 7#a7 are f disadvantag$ backgr\nds2 7#b7 h secur$ admissions to a m9ority-s]v+ in/itution2 & 7#c7 h id5tifi$ a heal? pr(essional z a m5tor at _! s*ool or in/itution & an academic advisor to assi/ 9 ! completion ( _! baccalaureate degree4 7e7 ,s*ol>%ips ,! ,secret>y may approve paym5t ( s*ol>%ips "u ?is section = su* individuals = any p]iod ( education 9 /ud5t und]graduate t5ure1 except t su* a s*ol>%ip may n be provid$ to an individual = m ?an #d ye>s1 & su* a s*ol>%ip may n exce$ #aj1jjj p] academic ye> = an individual 7not)/&+ any o!r provision ( law reg>d+ ! am\nt ( a s*ol>%ip74 7f7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #cdbj4 ,patsy ,m9k ,heal? & ,g5d] ,rese>* ,fell[%ip ,program 7a7 ,9 g5]al ,! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 9 collaboration ) ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 ! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use1 & ! ,director ( ! ,indian ,heal? ,s]vices1 %all aw>d rese>* fell[%ips to eligible individuals "u subsection 7b7 to conduct rese>* t w exam9e g5d] & heal? disp>ities & to pursue a c>e] 9 ! heal? pr(essions4 7b7 ,eligibility ,to be eligible to receive a fell[%ip "u subsection 7a71 an individual %all-- 7#a7 h exp]i5ce 9 heal? rese>* or public heal? practice2 7#b7 reside 9 a heal? pr(essional %ortage area z designat$ by ! ,secret>y "u section #ccb2 7#c7 h express$ an int]e/ 9 ! heal? pr(essions2 7#d7 demon/rate promise = becom+ a lead] 9 ! field ( wom5's heal?2 7#e7 secure admission to a heal? pr(essions s*ool or graduate program ) an emphasis 9 g5d] /udies2 & 7#f7 submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7c7 ,use ( funds ,a fell[%ip aw>d$ "u subsection 7a7 to an eligible individual %all be us$ to support an opportunity = ! individual to become a rese>*] & advance ! rese>* base on ! int]section betwe5 g5d] & heal?4 7d7 ,priority ,9 aw>d+ fell[%ips "u subsection 7a71 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion %all give priority to ^? applicants t-- 7#a7 are f disadvantag$ backgr\nds2 & 7#b7 h id5tifi$ a m5tor & academic advisor :o w assi/ 9 ! completion ( _! graduate or pr(essional degree & h secur$ a rese>* assi/ant position ) a rese>*] work+ 9 ! area ( g5d] & heal?4 7e7 ,fell[%ips ,! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion may approve fell[%ips = individuals "u ?is section = any p]iod ( education 9 ! /ud5t's graduate or heal? pr(ession t5ure1 except t su* a fell[%ip may n be provid$ to an individual = m ?an #c ye>s1 & su* a fell[%ip may n exce$ #ah1jjj p] academic ye> = an individual 7not)/&+ any o!r provision ( law reg>d+ ! am\nt ( a fell[%ip74 7f7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #cdba4 ,paul ,david ,well/one ,int]national ,heal? ,fell[%ip ,program 7a7 ,9 g5]al ,! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 9 collaboration ) ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 %all aw>d rese>* fell[%ips to eligible individuals "u subsection 7b7 to advance _! und]/&+ ( int]national heal?4 7b7 ,eligibility ,to be eligible to receive a fell[%ip "u subsection 7a71 an individual %all-- 7#a7 h educational exp]i5ce 9 ! field ( int]national heal?2 7#b7 reside 9 a heal? pr(essional %ortage area z det]m9$ by ! ,secret>y2 7#c7 demon/rate promise = becom+ a lead] 9 ! field ( int]national heal?2 7#d7 be a college s5ior or rec5t graduate ( a #d-ye> in/itution ( high] education2 & 7#e7 submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7c7 ,use ( funds ,a fell[%ip aw>d$ "u subsection 7a7 to an eligible individual %all be us$ to support an opportunity = ! individual to become a heal? pr(essional & to advance ! k ( ! individual ab\t int]national issues relat+ to heal? c>e access & quality4 7d7 ,priority ,9 aw>d+ fell[%ips "u subsection 7a71 ! ,director %all give priority to eligible individuals t-- 7#a7 are f a disadvantag$ backgr\nd2 & 7#b7 h id5tifi$ a m5tor at a heal? pr(essions s*ool or in/itution1 an academic advisor to assi/ 9 ! completion ( _! graduate or pr(essional degree1 & an advisor f an int]national heal? non-gov]nm5tal organization1 private volunte] organization1 or o!r int]national in/itution or program t focuses on increas+ heal? c>e access & quality = resid5ts 9 develop+ c\ntries4 7e7 ,fell[%ips ,a fell[%ip aw>d$ "u ?is section may n-- 7#a7 be provid$ to an eligible individual = m ?an a p]iod ( #f mon?s2 7#b7 be aw>d$ to a graduate ( a #d-ye> in/itution ( high] education t has n be5 enroll$ 9 su* in/itution = m ?an #a ye>2 & 7#c7 exce$ #d1jjj p] academic ye> 7not)/&+ any o!r provision ( law reg>d+ ! am\nt ( a fell[%ip74 7f7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section1 su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #cdbb4 ,edw>d ,r4 ,roybal ,heal? ,s*ol> ,program 7a7 ,9 g5]al ,! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 ! ,director ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 & ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 9 collaboration ) ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 %all aw>d grants to eligible entities to expose ent]+ graduate /ud5ts to ! heal? pr(essions4 7b7 ,eligibility ,to be eligible to receive a grant "u subsection 7a71 an entity %all-- 7#a7 be a cl9ical1 public heal?1 or heal? s]vices organization1 community-bas$1 academic1 or nonpr(it entity1 or o!r entity det]m9$ appropriate by ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality2 7#b7 s]ve 9 a heal? pr(essional %ortage area z designat$ by ! ,secret>y "u section #ccb2 7#c7 "w ) /ud5ts obta9+ a degree 9 ! heal? pr(essions2 & 7#d7 submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7c7 ,use ( funds ,am\nts receiv$ "u a grant aw>d$ "u subsection 7a7 %all be us$ to support opportunities t expose /ud5ts to non-rese>*-bas$ heal? pr(essions1 includ+-- 7#a7 public heal? policy2 7#b7 heal? c>e & ph>maceutical policy2 7#c7 heal? c>e adm9i/ration & managem5t2 7#d7 heal? economics2 & 7#e7 o!r pr(essions det]m9$ appropriate by ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 ! ,director ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 or ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration4 7d7 ,priority ,9 aw>d+ grants "u subsection 7a71 ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 ! ,director ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 & ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 9 collaboration ) ! ,deputy ,assi/ant = ,secret>y = ,m9ority ,heal?1 %all give priority to ^? entities t-- 7#a7 h exp]i5ce ) heal? disp>ity elim9ation programs2 7#b7 facilitate tra9+ 9 ! fields describ$ 9 subsection 7c72 & 7#c7 provide c\nsel+ or o!r s]vices design$ to assi/ /ud5ts 9 successfully complet+ _! education at ! po/second>y level4 7e7 ,/ip5ds 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 an entity receiv+ a grant "u ?is section may use ! funds made available ?r\gh su* grant to aw>d /ip5ds = educational & liv+ exp5ses to /ud5ts p>ticipat+ 9 ! opportunities support$ by ! grant4 7#b7 ,limitations ,a /ip5d aw>d$ "u p>agraph 7#a7 to an individual-- 7,a7 may n be provid$ = a p]iod t exce$s #b mon?s2 & 7,b7 may n exce$ #ajj p] day 7not)/&+ any o!r provision ( law reg>d+ ! am\nt ( a /ip5d74 7f7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #cdbc4 ,lead]%ip fell[%ip programs 7a7 ,9 g5]al ,! ,secret>y %all aw>d grants to national m9ority m$ical or heal? pr(essional associations to develop lead]%ip fell[%ip programs = und]repres5t$ heal? pr(essionals 9 ord] to-- 7#a7 assi/ su* pr(essionals 9 becom+ future lead]s 9 public heal? & heal? c>e deliv]y in/itutions2 & 7#b7 increase div]sity 9 decision-mak+ positions t c improve ! heal? ( und]s]v$ communities4 7b7 ,use ( funds ,a lead]%ip fell[%ip program support$ "u ?is section %all-- 7#a7 focus on tra9+ mid-c>e] physicians & heal? c>e executives :o h docum5t$ lead]%ip exp]i5ce & a commitm5t to public heal? s]vices 9 und]s]v$ communities2 & 7#b7 support ,f$]al public heal? policy & budget programs1 & priorities t impact heal? equity1 ?r\gh activities su* z didactic lectures & lead] site visits4 7c7 ,p]iod ( grants ,! p]iod dur+ :i* paym5ts are made "u a grant aw>d$ "u subsection 7a7 may n exce$ #c ye>s4 7d7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbf4 4 #cjg4 ,mc,nair ,po/baccalaureate ,a*ievem5t ,program ,section #djb;,e ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajgj;a-#ae7 is am5d$ by /rik+ subsection 7g7 & ins]t+ ! foll[+3 7g7 ,collaboration 9 heal? pr(ession div]sity tra9+ programs ,! ,secret>y %all coord9ate ) ! ,secret>y ( ,heal? & ,human ,s]vices to ensure t !re is collaboration betwe5 ! goals ( ! program "u ?is section & programs ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration t promote heal? work=ce div]sity4 ,! ,secret>y ( ,education %all take su* measures z may be necess>y to enc\rage /ud5ts p>ticipat+ 9 projects assi/$ "u ?is section to consid] heal? pr(ession c>e]s4 7h7 ,fund+ ,f am\nts appropriat$ pursuant to ! au?ority ( section #djb;,a7g71 ! ,secret>y %all1 to ! ext5t practicable1 allocate funds = projects au?oriz$ by ?is section 9 an am\nt t is n less ?an #ca1jjj1jjj = ea* ( ! fiscal ye>s #bjba ?r\gh #bjbf4 4 #cjh4 ,rules = det]m9ation ( full-"t equival5t resid5ts = co/-report+ p]iods 7a7 ,,dgme det]m9ations ,section #ahhf7;h77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77#d771 z am5d$ by section #bjf7;a71 is am5d$-- 7#a7 9 subp>agraph 7,e71 by /rik+ ,subject to subp>agraphs 7,j7 & 7,k71 su* rules & ins]t+ ,subject to subp>agraphs 7,j71 7,k71 & 7,m71 su* rules2 7#b7 9 subp>agraph 7,j71 by /rik+ ,su* rules & ins]t+ ,subject to subp>agraph 7,m71 su* rules2 7#c7 9 subp>agraph 7,k71 by /rik+ ,9 det]m9+ & ins]t+ ,subject to subp>agraph 7,m71 9 det]m9+2 & 7#d7 by add+ at ! end ! foll[+ new subp>agraph3 7,m7 ,treatm5t ( c]ta9 resid5ts & int]ns ,= purposes ( co/-report+ p]iods beg9n+ on or aft] ,octob] #a1 #bjba1 9 det]m9+ ! hospital's numb] ( full-"t equival5t resid5ts = purposes ( ?is p>agraph1 all ! "t sp5t by an int]n or resid5t 9 an approv$ m$ical resid5cy tra9+ program %all be c\nt$ t[>d ! det]m9ation ( full-"t equival5cy if ! hospital-- 7i7 is recogniz$ z a subsection 7d7 hospital2 7ii7 is recogniz$ z a subsection 7d7 ,pu]to ,rico hospital2 7iii7 is reimburs$ "u a reimbursem5t sy/em au?oriz$ "u section #ahad7;b77#c72 or 7iv7 is a provid]-bas$ hospital outpati5t dep>tm5t4 4 7b7 ,,ime det]m9ations ,section #ahhf7;d77#e77;,b77xi7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77xi771 z r$esignat$ by section #bjf7;b71 is am5d$-- 7#a7 9 subclause 7,,ii71 by /rik+ ,9 det]m9+ & ins]t+ ,subject to subclause 7,,iv71 9 det]m9+2 7#b7 9 subclause 7,,iii71 by /rik+ ,9 det]m9+ & ins]t+ ,subject to subclause 7,,iv71 9 det]m9+2 & 7#c7 by ins]t+ aft] subclause 7,,iii7 ! foll[+ new subclause3 7,,iv7 ,= purposes ( co/-report+ p]iods beg9n+ on or aft] ,octob] #a1 #bjba1 ! provisions ( subp>agraph 7,m7 ( subsection 7h77#d7 %all apply "u ?is subp>agraph 9 ! same mann] z !y apply "u su* subsection4 4 #cji4 ,develop+ & implem5t+ /rategies = local heal? equity 7a7 ,grants ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ jo9tly ) ! ,secret>y ( ,education & ! ,secret>y ( ,labor1 %all make grants to in/itutions ( high] education = ! purposes (-- 7#a7 9 accordance ) subsection 7b71 develop+ capacity-- 7,a7 to build an evid5ce base = successful /rategies = increas+ local heal? equity2 & 7,b7 to s]ve z national models ( driv+ local heal? equity2 7#b7 9 accordance ) subsection 7c71 develop+ a /rategic p>tn]%ip ) ! community 9 :i* ! in/itution is locat$2 & 7#c7 collect+ data on1 & p]iodically evaluat+1 ! effectiv5ess ( ! in/itution's programs fund$ ?r\gh ?is section to enable ! in/itution to adapt accord+ly = maximum effici5cy & success4 7b7 ,develop+ capacity = increas+ local heal? equity ,z a condition on receipt ( a grant "u subsection 7a71 an in/itution ( high] education %all agree to use ! grant to build an evid5ce base = successful /rategies = increas+ local heal? equity1 & to s]ve z a national model ( driv+ local heal? equity1 by support+-- 7#a7 res\rces to /r5g!n in/itutional metrics & capacity to execute in/itution-wide heal? work=ce goals t c s]ve z models = increas+ heal? equity 9 communities across ! ,unit$ ,/ates2 7#b7 collaborations among a cohort ( in/itutions 9 implem5t+ sy/emic *ange1 p>tn]%ip developm5t1 & programmatic ef=ts supportive ( heal? equity goals across discipl9es & populations2 & 7#c7 enhanc$ or newly develop$ data sy/ems & rese>* infra/ructure capable ( in=m+ curr5t & future work=ce ef=ts & build+ a f\ndation = a broad] rese>* ag5da t>get+ urban heal? disp>ities4 7c7 ,/rategic p>tn]%ips ,z a condition on receipt ( a grant "u subsection 7a71 an in/itution ( high] education %all agree to use ! grant to develop a /rategic p>tn]%ip ) ! community 9 :i* ! in/itution is locat$ = ! purposes (-- 7#a7 /r5g!n+ connections betwe5 ! in/itution & ! community-- 7,a7 to improve evaluation ( & address ! community's heal? & heal? work=ce ne$s2 & 7,b7 to engage ! community 9 heal? work=ce developm5t2 7#b7 develop+1 enhanc+1 or accel]at+ innovative und]graduate & graduate programs 9 ! biom$ical sci5ces & heal? pr(essions2 & 7#c7 /r5g!n+ pipel9e programs 9 ! biom$ical sci5ces & heal? pr(essions1 includ+ by develop+ p>tn]%ips betwe5 in/itutions ( high] education & elem5t>y s*ools & second>y s*ools to recruit ! next g5]ation ( heal? pr(essionals e>li] 9 ! pipel9e to a heal? c>e c>e]4 7d7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbf4 #caj4 ,loan =giv5ess = m5tal & behavioral heal? social work]s ,section #dee ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajhg;e7 is am5d$ by add+ at ! end ! foll[+3 7r7 ,repaym5t plan = m5tal & behavioral heal? social work]s 7#a7 ,9 g5]al ,! ,secret>y %all cancel ! balance ( int]e/ & pr9cipal due1 9 accordance ) p>agraph 7#b71 on any eligible ,f$]al ,direct ,loan n 9 default = a borr[] :o-- 7,a7 has made #abj mon?ly paym5ts on ! eligible ,f$]al ,direct ,loan aft] ,octob] #a1 #bjbj1 pursuant to any "o or a comb9ation ( ! foll[+-- 7i7 paym5ts "u an income-bas$ repaym5t plan "u section #dic;,c2 7ii7 paym5ts "u a /&>d repaym5t plan "u subsection 7d77#a77;,a71 bas$ on a #aj-ye> repaym5t p]iod2 7iii7 mon?ly paym5ts "u a repaym5t plan "u subsection 7d77#a7 or 7g7 ( n less ?an ! mon?ly am\nt calculat$ "u subsection 7d77#a77;,a71 bas$ on a #aj-ye> repaym5t p]iod2 or 7iv7 paym5ts "u an income cont+5t repaym5t plan "u subsection 7d77#a77;,d72 & 7,b7 7i7 is employ$ z a m5tal heal? or behavioral heal? social work]1 z def9$ by ! ,secret>y by regulation1 at ! "t ( su* =giv5ess2 & 7ii7 has be5 employ$ z su* a m5tal heal? or behavioral heal? social work] dur+ ! p]iod 9 :i* ! borr[] makes ea* ( ! #abj paym5ts z describ$ 9 subp>agraph 7,a74 7#b7 ,loan cancellation am\nt ,aft] ! conclusion ( ! employm5t p]iod describ$ 9 p>agraph 7#a71 ! ,secret>y %all cancel ! obligation to repay ! balance ( pr9cipal & int]e/ due z ( ! "t ( su* cancellation1 on ! eligible ,f$]al ,direct ,loans made to ! borr[] "u ?is "p4 7#c7 ,ineligibility = d\ble b5efits ,no borr[] may1 = ! same employm5t z a m5tal heal? or behavioral heal? social work]1 receive a r$uction ( loan obligations "u bo? ?is subsection & subsection 7m71 #dbh;,j1 #dbh,k1 #dbh,l1 or #dfj4 7#d7 ,def9ition ( eligible ,f$]al ,direct ,loan ,9 ?is subsection1 ! t]m eligible ,f$]al ,direct ,loan means a ,f$]al ,direct ,/af=d ,loan1 ,f$]al ,direct ,,plus ,loan1 ,f$]al ,direct ,unsubsidiz$ ,/af=d ,loan1 or a ,f$]al ,direct ,consolidation ,loan4 4 #caa4 ,heal? ,pr(essions ,work=ce ,fund 7a7 ,e/abli%m5t ,!re is e/abli%$ 9 ! ,heal? ,res\rces & ,s]vices ,adm9i/ration ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices a ,heal? ,pr(essions ,work=ce ,fund to provide = exp&$ & su/a9$ national inve/m5t 9 ! heal? pr(essions & nurs+ work=ce developm5t programs "u title ,,vii & title ,,viii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bib et seq42 #db ,u4,s4,c4 #bif et seq474 7b7 ,fund+ 7#a7 ,9 g5]al ,!re is au?oriz$ to be appropriat$1 & !re is appropriat$1 out ( any monies 9 ! ,treasury n o!rwise appropriat$1 to ! ,heal? ,pr(essions ,work=ce ,fund-- 7,a7 #cee1jjj1jjj = fiscal ye> #bjba2 7,b7 #cge1jjj1jjj = fiscal ye> #bjbb2 7,c7 #cib1jjj1jjj = fiscal ye> #bjbc2 7,d7 #dab1jjj1jjj = fiscal ye> #bjbd2 7,e7 #dcb1jjj1jjj = fiscal ye> #bjbe2 7,f7 #ded1jjj1jjj = fiscal ye> #bjbf2 7,g7 #dgf1jjj1jjj = fiscal ye> #bjbg2 7,h7 #ejj1jjj1jjj = fiscal ye> #bjbh2 7,i7 #ebe1jjj1jjj = fiscal ye> #bjbi2 & 7,j7 #eeb1jjj1jjj = fiscal ye> #bjcj4 7#b7 ,heal? pr(essions education programs ,= ! purpose ( c>ry+ out heal? pr(essions education programs au?oriz$ "u title ,,vii ( ! ,public ,heal? ,s]vice ,act1 9 addition to any o!r am\nts au?oriz$ to be appropriat$ = su* purpose1 !re is au?oriz$ to be appropriat$ out ( any monies 9 ! ,heal? ,pr(essions ,work=ce ,fund1 ! foll[+3 7,a7 #bdj1jjj1jjj = fiscal ye> #bjba4 7,b7 #bec1jjj1jjj = fiscal ye> #bjbb4 7,c7 #bfe1jjj1jjj = fiscal ye> #bjbc4 7,d7 #bgh1jjj1jjj = fiscal ye> #bjbd4 7,e7 #bib1jjj1jjj = fiscal ye> #bjbe4 7,f7 #cjg1jjj1jjj = fiscal ye> #bjbf4 7,g7 #cbb1jjj1jjj = fiscal ye> #bjbg4 7,h7 #cch1jjj1jjj = fiscal ye> #bjbh4 7,i7 #cee1jjj1jjj = fiscal ye> #bjbi4 7,j7 #cgc1jjj1jjj = fiscal ye> #bjcj4 7#c7 ,nurs+ work=ce developm5t programs ,= ! purpose ( c>ry+ out nurs+ work=ce developm5t programs au?oriz$ "u title ,,viii ( ! ,public ,heal? ,s]vice ,act1 9 addition to any o!r am\nts au?oriz$ to be appropriat$ = su* purpose1 !re is au?oriz$ to be appropriat$ out ( any monies 9 ! ,heal? ,pr(essions ,work=ce ,fund1 ! foll[+3 7,a7 #aae1jjj1jjj = fiscal ye> #bjba4 7,b7 #abb1jjj1jjj = fiscal ye> #bjbb4 7,c7 #abg1jjj1jjj = fiscal ye> #bjbc4 7,d7 #acd1jjj1jjj = fiscal ye> #bjbd4 7,e7 #adj1jjj1jjj = fiscal ye> #bjbe4 7,f7 #adg1jjj1jjj = fiscal ye> #bjbf4 7,g7 #aed1jjj1jjj = fiscal ye> #bjbg4 7,h7 #afb1jjj1jjj = fiscal ye> #bjbh4 7,i7 #agj1jjj1jjj = fiscal ye> #bjbi4 7,j7 #agi1jjj1jjj = fiscal ye> #bjcj4 #cab4 ,f9d+s2 s5se ( ,congress relat+ to graduate m$ical education 7a7 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,projections by ! ,association ( ,am]ican ,m$ical ,colleges & o!r exp]t entities1 su* z ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 h indicat$ a nationwide %ortage ( up to #aba1ijj physicians1 split ev5ly betwe5 prim>y c>e & speciali/s1 by #bjcb4 7#b7 ,prim>ily due to ! gr[+ & ag+ population1 ov] ! next decade1 physician dem& is expect$ to gr[ up to #ag p]c5t4 7#c7 ,! ,unit$ ,/ates ,c5sus ,bureau e/imates t ! ,unit$ ,/ates population w gr[ f #cba1jjj1jjj 9 #bjae to #cdg1jjj1jjj 9 #bjbe4 ,fur!r1 ! numb] ( ,m$ic>e b5efici>ies is e/imat$ to increase f #dg1hjj1jjj 9 #bjae to approximately #ff1jjj1jjj 9 #bjbe4 7#d7 ,approximately #cf p]c5t ( practic+ physicians are ov] ! age ( #ee & are likely to retire )9 ! next decade4 7#e7 ,a nationwide physician %ortage w result 9 _m p 9 ! ,unit$ ,/ates wait+ long] & travel+ f>!r = heal? c>e2 seek+ nonem]g5t c>e 9 em]g5cy dep>tm5ts2 & delay+ treatm5t until _! heal? c>e ne$s become m s]i\s1 complex1 & co/ly4 7#f7 ,*ang+ demographics 7su* z an ag+ population71 new heal? c>e deliv]y models 7su* z m$ical homes71 & o!r factors 7su* z disa/] prep>$ness7 are contribut+ to a %ortage ( bo? g5]ali/ & speciali/ physicians4 7#g7 ,^! %ortages w h ! mo/ sev]e impact on vuln]able & und]s]v$ populations1 includ+ racial & e?nic m9orities & ! approximately #bj p]c5t ( p 9 ! ,unit$ ,/ates :o live 9 rural or inn]-city locations designat$ z heal? pr(essional %ortage areas4 7#h7 ,! heal? c>e utilization equity model ( ! ,association ( ,am]ican ,m$ical ,colleges e/imates t if racial & e?nic m9orities & individuals f rural areas utiliz$ heal? c>e 9 a simil> way to _! ,caucasian c\nt]p>ts liv+ 9 metropolitan areas1 ! physician %ortage w\ld require an additional #if1jjj physicians4 7#i7 ,to address ! physician %ortage 9 rural & m$ically und]s]v$ areas1 m$ical education & tra9+ ne$ to be accessible to und]repres5t$ m9orities 7includ+ individuals :o are ,african ,am]ican1 ,hispanic1 ,native ,am]ican1 or ,native ,hawaiian71 & ne$ to increase pa?way programs = su* und]repres5t$ m9orities :o make up less ?an #ab p]c5t ( individuals enroll$ 9 graduate m$ical education & = int]national /ud5ts :o make up #be p]c5t ( individuals enroll$ 9 graduate m$ical education4 ,immigration pa?ways l /ud5t1 ex*ange-visitor1 & employm5t visas1 & programs l ! ,national ,int]e/ ,waiv] & ,conrad #cj ,j-#a ,visa ,waiv]1 help improve heal? access across ! ,unit$ ,/ates4 7#aj7 ,unit$ ,/ates m$ical s*ool enrollm5t 0 expect$ to gr[ by #cj p]c5t f #bjah to #bjai to help r$uce ! %ortage ( quality physicians 9 ! ,unit$ ,/ates4 7#aa7 ,an increase 9 ,unit$ ,/ates m$ical s*ool graduates mu/ be accompani$ by an increase ( #d1jjj graduate m$ical education tra9+ positions ea* ye>4 7#ab7 ,graduate m$ical education programs & tea*+ hospitals provide v5ues 9 :i* ! next g5]ation ( physicians le>ns to "w collaboratively ) o!r physicians & heal? pr(essionals1 adopt m effici5t c>e deliv]y models 7su* z c>e coord9ation & m$ical homes71 incorporate heal? in=mation te*nology & electronic heal? records 9 e aspect ( _! "w1 apply new me?ods ( assur+ quality & safety1 & p>ticipate 9 gr\ndbreak+ cl9ical & public heal? rese>*4 7#ac7 ,! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 7hav+ m b5efici>ies ?an any o!r heal? c>e program7 supports its fair %>e ( ! co/s associat$ ) graduate m$ical education4 7#ad7 ,9 g5]al1 ! level ( support ( graduate m$ical education by ! ,m$ic>e program has be5 capp$ s9ce #aiig & has n be5 increas$ to support ! expansion ( graduate m$ical education programs ne$$ to av]t ! project$ physician %ortage or to accommodate ! increase 9 ,unit$ ,/ates m$ical s*ool graduates4 7b7 ,s5se ( ,congress ,x is ! s5se ( ,congress t elim9at+ ! limit ( ! numb] ( resid5cy positions t receive "s level ( ,m$ic>e support "u section #ahhf7;h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h771 also ref]r$ to z ! ,m$ical graduate m$ical education cap1 is critical to-- 7#a7 ensur+ an appropriate supply ( physicians to meet ! heal? c>e ne$s 9 ! ,unit$ ,/ates2 7#b7 facilitat+ equitable access = all :o seek heal? c>e2 & 7#c7 mitigat+ disp>ities 9 heal? & heal? c>e4 #cac4 ,c>e] support = skill$1 int]nationally educat$ heal? pr(essionals 7a7 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,accord+ to a #bjah /udy1 ! ,/ate & local public heal? work=ce has %runk by m ?an #ej1jjj individuals s9ce ! beg9n+ ( ! #bjjh ,great ,recession & almo/ "o qu>t] ( individuals compris+ ! gov]nm5tal public heal? work=ce plan to leave or retire 9 ! com+ ye>s4 7#b7 ,%ortages are project$ = o!r heal? pr(essions1 includ+ )9 ! fields ( nurs+ 7#ejj1jjj by #bjbe71 d5ti/ry 7#ae1jjj by #bjbe71 ph>macy 7#ch1jjj by #bjcj71 m5tal & behavioral heal?1 prim>y c>e 7#df1jjj by #bjbe71 & community & alli$ heal?4 7#c7 ,a nationwide heal? work=ce %ortage w result 9 s]i\s heal? ?reats & m sev]e & co/ly heal? c>e ne$s1 due to1 9 "p1 a delay$ response to food-borne outbreaks1 em]g+ infecti\s diseases1 natural disa/]s1 few] canc] scre5+s1 & delay$ treatm5t4 7#d7 ,vuln]able & und]s]v$ populations & heal? pr(essional %ortage areas w be mo/ sev]ely impact$ by ! heal? work=ce %ortage4 7#e7 ,accord+ to ! ,migration ,policy ,in/itute1 m ?an #b1jjj1jjj college-educat$ immigrants 9 ! ,unit$ ,/ates today are unemploy$ or und]employ$ 9 l[- or semi-skill$ jobs t fail to draw on _! education & exp]tise4 7#f7 ,approximately #b out ( e #e int]nationally educat$ immigrants are unemploy$ or und]employ$4 7#g7 ,accord+ to ! ,drexel ,univ]sity ,c5t] = ,labor ,m>kets & ,policy1 und]employm5t = int]nationally educat$ immigrant wom5 is #bh p]c5t high] ?an = _! male c\nt]p>ts4 7#h7 ,accord+ to ! ,drexel ,univ]sity ,c5t] = ,labor ,m>kets & ,policy1 ! mean annual e>n+s ( und]employ$ immigrants 7 #cb1jjj1 or #dc p]c5t less ?an ,unit$ ,/ates born college graduates employ$ 9 ! college labor m>ket4 7#i7 ,accord+ to ,upw>dly ,global & ! ,welcome ,back ,initiative1 ) prop] guidance & support1 und]employ$ skill$ immigrants typically increase _! income by #bae p]c5t to #ijj p]c5t4 7#aj7 ,accord+ to ! ,brook+s ,in/itution & ! ,p>tn]%ip = a ,new ,am]ican ,economy1 immigrants work+ 9 ! heal? work=ce are1 on av]age1 bett] educat$ ?an ,unit$ ,/ates-born work]s 9 ! heal? work=ce4 7b7 ,grants to eligible entities 7#a7 ,au?ority to provide grants ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,bureau ( ,heal? ,work=ce )9 ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities1 or ! ,(fice ( ,m9ority ,heal? 79 ?is section ref]r$ to z ! ,secret>y71 may aw>d grants to eligible entities to c>ry out activities describ$ 9 subsection 7c74 7#b7 ,eligibility ,to be eligible to receive a grant "u ?is section1 an entity %all-- 7,a7 be a cl9ical1 public heal?1 or heal? s]vices organization1 a community-bas$ or nonpr(it entity1 an academic in/itution1 a fai?-bas$ organization1 a ,/ate1 c\nty1 or local gov]nm5t1 an area heal? education c5t]1 or ano!r entity det]m9$ appropriate by ! ,secret>y2 & 7,b7 submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7c7 ,au?oriz$ activities ,a grant aw>d$ "u ?is section %all be us$-- 7#a7 to provide s]vices to assi/ unemploy$ & und]employ$ skill$ immigrants1 resid+ 9 ! ,unit$ ,/ates1 :o h legal1 p]man5t "w au?orization & :o are int]nationally educat$ heal? pr(essionals1 ent] into ! heal? work=ce ( ! ,unit$ ,/ates ) employm5t mat*+ _! heal? pr(essional skills & education1 & advance 9 employm5t to positions t bett] mat* _! heal? pr(essional education & exp]tise2 7#b7 to provide tra9+ opportunities to r$uce b>ri]s to entry & advancem5t 9 ! heal? work=ce = skill$1 int]nationally educat$ immigrants2 7#c7 to educate employ]s reg>d+ ! abilities & capacities ( int]nationally educat$ heal? pr(essionals2 7#d7 to assi/ 9 ! evaluation ( =eign cr$5tials2 7#e7 to support preceptor%ips = int]national m$ical graduates 9 hospital prim>y c>e tra9+2 & 7#f7 to facilitate access to contextualiz$ & accel]at$ c\rses on ,engli% z a second language4 #cad4 ,/udy & report on /rategies = increas+ div]sity 7a7 ,/udy ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all conduct a /udy on /rategies = increas+ ! div]sity ( ! heal? pr(essional work=ce4 ,su* /udy %all include an analysis ( /rategies = increas+ ! numb] ( heal? pr(essionals f rural1 l[] income1 & und]repres5t$ m9ority communities1 includ+ :i* /rategies are mo/ effective = a*iev+ su* goal4 7b7 ,report ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al %all submit to ,congress a report on ! /udy conduct$ "u subsection 7a71 toge!r ) recomm5dations = su* legislation & adm9i/rative action z ! ,comptroll] ,g5]al det]m9es appropriate4 #cae4 ,conrad ,/ate #cj program2 physician ret5tion 7a7 ,conrad ,/ate #cj program ext5sion ,section #bbj7;c7 ( ! ,immigration & ,nationality ,te*nical ,corrections ,act ( #aiid 7,public ,law #ajc-daf2 #h ,u4,s4,c4 #aahb note7 is am5d$ by /rik+ ,septemb] #cj1 #bjae & ins]t+ ,septemb] #cj1 #bjba4 7b7 ,reta9+ physicians :o h practic$ 9 m$ically und]s]v$ communities ,section #bja7;b77#a7 ( ! ,immigration & ,nationality ,act 7#h ,u4,s4,c4 #aaea7;b77#a77 is am5d$ by add+ at ! end ! foll[+3 7,f7 7i7 ,ali5 physicians :o h complet$ s]vice requirem5ts = a national int]e/ waiv] reque/$ "u section #bjc7;b77#b77;,b77ii71 includ+-- 7,i7 ali5 physicians :o complet$ su* s]vice be=e ! date ( ! enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbj2 & 7,,ii7 ! sp\se or *ildr5 ( an ali5 physician describ$ 9 subclause 7,i74 7ii7 ,no?+ 9 ?is subp>agraph may be con/ru$-- 7,i7 to prev5t ! fil+ ( a petition ) ! ,secret>y ( ,homel& ,security = classification "u section #bjd7;a7 or ! fil+ ( an application = adju/m5t ( /atus "u section #bde by an ali5 physician describ$ 9 clause 7i7 be=e ! date on :i* su* ali5 physician completes ! s]vice describ$ 9 section #bad7l7 or work$ full-"t z a physician = an aggregate ( #e ye>s at ! location id5tifi$ 9 ! waiv] ( ! #b-ye> =eign resid5ce requirem5t "u section #bad7l7 or 9 an area or areas designat$ by ! ,secret>y ( ,heal? & ,human ,s]vices z hav+ a %ortage ( heal? c>e pr(essionals2 or 7,,ii7 to p]mit ! ,secret>y ( ,homel& ,security to grant a petition or application describ$ 9 subclause 7,i7 until ! ali5 has satisfi$ all ( ! requirem5ts ( ! waiv] receiv$ "u section #bad7l74 4 7c7 ,employm5t protections = physicians 7#a7 ,exceptions to #b-ye> =eign resid5cy requirem5t ,section #bad7l77#a7 ( ! ,immigration & ,nationality ,act 7#h ,u4,s4,c4 #aahd7l77#a77 is am5d$-- 7,a7 9 ! matt] prec$+ subp>agraph 7,a71 by /rik+ ,attorney ,g5]al %all n & ins]t+ ,secret>y ( ,homel& ,security may n2 7,b7 9 subp>agraph 7,a71 by /rik+ ,director ( ! ,unit$ ,/ates ,in=mation ,ag5cy & ins]t+ ,secret>y ( ,/ate2 7,c7 9 subp>agraph 7,b71 by ins]t+ 1 except z provid$ 9 p>agraphs 7#g7 & 7#h7 be=e ! semicolon at ! end2 7,d7 9 subp>agraph 7,c71 by am5d+ clauses 7i7 & 7ii7 to read z foll[s3 7i7 ! ali5 demon/rates a bona fide (f] ( full-"t employm5t at a heal? facility or heal? c>e organization1 :i* employm5t has be5 det]m9$ by ! ,secret>y ( ,homel& ,security to be 9 ! public int]e/2 & 7ii7 ! ali5-- 7,i7 has accept$ employm5t ) ! heal? facility or heal? c>e organization 9 a geographic area or areas :i* are designat$ by ! ,secret>y ( ,heal? & ,human ,s]vices z hav+ a %ortage ( heal? c>e pr(essionals2 7,,ii7 beg9s employm5t by ! lat] ( ! date t is-- 7aa7 #abj days aft] receiv+ su* waiv]2 7bb7 #abj days aft] complet+ graduate m$ical education or tra9+ "u a program approv$ pursuant to section #bab7;j77#a72 or 7cc7 #abj days aft] receiv+ nonimmigrant /atus or employm5t au?orization1 if ! ali5 or ! ali5's employ] petitions = su* nonimmigrant /atus or employm5t au?orization n lat] ?an #abj days aft] ! date on :i* ! ali5 completes 8 or h] graduate m$ical education or tra9+ "u a program approv$ pursuant to section #bab7;j77#a72 & 7,,iii7 agrees to cont9ue to "w = a total ( n less ?an #c ye>s 9 ! /atus au?oriz$ = su* employm5t "u ?is subsection1 except z provid$ 9 p>agraph 7#h74 2 & 7,e7 9 subp>agraph 7,d71 9 ! matt] prec$+ clause 7i71 by ins]t+ subject to p>agraph 7#h71 be=e 9 ! case4 7#b7 ,all[able visa /atus = physicians fulfill+ waiv] requirem5ts 9 m$ically und]s]v$ areas ,section #bad7l77#b77;,a7 ( su* ,act 7#h ,u4,s4,c4 #aahd7l77#b77;,a77 is am5d$ to read z foll[s3 7,a7 ,^u ! reque/ ( an int]e/$ ,f$]al ag5cy or an int]e/$ ,/ate ag5cy = recomm5dation ( a waiv] "u ?is section by a physician :o is ma9ta9+ valid nonimmigrant /atus "u section #aja7;a77#ae77;,j7 & receiv$ a favorable recomm5dation by ! ,secret>y ( ,/ate1 ! ,secret>y ( ,homel& ,security may *ange ! /atus ( su* physician to any /atus au?oriz$ = employm5t "u ?is ,act4 ,! num]ical limitations set =? 9 subsection 7g77#a77;,a7 %all n apply to any ali5 ^: /atus is *ang$ "u ?is subp>agraph4 4 7#c7 ,violation ( agreem5ts ,section #bad7l77#c77;,a7 ( su* ,act 7#h ,u4,s4,c4 #aahd7l77#c77;,a77 is am5d$ by ins]t+ sub/antial requirem5t ( an be=e agreem5t ent]$ into4 7#d7 ,physician employm5t 9 und]s]v$ areas ,section #bad7l7 ( su* ,act 7#h ,u4,s4,c4 #aahd7l771 z am5d$ by ?is section1 is fur!r am5d$ by add+ at ! end ! foll[+3 7#d7 7,a7 ,if an int]e/$ ,/ate ag5cy d5ies ! application = a waiv] "u p>agraph 7#a77;,b7 f a physician pursu+ graduate m$ical education or tra9+ pursuant to section #aja7;a77#ae77;,j7 because ! ,/ate has reque/$ ! maximum numb] ( waiv]s p]mitt$ = t fiscal ye>1 ! physician's nonimmigrant /atus %all be ext5d$ = up to #f mon?s if ! physician agrees to seek a waiv] "u ?is subsection 7except = p>agraph 7#a77;,d77ii77 to "w = an employ] describ$ 9 p>agraph 7#a77;,c7 9 a ,/ate t has n yet reque/$ ! maximum numb] ( waiv]s4 7,b7 ,a physician describ$ 9 subp>agraph 7,a7 may only "w = ! employ] ref]r$ to 9 subp>agraph 7,a7 dur+ ! p]iod beg9n+ on ! date on :i* a new waiv] application is fil$ ) su* ,/ate & end+ on ! e>li] (-- 7i7 ! date on :i* ! ,secret>y ( ,homel& ,security d5ies su* waiv]2 or 7ii7 ! date on :i* ! ,secret>y approves an application = *ange ( /atus "u p>agraph 7#b77;,a7 pursuant to ! approval ( su* waiv]4 4 7#e7 ,contract requirem5ts ,section #bad7l7 ( su* ,act1 z am5d$ by ?is section1 is fur!r am5d$ by add+ at ! end ! foll[+3 7#e7 ,an ali5 grant$ a waiv] "u p>agraph 7#a77;,c7 %all ent] into an employm5t agreem5t ) ! contract+ heal? facility or heal? c>e organization t-- 7,a7 specifies ! maximum numb] ( on-call h\rs p] week 7:i* may be a mon?ly av]age7 t ! ali5 w be expect$ to be available & ! comp5sation ! ali5 w receive = on-call "t2 7,b7 specifies-- 7i7 :e!r ! contract+ facility or organization w pay ! ali5's malpractice insurance premiums2 7ii7 :e!r ! employ] w provide malpractice insurance2 & 7iii7 ! am\nt ( su* insurance t w be provid$2 7,c7 describes all ( ! "w locations t ! ali5 w "w1 includ+ a /atem5t t ! contract+ facility or organization w n add additional "w locations )\t ! approval ( ! ,f$]al ag5cy or ,/ate ag5cy t reque/$ ! waiv]2 & 7,d7 does n include a non-compete provision4 7#f7 ,an ali5 grant$ a waiv] "u ?is subsection ^: employm5t relation%ip ) a heal? facility or heal? c>e organization t]m9ates "u p>agraph 7#a77;,c77ii7 dur+ ! #c-ye> s]vice p]iod requir$ "u p>agraph 7#a7 %all be consid]$ to be ma9ta9+ lawful /atus 9 an au?oriz$ p]iod ( /ay dur+ ! #abj-;day p]iod ref]r$ to 9 items 7aa7 & 7bb7 ( subclause 7,,iii7 ( p>agraph 7#a77;,c77ii7 or ! #de-;day p]iod ref]r$ to 9 subclause 7,,iii77cc7 ( su* p>agraph4 4 7#f7 ,recaptur+ waiv] slots lo/ to o!r /ates ,section #bad7l7 ( su* ,act1 z am5d$ by ?is section1 is fur!r am5d$ by add+ at ! end ! foll[+3 7#g7 ,if a recipi5t ( a waiv] "u ?is subsection t]m9ates ! recipi5t's employm5t ) a heal? facility or heal? c>e organization pursuant to p>agraph 7#a77;,c77ii71 includ+ t]m9ation ( employm5t because ( circum/ances describ$ 9 p>agraph 7#a77;,c77ii77,,iii71 & accepts new employm5t ) su* a facility or organization 9 a diff]5t ,/ate1 ! ,/ate f :i* ! ali5 is dep>t+ may be accord$ an additional waiv] by ! ,secret>y ( ,/ate = use 9 ! fiscal ye> 9 :i* ! ali5's employm5t 0 t]m9at$4 4 7#g7 ,exception to #c-ye> "w requirem5t ,section #bad7l7 ( su* ,act1 z am5d$ by ?is section1 is fur!r am5d$ by add+ at ! end ! foll[+3 7#h7 ,! #c-ye> "w requirem5t set =? 9 subp>agraphs 7,c7 & 7,d7 ( p>agraph 7#a7 %all n apply if-- 7,a7 7i7 ! ,secret>y ( ,homel& ,security det]m9es t ext5uat+ circum/ances1 includ+ violations by ! employ] ( ! employm5t agreem5t ) ! ali5 or ( labor & employm5t laws1 exi/ t ju/ify a less] p]iod ( employm5t at su* facility or organization2 & 7ii7 n lat] ?an #abj days aft] ! employm5t t]m9ation date 7unless ! ,secret>y det]m9es t ext5uat+ circum/ances w\ld ju/ify an ext5sion71 ! ali5 demon/rates ano!r bona fide (f] ( employm5t at a heal? facility or heal? c>e organization 9 a geographic area or areas :i* are designat$ by ! ,secret>y ( ,heal? & ,human ,s]vices z hav+ a %ortage ( heal? c>e pr(essionals1 = ! rema9d] ( su* #c-ye> p]iod2 7,b7 7i7 ! int]e/$ ,/ate ag5cy t reque/$ ! waiv] atte/s t ext5uat+ circum/ances1 includ+ violations by ! employ] ( ! employm5t agreem5t ) ! ali5 or ( labor & employm5t laws1 exi/ t ju/ify a less] p]iod ( employm5t at su* facility or organization2 & 7ii7 n lat] ?an #abj days aft] ! employm5t t]m9ation date 7unless ! ,secret>y det]m9es t ext5uat+ circum/ances w\ld ju/ify an ext5sion71 ! ali5 demon/rates ano!r bona fide (f] ( employm5t at a heal? facility or heal? c>e organization 9 a geographic area or areas :i* are designat$ by ! ,secret>y ( ,heal? & ,human ,s]vices z hav+ a %ortage ( heal? c>e pr(essionals1 = ! rema9d] ( su* #c-ye> p]iod2 or 7,c7 ! ali5-- 7i7 elects n to pursue a det]m9ation ( ext5uat+ circum/ances pursuant to subclause 7,a7 or 7,b72 7ii7 t]m9ates ! ali5's employm5t relation%ip ) ! heal? facility or heal? c>e organization at :i* ! ali5 0 employ$2 7iii7 n lat] ?an #de days aft] ! employm5t t]m9ation date1 demon/rates ano!r bona fide (f] ( employm5t at a heal? facility or heal? c>e organization 9 a geographic area or areas1 9 ! ,/ate t reque/$ ! ali5's waiv]1 :i* are designat$ by ! ,secret>y ( ,heal? & ,human ,s]vices z hav+ a %ortage ( heal? c>e pr(essionals2 & 7iv7 agrees to be employ$ = ! rema9d] ( su* #c-ye> p]iod1 & #a additional ye> = ea* t]m9ation "u clause 7ii74 4 7d7 ,allotm5t ( ,conrad #cj waiv]s 7#a7 ,9 g5]al ,section #bad7l7 ( ! ,immigration & ,nationality ,act 7#h ,u4,s4,c4 #aahd7l771 z am5d$ by subsection 7c71 is fur!r am5d$ by add+ at ! end ! foll[+3 7#i7 7,a7 7i7 ,all ,/ates %all be allott$ #ce waiv]s "u p>agraph 7#a77;,b7 = ea* fiscal ye> if #ij p]c5t ( ! waiv]s available to ! ,/ates receiv+ at lea/ #e waiv]s 7 us$ 9 ! previ\s fiscal ye>4 7ii7 ,:5 an allotm5t occurs "u clause 7i71 all ,/ates %all be allott$ an additional #e waiv]s "u p>agraph 7#a77;,b7 = ea* subsequ5t fiscal ye> if #ij p]c5t ( ! waiv]s available to ! ,/ates receiv+ at lea/ #e waiv]s 7 us$ 9 ! previ\s fiscal ye>4 ,if ! ,/ates are allott$ #de or m waiv]s = a fiscal ye>1 ! ,/ates w only receive an additional increase ( #e waiv]s ! foll[+ fiscal ye> if #ie p]c5t ( ! waiv]s available to ! ,/ates receiv+ at lea/ #a waiv] 7 us$ 9 ! previ\s fiscal ye>4 7,b7 ,any increase 9 allotm5ts "u subp>agraph 7,a7 %all be ma9ta9$ indef9itely1 unless 9 a fiscal ye>1 ! total numb] ( su* waiv]s grant$ is #e p]c5t l[] ?an 9 ! la/ ye> 9 :i* !re 0 an increase 9 ! numb] ( waiv]s allott$ pursuant to ?is p>agraph4 ,9 su* case-- 7i7 ! numb] ( waiv]s allott$ beg9n+ 9 ! next fiscal ye> %all be decreas$ by #e = all ,/ates2 & 7ii7 ea* additional #e p]c5t decrease 9 su* waiv]s grant$ f ! la/ ye> 9 :i* !re 0 an increase 9 ! allotm5t1 %all result 9 an additional decrease ( #e waiv]s allott$ = all ,/ates1 provid$ t ! numb] ( waiv]s allott$ = all ,/ates %all n drop bel[ #cj4 4 7#b7 ,academic m$ical c5t]s ,section #bad7l77#a77;,d7 ( su* ,act1 z am5d$ by subsection 7c77#a77;,e71 is fur!r am5d$-- 7,a7 9 clause 7ii71 by /rik+ & at ! end2 7,b7 9 clause 7iii71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+3 7iv7 9 ! case ( a reque/ by an int]e/$ ,/ate ag5cy-- 7,i7 ! head ( su* ag5cy det]m9es t ! ali5 is to practice m$ic9e 91 or be on ! faculty ( a resid5cy program at1 an academic m$ical c5t] 7z def9$ 9 section #daa4cee7;e77#b7 ( title #db1 ,code ( ,f$]al ,regulations71 )\t reg>d to :e!r su* facility is locat$ )9 an area designat$ by ! ,secret>y ( ,heal? & ,human ,s]vices z hav+ a %ortage ( heal? c>e pr(essionals2 & 7,,ii7 ! head ( su* ag5cy det]m9es t-- 7aa7 ! ali5 physician's "w is 9 ! public int]e/2 & 7bb7 subject to p>agraph 7#f71 ! grant ( su* waiv] w\ld n cause ! numb] ( ! waiv]s grant$ on behalf ( ali5s = su* ,/ate = a fiscal ye> to exce$ #c1 )9 ! limitation "u subp>agraph 7,b74 4 7e7 ,am5dm5ts to ! proc$ures1 def9itions1 & o!r provisions relat$ to physician immigration 7#a7 ,dual int5t = physicians seek+ graduate m$ical tra9+ ,section #bad7;b7 ( ! ,immigration & ,nationality ,act 7#h ,u4,s4,c4 #aahd7;b77 is am5d$ by /rik+ & o!r ?an a nonimmigrant describ$ 9 any provision ( section #aja7;a77#ae77;,h77i7 except subclause 7b#a7 ( su* section7 & ins]t+ a nonimmigrant describ$ 9 any provision ( section #aja7;a77#ae77;,h77i7 7except subclause 7b#a7 ( su* section71 & an ali5 com+ to ! ,unit$ ,/ates to receive graduate m$ical education or tra9+ z describ$ 9 section #bab7;j7 or to take exam9ations requir$ to receive graduate m$ical education or tra9+ z describ$ 9 section #bab7;j774 7#b7 ,physician national int]e/ waiv] cl>ifications 7,a7 ,practice & geographic area ,section #bjc7;b77#b77;,b77ii77,i7 ( ! ,immigration & ,nationality ,act 7#h ,u4,s4,c4 #aaec7;b77#b77;,b77ii77,i77 is am5d$ by /rik+ items 7aa7 & 7bb7 & ins]t+ ! foll[+3 7aa7 ! ali5 physician agrees to "w on a full-"t basis practic+ prim>y c>e1 specialty m$ic9e1 or a comb9ation !re(1 9 an area or areas designat$ by ! ,secret>y ( ,heal? & ,human ,s]vices z hav+ a %ortage ( heal? c>e pr(essionals1 or at a heal? c>e facility "u ! jurisdiction ( ! ,secret>y ( ,vet]ans ,affairs2 or 7bb7 ! ali5 physician is pursu+ su* waiv] bas$ ^u s]vice at a facility or facilities t s]ve pati5ts :o reside 9 a geographic area or areas designat$ by ! ,secret>y ( ,heal? & ,human ,s]vices z hav+ a %ortage ( heal? c>e pr(essionals 7)\t reg>d to :e!r su* facility or facilities are locat$ )9 su* an area7 & a ,f$]al ag5cy1 or a local1 c\nty1 regional1 or ,/ate dep>tm5t ( public heal? det]m9es ! ali5 physician's "w 0 or w be 9 ! public int]e/4 4 7,b7 ,five-ye> s]vice requirem5t ,section #bjc7;b77#b77;,b77ii7 ( su* ,act is am5d$-- 7i7 by mov+ subclauses 7,,ii71 7,,iii71 & 7,,iv7 #d ems to ! left2 & 7ii7 9 subclause 7,,ii7-- 7,i7 by ins]t+ 7aa7 aft] 7,,ii72 & 7,,ii7 by add+ at ! end ! foll[+3 7bb7 ,! #e-ye> s]vice requirem5t describ$ 9 item 7aa7 %all beg9 on ! date on :i* ! ali5 physician beg9s "w 9 ! %ortage area 9 any legal /atus & n on ! date on :i* an immigrant visa petition is fil$ or approv$4 ,su* s]vice %all be aggregat$ )\t reg>d to :5 su* s]vice began & )\t reg>d to :e!r su* s]vice began dur+ or 9 conjunction ) a c\rse ( graduate m$ical education4 7cc7 ,an ali5 physician %all n be requir$ to submit an employm5t contract ) a t]m exce$+ ! balance ( ! #e-ye> commitm5t yet to be s]v$ or an employm5t contract dat$ )9 a m9imum "t p]iod be=e fil+ a visa petition "u ?is subsection4 7dd7 ,an ali5 physician %all n be requir$ to file additional immigrant visa petitions ^u a *ange ( "w location f ! location approv$ 9 ! orig9al national int]e/ immigrant petition4 4 7#c7 ,te*nical cl>ification reg>d+ advanc$ degree = physicians ,section #bjc7;b77#b77;,a7 ( su* ,act 7#h ,u4,s4,c4 #aaec7;b77#b77;,a77 is am5d$ by add+ at ! end ! foll[+3 ,an ali5 physician hold+ a =eign m$ical degree t has be5 deem$ suffici5t = acceptance by an accr$it$ ,unit$ ,/ates m$ical resid5cy or fell[%ip program %all be consid]$ a memb] ( ! pr(essions hold+ an advanc$ degree or its equival5t = purposes ( ?is p>agraph44 7#d7 ,%ort-,t]m "w au?orization = physicians complet+ _! resid5cies 7,a7 ,9 g5]al ,a physician complet+ graduate m$ical education or tra9+ describ$ 9 section #bab7;j7 ( ! ,immigration & ,nationality ,act 7#h ,u4,s4,c4 #aahb7;j77 z a nonimmigrant describ$ 9 section #aja7;a77#ae77;,h77i7 ( su* ,act 7#h ,u4,s4,c4 #aaja7;a77#ae77;,h77i77-- 7i7 %all h su* nonimmigrant /atus automatically ext5d$ until ,octob] #a ( ! fiscal ye> = :i* a petition = a cont9uation ( su* nonimmigrant /atus has be5 submitt$ 9 a timely mann] & ! employm5t />t date = ! b5efici>y ( su* petition is ,octob] #a ( t fiscal ye>2 & 7ii7 %all be au?oriz$ to be employ$ incid5t to /atus dur+ ! p]iod betwe5 ! fil+ ( su* petition & ,octob] #a ( su* fiscal ye>4 7,b7 ,t]m9ation ,! /atus & employm5t au?orization ( a physician describ$ 9 subp>agraph 7,a7 %all t]m9ate on ! date t is #cj days aft] ! date on :i* a petition describ$ 9 clause 7i77,i7 is reject$1 d5i$ or revok$4 7,c7 ,automatic ext5sion ,! /atus & employm5t au?orization ( a physician describ$ 9 subp>agraph 7,a7 w automatically ext5d to ,octob] #a ( ! next fiscal ye> if all ( ! visas describ$ 9 section #aja7;a77#ae77;,h77i7 ( ! ,immigration & ,nationality ,act 7#h ,u4,s4,c4 #aaja7;a77#ae77;,h77i77 t 7 au?oriz$ to be issu$ = ! fiscal ye> h be5 issu$4 7#e7 ,applicability ( section #bab7;e7 to sp\ses & *ildr5 ( ,j-#a ex*ange visitors ,a sp\se or *ild ( an ex*ange visitor describ$ 9 section #aja7;a77#ae77;,j7 ( ! ,immigration & ,nationality ,act 7#h ,u4,s4,c4 #aaja7;a77#ae77;,j77 %all n be subject to ! requirem5ts "u section #bab7;e7 ( su* ,act 7#h ,u4,s4,c4 #aahb7;e774 ,,iv ,improv+ ,heal? ,c>e ,access & ,quality ,a ,improvem5t ( ,cov]age #dja4 ,repeal ( requirem5t = docum5tation evid5c+ citiz5%ip or nationality "u ! ,m$icaid program 7a7 ,repeal ,subsections 7i77#bb7 & 7x7 ( section #aijc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 are ea* repeal$4 7b7 ,con=m+ am5dm5ts 7#a7 ,/ate paym5ts = m$ical assi/ance ,section #aijb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is am5d$-- 7,a7 by am5d+ p>agraph 7#df7 ( subsection 7a7 to read z foll[s3 7#df7 provide t in=mation is reque/$ & ex*ang$ = purposes ( income & eligibility v]ification 9 accordance ) a ,/ate sy/em :i* meets ! requirem5ts ( section #aacg ( ?is ,act2 2 7,b7 9 subsection 7e77#ac77;,a77i7-- 7i7 9 ! matt] prec$+ subclause 7,i71 by /rik+ sections #aijb7;a77#df77;,b7 & #aacg7;d7 & ins]t+ section #aacg7;d72 & 7ii7 9 subclause 7,,iv71 by /rik+ #aijb7;a77#df77;,b7 or2 & 7,c7 by /rik+ subsection 7ee74 7#b7 ,paym5t to ,/ates ,section #aijc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 is am5d$-- 7,a7 9 subsection 7i71 by r$esignat+ p>agraphs 7#bc7 ?r\gh 7#bg7 z p>agraphs 7#bb7 ?r\gh 7#bf71 respectively2 & 7,b7 by r$esignat+ subsections 7y71 7z71 & 7aa7 z subsections 7x71 7y71 & 7z71 respectively4 7#c7 ,repeal ,subsection 7c7 ( section #fjcf ( ! ,deficit ,r$uction ,act ( #bjje 7#db ,u4,s4,c4 #acif;b note7 is repeal$4 7c7 ,effective date ,! am5dm5ts made by ?is section %all take effect on ! date ( enactm5t ( ?is ,act4 #djb4 ,remov+ citiz5%ip & immigration b>ri]s to access to af=dable heal? c>e "u ,,aca 7a7 ,9 g5]al 7#a7 ,premium tax cr$its ,section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7,a7 9 subsection 7c77#a77;,b7-- 7i7 by am5d+ ! head+ to read z foll[s3 ,special rule = c]ta9 individuals ineligible = ,m$icaid due to /atus2 & 7ii7 9 clause 7ii71 by /rik+ lawfully pres5t 9 ! ,unit$ ,/ates1 b & ins]t+ :o2 & 7,b7 by /rik+ subsection 7e74 7#b7 ,co/-%>+ r$uctions ,section #adjb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjga7 is am5d$ by /rik+ subsection 7e74 7#c7 ,basic heal? program eligibility ,section #acca7;e77#a77;,b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjea7;e77#a77;,b77 is am5d$ by /rik+ lawfully pres5t 9 ! ,unit$ ,/ates4 7#d7 ,re/rictions on ,f$]al paym5ts ,section #adab ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjhb7 is am5d$ by /rik+ subsection 7d74 7#e7 ,requirem5t to ma9ta9 m9imum ess5tial cov]age ,section #ejjj;,a7d7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ p>agraph 7#c7 & by r$esignat+ p>agraph 7#d7 z p>agraph 7#c74 7b7 ,con=m+ am5dm5ts 7#a7 ,section #adaa7;a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjha7;a77 is am5d$ by /rik+ p>agraph 7#a7 & r$esignat+ p>agraphs 7#b71 7#c71 & 7#d7 z p>agraphs 7#a71 7#b71 & 7#c71 respectively4 7#b7 ,section #acab7;f7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjcb7;f77 is am5d$-- 7,a7 9 ! head+1 by /rik+ 2 access limit$ to citiz5s & lawful resid5ts2 & 7,b7 by /rik+ p>agraph 7#c74 #djc4 ,/udy on ! un9sur$ 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y7 %all-- 7#a7 conduct a /udy1 9 accordance ) ! /&>ds "u section #caja ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjjkk71 on ! demographic *>act]i/ics ( ! population ( individuals :o d n h heal? insurance cov]age or oral heal? cov]age2 & 7#b7 pr$ict1 bas$ on su* /udy1 ! demographic *>act]i/ics ( ! population ( individuals :o w\ld rema9 )\t heal? insurance cov]age aft] ! end ( any annual op5 enrollm5t or any special enrollm5t p]iod or ^u enactm5t & implem5tation ( any legislative *anges to ! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh7 t affect ! numb] ( p]sons eligible = cov]age4 7b7 ,report+ requirem5ts 7#a7 ,9 g5]al ,n lat] ?an #ab mon?s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ! ,congress ! results ( ! /udy "u subsection 7a77#a7 & ! pr$iction made "u subsection 7a77#b74 7#b7 ,report+ ( demographic *>act]i/ics ,! ,secret>y %all-- 7,a7 report ! demographic *>act]i/ics "u p>agraphs 7#a7 & 7#b7 ( subsection 7a7 on ! basis ( racial & e?nic gr\p1 & %all /ratify ! report+ on ea* racial & e?nic gr\p by o!r demographic *>act]i/ics t c impact access to heal? insurance cov]age1 su* z sexual ori5tation1 g5d] id5tity1 prim>y language1 disability /atus1 sex1 socioeconomic /atus1 age gr\p1 & citiz5%ip & immigration /atus1 9 a mann] consi/5t ) title ,i ( ?is ,act1 includ+ ! am5dm5ts made by su* title2 & 7,b7 n use su* report to engage 9 or anticipate any deportation or immigration relat$ en=cem5t action by any entity1 includ+ ! ,dep>tm5t ( ,homel& ,security4 #djd4 ,m$icaid 9 ! t]ritories 7a7 ,elim9ation ( g5]al ,m$icaid fund+ limitations 7,cap7 = t]ritories 7#a7 ,repeal ( provisions relat$ to cap aft] #bjai ,subsections 7a71 7b71 & 7d7 ( section #bjb ( subtitle ,b ( title ,i ( division ,n ( ! ,fur!r ,consolidat$ ,appropriations ,act1 #bjbj 7,public ,law #aaf-id7 & section #fjji ( ! ,families ,fir/ ,coronavirus ,response ,act 7,public ,law #aaf-abg7 are repeal$ & ! provisions ( law am5d$ by su* subsections & section are re/or$ z if su* subsections & section _h n be5 enact$4 7#b7 ,sunset ( ,m$icaid fund+ limitations = t]ritories ,section #aajh ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acjh7 7z re/or$ by p>agraph 7#a77 is am5d$-- 7,a7 9 subsection 7f71 9 ! matt] prec$+ p>agraph 7#a71 by /rik+ subsection 7g7 & ins]t+ subsections 7g7 & 7h72 7,b7 9 subsection 7g77#b71 9 ! matt] prec$+ subp>agraph 7,a71 by ins]t+ & subsection 7h7 aft] p>agraphs 7#c7 & 7#e72 & 7,c7 by add+ at ! end ! foll[+ new subsection3 7h7 ,sunset ( ,m$icaid fund+ limitations = ,pu]to ,rico1 ! ,virg9 ,isl&s ( ! ,unit$ ,/ates1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa ,subsections 7f7 & 7g7 %all n apply to ,pu]to ,rico1 ! ,virg9 ,isl&s ( ! ,unit$ ,/ates1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa beg9n+ ) fiscal ye> #bjbj4 4 7#c7 ,con=m+ am5dm5ts 7,a7 ,section #aijb7;j7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7j77 is am5d$ by /rik+ 1 ! limitation 9 section #aajh7;f714 7,b7 ,section #aijc7u7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7u77 is am5d$ by /rik+ p>agraph 7#d74 7#d7 ,effective date ,! am5dm5ts made by ?is subsection %all apply beg9n+ ) fiscal ye> #bjbj4 7b7 ,elim9ation ( specific ,f$]al m$ical assi/ance p]c5tage 7,,fmap7 limitation = t]ritories ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is am5d$-- 7#a7 9 clause 7#b7 ( subsection 7b71 by ins]t+ = fiscal ye>s be=e fiscal ye> #bjbj aft] ,am]ican ,samoa2 & 7#b7 9 subsection 7ff7-- 7,a7 by /rik+ 7z77#b7-- & all t foll[s ?r\gh beg9n+ ,octob] #a1 #bjai & ins]t+ 7z77#b71 = ! p]iod beg9n+ ,octob] #a1 #bjai2 7,b7 by /rik+ #ajj p]c5t2 & ins]t+ #ajj p]c5t42 & 7,c7 by /rik+ p>agraphs 7#b7 & 7#c74 7c7 ,application ( ,m$icaid waiv] au?ority to all ( ! t]ritories 7#a7 ,9 g5]al ,section #aijb7;j7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7j771 z am5d$ by subsection 7a77#c77;,a71 is am5d$-- 7,a7 by /rik+ ,am]ican ,samoa & ! ,nor!rn ,m>iana ,isl&s & ins]t+ ,pu]to ,rico1 ! ,virg9 ,isl&s ( ! ,unit$ ,/ates1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa2 7,b7 by /rik+ ,am]ican ,samoa or ! ,nor!rn ,m>iana ,isl&s & ins]t+ ,pu]to ,rico1 ! ,virg9 ,isl&s ( ! ,unit$ ,/ates1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 or ,am]ican ,samoa2 7,c7 by ins]t+ 7#a7 aft] 7j72 7,d7 by ins]t+ except z o!rwise provid$ 9 ?is subsection1 aft] ,not)/&+ any o!r requirem5t ( ?is title2 & 7,e7 by add+ at ! end ! foll[+3 7#b7 ,! ,secret>y may n waive "u ?is subsection ! requirem5t ( subsection 7a77#aj77;,a77i77,,ix7 7relat+ to cov]age ( adults =m]ly "u fo/] c>e7 ) respect to any t]ritory4 4 7#b7 ,effective date ,! am5dm5ts made by ?is subsection %all apply beg9n+ ,octob] #a1 #bjba4 7d7 ,p]mitt+ ,m$icaid ,,d% allotm5ts = t]ritories ,section #aibc7;f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7 is am5d$-- 7#a7 9 p>agraph 7#f71 by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,t]ritories 7i7 ,fiscal ye> #bjbj ,= fiscal ye> #bjbj1 ! ,,d% allotm5t = ,pu]to ,rico1 ! ,virg9 ,isl&s ( ! ,unit$ ,/ates1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa %all be> ! same ratio to #cjj1jjj1jjj z ! ratio ( ! numb] ( individuals :o are l[-income or un9sur$ & resid+ 9 su* respective t]ritory 7z e/imat$ f "t to "t by ! ,secret>y7 be>s to ! sums ( ! numb] ( su* individuals resid+ 9 all ( ! t]ritories4 7ii7 ,subsequ5t fiscal ye> ,= ea* subsequ5t fiscal ye>1 ! ,,d% allotm5t = ea* su* t]ritory is subject to an increase 9 accordance ) p>agraph 7#b74 2 & 7#b7 9 p>agraph 7#i71 by ins]t+ be=e ! p]iod at ! end ! foll[+3 1 & includes1 beg9n+ ) fiscal ye> #bjbj1 ,pu]to ,rico1 ! ,virg9 ,isl&s ( ! ,unit$ ,/ates1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa4 #dje4 ,ext5sion ( ,m$ic>e second>y pay] 7a7 ,9 g5]al ,section #ahfb7;b77#a77;,c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7b77#a77;,c77 is am5d$-- 7#a7 9 ! la/ s5t5ce1 by ins]t+ 1 & be=e ,janu>y #a1 #bjba aft] prior to su* date72 & 7#b7 by add+ at ! end ! foll[+ new s5t5ce3 ,effective = items & s]vices furni%$ on or aft] ,janu>y #a1 #bjba 7) respect to p]iods beg9n+ on or aft] ! date t is #db mon?s prior to su* date71 clauses 7i7 & 7ii7 %all be appli$ by sub/itut+ #db-mon? = #ab-mon? ea* place x appe>s44 7b7 ,effective date ,! am5dm5ts made by ?is section %all take effect on ! date ( enactm5t ( ?is ,act4 ,= purposes ( det]m9+ an individual's /atus "u section #ahfb7;b77#a77;,c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7b77#a77;,c771 z am5d$ by subsection 7a71 an individual :o is )9 ! coord9at+ p]iod z ( ! date ( enactm5t ( ?is ,act %all h t p]iod ext5d$ to ! full #db mon?s describ$ 9 ! la/ s5t5ce ( su* section1 z add$ by ! am5dm5t made by subsection 7a77#b74 #djf4 ,indian def9$ 9 title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7a7 ,def9ition ( indian ,section #acjd ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjbd7 is am5d$ by add+ at ! end ! foll[+3 7f7 ,indian 7#a7 ,9 g5]al ,9 ?is title1 ! t]m ,indian means any individual-- 7,a7 describ$ 9 p>agraph 7#ac7 or 7#bh7 ( section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc72 7,b7 :o is eligible = heal? s]vices provid$ by ! ,indian ,heal? ,s]vice "u section #hji ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afgi72 7,c7 :o is ( ,indian desc5t & belongs to an ,indian community s]v$ by a local facility or program ( ! ,indian ,heal? ,s]vice2 or 7,d7 :o is o!rwise describ$ 9 p>agraph 7#b74 7#b7 ,inclusions ,an individual is describ$ 9 ?is p>agraph if ! individual is any ( ! foll[+3 7,a7 ,a memb] ( a f$]ally recogniz$ ,indian ,tribe4 7,b7 ,a resid5t ( an urban c5t] :o meets any ( ! foll[+ crit]ia3 7i7 ,memb]%ip 9 a ,tribe1 b&1 or o!r organiz$ gr\p ( ,indians1 includ+ ^? ,tribes1 b&s1 or gr\ps t]m9at$ s9ce #aidj & ^? recogniz$ z ( ! date ( enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjah or lat] by ! ,/ate 9 :i* !y reside1 or be+ a desc5dant1 9 ! fir/ or second degree1 ( any su* memb]4 7ii7 ,is an ,eskimo or ,aleut or o!r ,alaska ,native4 7iii7 ,is consid]$ by ! ,secret>y ( ! ,int]ior to be an ,indian = any purpose4 7iv7 ,is det]m9$ to be an ,indian "u regulations promulgat$ by ! ,secret>y4 7,c7 ,an individual :o is consid]$ by ! ,secret>y ( ! ,int]ior to be an ,indian = any purpose4 7,d7 ,an individual :o is consid]$ by ! ,secret>y to be an ,indian = purposes ( eligibility = ,indian heal? c>e s]vices1 includ+ z a ,cali=nia ,indian1 ,eskimo1 ,aleut1 or o!r ,alaska ,native4 4 7b7 ,con=m+ am5dm5ts 7#a7 ,af=dable *oices heal? b5efit plans ,section #acaa7;c77#f77;,d7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7;c77#f77;,d77 is am5d$ by /rik+ 7z def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act74 7#b7 ,r$uc$ co/-%>+ = individuals enroll+ 9 qualifi$ heal? plans ,section #adjb7;d7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjga7;d77 is am5d$-- 7,a7 9 p>agraph 7#a71 9 ! matt] prec$+ subp>agraph 7,a71 by /rik+ 7z def9$ 9 section #d7;d7 ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej;b7d772 & 7,b7 9 p>agraph 7#b71 9 ! matt] prec$+ subp>agraph 7,a71 by /rik+ 7z s def9$74 7#c7 ,exemption f p5alty = n ma9ta9+ m9imum ess5tial cov]age ,section #ejjj;,a7e7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ p>agraph 7#c7 & ins]t+ ! foll[+3 7#c7 ,indians ,any applicable individual :o is an ,indian 7z def9$ 9 section #acjd7;f7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act74 4 #djg4 ,remov+ ,m$ic>e b>ri] to heal? c>e 7a7 ,"p ,a ,section #ahah7;a77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#b7;a77#c77 is am5d$ by /rik+ an ali5 & all t foll[s ?r\gh "u ?is section & ins]t+ an individual :o is lawfully pres5t 9 ! ,unit$ ,/ates4 7b7 ,"p ,b ,section #ahcf7b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieo7#b77 is am5d$ by /rik+ an ali5 & all t foll[s ?r\gh "u ?is "p & ins]t+ an individual :o is lawfully pres5t 9 ! ,unit$ ,/ates4 #djh4 #ajj p]c5t ,,fmap = m$ical assi/ance provid$ by urban ,indian heal? c5t]s 7a7 ,9 g5]al ,! ?ird s5t5ce ( section #aije7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif7;b77 is am5d$ by ins]t+ or are receiv$ ?r\gh a program op]at$ by an urban ,indian organization ?r\gh a grant or contract "u title ,v ( ! ,indian ,heal? ,c>e ,improvem5t ,act aft] 7z def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act74 7b7 ,effective date ,! am5dm5t made by ?is section %all apply to m$ical assi/ance provid$ on or aft] ! date ( enactm5t ( ?is ,act4 #dji4 #ajj p]c5t ,,fmap = m$ical assi/ance provid$ to a ,native ,hawaiian ?r\gh a f$]ally qualifi$ heal? c5t] or a ,native ,hawaiian heal? c>e sy/em "u ! ,m$icaid program 7a7 ,9 g5]al ,! ?ird s5t5ce ( section #aije7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b771 z am5d$ by section #djh7;a71 is am5d$ by ins]t+ be=e ! p]iod ! foll[+3 1 & ) respect to m$ical assi/ance provid$ to a ,native ,hawaiian 7z def9$ 9 section #ab7b7 ( ! ,native ,hawaiian ,heal? ,c>e ,improvem5t ,act7 ?r\gh a f$]ally qualifi$ heal? c5t] or a ,native ,hawaiian heal? c>e sy/em 7z def9$ 9 section #ab7f7 ( su* ,act71 :e!r directly1 by ref]ral1 or "u contract or o!r arrangem5t betwe5 su* f$]ally qualifi$ heal? c5t] or ,native ,hawaiian heal? c>e sy/em & ano!r heal? c>e provid]4 7b7 ,effective date ,! am5dm5t made by ?is section %all apply to m$ical assi/ance provid$ on or aft] ! date ( enactm5t ( ?is ,act4 #daj4 ,m$icaid cov]age = citiz5s ( freely associat$ /ates 7a7 ,9 g5]al ,section #djb7;b77#b7 ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#h ,u4,s4,c4 #afab7;b77#b77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,g7 ,m$icaid exception = citiz5s ( freely associat$ /ates ,) respect to eligibility = b5efits = ! designat$ ,f$]al program describ$ 9 p>agraph 7#c77;,c71 section #dja7;a7 & p>agraph 7#a7 %all n apply to any individual :o lawfully resides 9 #a ( ! #ej ,/ates or ! ,di/rict ( ,columbia 9 accordance ) ! ,compacts ( ,free ,association betwe5 ! ,gov]nm5t ( ! ,unit$ ,/ates & ! ,gov]nm5ts ( ! ,f$]at$ ,/ates ( ,micronesia1 ! ,republic ( ! ,m>%all ,isl&s1 & ! ,republic ( ,palau & %all n apply1 at ! option ( ! ,gov]nors ( ,pu]to ,rico1 ! ,virg9 ,isl&s1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 or ,am]ican ,samoa1 respectively1 z communicat$ to ! ,secret>y ( ,heal? & ,human ,s]vices 9 writ+1 to any individual :o lawfully resides 9 ! respective t]ritory 9 accordance ) su* ,compacts4 4 7b7 ,exception to #e-,ye> limit$ eligibility ,section #djc7;d7 ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#h ,u4,s4,c4 #afac7;d77 is am5d$-- 7#a7 9 p>agraph 7#a71 by /rik+ or at ! end2 7#b7 9 p>agraph 7#b71 by /rik+ ! p]iod at ! end & ins]t+ 2 or2 & 7#c7 by add+ at ! end ! foll[+ new p>agraph3 7#c7 an individual describ$ 9 section #djb7;b77#b77;,g71 b only ) respect to ! designat$ ,f$]al program describ$ 9 section #djb7;b77#c77;,c74 4 7c7 ,def9ition ( qualifi$ ali5 ,section #dca7;b7 ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#h ,u4,s4,c4 #afda7;b77 is am5d$-- 7#a7 9 p>agraph 7#f71 by /rik+ 2 or at ! end & ins]t+ a comma2 7#b7 9 p>agraph 7#g71 by /rik+ ! p]iod at ! end & ins]t+ 1 or2 & 7#c7 by add+ at ! end ! foll[+ new p>agraph3 7#h7 an individual :o lawfully resides 9 ! ,unit$ ,/ates 9 accordance ) a ,compact ( ,free ,association ref]r$ to 9 section #djb7;b77#b77;,g71 b only ) respect to ! designat$ ,f$]al program describ$ 9 section #djb7;b77#c77;,c7 7relat+ to ! ,m$icaid program74 4 7d7 ,effective date ,! am5dm5ts made by ?is section take effect on ,octob] #a1 #bjba4 ,b ,expansion ( ,access #dab4 ,am5dm5t to ! ,public ,heal? ,s]vice ,act ,title ,,xxxiv ( ! ,public ,heal? ,s]vice ,act1 z am5d$ by titles ,i1 ,,ii1 ,,iii1 & ,,ix ( ?is ,act1 is fur!r am5d$ by ins]t+ aft] subtitle ,d ! foll[+3 ,e ,recon/ruction & ,improvem5t ,grants = ,public ,heal? ,c>e ,facilities ,s]v+ ,pacific ,isl&]s & ! ,insul> ,areas #cdea4 ,grant support = quality improvem5t initiatives 7a7 ,9 g5]al ,! ,secret>y1 9 collaboration ) ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 & ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 %all aw>d grants to eligible entities = ! conduct ( demon/ration projects to improve ! quality ( & access to heal? c>e4 7b7 ,eligibility ,to be eligible to receive a grant "u subsection 7a71 an entity %all-- 7#a7 be a heal? c5t]1 hospital1 heal? plan1 heal? sy/em1 community cl9ic1 or o!r heal? entity det]m9$ appropriate by ! ,secret>y-- 7,a7 t1 by legal m&ate or explicitly adopt$ mission1 provides pati5ts ) access to s]vices reg>dless ( _! ability to pay2 7,b7 t provides c>e or treatm5t = a sub/antial numb] ( pati5ts :o are un9sur$1 are receiv+ assi/ance "u a ,/ate plan "u title ,,xix ( ! ,social ,security ,act 7or "u a waiv] ( su* plan71 or are memb]s ( vuln]able populations1 z det]m9$ by ! ,secret>y2 & 7,c7 7i7 ) respect to :i*1 n less ?an #ej p]c5t ( ! entity's pati5t population is made up ( racial & e?nic m9ority gr\ps2 or 7ii7 t-- 7,i7 s]ves a disproportionate p]c5tage ( local pati5ts t are f a racial & e?nic m9ority gr\p1 or t has a pati5t population1 at lea/ #ej p]c5t ( :i* is compos$ ( individuals ) limit$ ,engli% pr(ici5cy2 & 7,,ii7 provides an assurance t am\nts receiv$ "u ! grant w be us$ only to support quality improvem5t activities 9 ! racial & e?nic m9ority population s]v$2 & 7#b7 prep>e & submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7c7 ,priority ,9 aw>d+ grants "u subsection 7a71 ! ,secret>y %all give priority to applicants meet+ ! crit]ia "u subsection 7b7 t-- 7#a7 demon/rate an int5t to op]ate z "p ( a heal? c>e p>tn]%ip1 network1 collaborative1 coalition1 or alliance :]e ea* memb] entity contributes to ! design1 implem5tation1 & evaluation ( ! propos$ int]v5tion2 or 7#b7 int5d to use funds to c>ry out sy/emwide *anges ) respect to heal? c>e quality improvem5t1 includ+-- 7,a7 improv$ sy/ems = data collection & report+2 7,b7 innovative collaborative or simil> processes2 7,c7 gr\p programs ) behavioral or self-managem5t int]v5tions2 7,d7 case managem5t s]vices2 7,e7 physician or pati5t rem9d] sy/ems2 7,f7 educational int]v5tions2 or 7,g7 o!r activities det]m9$ appropriate by ! ,secret>y4 7d7 ,use ( funds ,an entity %all use am\nts receiv$ "u a grant "u subsection 7a7 to support ! implem5tation & evaluation ( heal? c>e quality improvem5t activities or m9ority heal? & heal? c>e disp>ity r$uction activities t include-- 7#a7 ) respect to heal? c>e sy/ems1 activities relat+ to improv+-- 7,a7 pati5t safety2 7,b7 timel9ess ( c>e2 7,c7 effectiv5ess ( c>e2 7,d7 effici5cy ( c>e2 7,e7 pati5t c5t]$ness2 & 7,f7 heal? in=mation te*nology2 & 7#b7 ) respect to pati5ts1 activities relat+ to-- 7,a7 /ay+ heal?y2 7,b7 gett+ well1 m5tally & physically2 7,c7 liv+ effectively ) illness or disability2 7,d7 cop+ ) end-(-life issues2 & 7,e7 %>$ decision mak+4 7e7 ,common data sy/ems ,! ,secret>y %all provide f9ancial & o!r te*nical assi/ance to grantees "u ?is section = ! developm5t ( common data sy/ems4 7f7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbf4 #cdeb4 ,c5t]s ( excell5ce 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all designate c5t]s ( excell5ce at public hospitals1 & o!r heal? sy/ems s]v+ l>ge numb]s ( m9ority pati5ts1 t-- 7#a7 meet ! requirem5ts ( section #cdea7;b77#a72 7#b7 demon/rate excell5ce 9 provid+ c>e to m9ority populations2 & 7#c7 demon/rate excell5ce 9 r$uc+ disp>ities 9 heal? & heal? c>e4 7b7 ,requirem5ts ,a hospital or heal? sy/em t s]ves z a c5t] ( excell5ce "u subsection 7a7 %all-- 7#a7 design1 implem5t1 & evaluate programs & policies relat+ to ! deliv]y ( c>e 9 racially1 e?nically1 & l+ui/ically div]se populations2 7#b7 provide tra9+ & te*nical assi/ance to o!r hospitals & heal? sy/ems relat+ to ! provision ( quality heal? c>e to m9ority populations2 & 7#c7 develop activities = graduate or cont9u+ m$ical education t in/itutionalize a focus on cultural compet5ce tra9+ = heal? c>e provid]s4 7c7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section1 su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbf4 #cdec4 ,recon/ruction & improvem5t grants = public heal? c>e facilities s]v+ pacific isl&]s & ! insul> areas 7a7 ,9 g5]al ,! ,secret>y %all provide direct f9ancial assi/ance to designat$ heal? c>e provid]s & community heal? c5t]s 9 ,am]ican ,samoa1 ,guam1 ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 ! ,unit$ ,/ates ,virg9 ,isl&s1 ,pu]to ,rico1 & ,hawaii = ! purposes ( recon/ruct+ & improv+ heal? c>e facilities & s]vices 9 a culturally compet5t & su/a9able mann]4 7b7 ,eligibility ,to be eligible to receive direct f9ancial assi/ance "u subsection 7a71 an entity %all be a public heal? facility or community heal? c5t] locat$ 9 ,am]ican ,samoa1 ,guam1 ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 ! ,unit$ ,/ates ,virg9 ,isl&s1 ,pu]to ,rico1 or ,hawaii t-- 7#a7 is own$ or op]at$ by-- 7,a7 ! ,gov]nm5t ( ,am]ican ,samoa1 ,guam1 ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 ! ,unit$ ,/ates ,virg9 ,isl&s1 ,pu]to ,rico1 or ,hawaii or a unit ( local gov]nm5t2 or 7,b7 a nonpr(it organization2 & 7#b7 7,a7 provides c>e or treatm5t = a sub/antial numb] ( pati5ts :o are un9sur$1 receiv+ assi/ance "u title ,,xviii ( ! ,social ,security ,act1 or a ,/ate plan "u title ,,xix ( su* ,act 7or "u a waiv] ( su* plan71 or :o are memb]s ( a vuln]able population1 z det]m9$ by ! ,secret>y2 or 7,b7 s]ves a disproportionate p]c5tage ( local pati5ts t are f a racial & e?nic m9ority gr\p4 7c7 ,report ,n lat] ?an #ahj days aft] ! date ( enactm5t ( ?is title & annually !reaft]1 ! ,secret>y %all submit to ! ,congress & ! ,presid5t a report t includes an assessm5t ( heal? res\rces & facilities s]v+ populations 9 ,am]ican ,samoa1 ,guam1 ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 ! ,unit$ ,/ates ,virg9 ,isl&s1 ,pu]to ,rico1 & ,hawaii4 ,9 prep>+ su* report1 ! ,secret>y %all-- 7#a7 consult ) & obta9 in=mation on all heal? c>e facilities ne$s f ! entities receiv+ direct f9ancial assi/ance "u subsection 7a72 7#b7 include all am\nts ( ,f$]al assi/ance receiv$ by ea* su* entity 9 ! prec$+ fiscal ye>2 7#c7 review ! total unmet ne$s ( heal? c>e facilities s]v+ ,am]ican ,samoa1 ,guam1 ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 ! ,unit$ ,/ates ,virg9 ,isl&s1 ,pu]to ,rico1 & ,hawaii1 includ+ ne$s = r5ovation & expansion ( exi/+ facilities2 7#d7 include a /rategic plan = address+ ! ne$s ( ea* su* population id5tifi$ 9 ! report2 & 7#e7 evaluate ! effectiv5ess ( ! c>e provid$ by measur+ pati5t outcomes & co/ measures4 7d7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ su* sums z necess>y to c>ry out ?is section4 4 #dac4 ,protect+ s5sitive locations ,section #bhg ( ! ,immigration & ,nationality ,act 7#h ,u4,s4,c4 #aceg7 is am5d$-- 7#a7 by /rik+ ,s]vice ea* place su* t]m appe>s & ins]t+ ,dep>tm5t ( ,homel& ,security2 7#b7 by /rik+ ,attorney ,g5]al ea* place su* t]m appe>s & ins]t+ ,secret>y ( ,homel& ,security2 7#c7 9 subsection 7f77#a71 by /rik+ ,commission] & ins]t+ ,director ( ,u4,s4 ,citiz5%ip & ,immigration ,s]vices2 7#d7 9 subsection 7h7-- 7,a7 by /rik+ ( ! ,immigration & ,nationality ,act2 & 7,b7 by /rik+ ( su* ,act2 & 7#e7 by add+ at ! end ! foll[+3 7i7 7#a7 ,9 ?is subsection3 7,a7 ,! t]m appropriate congressional committees means-- 7i7 ! ,committee on ,homel& ,security & ,gov]nm5tal ,affairs ( ! ,s5ate2 7ii7 ! ,committee on ! ,judici>y ( ! ,s5ate2 7iii7 ! ,committee on ,homel& ,security ( ! ,h\se ( ,repres5tatives2 & 7iv7 ! ,committee on ! ,judici>y ( ! ,h\se ( ,repres5tatives4 7,b7 ,! t]m en=cem5t action-- 7i7 means an appreh5sion1 arre/1 int]view1 reque/ = id5tification1 se>*1 or surveillance = ! purposes ( immigration en=cem5t2 & 7ii7 includes an en=cem5t action at1 or focus$ on1 a s5sitive location t is "p ( a jo9t case l$ by ano!r law en=cem5t ag5cy4 7,c7 ,! t]m exig5t circum/ances means a situation involv+-- 7i7 ! imm95t risk ( dea?1 viol5ce1 or physical h>m to any p]son or prop]ty1 includ+ a situation implicat+ t]rorism or ! national security ( ! ,unit$ ,/ates2 7ii7 ! imm$iate arre/ or pursuit ( a dang]\s felon1 t]rori/ suspect1 or o!r individual pres5t+ an imm95t dang]2 or 7iii7 ! imm95t risk ( de/ruction ( evid5ce t is mat]ial to an ongo+ crim9al case4 7,d7 ,! t]m prior approval means-- 7i7 9 ! case ( (fic]s & ag5ts ( ,u4,s4 ,immigration & ,cu/oms ,en=cem5t1 prior writt5 approval to c>ry out an en=cem5t action involv+ a specific individual or individuals au?oriz$ by-- 7,i7 ! ,assi/ant ,director ( ,op]ations1 ,homel& ,security ,inve/igations2 7,,ii7 ! ,executive ,associate ,director1 ,homel& ,security ,inve/igations2 7,,iii7 ! ,assi/ant ,director = ,field ,op]ations1 ,en=cem5t & ,removal ,op]ations2 or 7,,iv7 ! ,executive ,associate ,director = ,field ,op]ations1 ,en=cem5t & ,removal ,op]ations2 7ii7 9 ! case ( (fic]s & ag5ts ( ,u4,s4 ,cu/oms & ,bord] ,protection1 prior writt5 approval to c>ry out an en=cem5t action involv+ a specific individual or individuals au?oriz$ by-- 7,i7 a ,*ief ,patrol ,ag5t2 7,,ii7 ! ,director ( ,field ,op]ations2 7,,iii7 ! ,director ( ,air & ,m>9e ,op]ations2 or 7,,iv7 ! ,int]nal ,affairs ,special ,ag5t 9 ,*>ge2 & 7iii7 9 ! case ( o!r ,f$]al1 ,/ate1 or local law en=cem5t (fic]s1 to c>ry out an en=cem5t action involv+ a specific individual or individuals au?oriz$ by-- 7,i7 ! head ( ! ,f$]al ag5cy c>ry+ out ! en=cem5t action2 or 7,,ii7 ! head ( ! ,/ate or local law en=cem5t ag5cy c>ry+ out ! en=cem5t action4 7,e7 ,! t]m s5sitive location includes all ( ! physical space locat$ )9 #a1jjj feet (-- 7i7 any m$ical treatm5t or heal? c>e facility1 includ+ any hospital1 doctor's (fice1 accr$it$ heal? cl9ic1 alcohol or drug treatm5t c5t]1 or em]g5t or urg5t c>e facility2 7ii7 any public or private s*ool1 includ+ any kn[n & lic5s$ day c>e facility1 pres*ool1 o!r e>ly le>n+ program facility1 prim>y s*ool1 second>y s*ool1 po/second>y s*ool 7includ+ colleges & univ]sities71 or o!r in/itution ( le>n+ 7includ+ vocational or trade s*ools72 7iii7 any s*ola/ic or education-relat$ activity or ev5t1 includ+ field trips & int]s*ola/ic ev5ts2 7iv7 any s*ool bus or s*ool bus /op dur+ p]iods :5 s*ool *ildr5 are pres5t on ! bus or at ! /op2 7v7 any organization or subdivision ( gov]nm5t t-- 7,i7 assi/s *ildr51 pregnant wom51 victims ( crime or abuse1 or individuals ) significant m5tal or physical disabilities2 or 7,,ii7 provides social s]vices & assi/ance1 includ+ em]g5cy & disa/] s]vices or assi/ance ) food & nutrition1 h\s+ af=dability & income or o!r s]vices fund$ by ,/ate or local gov]nm5t1 *>itable giv+1 ! ,special ,supplem5tal ,nutrition ,program = ,wom51 ,infants1 & ,*ildr5 7,,wic71 ,supplem5tal ,nutrition ,assi/ance ,program 7,,snap71 ,tempor>y ,assi/ance = ,ne$y ,families 7,,tanf71 or ! ,unit$ ,/ates ,h\s+ ,act2 7vi7 any *ur*1 synagogue1 mosque1 or o!r place ( wor%ip1 includ+ build+s r5t$ = ! purpose ( religi\s s]vices1 retreats1 c\nsel+1 work%ops1 in/ruction1 & education2 7vii7 any ,f$]al1 ,/ate1 or local c\r?\se1 includ+ ! (fice ( an individual's legal c\nsel or repres5tative1 & a probation1 p>ole1 or sup]vis$ release (fice2 7viii7 ! site ( a fun]al1 w$d+1 or o!r religi\s c]emony or obs]vance2 7ix7 any public demon/ration1 su* z a m>*1 rally1 or p>ade2 7x7 any dome/ic viol5ce %elt]1 rape crisis c5t]1 sup]vis$ visitation c5t]1 family ju/ice c5t]1 or victim s]vices provid]2 or 7xi7 any o!r location specifi$ by ! ,secret>y ( ,homel& ,security = purposes ( ?is subsection4 7#b7 7,a7 ,an en=cem5t action may n take place at1 or be focus$ on1 a s5sitive location unless-- 7i7 ! action involves exig5t circum/ances2 & 7ii7 prior approval = ! en=cem5t action 0 obta9$ f ! appropriate (ficial4 7,b7 ,if an en=cem5t action is initiat$ pursuant to subp>agraph 7,a7 & ! exig5t circum/ances p]mitt+ ! en=cem5t action cease1 ! en=cem5t action %all be discont9u$ until su* exig5t circum/ances reem]ge4 7,c7 ,if an en=cem5t action is c>ri$ out 9 violation ( ?is subsection-- 7i7 no in=mation result+ f ! en=cem5t action may be ent]$ into ! record or receiv$ into evid5ce 9 a removal proce$+ result+ f ! en=cem5t action2 & 7ii7 ! ali5 :o is ! subject ( su* removal proce$+ may file a motion = ! imm$iate t]m9ation ( ! removal proce$+4 7#c7 7,a7 ,?is subsection %all apply to any en=cem5t action by (fic]s or ag5ts ( ! ,dep>tm5t ( ,homel& ,security1 includ+-- 7i7 (fic]s or ag5ts ( ,u4,s4 ,immigration & ,cu/oms ,en=cem5t2 7ii7 (fic]s or ag5ts ( ,u4,s4 ,cu/oms & ,bord] ,protection2 & 7iii7 any individual designat$ to p]=m immigration en=cem5t functions pursuant to subsection 7g74 7,b7 ,:ile c>ry+ out an en=cem5t action at a s5sitive location1 (fic]s & ag5ts ref]r$ to 9 subp>agraph 7,a7 %all make e ef=t-- 7i7 to limit ! "t sp5t at ! s5sitive location2 7ii7 to limit ! en=cem5t action at ! s5sitive location to ! p]son or p]sons = :om prior approval 0 obta9$2 & 7iii7 to conduct !mselves discreetly4 7,c7 ,if1 :ile c>ry+ out an en=cem5t action t is n initiat$ at or focus$ on a s5sitive location1 (fic]s or ag5ts are l$ to a s5sitive location1 & no exig5t circum/ance & prior approval ) respect to ! s5sitive location exi/s1 su* (fic]s or ag5ts %all-- 7i7 cease be=e tak+ any fur!r en=cem5t action2 7ii7 conduct !mselves 9 a discreet mann]2 7iii7 ma9ta9 surveillance2 & 7iv7 imm$iately consult _! sup]visor 9 ord] to det]m9e :e!r su* en=cem5t action %\ld be discont9u$4 7,d7 ,! limitations "u ?is p>agraph %all n apply to ! transportation ( an individual appreh5d$ at or ne> a l& or sea bord] to a hospital or heal? c>e provid] = ! purpose ( provid+ m$ical c>e to su* individual4 7#d7 7,a7 ,ea* (ficial specifi$ 9 subp>agraph 7,b7 %all ensure t ! employees "u 8 or h] sup]vision receive annual tra9+ on compliance )-- 7i7 ! requirem5ts "u ?is subsection 9 en=cem5t actions at or focus$ on s5sitive locations & en=cem5t actions t lead (fic]s or ag5ts to a s5sitive location2 & 7ii7 ! requirem5ts "u section #bci ( ?is ,act & section #chd ( ! ,illegal ,immigration ,re=m & ,immigrant ,responsibility ,act ( #aiif 7#h ,u4,s4,c4 #acfg74 7,b7 ,! (ficials specifi$ 9 ?is subp>agraph are-- 7i7 ! ,*ief ,c\nsel ( ,u4,s4 ,immigration & ,cu/oms ,en=cem5t2 7ii7 ! ,field ,(fice ,directors ( ,u4,s4 ,immigration & ,cu/oms ,en=cem5t2 7iii7 ea* ,special ,ag5t 9 ,*>ge ( ,u4,s4 ,immigration & ,cu/oms ,en=cem5t2 7iv7 ea* ,*ief ,patrol ,ag5t ( ,u4,s4 ,cu/oms & ,bord] ,protection2 7v7 ! ,director ( ,field ,op]ations ( ,u4,s4 ,cu/oms & ,bord] ,protection2 7vi7 ! ,director ( ,air & ,m>9e ,op]ations ( ,u4,s4 ,cu/oms & ,bord] ,protection2 7vii7 ! ,int]nal ,affairs ,special ,ag5t 9 ,*>ge ( ,u4,s4 ,cu/oms & ,bord] ,protection2 & 7viii7 ! *ief law en=cem5t (fic] ( ea* ,/ate or local law en=cem5t ag5cy t ent]s into a writt5 agreem5t ) ! ,dep>tm5t ( ,homel& ,security pursuant to subsection 7g74 7#e7 ,! ,secret>y ( ,homel& ,security %all modify ! ,notice to ,appe> =m 7,i-#hfb7-- 7,a7 to provide ! subjects ( an en=cem5t action ) in=mation1 writt5 9 pla9 language1 summ>iz+ ! re/rictions aga9/ en=cem5t actions at s5sitive locations set =? 9 ?is subsection & ! rem$ies available to ! ali5 if su* action violates su* re/rictions2 7,b7 to ensure t ! in=mation describ$ 9 subp>agraph 7,a7 is accessible to individuals ) limit$ ,engli% pr(ici5cy2 & 7,c7 to ensure t subjects ( an en=cem5t action are n p]mitt$ to v]ify t ! (fic]s or ag5ts t c>ri$ out su* action compli$ ) ! re/rictions set =? 9 ?is subsection4 7#f7 7,a7 ,! ,director ( ,u4,s4 ,immigration & ,cu/oms ,en=cem5t & ! ,commission] ( ,u4,s4 ,cu/oms & ,bord] ,protection %all ea* submit an annual report to ! appropriate congressional committees t includes ! in=mation set =? 9 subp>agraph 7,b7 ) respect to ! respective ag5cy4 7,b7 ,ea* report submitt$ "u subp>agraph 7,a7 %all include1 ) respect to ! submitt+ ag5cy dur+ ! report+ p]iod-- 7i7 ! numb] ( en=cem5t actions t 7 c>ri$ out at1 or focus$ on1 a s5sitive location2 7ii7 ! numb] ( en=cem5t actions 9 :i* (fic]s or ag5ts 7 subsequ5tly l$ to a s5sitive location2 & 7iii7 = ea* en=cem5t action describ$ 9 clause 7i7 or 7ii7-- 7,i7 ! date on :i* x occurr$2 7,,ii7 ! specific site1 city1 c\nty1 & ,/ate 9 :i* x occurr$2 7,,iii7 ! compon5ts ( ! ag5cy involv$ 9 ! en=cem5t action2 7,,iv7 a description ( ! en=cem5t action1 includ+ ! nature ( ! crim9al activity ( its int5d$ t>get2 7,v7 ! numb] ( individuals1 if any1 arre/$ or tak5 into cu/ody2 7,,vi7 ! numb] ( collat]al arre/s1 if any1 & ! reasons = ea* su* arre/2 7,,vii7 a c]tification :e!r ! location adm9i/rator 0 contact$ be=e1 dur+1 or aft] ! en=cem5t action2 & 7,,viii7 ! p]c5tage ( all ( ! /aff memb]s & sup]visors report+ to ! (ficials li/$ 9 p>agraph 7#d77;,b7 :o complet$ ! tra9+ requir$ "u p>agraph 7#d77;,a74 7#g7 ,no?+ 9 ! subsection may be con/ru$-- 7,a7 to affect ! au?ority ( ,f$]al1 ,/ate1 or local law en=cem5t ag5cies-- 7i7 to en=ce g5]ally applicable ,f$]al or ,/ate crim9al laws unrelat$ to immigration2 or 7ii7 to protect resid5ts f imm95t ?reats to public safety2 or 7,b7 to limit or ov]ride ! protections provid$ 9-- 7i7 section #bci2 or 7ii7 section #chd ( ! ,illegal ,immigration ,re=m & ,immigrant ,responsibility ,act ( #aiif 7#h ,u4,s4,c4 #acfg74 4 #dad4 ,grants = racial & e?nic approa*es to community heal? 7a7 ,purpose ,x is ! purpose ( ?is section to aw>d grants to assi/ communities 9 mobiliz+ & organiz+ res\rces 9 support ( effective & su/a9able programs t w r$uce or elim9ate disp>ities 9 heal? & heal? c>e exp]i5c$ by racial & e?nic m9ority individuals4 7b7 ,au?ority ,to ,aw>d ,grants ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration 7ref]r$ to 9 ?is section z ! ,secret>y71 %all aw>d grants to eligible entities to assi/ 9 design+1 implem5t+1 & evaluat+ culturally & l+ui/ically appropriate1 sci5ce-bas$1 & community-driv5 su/a9able /rategies to elim9ate racial & e?nic heal? & heal? c>e disp>ities4 7c7 ,eligible ,entities ,to be eligible to receive a grant "u ?is section1 an entity %all-- 7#a7 repres5t a coalition-- 7,a7 ^: pr9cipal purpose is to develop & implem5t int]v5tions to r$uce or elim9ate a heal? or heal? c>e disp>ity 9 a t>get$ racial or e?nic m9ority gr\p 9 ! community s]v$ by ! coalition2 & 7,b7 t includes-- 7i7 memb]s select$ f among-- 7,i7 public heal? dep>tm5ts2 7,,ii7 community-bas$ organizations2 7,,iii7 univ]sity & rese>* organizations2 7,,iv7 ,indian tribes or tribal organizations 7z su* t]ms are def9$ 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #ecjd771 ! ,indian ,heal? ,s]vice1 or any o!r organization t s]ves ,alaska ,natives2 & 7,v7 int]e/$ public or private heal? c>e provid]s or organizations z det]m9$ appropriate by ! ,secret>y2 & 7ii7 at lea/ #a memb] f a community-bas$ organization t repres5ts ! t>get$ racial or e?nic m9ority gr\p2 & 7#b7 submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require1 :i* %all include-- 7,a7 a description ( ! t>get$ racial or e?nic populations 9 ! community to be s]v$ "u ! grant2 7,b7 a description ( at lea/ #a heal? disp>ity t exi/s 9 ! racial or e?nic t>get$ populations1 includ+ heal? issues su* z infant mortality1 brea/ & c]vical canc] scre5+ & managem5t1 musculoskeletal diseases & obesity1 pro/ate canc] scre5+ & managem5t1 c>diovascul> disease1 diabetes1 *ild & adult immunization levels1 oral disease1 or o!r heal? priority areas z designat$ by ! ,secret>y2 & 7,c7 a demon/ration ( a prov5 record ( accompli%m5t ( ! coalition memb]s 9 s]v+ & work+ ) ! t>get$ community4 7d7 ,su/a9ability ,! ,secret>y %all give priority to an eligible entity "u ?is section if ! entity agrees t1 ) respect to ! co/s to be incurr$ by ! entity 9 c>ry+ out ! activities = :i* ! grant 0 aw>d$1 ! entity 7& ea* ( ! p>ticipat+ p>tn]s 9 ! coalition repres5t$ by ! entity7 w ma9ta9 its exp5ditures ( non-,f$]al funds = su* activities at a level t is n less ?an ! level ( su* exp5ditures dur+ ! fiscal ye> imm$iately prec$+ ! fir/ fiscal ye> = :i* ! grant is aw>d$4 7e7 ,nonduplication ,any funds provid$ to an eligible entity ?r\gh a grant "u ?is section %all-- 7#a7 supplem5t1 n supplant1 any o!r ,f$]al funds made available to ! entity = ! purposes ( ?is section2 & 7#b7 n be us$ to duplicate ! activities ( any o!r heal? disp>ity grant program "u ?is ,act1 includ+ an am5dm5t made by ?is ,act4 7f7 ,te*nical ,assi/ance ,! ,secret>y may1 ei!r directly or by grant or contract1 provide any entity t receives a grant "u ?is section ) te*nical & o!r nonf9ancial assi/ance necess>y to meet ! requirem5ts ( ?is section4 7g7 ,dissem9ation ,! ,secret>y %all enc\rage & enable eligible entities receiv+ grants "u ?is section to %>e be/ practices1 evaluation results1 & reports ) communities n affiliat$ ) su* entities1 by us+ ! int]net1 conf]5ces1 & o!r p]t95t in=mation reg>d+ ! projects fund$ by ?is section1 includ+ ?r\gh us+ outrea* ef=ts ( ! ,(fice ( ,m9ority ,heal? & ! ,c5t]s = ,disease ,control & ,prev5tion4 7h7 ,adm9i/rative ,burd5s ,! ,secret>y %all make e ef=t to m9imize duplicative or unnecess>y adm9i/rative burd5s on eligible entities receiv+ grants "u ?is section4 7i7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ su* sums z may be necess>y to c>ry out ?is section4 #dae4 ,bord] heal? grants 7a7 ,def9itions ,9 ?is section3 7#a7 ,bord] area ,! t]m bord] area means ! ,unit$ ,/ates-,mexico ,bord] ,area1 z def9$ 9 section #h ( ! ,unit$ ,/ates-,mexico ,bord] ,heal? ,commission ,act 7#bb ,u4,s4,c4 #bijn-#f74 7#b7 ,eligible entity ,! t]m eligible entity means an entity t is locat$ 9 ! bord] area & is any ( ! foll[+3 7,a7 ,a ,/ate1 local gov]nm5t1 or ,tribal gov]nm5t4 7,b7 ,a public in/itution ( high] education4 7,c7 ,a nonpr(it heal? organization4 7,d7 ,a community heal? c5t]4 7,e7 ,a community cl9ic t is a heal? c5t] receiv+ assi/ance "u section #ccj ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;b74 7b7 ,au?orization ,f funds appropriat$ "u subsection 7f71 ! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y71 act+ ?r\gh ! ,unit$ ,/ates memb]s ( ! ,unit$ ,/ates-,mexico ,bord] ,heal? ,commission1 %all aw>d grants to eligible entities to address priorities & recomm5dations to improve ! heal? ( bord] area resid5ts t are e/abli%$ by-- 7#a7 ! ,unit$ ,/ates memb]s ( ! ,unit$ ,/ates-,mexico ,bord] ,heal? ,commission2 7#b7 ! ,/ate bord] heal? (fices2 & 7#c7 ! ,secret>y4 7c7 ,application ,an eligible entity t desires a grant "u subsection 7b7 %all submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7d7 ,use ( funds ,an eligible entity t receives a grant "u subsection 7b7 %all use ! grant funds =-- 7#a7 programs relat+ to-- 7,a7 mat]nal & *ild heal?2 7,b7 prim>y c>e & prev5tative heal?2 7,c7 public heal? & public heal? infra/ructure2 7,d7 musculoskeletal heal? & obesity2 7,e7 heal? education & promotion2 7,f7 oral heal?2 7,g7 m5tal & behavioral heal?2 7,h7 sub/ance use disord]s2 7,i7 heal? conditions t h a high preval5ce 9 ! bord] area2 7,j7 m$ical & heal? s]vices rese>*2 7,k7 work=ce tra9+ & developm5t2 7,l7 community heal? work]s1 pati5t navigators1 & promotores2 7,m7 heal? c>e infra/ructure problems 9 ! bord] area 7includ+ plann+ & con/ruction grants72 7,n7 heal? disp>ities 9 ! bord] area2 7,o7 environm5tal heal?2 & 7,p7 outrea* & enrollm5t s]vices ) respect to ,f$]al programs 7includ+ programs au?oriz$ "u titles ,,xix & ,,xxi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq42 #db ,u4,s4,c4 #acig;aa et seq4772 & 7#b7 o!r programs det]m9$ appropriate by ! ,secret>y4 7e7 ,supplem5t1 n supplant ,am\nts provid$ to an eligible entity aw>d$ a grant "u subsection 7b7 %all be us$ to supplem5t & n supplant o!r funds available to ! eligible entity to c>ry out ! activities describ$ 9 subsection 7d74 7f7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section1 #bjj1jjj1jjj = fiscal ye> #bjba1 & su* sums z may be necess>y = ea* succe$+ fiscal ye>4 #daf4 ,critical access hospital improvem5ts 7a7 ,elim9ation ( isolation te/ = co/-,bas$ ambulance reimbursem5t 7#a7 ,9 g5]al ,section #ahcd7l77#h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77#h77 is am5d$-- 7,a7 9 subp>agraph 7,b7-- 7i7 by /rik+ own$ &2 & 7ii7 by ins]t+ 7includ+ :5 su* s]vices are provid$ by ! entity "u an arrangem5t ) ! hospital7 aft] hospital2 & 7,b7 by /rik+ ! comma at ! end ( subp>agraph 7,b7 & all t foll[s & ins]t+ a p]iod4 7#b7 ,effective date ,! am5dm5ts made by ?is subsection %all apply to s]vices furni%$ on or aft] ,janu>y #a1 #bjba4 7b7 ,provision ( a m flexible alt]native to ! ,,cah designation #be inpati5t b$ limit requirem5t 7#a7 ,9 g5]al ,section #ahbj7;c77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#d7;c77#b77 is am5d$-- 7,a7 9 subp>agraph 7,b77iii71 by /rik+ provides n m ?an & ins]t+ subject to subp>agraph 7,f71 provides n m ?an2 & 7,b7 by add+ at ! end ! foll[+ new subp>agraph3 7,f7 ,alt]native to #be inpati5t b$ limit requirem5t 7i7 ,9 g5]al ,a ,/ate may elect to treat a facility1 ) respect to ! designation ( ! facility = a co/-report+ p]iod1 z satisfy+ ! requirem5t ( subp>agraph 7,b77iii7 relat+ to a maximum numb] ( acute c>e inpati5t b$s if ! facility elects1 9 accordance ) a me?od specifi$ by ! ,secret>y & be=e ! beg9n+ ( ! co/ report+ p]iod1 to meet ! requirem5t "u clause 7ii74 7ii7 ,alt]nate requirem5t ,! requirem5t "u ?is clause1 ) respect to a facility & a co/-report+ p]iod1 is t ! total numb] ( inpati5t b$ days describ$ 9 subp>agraph 7,b77iii7 dur+ su* p]iod w n exce$ #g1cjj4 ,= purposes ( ?is subp>agraph1 an individual :o is an inpati5t 9 a b$ 9 ! facility = a s+le day %all be c\nt$ z "o inpati5t b$ day4 7iii7 ,)drawal ( election ,! option describ$ 9 clause 7i7 %all n apply to a facility = a co/-report+ p]iod if ! facility 7= any two consecutive co/-report+ p]iods dur+ ! previ\s #e co/-report+ p]iods7 0 treat$ "u su* option & _h a total numb] ( inpati5t b$ days = ea* ( su* two co/-report+ p]iods t exce$$ ! numb] specifi$ 9 su* clause4 4 7#b7 ,effective date ,! am5dm5ts made by p>agraph 7#a7 %all apply to co/-report+ p]iods beg9n+ on or aft] ! date ( ! enactm5t ( ?is ,act4 #dag4 ,e/abli%m5t ( ,rural ,community ,hospital 7,,r*7 ,program 7a7 ,9 g5]al ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 z am5d$ by section #bjg7;b77#a71 is am5d$ by add+ at ! end ( ! foll[+ new subsection3 7lll7 ,rural ,community ,hospital2 ,rural ,community ,hospital ,s]vices 7#a7 ,! t]m rural community hospital means a hospital 7z def9$ 9 subsection 7e77 t-- 7,a7 is locat$ 9 a rural area 7z def9$ 9 section #ahhf7;d77#b77;,d77 or treat$ z be+ s locat$ pursuant to section #ahhf7;d77#h77;,e72 7,b7 subject to p>agraph 7#b71 has less ?an #ea acute c>e inpati5t b$s1 z report$ 9 its mo/ rec5t co/ report2 7,c7 makes available #bd-;h\r em]g5cy c>e s]vices2 7,d7 subject to p>agraph 7#c71 has a provid] agreem5t 9 effect ) ! ,secret>y & is op5 to ! public z ( ,janu>y #a1 #bjaj2 & 7,e7 applies to ! ,secret>y = su* designation4 7#b7 ,= purposes ( p>agraph 7#a77;,b71 b$s 9 a psy*iatric or rehabilitation unit ( ! hospital :i* is a di/9ct "p ( ! hospital %all n be c\nt$4 7#c7 ,p>agraph 7#a77;,d7 %all n be con/ru$ to prohibit any ( ! foll[+ f qualify+ z a rural community hospital3 7,a7 ,a replacem5t facility 7z def9$ by ! ,secret>y 9 regulations 9 effect on ,janu>y #a1 #bjab7 ) ! same s]vice area 7z def9$ by ! ,secret>y 9 regulations 9 effect on su* date74 7,b7 ,a facility obta9+ a new provid] numb] pursuant to a *ange ( own]%ip4 7,c7 ,a facility :i* has a b9d+ writt5 agreem5t ) an outside1 unrelat$ p>ty = ! con/ruction1 recon/ruction1 lease1 r5tal1 or f9anc+ ( a build+ z ( ,janu>y #a1 #bjab4 7#d7 ,no?+ 9 ?is subsection %all be con/ru$ z prohibit+ a critical access hospital f qualify+ z a rural community hospital if ! critical access hospital meets ! conditions o!rwise applicable to hospitals "u subsection 7e7 & section #ahff4 7#e7 ,no?+ 9 ?is subsection %all be con/ru$ z prohibit+ a rural community hospital p>ticipat+ 9 ! demon/ration program "u section #daj;,a ( ! ,m$ic>e ,prescription ,drug1 ,improvem5t1 & ,mod]nization ,act ( #bjjc 7,public ,law #ajh-agc2 #aag ,/at4 #bcac7 f qualify+ z a rural community hospital if ! rural community hospital meets ! conditions o!rwise applicable to hospitals "u subsection 7e7 & section #ahff4 4 7b7 ,paym5t 7#a7 ,inpati5t hospital s]vices ,section #ahad ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7m7 ,paym5t = ,inpati5t ,s]vices ,furni%$ 9 ,rural ,community ,hospitals ,! am\nt ( paym5t "u ?is "p = inpati5t hospital s]vices furni%$ 9 a rural community hospital1 o!r ?an su* s]vices furni%$ 9 a psy*iatric or rehabilitation unit ( ! hospital :i* is a di/9ct "p1 is1 at ! election ( ! hospital 9 ! application ref]r$ to 9 section #ahfa7lll77#a77;,e7-- 7#a7 #aja p]c5t ( ! reasonable co/s ( provid+ su* s]vices1 )\t reg>d to ! am\nt ( ! cu/om>y or o!r *>ge1 or 7#b7 ! am\nt ( paym5t provid$ = "u ! prospective paym5t sy/em = inpati5t hospital s]vices "u section #ahhf7;d74 4 7#b7 ,outpati5t s]vices ,section #ahcd ( su* ,act 7#db ,u4,s4,c4 #aciem7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7x7 ,paym5t = outpati5t s]vices furni%$ 9 rural community hospitals ,! am\nt ( paym5t "u ?is "p = outpati5t s]vices furni%$ 9 a rural community hospital is1 at ! election ( ! hospital 9 ! application ref]r$ to 9 section #ahfa7lll77#a77;,e7-- 7#a7 #aja p]c5t ( ! reasonable co/s ( provid+ su* s]vices1 )\t reg>d to ! am\nt ( ! cu/om>y or o!r *>ge & any limitation "u section #ahfa7v77#a77,u71 or 7#b7 ! am\nt ( paym5t provid$ = "u ! prospective paym5t sy/em = cov]$ ,,opd s]vices "u section #ahcc7t74 4 7#c7 ,exemption f #cj-p]c5t r$uction 9 reimbursem5t = bad debt ,section #ahfa7v77#a77,t7 ( su* ,act 7#db ,u4,s4,c4 #aciex7v77#a77,t77 is am5d$ by ins]t+ 7o!r ?an = a rural community hospital7 aft] ,9 det]m9+ su* reasonable co/s = hospitals4 7c7 ,b5efici>y co/-,%>+ = outpati5t s]vices ,section #ahcd7x7 ( su* ,act 7z add$ by subsection 7b77#b77 is am5d$-- 7#a7 by r$esignat+ p>agraphs 7#a7 & 7#b7 z subp>agraphs 7,a7 & 7,b71 respectively2 7#b7 by ins]t+ 7#a7 aft] 7x72 & 7#c7 by add+ at ! end ! foll[+3 7#b7 ,! am\nts ( b5efici>y co/-%>+ = outpati5t s]vices furni%$ 9 a rural community hospital "u ?is "p %all be z foll[s3 7,a7 ,= items & s]vices t w\ld h be5 paid "u section #ahcc7t7 if furni%$ by a hospital1 ! am\nt ( co/-%>+ det]m9$ "u p>agraph 7#h7 ( su* section4 7,b7 ,= items & s]vices t w\ld h be5 paid "u section #ahcc7;h7 if furni%$ by a provid] ( s]vices or suppli]1 no co/-%>+ %all apply4 7,c7 ,= all o!r items & s]vices1 ! am\nt ( co/-%>+ t w\ld apply to ! item or s]vice "u ! me?odology t w\ld be us$ to det]m9e paym5t = su* item or s]vice if provid$ by a physician1 provid] ( s]vices1 or suppli]1 z ! case may be4 4 7d7 ,con=m+ am5dm5ts 7#a7 ,"p ,a paym5t ,section #ahad7;b7 ( su* ,act 7#db ,u4,s4,c4 #acie;f7b77 is am5d$ 9 ! matt] prec$+ p>agraph 7#a7 by ins]t+ o!r ?an inpati5t hospital s]vices furni%$ by a rural community hospital1 aft] critical access hospital s]vices14 7#b7 ,"p ,b paym5t ,section #ahcc7;a7 ( su* ,act 7#db ,u4,s4,c4 #aciel7a771 z am5d$ by section #bjg7;b77#c71 is am5d$-- 7,a7 by /rik+ & at ! end ( p>agraph 7#i72 7,b7 by /rik+ ! p]iod at ! end ( p>agraph 7#aj7 & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+3 7#aa7 9 ! case ( outpati5t s]vices furni%$ by a rural community hospital1 ! am\nts describ$ 9 section #ahcd7x74 4 7#c7 ,te*nical am5dm5ts 7,a7 ,consultation ) ,/ate ag5cies ,section #ahfc ( su* ,act 7#db ,u4,s4,c4 #aciez7 is am5d$ by /rik+ & 7dd77#b7 & ins]t+ 7dd77#b71 & 7lll77#a74 7,b7 ,provid] agreem5ts ,section #ahff7;a77#b77;,a7 ( su* ,act 7#db ,u4,s4,c4 #acie;cc7a77#b77;,a77 is am5d$ by ins]t+ section #ahcd7x77#b71 aft] section #ahcc7;b714 7e7 ,effective date ,! am5dm5ts made by ?is section %all apply to items & s]vices furni%$ on or aft] ,octob] #a1 #bjba4 #dah4 ,m$ic>e remote monitor+ pilot projects 7a7 ,pilot projects 7#a7 ,9 g5]al ,n lat] ?an #i mon?s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y7 %all conduct pilot projects "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 = ! purpose ( provid+ inc5tives to home heal? ag5cies to utilize home monitor+ & communications te*nologies t-- 7,a7 enhance heal? outcomes = ,m$ic>e b5efici>ies2 & 7,b7 r$uce exp5ditures "u su* title4 7#b7 ,site requirem5ts 7,a7 ,urban & ,rural ,! ,secret>y %all conduct ! pilot projects "u ?is section 9 bo? urban & rural areas4 7,b7 ,site 9 a small ,/ate ,! ,secret>y %all conduct at lea/ #c ( ! pilot projects 9 a ,/ate ) a population ( less ?an #a1jjj1jjj4 7#c7 ,def9ition ( home heal? ag5cy ,9 ?is section1 ! t]m home heal? ag5cy has ! mean+ giv5 t t]m 9 section #ahfa7o7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7o774 7b7 ,m$ic>e b5efici>ies )9 ! scope ( projects ,! ,secret>y %all specify ! crit]ia = id5tify+ ^? ,m$ic>e b5efici>ies :o %all be consid]$ )9 ! scope ( ! pilot projects "u ?is section = purposes ( ! application ( subsection 7c7 & = ! assessm5t ( ! effectiv5ess ( ! home heal? ag5cy 9 a*iev+ ! objectives ( ?is section4 ,su* crit]ia may provide = ! inclusion 9 ! projects ( ,m$ic>e b5efici>ies :o beg9 receiv+ home heal? s]vices "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 aft] ! date ( ! implem5tation ( ! projects4 7c7 ,inc5tives 7#a7 ,p]=mance t>gets ,! ,secret>y %all e/abli% = ea* home heal? ag5cy p>ticipat+ 9 a pilot project "u ?is section a p]=mance t>get us+ "o ( ! foll[+ me?odologies1 z det]m9$ appropriate by ! ,secret>y3 7,a7 ,adju/$ hi/orical p]=mance t>get ,! ,secret>y %all e/abli% = ! ag5cy-- 7i7 a base exp5diture am\nt equal to ! av]age total paym5ts made to ! ag5cy "u p>ts ,a & ,b ( title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 = ,m$ic>e b5efici>ies det]m9$ to be )9 ! scope ( ! pilot project 9 a base p]iod det]m9$ by ! ,secret>y2 & 7ii7 an annual p] capita exp5diture t>get = su* b5efici>ies1 reflect+ ! base exp5diture am\nt adju/$ = risk & adju/$ gr[? rates4 7,b7 ,comp>ative p]=mance t>get ,! ,secret>y %all e/abli% = ! ag5cy a comp>ative p]=mance t>get equal to ! av]age total paym5ts "u su* p>ts ,a & ,b dur+ ! pilot project = comp>able individuals 9 ! same geographic area t are n det]m9$ to be )9 ! scope ( ! pilot project4 7#b7 ,inc5tive ,subject to p>agraph 7#c71 ! ,secret>y %all pay to ea* p>ticipat+ home c>e ag5cy an inc5tive paym5t = ea* ye> "u ! pilot project equal to a portion ( ! ,m$ic>e sav+s realiz$ = su* ye> relative to ! p]=mance t>get "u p>agraph 7#a74 7#c7 ,limitation on exp5ditures ,! ,secret>y %all limit inc5tive paym5ts "u ?is section 9 ord] to ensure t ! aggregate exp5ditures "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 7includ+ inc5tive paym5ts "u ?is subsection7 d n exce$ ! am\nt t ! ,secret>y e/imates w\ld h be5 exp5d$ if ! pilot projects "u ?is section _h n be5 implem5t$4 7d7 ,waiv] au?ority ,! ,secret>y may waive su* provisions ( titles ,,xi & ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq42 #db ,u4,s4,c4 #acie et seq47 z ! ,secret>y det]m9es to be appropriate = ! conduct ( ! pilot projects "u ?is section4 7e7 ,report to ,congress ,n lat] ?an #e ye>s aft] ! date t ! fir/ pilot project "u ?is section is implem5t$1 ! ,secret>y %all submit to ,congress a report on ! pilot projects4 ,su* report %all conta9 a detail$ description ( issues relat$ to ! expansion ( ! projects "u subsection 7f7 & recomm5dations = su* legislation & adm9i/rative actions z ! ,secret>y consid]s appropriate4 7f7 ,expansion ,if ! ,secret>y det]m9es t any ( ! pilot projects "u ?is section enhance heal? outcomes = ,m$ic>e b5efici>ies & r$uce exp5ditures "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 ! ,secret>y may initiate comp>able projects 9 additional areas4 7g7 ,inc5tive paym5ts h no effect on o!r ,m$ic>e paym5ts to ag5cies ,an inc5tive paym5t "u ?is section-- 7#a7 %all be 9 addition to ! paym5ts t a home heal? ag5cy w\ld o!rwise receive "u title ,,xviii ( ! ,social ,security ,act = ! provision ( home heal? s]vices2 & 7#b7 %all h no effect on ! am\nt ( su* paym5ts4 #dai4 ,rural ,heal? ,quality ,advisory ,commission & demon/ration projects 7a7 ,rural ,heal? ,quality ,advisory ,commission 7#a7 ,e/abli%m5t ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is section1 ! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y7 %all e/abli% a commission to be kn[n z ! ,rural ,heal? ,quality ,advisory ,commission 79 ?is section ref]r$ to z ! ,commission74 7#b7 ,duties ( commission 7,a7 ,national plan ,! ,commission %all develop1 coord9ate1 & facilitate implem5tation ( a national plan = rural heal? quality improvem5t4 ,! national plan %all-- 7i7 id5tify objectives = rural heal? quality improvem5t2 7ii7 id5tify /rategies to elim9ate kn[n gaps 9 rural heal? sy/em capacity & improve rural heal? quality2 & 7iii7 provide recomm5dations = ,f$]al programs to id5tify opportunities = /r5g!n+ & align+ policies & programs to improve rural heal? quality4 7,b7 ,demon/ration projects ,! ,commission %all design demon/ration projects to recomm5d to ! ,secret>y to te/ alt]native models = rural heal? quality improvem5t1 includ+ ) respect to bo? p]sonal & population heal?4 7,c7 ,monitor+ ,! ,commission %all monitor progress t[>d ! objectives id5tifi$ pursuant to subp>agraph 7,a77i74 7#c7 ,memb]%ip 7,a7 ,numb] ,! ,commission %all be compos$ ( #aa memb]s appo9t$ by ! ,secret>y4 7,b7 ,selection ,! ,secret>y %all select ! memb]s ( ! ,commission f among individuals ) significant rural heal? c>e & heal? c>e quality exp]tise1 includ+ exp]tise 9 cl9ical heal? c>e1 heal? c>e quality rese>*1 population or public heal?1 or pur*as] organizations4 7#d7 ,contract+ au?ority ,subject to ! availability ( funds1 ! ,commission may ent] into contracts & make o!r arrangem5ts1 z may be necess>y to c>ry out ! duties describ$ 9 p>agraph 7#b74 7#e7 ,/aff ,^u ! reque/ ( ! ,commission1 ! ,secret>y may detail1 on a reimbursable basis1 any ( ! p]sonnel ( ! ,(fice ( ,rural ,heal? ,policy ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 or ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices to ! ,commission to assi/ 9 c>ry+ out ?is subsection4 7#f7 ,reports to congress ,n lat] ?an #a ye> aft] ! e/abli%m5t ( ! ,commission1 & annually !reaft]1 ! ,commission %all submit a report to ! ,congress on rural heal? quality4 ,ea* su* report %all include ! foll[+3 7,a7 ,an inv5tory ( relevant programs & recomm5dations = improv$ coord9ation & integration ( policy & programs4 7,b7 ,an assessm5t ( a*ievem5t ( ! objectives id5tifi$ 9 ! national plan develop$ "u p>agraph 7#b7 & recomm5dations = realiz+ su* objectives4 7,c7 ,recomm5dations on ,f$]al legislation1 regulations1 or adm9i/rative policies to enhance rural heal? quality & outcomes4 7b7 ,rural ,heal? ,quality ,demon/ration ,projects 7#a7 ,9 g5]al ,n lat] ?an #bgj days aft] ! date ( ! enactm5t ( ?is section1 ! ,secret>y1 9 consultation ) ! ,rural ,heal? ,quality ,advisory ,commission1 ! ,(fice ( ,rural ,heal? ,policy ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 & ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 %all make grants to eligible entities = a total ( #e demon/ration projects to implem5t & evaluate me?ods = improv+ ! quality ( heal? c>e 9 rural communities4 ,ea* su* demon/ration project %all include-- 7,a7 alt]native community models t-- 7i7 w a*ieve great] integration ( p]sonal & population heal? s]vices2 & 7ii7 address safety1 effectiv5ess1 pati5t- or community-c5t]$ness1 timel9ess1 effici5cy1 & equity 7! #f aims id5tifi$ by ! ,national ,academy ( ,m$ic9e 7=m]ly kn[n z ! ,in/itute ( ,m$ic9e7 9 its report entitl$ ,cross+ ! ,quality ,*asm3 ,a ,new ,heal? ,sy/em = ! #ba/ ,c5tury releas$ on ,m>* #a1 #bjja72 7,b7 innovative approa*es to ! f9anc+ & deliv]y ( heal? s]vices to a*ieve rural heal? quality goals2 & 7,c7 developm5t ( quality improvem5t support /ructures to assi/ rural heal? sy/ems & pr(essionals 7su* z work=ce support /ructures1 quality monitor+ & report+1 cl9ical c>e protocols1 & in=mation te*nology applications74 7#b7 ,eligible entities ,9 ?is subsection1 ! t]m eligible entity means a consortium t-- 7,a7 %all include-- 7i7 at lea/ "o heal? c>e provid] or heal? c>e deliv]y sy/em locat$ 9 a rural area2 & 7ii7 at lea/ "o organization repres5t+ multiple community /akehold]s2 & 7,b7 may include o!r p>tn]s su* z rural rese>* c5t]s4 7#c7 ,consultation ,9 develop+ ! program = aw>d+ grants "u ?is subsection1 ! ,secret>y %all consult ) ! ,adm9i/rator ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 rural heal? c>e provid]s1 rural heal? c>e rese>*]s1 & private & nonpr(it gr\ps 7includ+ national associations7 :i* are und]tak+ simil> ef=ts4 7#d7 ,exp$it$ waiv]s ,! ,secret>y %all exp$ite ! process+ ( any waiv] t-- 7,a7 is au?oriz$ "u title ,,xviii or ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq42 #db ,u4,s4,c4 #acif et seq472 & 7,b7 is necess>y to c>ry out a demon/ration project "u ?is subsection4 7#e7 ,demon/ration project sites ,! ,secret>y %all ensure t ! #e demon/ration projects fund$ "u ?is subsection are conduct$ at a v>iety ( sites repres5t+ ! div]sity ( rural communities 9 ! ,unit$ ,/ates4 7#f7 ,duration ,ea* demon/ration project "u ?is subsection %all be = a p]iod ( #d ye>s4 7#g7 ,indep5d5t evaluation ,! ,secret>y %all ent] into an arrangem5t ) an entity t has exp]i5ce work+ directly ) rural heal? sy/ems = ! conduct ( an indep5d5t evaluation ( ! program c>ri$ out "u ?is subsection4 7#h7 ,report ,n lat] ?an #a ye> aft] ! conclusion ( all ( ! demon/ration projects fund$ "u ?is subsection1 ! ,secret>y %all submit a report to ! ,congress on ! results ( su* projects4 ,! report %all include-- 7,a7 an evaluation ( pati5t access to c>e1 pati5t outcomes1 & an analysis ( ! co/ effectiv5ess ( ea* su* project2 & 7,b7 recomm5dations on ,f$]al legislation1 regulations1 or adm9i/rative policies to enhance rural heal? quality & outcomes4 7c7 ,appropriation 7#a7 ,9 g5]al ,out ( funds 9 ! ,treasury n o!rwise appropriat$1 !re are appropriat$ to ! ,secret>y to c>ry out ?is section #cj1jjj1jjj = ! p]iod ( fiscal ye>s #bjba ?r\gh #bjbe4 7#b7 ,availability 7,a7 ,9 g5]al ,funds appropriat$ "u p>agraph 7#a7 %all rema9 available = exp5diture ?r\gh fiscal ye> #bjbe4 7,b7 ,report ,= purposes ( c>ry+ out subsection 7b77#h71 funds appropriat$ "u p>agraph 7#a7 %all rema9 available = exp5diture ?r\gh fiscal ye> #bjbf4 7#c7 ,res]vation ,( ! am\nt appropriat$ "u p>agraph 7#a71 ! ,secret>y %all res]ve-- 7,a7 #e1jjj1jjj to c>ry out subsection 7a72 & 7,b7 #be1jjj1jjj to c>ry out subsection 7b71 ( :i*-- 7i7 #b p]c5t %all be = ! provision ( te*nical assi/ance to grant recipi5ts2 & 7ii7 #e p]c5t %all be = indep5d5t evaluation "u subsection 7b77#g74 #dbj4 ,rural heal? c>e s]vices ,section #ccj;,a ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;c7 is am5d$ to read z foll[s3 #ccj;,a4 ,rural heal? c>e s]vices outrea*1 rural heal? network developm5t1 ,delta rural disp>ities & heal? sy/ems developm5t1 & small rural heal? c>e provid] quality improvem5t grant programs 7a7 ,purpose ,! purpose ( ?is section is to provide = grants-- 7#a7 "u subsection 7b71 to promote rural heal? c>e s]vices outrea*2 7#b7 "u subsection 7c71 to provide = ! plann+ & implem5tation ( integrat$ heal? c>e networks 9 rural areas2 7#c7 "u subsection 7d71 to assi/ rural communities 9 ! ,delta ,region to r$uce heal? disp>ities & to promote & enhance heal? sy/em developm5t2 & 7#d7 "u subsection 7e71 to provide = ! plann+ & implem5tation ( small rural heal? c>e provid] quality improvem5t activities4 7b7 ,rural heal? c>e s]vices outrea* grants 7#a7 ,grants ,! ,director ( ! ,(fice ( ,rural ,heal? ,policy ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration 7ref]r$ to 9 ?is section z ! ,director7 may aw>d grants to eligible entities to promote rural heal? c>e s]vices outrea* by exp&+ ! deliv]y ( heal? c>e s]vices to include new & enhanc$ s]vices 9 rural areas4 ,! ,director may aw>d ! grants = p]iods ( n m ?an #c ye>s4 7#b7 ,eligibility ,to be eligible to receive a grant "u ?is subsection = a project1 an entity-- 7,a7 %all be a rural public or rural nonpr(it private entity1 a facility t qualifies z a rural heal? cl9ic "u title ,,xviii ( ! ,social ,security ,act1 a public or nonpr(it entity exi/+ exclusively to provide s]vices to migrant & seasonal f>m work]s 9 rural areas1 or a ,tribal gov]nm5t ^: grant-fund$ activities w be conduct$ )9 f$]ally recogniz$ ,tribal areas2 7,b7 %all repres5t a consortium compos$ ( memb]s-- 7i7 t include #c or m indep5d5tly own$ heal? c>e entities2 & 7ii7 t may be nonpr(it or =-pr(it entities2 & 7,c7 %all n previ\sly h receiv$ a grant "u ?is subsection = ! same or a simil> project1 unless ! entity is propos+ to exp& ! scope ( ! project or ! area t w be s]v$ ?r\gh ! project4 7#c7 ,applications ,to be eligible to receive a grant "u ?is subsection1 an eligible entity %all prep>e & submit to ! ,director an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,director may require1 includ+-- 7,a7 a description ( ! project t ! eligible entity w c>ry out us+ ! funds provid$ "u ! grant2 7,b7 a description ( ! mann] 9 :i* ! project fund$ "u ! grant w meet ! heal? c>e ne$s ( rural populations 9 ! local community or region to be s]v$2 7,c7 a plan = quantify+ h[ heal? c>e ne$s w be met ?r\gh id5tification ( ! t>get population & b5*m>ks ( s]vice deliv]y or heal? /atus1 su* z-- 7i7 quantifiable measurem5ts ( heal? /atus improvem5t = projects focus+ on heal? promotion2 or 7ii7 b5*m>ks ( increas$ access to prim>y c>e1 includ+ track+ factors su* z ! numb] & type ( prim>y c>e visits1 id5tification ( a m$ical home1 or o!r g5]al measures ( su* access2 7,d7 a description ( h[ ! local community or region to be s]v$ w be involv$ 9 ! developm5t & ongo+ op]ations ( ! project2 7,e7 a plan = su/a9+ ! project aft] ,f$]al support = ! project has end$2 7,f7 a description ( h[ ! project w be evaluat$2 7,g7 ! adm9i/rative capacity to submit annual p]=mance data electronically z specifi$ by ! ,director2 & 7,h7 o!r su* in=mation z ! ,director det]m9es to be appropriate4 7c7 ,rural heal? network developm5t grants 7#a7 ,grants 7,a7 ,9 g5]al ,! ,director may aw>d rural heal? network developm5t grants to eligible entities to promote1 ?r\gh plann+ & implem5tation1 ! developm5t ( integrat$ heal? c>e networks t h comb9$ ! functions ( ! entities p>ticipat+ 9 ! networks 9 ord] to-- 7i7 a*ieve effici5cies & economies ( scale2 7ii7 exp& access to1 coord9ate1 & improve ! quality ( ! heal? c>e deliv]y sy/em ?r\gh developm5t ( organizational effici5cies2 7iii7 implem5t heal? in=mation te*nology to a*ieve effici5cies1 r$uce m$ical errors1 & improve quality2 7iv7 coord9ate c>e & manage *ronic illness2 & 7v7 /r5g!n ! rural heal? c>e sy/em z a :ole 9 su* a mann] z to %[ a quantifiable return on inve/m5t to ! p>ticipants 9 ! network4 7,b7 ,grant p]iods ,! ,director may aw>d su* a rural heal? network developm5t grant-- 7i7 = a p]iod ( #c ye>s = implem5tation activities2 or 7ii7 = a p]iod ( #a ye> = plann+ activities to assi/ 9 ! initial developm5t ( an integrat$ heal? c>e network1 if ! propos$ p>ticipants 9 ! network d n h a hi/ory ( collaborative ef=ts & a #c-ye> grant w\ld be inappropriate4 7#b7 ,eligibility ,to be eligible to receive a grant "u ?is subsection1 an entity-- 7,a7 %all be a rural public or rural nonpr(it private entity1 a facility t qualifies z a rural heal? cl9ic "u title ,,xviii ( ! ,social ,security ,act1 a public or nonpr(it entity exi/+ exclusively to provide s]vices to migrant & seasonal f>m work]s 9 rural areas1 or a ,tribal gov]nm5t ^: grant-fund$ activities w be conduct$ )9 f$]ally recogniz$ ,tribal areas2 7,b7 %all repres5t a network compos$ ( p>ticipants-- 7i7 t include #c or m indep5d5tly own$ heal? c>e entities2 & 7ii7 t may be nonpr(it or =-pr(it entities2 & 7,c7 %all n previ\sly h receiv$ a grant "u ?is subsection 7o!r ?an a #a-ye> grant = plann+ activities7 = ! same or a simil> project4 7#c7 ,applications ,to be eligible to receive a grant "u ?is subsection1 an eligible entity1 9 consultation ) ! appropriate ,/ate (fice ( rural heal? or ano!r appropriate ,/ate entity1 %all prep>e & submit to ! ,director an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,director may require1 includ+-- 7,a7 a description ( ! project t ! eligible entity w c>ry out us+ ! funds provid$ "u ! grant2 7,b7 an explanation ( ! reasons :y ,f$]al assi/ance is requir$ to c>ry out ! project2 7,c7 a description (-- 7i7 ! hi/ory ( collaborative activities c>ri$ out by ! p>ticipants 9 ! network2 7ii7 ! degree to :i* ! p>ticipants are ready to integrate _! functions2 & 7iii7 h[ ! local community or region to be s]v$ w b5efit f & be involv$ 9 ! activities c>ri$ out by ! network2 7,d7 a description ( h[ ! local community or region to be s]v$ w exp]i5ce increas$ access to quality heal? c>e s]vices across ! cont9uum ( c>e z a result ( ! integration activities c>ri$ out by ! network1 includ+ a description (-- 7i7 return on inve/m5t = ! community & ! network memb]s2 & 7ii7 o!r quantifiable p]=mance measures t %[ ! b5efit ( ! network activities2 7,e7 a plan = su/a9+ ! project aft] ,f$]al support = ! project has end$2 7,f7 a description ( h[ ! project w be evaluat$2 7,g7 ! adm9i/rative capacity to submit annual p]=mance data electronically z specifi$ by ! ,director2 & 7,h7 o!r su* in=mation z ! ,director det]m9es to be appropriate4 7d7 ,delta rural disp>ities & heal? sy/ems developm5t grants 7#a7 ,grants ,! ,director may aw>d grants to eligible entities to support r$uction ( heal? disp>ities1 improve access to heal? c>e1 & enhance rural heal? sy/em developm5t 9 ! ,delta ,region4 7#b7 ,eligibility ,to be eligible to receive a grant "u ?is subsection1 an entity %all be a rural public or rural nonpr(it private entity1 a facility t qualifies z a rural heal? cl9ic "u title ,,xviii ( ! ,social ,security ,act1 a public or nonpr(it entity exi/+ exclusively to provide s]vices to migrant & seasonal f>m work]s 9 rural areas1 or a ,tribal gov]nm5t ^: grant-fund$ activities w be conduct$ )9 f$]ally recogniz$ ,tribal areas4 7#c7 ,applications ,to be eligible to receive a grant "u ?is subsection1 an eligible entity %all prep>e & submit to ! ,director an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,director may require1 includ+-- 7,a7 a description ( ! project t ! eligible entity w c>ry out us+ ! funds provid$ "u ! grant2 7,b7 an explanation ( ! reasons :y ,f$]al assi/ance is requir$ to c>ry out ! project2 7,c7 a description ( ! mann] 9 :i* ! project fund$ "u ! grant w meet ! heal? c>e ne$s ( ! ,delta ,region2 7,d7 a description ( h[ ! local community or region to be s]v$ w exp]i5ce increas$ access to quality heal? c>e s]vices z a result ( ! activities c>ri$ out by ! entity2 7,e7 a description ( h[ heal? disp>ities w be r$uc$ or ! heal? sy/em w be improv$2 7,f7 a plan = su/a9+ ! project aft] ,f$]al support = ! project has end$2 7,g7 a description ( h[ ! project w be evaluat$ includ+ process & outcome measures relat$ to ! quality ( c>e provid$ or h[ ! heal? c>e sy/em improves its p]=mance2 7,h7 a description ( h[ ! grantee w develop an advisory gr\p made up ( repres5tatives ( ! communities to be s]v$ to provide guidance to ! grantee to be/ meet community ne$2 & 7,i7 o!r su* in=mation z ! ,director det]m9es to be appropriate4 7e7 ,small rural heal? c>e provid] quality improvem5t grants 7#a7 ,grants ,! ,director may aw>d grants to provide = ! plann+ & implem5tation ( small rural heal? c>e provid] quality improvem5t activities4 ,! ,director may aw>d ! grants = p]iods ( #a to #c ye>s4 7#b7 ,eligibility ,to be eligible = a grant "u ?is subsection1 an entity-- 7,a7 %all be-- 7i7 a rural public or rural nonpr(it private heal? c>e provid] or provid] ( heal? c>e s]vices1 su* z a rural heal? cl9ic2 or 7ii7 ano!r rural provid] or network ( small rural provid]s id5tifi$ by ! ,director z a key s\rce ( local c>e2 & 7,b7 %all n previ\sly h receiv$ a grant "u ?is subsection = ! same or a simil> project4 7#c7 ,pref]5ce ,9 aw>d+ grants "u ?is subsection1 ! ,director %all give pref]5ce to facilities t qualify z rural heal? cl9ics "u title ,,xviii ( ! ,social ,security ,act4 7#d7 ,applications ,to be eligible to receive a grant "u ?is subsection1 an eligible entity %all prep>e & submit to ! ,director an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,director may require1 includ+-- 7,a7 a description ( ! project t ! eligible entity w c>ry out us+ ! funds provid$ "u ! grant2 7,b7 an explanation ( ! reasons :y ,f$]al assi/ance is requir$ to c>ry out ! project2 7,c7 a description ( ! mann] 9 :i* ! project fund$ "u ! grant w assure cont9u\s quality improvem5t 9 ! provision ( s]vices by ! entity2 7,d7 a description ( h[ ! local community or region to be s]v$ w exp]i5ce increas$ access to quality heal? c>e s]vices z a result ( ! activities c>ri$ out by ! entity2 7,e7 a plan = su/a9+ ! project aft] ,f$]al support = ! project has end$2 7,f7 a description ( h[ ! project w be evaluat$ includ+ process & outcome measures relat$ to ! quality ( c>e provid$2 & 7,g7 o!r su* in=mation z ! ,director det]m9es to be appropriate4 7f7 ,g5]al requirem5ts 7#a7 ,prohibit$ uses ( funds ,an entity t receives a grant "u ?is section may n use funds provid$ ?r\gh ! grant-- 7,a7 to build or acquire real prop]ty2 or 7,b7 = con/ruction4 7#b7 ,coord9ation ) o!r ag5cies ,! ,director %all coord9ate activities c>ri$ out "u grant programs describ$ 9 ?is section1 to ! ext5t practicable1 ) ,f$]al & ,/ate ag5cies & nonpr(it organizations t are op]at+ simil> grant programs1 to maximize ! effect ( public doll>s 9 fund+ m]itori\s proposals4 7g7 ,report ,n lat] ?an ,septemb] #cj1 #bjbb1 ! ,secret>y %all prep>e & submit to ! appropriate committees ( ,congress a report on ! progress & accompli%m5ts ( ! grant programs describ$ 9 subsections 7b71 7c71 7d71 & 7e74 7h7 ,def9ition ( ,delta ,region ,9 ?is section1 ! t]m ,delta ,region has ! mean+ giv5 to ! t]m region 9 section #chb;,a ( ! ,consolidat$ ,f>m & ,rural ,developm5t ,act 7#g ,u4,s4,c4 #bjji;aa74 7i7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section #dj1jjj1jjj = fiscal ye> #bjba1 & su* sums z may be necess>y = ea* ( fiscal ye>s #bjbb ?r\gh #bjbe4 4 #dba4 ,community heal? c5t] collaborative access expansion ,section #ccj7r77#d7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;b7r77#d77 is am5d$-- 7#a7 9 subp>agraph 7,a71 by /rik+ prim>y heal? c>e s]vices ea* place x appe>s & ins]t+ prim>y heal? c>e & o!r m5tal1 d5tal1 & physical heal? s]vices2 & 7#b7 9 subp>agraph 7,b7-- 7,a7 9 clause 7i71 by /rik+ & at ! end2 7,b7 9 clause 7ii71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+3 7iii7 9 ! case ( a rural heal? cl9ic describ$ 9 su* subp>agraph-- 7,i7 t su* cl9ic provides1 to ! ext5t possible1 enabl+ s]vices1 su* z transportation & language assi/ance 7includ+ translation & int]pretation72 & 7,,ii7 t ! prim>y heal? c>e & o!r s]vices describ$ 9 su* subp>agraph are subject to full reimbursem5t accord+ to ! prospective paym5t sy/em = ,f$]ally qualifi$ heal? c5t] s]vices "u section #ahcd7o7 ( ! ,social ,security ,act4 4 #dbb4 ,facilitat+ ! provision ( teleheal? s]vices across ,/ate l9es 7a7 ,9 g5]al ,= purposes ( exp$it+ ! provision ( teleheal? s]vices1 = :i* paym5t is made "u ! ,m$ic>e ,program1 across ,/ate l9es1 ! ,secret>y ( ,heal? & ,human ,s]vices %all1 9 consultation ) repres5tatives ( ,/ates1 physicians1 heal? c>e practition]s1 & pati5t advocates1 enc\rage & facilitate ! adoption ( provisions all[+ = multi/ate practition] practice across ,/ate l9es4 7b7 ,def9itions ,9 subsection 7a73 7#a7 ,teleheal? s]vice ,! t]m teleheal? s]vice has ! mean+ giv5 t t]m 9 subp>agraph 7,f7 ( section #ahcd7m77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d774 7#b7 ,physician1 practition] ,! t]ms physician & practition] h ! mean+ giv5 ^? t]ms 9 subp>agraphs 7,d7 & 7,e71 respectively1 ( su* section4 7#c7 ,m$ic>e program ,! t]m ,m$ic>e ,program means ! program ( heal? insurance adm9i/]$ by ! ,secret>y ( ,heal? & ,human ,s]vices "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 #dbc4 ,scor+ ( prev5tive heal? sav+s ,section #bjb ( ! ,congressional ,budget & ,imp\ndm5t ,control ,act ( #aigd 7#b ,u4,s4,c4 #fjb7 is am5d$ by add+ at ! end ! foll[+3 7h7 ,scor+ ( prev5tive heal? sav+s 7#a7 ,det]m9ation by ! ,director ,^u a reque/ by ! *airman or rank+ m9ority memb] ( ! ,committee on ! ,budget ( ! ,s5ate1 or by ! *airman or rank+ m9ority memb] ( ! ,committee on ! ,budget ( ! ,h\se ( ,repres5tatives1 ! ,director %all det]m9e if a propos$ measure w\ld result 9 r$uctions 9 budget outlays 9 budget>y outye>s ?r\gh ! use ( prev5tive heal? & prev5tive heal? s]vices4 7#b7 ,projections ,if ! ,director det]m9es t a measure w\ld result 9 sub/antial r$uctions 9 budget outlays z describ$ 9 p>agraph 7#a71 ! ,director-- 7,a7 %all include1 9 any projection prep>$ by ! ,director1 a description & e/imate ( ! r$uctions 9 budget outlays 9 ! budget>y outye>s & a description ( ! basis = su* conclusions2 & 7,b7 may prep>e a budget projection t includes "s or all ( ! budget>y outye>s1 not)/&+ ! "t p]iods = projections describ$ 9 subsection 7e7 & sections #cjh1 #djb1 & #dbd4 7#c7 ,def9itions ,z us$ 9 ?is subsection-- 7,a7 ! t]m budget>y outye>s means ! #b consecutive #aj-ye> p]iods beg9n+ ) ! fir/ fiscal ye> t is #aj ye>s aft] ! budget ye> provid$ = 9 ! mo/ rec5tly agre$ to concurr5t resolution on ! budget2 & 7,b7 ! t]m prev5tive heal? means an action t focuses on ! heal? ( ! public1 individuals1 & def9$ populations 9 ord] to protect1 promote1 & ma9ta9 heal?1 wellness1 & functional ability1 & prev5t disease1 disability1 & premature dea? t is demon/rat$ by cr$ible & publicly available epidemiological projection models1 incorporat+ cl9ical trials or obs]vational /udies 9 humans1 to avoid future heal? c>e co/s4 4 #dbd4 ,s5se ( ,congress on ,ma9t5ance ( ,ef=t ,provisions ,reg>d+ ,*ildr5's ,heal? ,x is ! s5se ( ! ,congress t-- 7#a7 ! ma9t5ance ( ef=t provisions add$ to sections #aijb & #baje7;d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a2 #db ,u4,s4,c4 #acig;ee7d77 by sections #bjja7;b7 & #baja7;b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7 int5d$ to ma9ta9 ! eligibility /&>ds = ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 & ,*ildr5's ,heal? ,insurance ,program "u title ,,xxi ( su* ,act 7#db ,u4,s4,c4 #acig;aa et seq47 until ! ,am]ican ,heal? ,b5efit ,ex*anges 9 ! ,/ates are fully op]ational2 7#b7 x is imp]ative t ! ma9t5ance ( ef=t provisions are en=c$ to ! /rict /&>d int5d$ by ! ,congress ?r\gh ,septemb] #cj1 #bjbg2 7#c7 waiv+ ! ma9t5ance ( ef=t provisions %\ld n be p]mitt$2 7#d7 ! ma9t5ance ( ef=t provisions ensure ! cont9u$ success ( ! ,m$icaid program & ,*ildr5's ,heal? ,insurance ,program & 7 int5d$ to specifically protect vuln]able & disabl$ adults1 *ildr51 & s5ior citiz5s1 _m ( :om are also memb]s ( communities ( color2 & 7#e7 ! ma9t5ance ( ef=t provisions mu/ be /rictly en=c$ & proposals to weak5 ! ma9t5ance ( ef=t provisions mu/ n be consid]$4 #dbe4 ,protection ( ! ,,hhs ,(fices ( ,m9ority ,heal? 7a7 ,9 g5]al ,pursuant to section #agjg;,a ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f;a71 ! ,(fices ( ,m9ority ,heal? e/abli%$ )9 ! ,c5t]s = ,disease ,control & ,prev5tion1 ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 ! ,sub/ance ,abuse & ,m5tal ,heal? ,s]vices ,adm9i/ration1 ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 ! ,food & ,drug ,adm9i/ration1 & ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 are (fices t1 reg>dless ( *ange 9 ! /ructure ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 %all report to ! ,secret>y ( ,heal? & ,human ,s]vices4 7b7 ,s5se ( ,congress ,x is ! s5se ( ! ,congress t any ef=t to elim9ate or consolidate su* ,(fices ( ,m9ority ,heal? und]m9es ! progress a*iev$ s f>4 #dbf4 ,(fice ( ,m9ority ,heal? 9 ,vet]ans ,heal? ,adm9i/ration ( ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,e/abli%m5t & functions ,sub*apt] ,i ( *apt] #gc ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by ins]t+ aft] section #gcjh ! foll[+ new section3 #gcjh;,a4 ,(fice ( ,m9ority ,heal? 7a7 ,e/abli%m5t ,!re is e/abli%$ 9 ! ,dep>tm5t )9 ! ,(fice ( ! ,"u ,secret>y = ,heal? an (fice to be kn[n z ! ,(fice ( ,m9ority ,heal? 79 ?is section ref]r$ to z ! ,(fice74 7b7 ,head ,! ,director ( ! ,(fice ( ,m9ority ,heal? %all be ! head ( ! ,(fice4 ,! ,director ( ! ,(fice ( ,m9ority ,heal? %all be appo9t$ by ! ,"u ,secret>y = ,heal? f among individuals qualifi$ to p]=m ! duties ( ! position4 7c7 ,functions ,! functions ( ! ,(fice are z foll[s3 7#a7 ,to e/abli% %ort-range & long-range goals & objectives & coord9ate all o!r activities )9 ! ,vet]ans ,heal? ,adm9i/ration t relate to disease prev5tion1 heal? promotion1 heal? c>e s]vices deliv]y1 & heal? c>e rese>* conc]n+ vet]ans :o are memb]s ( a racial or e?nic m9ority gr\p4 7#b7 ,to support rese>*1 demon/rations1 & evaluations to te/ new & innovative models = ! dis*>ge ( activities describ$ 9 p>agraph 7#a74 7#c7 ,to increase k & und]/&+ ( heal? risk factors = vet]ans :o are memb]s ( a racial or e?nic m9ority gr\p4 7#d7 ,to develop me*anisms t support bett] heal? c>e in=mation dissem9ation1 education1 prev5tion1 & s]vices deliv]y to vet]ans f disadvantag$ backgr\nds1 includ+ vet]ans :o are memb]s ( a racial or e?nic m9ority gr\p4 7#e7 ,to ent] into contracts or agreem5ts ) appropriate public & nonpr(it private entities to develop & c>ry out programs to provide bil+ual or int]pretive s]vices to assi/ vet]ans :o are memb]s ( a racial or e?nic m9ority gr\p & :o lack pr(ici5cy 9 speak+ ! ,engli% language 9 access+ & receiv+ heal? c>e s]vices ?r\gh ! ,vet]ans ,heal? ,adm9i/ration4 7#f7 ,to c>ry out programs to improve access to heal? c>e s]vices ?r\gh ! ,vet]ans ,heal? ,adm9i/ration = vet]ans ) limit$ pr(ici5cy 9 speak+ ! ,engli% language1 includ+ ! developm5t & evaluation ( demon/ration & pilot projects = t purpose4 7#g7 ,to advise ! ,"u ,secret>y = ,heal? on matt]s relat+ to ! developm5t1 implem5tation1 & evaluation ( heal? pr(essions education 9 decreas+ disp>ities 9 heal? c>e outcomes betwe5 vet]ans :o are memb]s ( a racial or e?nic m9ority gr\p & o!r vet]ans1 includ+ cultural compet5cy z a me?od ( elim9at+ su* heal? disp>ities4 7#h7 ,to p]=m su* o!r functions & duties z ! ,secret>y or ! ,"u ,secret>y = ,heal? consid]s appropriate4 7d7 ,def9itions ,9 ?is section3 7#a7 ,! t]m racial or e?nic m9ority gr\p means any ( ! foll[+3 7,a7 ,am]ican ,indians 7includ+ ,alaska ,natives1 ,eskimos1 & ,aleuts74 7,b7 ,asian ,am]icans4 7,c7 ,native ,hawaiians & o!r ,pacific ,isl&]s4 7,d7 ,blacks4 7,e7 ,hispanics4 7#b7 ,! t]m ,hispanic means individuals ^: orig9 is ,mexican1 ,pu]to ,rican1 ,cuban1 ,c5tral or ,s\? ,am]ican1 or any o!r ,spani%-speak+ c\ntry4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( su* sub*apt] is am5d$ by ins]t+ aft] ! item relat+ to section #gcjh ! foll[+ new item3 #gcjh;,a4 ,(fice ( ,m9ority ,heal?4 4 #dbg4 ,/udy ( ,,d% paym5ts to ensure hospital access = l[-income pati5ts 7a7 ,9 g5]al ,n lat] ?an ,janu>y #a1 #bjba1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all conduct a /udy on h[ am5dm5ts made by ! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh7 & ! ,heal? ,c>e & ,education ,reconciliation ,act ( #bjaj 7,public ,law #aaa-aeb7 to titles ,,xviii & ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq42 #db ,u4,s4,c4 #acif et seq47 relat+ to disproportionate %>e hospital adju/m5t paym5ts "u ,m$ic>e & ,m$icaid 7& subsequ5t am5dm5ts made ) respect to su* paym5ts7 affect ! timely access to heal? c>e s]vices = l[-income pati5ts4 ,su* /udy %all-- 7#a7 evaluate & exam9e :e!r ,/ates elect+ to make m$ical assi/ance available "u section #aijb7;a77#aj77;,a77i77,,viii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77i77,,viii77 7includ+ ,/ates mak+ su* an election ?r\gh a waiv] ( ! ,/ate plan7 to individuals describ$ 9 su* section mitigate ! ne$ = paym5ts to disproportionate %>e hospitals "u section #ahhf7;d77#e77;,f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,f77 & section #aibc ( su* ,act 7#db ,u4,s4,c4 #acifr-#d71 includ+ ! impact ( su* ,/ates elect+ to make m$ical assi/ance available to su* individuals on-- 7,a7 ! numb] ( individuals 9 ! ,unit$ ,/ates :o are )\t heal? insurance & ! di/ribution ( su* individuals 9 relation to areas prim>ily s]v$ by disproportionate %>e hospitals2 & 7,b7 ! l[-income utilization rate ( su* hospitals & ! result+ fiscal su/a9ability ( su* hospitals2 7#b7 evaluate ! appropriate level & di/ribution ( su* paym5ts among su* disproportionate %>e hospitals = purposes (-- 7,a7 suffici5tly acc\nt+ = ! level ( uncomp5sat$ c>e provid$ by su* hospitals to l[-income pati5ts2 & 7,b7 provid+ timely access to heal? s]vices = individuals 9 m$ically und]s]v$ areas2 & 7#c7 assess1 ) respect to su* disproportionate %>e hospitals-- 7,a7 ! role play$ by su* hospitals 9 provid+ critical access to em]g5cy1 inpati5t1 & outpati5t heal? s]vices1 z well z ! location ( su* hospitals 9 relation to m$ically und]s]v$ areas2 & 7,b7 ! ext5t to :i* su* hospitals satisfy ! requirem5ts e/abli%$ = *>itable hospital organizations "u section #eja7r7 ( ! ,int]nal ,rev5ue ,code ( #aihf ) respect to community heal? ne$s assessm5ts1 f9ancial assi/ance policy requirem5ts1 limitations on *>ges1 & bill+ & collection requirem5ts4 7b7 ,reports 7#a7 ,report to ,congress ,n lat] ?an #ahj days aft] ! date on :i* ! /udy "u subsection 7a7 is complet$1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives & ! ,committee on ,f9ance ( ! ,s5ate a report t conta9s-- 7,a7 ! results ( ! /udy2 7,b7 recomm5dations to ,congress = any legislative *anges to ! paym5ts to disproportionate %>e hospitals "u section #ahhf7;d77#e77;,f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,f77 & section #aibc ( su* ,act 7#db ,u4,s4,c4 #acifr-#d7 t are ne$$ to ensure access to heal? s]vices = l[-income pati5ts t-- 7i7 are bas$ on ! numb] ( individuals )\t heal? insurance1 ! am\nt ( uncomp5sat$ c>e provid$ by su* hospitals1 & ! impact ( r$uc$ paym5t levels on l[-income communities2 & 7ii7 takes into acc\nt any reports submitt$ by ! ,secret>y ( ! ,treasury1 9 consultation ) ! ,secret>y ( ,heal? & ,human ,s]vices1 to congressional committees reg>d+ ! co/s incurr$ by *>itable hospital organizations = *>ity c>e1 bad debt1 nonreimburs$ exp5ses = s]vices provid$ to individuals "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act & ! ,m$icaid program "u title ,,xix ( su* ,act1 & any community b5efit activities provid$ by su* organizations4 7#b7 ,report to ! ,secret>y ( ,heal? & ,human ,s]vices ,n lat] ?an #ahj days aft] ! date on :i* ! /udy "u subsection 7a7 is complet$1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ! ,secret>y ( ,heal? & ,human ,s]vices a report t conta9s-- 7,a7 ! results ( ! /udy2 & 7,b7 any recomm5dations = purposes ( assi/+ 9 ! developm5t ( ! me?odology = ! adju/m5t ( paym5ts to disproportionate %>e hospitals1 z requir$ "u section #ahhf7r7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7r77 & ! r$uction ( su* paym5ts "u section #aibc7;f77#g7 ( su* ,act 7#db ,u4,s4,c4 #acifr-#d7;f77#g771 tak+ into acc\nt ! reports ref]r$ to 9 p>agraph 7#a77;,b77ii74 #dbh4 ,assi/ant ,secret>y ( ! ,indian ,heal? ,s]vice 7a7 ,ref]5ces ,any ref]5ce 9 a law1 regulation1 docum5t1 pap]1 or o!r record ( ! ,unit$ ,/ates to ! ,director ( ! ,indian ,heal? ,s]vice %all be deem$ to be a ref]5ce to ! ,assi/ant ,secret>y ( ! ,indian ,heal? ,s]vice4 7b7 ,executive ,s*$ule ,section #ecae ( title #e1 ,unit$ ,/ates ,code1 is am5d$ 9 ! matt] relat+ to ! ,assi/ant ,secret>ies ( ,heal? & ,human ,s]vices by /rik+ 7#f7 & ins]t+ 7#g71 "o ( :om %all be ! ,assi/ant ,secret>y ( ! ,indian ,heal? ,s]vice4 7c7 ,con=m+ am5dm5t ,section #ecaf ( title #e1 ,unit$ ,/ates ,code1 is am5d$ by /rik+ ,director1 ,indian ,heal? ,s]vice1 ,dep>tm5t ( ,heal? & ,human ,s]vices44 #dbi4 ,reau?orization ( ! ,native ,hawaiian ,heal? ,c>e ,improvem5t ,act 7a7 ,native ,hawaiian heal? c>e sy/ems ,section #f7;h77#a7 ( ! ,native ,hawaiian ,heal? ,c>e ,improvem5t ,act 7#db ,u4,s4,c4 #aagje7;h77#a77 is am5d$ by /rik+ may be necess>y = fiscal ye>s #aiic ?r\gh #bjai & ins]t+ are necess>y4 7b7 ,adm9i/rative grant = papa ola lokahi ,section #g7;b7 ( ! ,native ,hawaiian ,heal? ,c>e ,improvem5t ,act 7#db ,u4,s4,c4 #aagjf7;b77 is am5d$ by /rik+ may be necess>y = fiscal ye>s #aiic ?r\gh #bjai & ins]t+ are necess>y4 7c7 ,native ,hawaiian heal? s*ol>%ips ,section #aj7;c7 ( ! ,native ,hawaiian ,heal? ,c>e ,improvem5t ,act 7#db ,u4,s4,c4 #aagji7;c77 is am5d$ by /rik+ may be necess>y = fiscal ye>s #aiic ?r\gh #bjai & ins]t+ are necess>y4 #dcj4 ,availability ( non-,engli% language speak+ provid]s 7a7 ,9 g5]al ,section #acaa7;c77#a77;,b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7;c77#a77;,b77 is am5d$ by ins]t+ be=e ! semicolon ! foll[+3 & ! ability ( su* provid] to provide c>e 9 a language o!r ?an ,engli% ei!r ?r\gh ! provid] speak+ su* language or by ! provid] hav+ a qualifi$ int]pret] = an individual ) limit$ ,engli% pr(ici5cy 7z def9$ 9 section #cdjj ( su* ,act7 :o speaks su* language available dur+ (fice h\rs4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all n apply to any plan beg9n+ on or prior to ! date t is #a ye> aft] ! date ( ! enactm5t ( ?is ,act4 #dca4 ,access to ess5tial community provid]s 7a7 ,ess5tial community provid]s ,section #acaa7;c77#a77;,c7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7;c77#a77;,c77 is am5d$-- 7#a7 by ins]t+ 7i7 aft] 7,c72 & 7#b7 by add+ at ! end ! foll[+ new clauses3 7ii7 n lat] ?an ,janu>y #a1 #bjba1 increase ! p]c5tage ( ess5tial community provid]s z describ$ 9 clause 7i7 includ$ 9 its network by #aj p]c5t annually 7bas$ on ! level 9 ! plan = #bjaf7 until #ij p]c5t ( all f$]ally qualifi$ heal? c5t]s & #ge p]c5t ( all o!r su* ess5tial community provid]s 9 ! contract s]vice area are 9-network2 & 7iii7 include at lea/ "o ess5tial community provid] 9 ea* ( ! ess5tial community provid] categories describ$ 9 section #aef4bce7;a77#b77;ii77,b7 ( title #de1 ,code ( ,f$]al ,regulations 7z 9 effect on ! date ( enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbj71 9 ea* c\nty 9 ! s]vice area1 :]e available2 4 7b7 ,report+ requirem5ts ,section #acaa7;e77#c7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7;e77#c77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,e7 ,data on ess5tial community provid]s ,! ,secret>y %all require qualifi$ heal? plans to submit annually to ! ,secret>y data on ! p]c5tage ( ess5tial community provid]s z describ$ 9 clause 7ii7 ( subsection 7c77#a77;,c71 by c\nty1 t contract ) ea* qualifi$ heal? plan (f]$ 9 t c\nty & ! p]c5tage ( su* ess5tial community provid]s1 by category z describ$ 9 clause 7iii7 ( su* subsection1 t contract ) ea* qualifi$ heal? plan (f]$ 9 t c\nty4 ,su* data %all be made available to ! g5]al public4 4 7c7 ,ess5tial ,community ,provid] provisions appli$ "u ,m$ic>e & ,m$icaid 7#a7 ,m$ic>e ,section #aheb7;d77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;d77#a77 is am5d$-- 7,a7 by /rik+ & at ! end ( subp>agraph 7,d72 7,b7 by /rik+ ! p]iod at ! end ( subp>agraph 7,e7 & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,f7 ! plan meets ! requirem5ts ( clauses 7ii7 & 7iii7 ( section #acaa7;c77#a77;,c7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7relat+ to inclusion 9 networks ( ess5tial community provid]s74 4 7#b7 ,m$icaid ,section #aicb7;b77#e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;b77#e77 is am5d$-- 7,a7 by /rik+ & at ! end ( subp>agraph 7,a72 7,b7 by /rik+ ! p]iod at ! end ( subp>agraph 7,b7 & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,c7 meets ! requirem5ts ( clauses 7ii7 & 7iii7 ( section #acaa7;c77#a77;,c7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7relat+ to inclusion 9 networks ( ess5tial community provid]s7 ) respect to s]vices (f]$ 9 ! s]vice area involv$4 4 #dcb4 ,provid] network adequacy 9 communities ( color 7a7 ,9 g5]al ,section #acaa7;c77#a77;,b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7;c77#a77;,b771 z am5d$ by section #dcj7;a71 is fur!r am5d$-- 7#a7 by ins]t+ 7i7 aft] 7,b72 & 7#b7 by add+ at ! end ! foll[+ new clauses3 7ii7 meet su* network adequacy /&>ds z ! ,secret>y may e/abli% ) reg>d to-- 7,i7 appo9tm5t wait "t2 7,,ii7 travel "t & di/ance to heal? c>e provid] facilities & provid]s by public & private transit2 7,,iii7 h\rs ( op]ation to accommodate individuals :o _c come to provid] appo9tm5ts dur+ /&>d bus9ess h\rs2 & 7,,iv7 o!r network adequacy /&>ds to ensure t c>e ?r\gh ^! plans is accessible to div]se communities1 includ+ individuals ) limit$ ,engli% pr(ici5cy z def9$ 9 section #cdjj ( su* ,act2 & 7iii7 provide cov]age = s]vices = enrollees ?r\gh out-(-network provid]s at no additional co/ to ! enrollees 9 cases :]e 9-network provid]s are unable to comply ) ! /&>ds e/abli%$ "u subclause 7,,iii7 or 7,,iv7 ( clause 7ii7 = su* s]vices & ! out-(-network provid]s c deliv] su* s]vices 9 compliance ) su* /&>ds4 7b7 ,effective date ,! am5dm5ts made by subsection 7a7 %all n apply to plans beg9n+ on or prior to ! date t is #a ye> aft] ! date ( ! enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbj4 4 #dcc4 ,improv+ access to d5tal c>e 7a7 ,reports to ,congress 7#a7 ,,gao reports ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress-- 7,a7 a report on ! ,alaska ,d5tal ,heal? ,aide ,!rapi/s program & ! ,d5tal ,!rapi/ & ,advanc$ ,d5tal ,!rapi/ programs 9 ,m9nesota1 to assess ! effectiv5ess ( d5tal !rapi/s 9-- 7i7 improv+ access to timely d5tal c>e among communities ( color2 7ii7 provid+ high-quality c>e2 7iii7 provid+ culturally compet5t c>e2 & 7iv7 provid+ accessible c>e to p ) disabilities2 7,b7 a report on ,/ate v>iations 9 ! use ( d5tal hygi5i/s & ! effectiv5ess ( exp&+ ! scope ( practice = d5tal hygi5i/s 9-- 7i7 improv+ access to timely d5tal c>e among communities ( color2 7ii7 provid+ high-quality c>e2 7iii7 provid+ culturally compet5t c>e2 & 7iv7 provid+ accessible c>e to p ) disabilities2 & 7,c7 a report on ! use ( teleheal? s]vices to enhance s]vices provid$ by d5tal hygi5i/s & !rapi/s1 includ+ recomm5dations = any modifications to ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act & ! ,m$icaid program "u title ,,xix ( su* ,act to bett] provide = teleheal? consultations 9 conjunction ) !rapi/s' & hygi5i/s' c>e4 7#b7 ,,hrsa report on d5tal %ortage areas ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all submit to ,congress a report :i* details geographic d5tal access %ortages & ! prep>$ness ( d5tal provid]s to (f] culturally & l+ui/ically appropriate1 af=dable1 accessible1 & timely s]vices4 7b7 ,expansion ( d5tal heal? aid !rapi/s 9 ,tribal communities ,section #aai7;d7 ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afafl7d77 is am5d$-- 7#a7 9 p>agraph 7#b71 by /rik+ ,subject to & all t foll[s & ins]t+ ,subject to p>agraph 7#c71 9 e/abli%+ a national program "u p>agraph 7#a71 ! ,secret>y %all n r$uce ! am\nts provid$ = ! ,community ,heal? ,aide ,program describ$ 9 subsections 7a7 & 7b742 7#b7 by /rik+ p>agraph 7#c72 & 7#c7 by r$esignat+ p>agraph 7#d7 z p>agraph 7#c74 7c7 ,cov]age ( d5tal s]vices "u ! ,m$ic>e program 7#a7 ,cov]age ,section #ahfa7s77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is am5d$-- 7,a7 9 subp>agraph 7,,gg71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,,hh71 by /rik+ ! p]iod & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,,ii7 oral heal? s]vices 7z def9$ 9 subsection 7mmm772 4 7#b7 ,oral heal? s]vices def9$ ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 z am5d$ by sections #bjg7;b77#a7 & #dag7;a71 is am5d$ by add+ at ! end ! foll[+ new subsection3 7mmm7 ,oral ,heal? ,s]vices 7#a7 ,! t]m oral heal? s]vices means s]vices 7z def9$ by ! ,secret>y7 t are necess>y to prev5t disease & promote oral heal?1 re/ore oral /ructures to heal? & function1 & treat em]g5cy conditions4 7#b7 ,= purposes ( p>agraph 7#a71 su* t]m %all include mobile & portable oral heal? s]vices 7z def9$ by ! ,secret>y7 t-- 7,a7 are provid$ = ! purpose ( ov]com+ mobility1 transportation1 & access b>ri]s = individuals2 & 7,b7 satisfy ! /&>ds & c]tification requirem5ts e/abli%$ "u section #aijb7;a77#hb77;,b7 = ! ,/ate 9 :i* ! s]vices are provid$4 4 7#c7 ,paym5t & co9surance ,section #ahcc7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is am5d$-- 7,a7 by /rik+ & be=e 7,,dd72 & 7,b7 by ins]t+ be=e ! semicolon at ! end ! foll[+3 1 & 7,,ee7 ) respect to oral heal? s]vices 7z def9$ 9 section #ahfa7mmm771 ! am\nt paid %all be 7i7 9 ! case ( su* s]vices t are prev5tive1 #ajj p]c5t ( ! less] ( ! actual *>ge = ! s]vices or ! am\nt det]m9$ "u ! paym5t basis det]m9$ "u section #ahdh1 & 7ii7 9 ! case ( all o!r su* s]vices1 #hj p]c5t ( ! less] ( ! actual *>ge = ! s]vices or ! am\nt det]m9$ "u ! paym5t basis det]m9$ "u section #ahdh4 7#d7 ,paym5t "u physician fee s*$ule ,section #ahdh7;j77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c77 is am5d$ by ins]t+ 7#b77;,,ii71 aft] risk assessm5t714 7#e7 ,d5tures ,section #ahfa7s77#h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#h77 is am5d$-- 7,a7 by /rik+ 7o!r ?an d5tal7 & ins]t+ 7includ+ d5tures72 & 7,b7 by /rik+ int]nal body4 7#f7 ,repeal ( gr\nd = exclusion ,section #ahfb7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7 is am5d$ by /rik+ p>agraph 7#ab74 7#g7 ,effective date ,! am5dm5ts made by ?is section %all apply to s]vices furni%$ on or aft] ,janu>y #a1 #bjba4 7d7 ,cov]age ( d5tal s]vices "u ! ,m$icaid program 7#a7 ,9 g5]al ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is am5d$-- 7,a7 9 subsection 7a77#aj71 by /rik+ d5tal s]vices & ins]t+ oral heal? s]vices 7z def9$ 9 subsection 7gg77#a772 & 7,b7 by add+ at ! end ! foll[+ new subsection3 7gg7 7#a7 ,subject to p>agraphs 7#b7 & 7#c71 = purposes ( ?is title1 ! t]m oral heal? s]vices means s]vices 7z def9$ by ! ,secret>y7 t are necess>y to prev5t disease & promote oral heal?1 re/ore oral /ructures to heal? & function1 & treat em]g5cy conditions4 7#b7 ,= purposes ( p>agraph 7#a71 su* t]m %all include-- 7,a7 d5tures2 & 7,b7 mobile & portable oral heal? s]vices 7z def9$ by ! ,secret>y7 t-- 7i7 are provid$ = ! purpose ( ov]com+ mobility1 transportation1 & access b>ri]s = individuals2 & 7ii7 satisfy ! /&>ds & c]tification requirem5ts e/abli%$ "u section #aijb7;a77#hg77;,c7 = ! ,/ate 9 :i* ! s]vices are provid$4 7#c7 ,= purposes ( p>agraph 7#a71 su* t]m %all n include d5tal c>e or s]vices provid$ to individuals "u ! age ( #ba "u subsection 7r77#c74 4 7#b7 ,con=m+ am5dm5ts 7,a7 ,/ate plan requirem5ts ,section #aijb7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77 is am5d$-- 7i7 9 p>agraph 7#aj77;,a71 9 ! matt] prec$+ clause 7i71 by ins]t+ 7#aj71 aft] 7#e712 7ii7 9 p>agraph 7#he71 by /rik+ & at ! end2 7iii7 9 p>agraph 7#hf71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7iv7 by ins]t+ aft] p>agraph 7#hf7 ! foll[+3 7#hg7 provide =-- 7,a7 in=m+1 9 writ+1 all individuals :o h be5 det]m9$ to be eligible = m$ical assi/ance ( ! availability ( oral heal? s]vices 7z def9$ 9 section #aije7;gg772 7,b7 conduct+ t>get$ outrea* to pregnant wom5 :o h be5 det]m9$ to be eligible = m$ical assi/ance ab\t ! availability ( m$ical assi/ance = su* d5tal s]vices & ! importance ( receiv+ d5tal c>e :ile pregnant2 & 7,c7 e/abli%+ & ma9ta9+ /&>ds = & c]tification ( mobile & portable oral heal? s]vices 7z describ$ 9 subsections 7r77#c77;,c7 & 7gg77#b77;,b7 ( section #aije74 4 7,b7 ,def9ition ( m$ical assi/ance ,section #aije7;a77#ab7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77#ab77 is am5d$ by /rik+ 1 d5tures14 7#c7 ,mobile & portable oral heal? s]vices "u ,,epsdt ,section #aije7r77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7r77#c77 is am5d$-- 7,a7 9 subp>agraph 7,a77ii71 by /rik+ 2 & & ins]t+ a semicolon2 7,b7 9 subp>agraph 7,b71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,c7 :i* %all include mobile & portable oral heal? s]vices 7z def9$ by ! ,secret>y7 t-- 7i7 are provid$ = ! purpose ( ov]com+ mobility1 transportation1 or access b>ri]s = *ildr52 & 7ii7 satisfy ! /&>ds & c]tification requirem5ts e/abli%$ "u section #aijb7;a77#hg77;,c7 = ! ,/ate 9 :i* ! s]vices are provid$4 4 7e7 ,oral heal? s]vices z an ess5tial heal? b5efit ,section #acjb7;b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjbb7;b77 is am5d$-- 7#a7 9 p>agraph 7#a7-- 7,a7 9 subp>agraph 7,j71 by /rik+ oral &2 & 7,b7 by add+ at ! end ! foll[+3 7,k7 ,oral heal? s]vices = *ildr5 & adults4 2 & 7#b7 by add+ at ! end ! foll[+3 7#f7 ,oral heal? s]vices ,= purposes ( p>agraph 7#a77,k71 ! t]m oral heal? s]vices means s]vices 7z def9$ by ! ,secret>y7 t are necess>y to prev5t any oral disease & promote oral heal?1 re/ore oral /ructures to heal? & function1 & treat em]g5cy oral conditions4 4 7f7 ,demon/ration program on tra9+ & employm5t ( alt]native d5tal heal? c>e provid]s = d5tal heal? c>e s]vices = vet]ans 9 rural & o!r und]s]v$ communities 7#a7 ,demon/ration program au?oriz$ ,! ,secret>y ( ,vet]ans ,affairs may c>ry out a demon/ration program to e/abli% programs to tra9 & employ alt]native d5tal heal? c>e provid]s 9 ord] to increase access to d5tal heal? c>e s]vices = vet]ans :o are entitl$ to su* s]vices f ! ,dep>tm5t ( ,vet]ans ,affairs & reside 9 rural & o!r und]s]v$ communities4 7#b7 ,teleheal? ,= purposes ( alt]native d5tal heal? c>e provid]s & o!r d5tal c>e provid]s :o are lic5s$ to provide cl9ical c>e1 d5tal s]vices provid$ "u ! demon/ration program "u ?is subsection may be adm9i/]$ by su* provid]s ?r\gh teleheal?-enabl$ collaboration & sup]vision :5 appropriate & feasible4 7#c7 ,alt]native d5tal heal? c>e provid]s def9$ ,9 ?is subsection1 ! t]m alt]native d5tal heal? c>e provid]s has ! mean+ giv5 t t]m 9 section #cdj;,g-#a7;a77#b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bef;g-#a7;a77#b774 7#d7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ su* sums z are necess>y to c>ry out ! demon/ration program "u ?is subsection4 7g7 ,demon/ration program on tra9+ & employm5t ( alt]native d5tal heal? c>e provid]s = d5tal heal? c>e s]vices = memb]s ( ! ,arm$ ,=ces & dep5d5ts lack+ ready access to su* s]vices 7#a7 ,demon/ration program au?oriz$ ,! ,secret>y ( ,def5se may c>ry out a demon/ration program to e/abli% programs to tra9 & employ alt]native d5tal heal? c>e provid]s 9 ord] to increase access to d5tal heal? c>e s]vices = memb]s ( ! ,arm$ ,=ces & _! dep5d5ts :o lack ready access to su* s]vices1 includ+ ! foll[+3 7,a7 ,memb]s & dep5d5ts :o reside 9 rural areas or areas o!rwise und]s]v$ by d5tal heal? c>e provid]s4 7,b7 ,memb]s ( a res]ve compon5t ( ! ,arm$ ,=ces 9 active /atus :o are pot5tially deployable4 7#b7 ,teleheal? ,= purposes ( alt]native d5tal heal? c>e provid]s & o!r d5tal c>e provid]s :o are lic5s$ to provide cl9ical c>e1 d5tal s]vices provid$ "u ! demon/ration program "u ?is subsection may be adm9i/]$ by su* provid]s ?r\gh teleheal?-enabl$ collaboration & sup]vision :5 appropriate & feasible4 7#c7 ,def9itions ,9 ?is subsection3 7,a7 ,active /atus ,! t]m active /atus has ! mean+ giv5 t t]m 9 section #aja7;d7 ( title #aj1 ,unit$ ,/ates ,code4 7,b7 ,alt]native d5tal heal? c>e provid]s ,! t]m alt]native d5tal heal? c>e provid]s has ! mean+ giv5 t t]m 9 section #cdj;,g-#a7;a77#b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bef;g-#a7;a77#b774 7#d7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ su* sums z are necess>y to c>ry out ! demon/ration program "u ?is subsection4 7h7 ,demon/ration program on tra9+ & employm5t ( alt]native d5tal heal? c>e provid]s = d5tal heal? c>e s]vices = prison]s )9 ! cu/ody ( ! bureau ( prisons 7#a7 ,demon/ration program au?oriz$ ,! ,attorney ,g5]al1 act+ ?r\gh ! ,director ( ! ,bureau ( ,prisons1 may c>ry out a demon/ration program to e/abli% programs to tra9 & employ alt]native d5tal heal? c>e provid]s 9 ord] to increase access to d5tal heal? s]vices = prison]s )9 ! cu/ody ( ! ,bureau ( ,prisons4 7#b7 ,teleheal? ,= purposes ( alt]native d5tal heal? c>e provid]s & o!r d5tal c>e provid]s :o are lic5s$ to provide cl9ical c>e1 d5tal s]vices provid$ "u ! demon/ration program "u ?is subsection may be adm9i/]$ by su* provid]s ?r\gh teleheal?-enabl$ collaboration & sup]vision :5 appropriate & feasible4 7#c7 ,alt]native d5tal heal? c>e provid]s def9$ ,9 ?is subsection & subsection 7i71 ! t]m alt]native d5tal heal? c>e provid]s has ! mean+ giv5 t t]m 9 section #cdj;,g-#a7;a77#b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bef;g-#a7;a77#b774 7#d7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ su* sums z are necess>y to c>ry out ! demon/ration program "u ?is subsection4 7i7 ,demon/ration program on tra9+ & employm5t ( alt]native d5tal heal? c>e provid]s = d5tal heal? c>e s]vices "u ! indian heal? s]vice 7#a7 ,demon/ration program au?oriz$ ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,indian ,heal? ,s]vice1 may c>ry out a demon/ration program to e/abli% programs to tra9 & employ alt]native d5tal heal? c>e provid]s 9 ord] to help elim9ate oral heal? disp>ities & increase access to d5tal s]vices ?r\gh heal? programs op]at$ by ! ,indian ,heal? ,s]vice1 ,indian tribes1 tribal organizations1 & urban ,indian organizations 7z ! prec$+ #c t]ms are def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc774 7#b7 ,teleheal? ,= purposes ( alt]native d5tal heal? c>e provid]s & o!r d5tal c>e provid]s :o are lic5s$ to provide cl9ical c>e1 d5tal s]vices provid$ "u ! demon/ration program "u ?is subsection may be adm9i/]$ by su* provid]s ?r\gh teleheal?-enabl$ collaboration & sup]vision :5 appropriate & feasible4 7#c7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ su* sums z are necess>y to c>ry out ! demon/ration program "u ?is subsection4 #dcd4 ,provid+ = a special enrollm5t p]iod = pregnant individuals 7a7 ,public heal? s]vice act ,section #bgjb7;b77#b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#a7;b77#b77 is am5d$ by ins]t+ includ+ a special enrollm5t p]iod = pregnant individuals1 beg9n+ on ! date on :i* ! pregnancy is report$ to ! heal? insurance issu] be=e ! p]iod at ! end4 7b7 ,pati5t protection & af=dable c>e act ,section #acaa7;c77#f7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7;c77#f77 is am5d$-- 7#a7 9 subp>agraph 7,c71 by /rik+ & at ! end2 7#b7 by r$esignat+ subp>agraph 7,d7 z subp>agraph 7,e72 & 7#c7 by ins]t+ aft] subp>agraph 7,c7 ! foll[+ new subp>agraph3 7,d7 a special enrollm5t p]iod = pregnant individuals1 beg9n+ on ! date on :i* ! pregnancy is report$ to ! ,ex*ange2 & 4 7c7 ,special enrollm5t p]iods 7#a7 ,int]nal rev5ue code ,section #ihja7;f7 ( ! ,int]nal ,rev5ue ,code ( #aihf 7#bf ,u4,s4,c4 #ihja7;f77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#d7 ,= pregnant individuals 7,a7 ,a gr\p heal? plan %all p]mit an employee :o is eligible1 b n enroll$1 = cov]age "u ! t]ms ( ! plan 7or a dep5d5t ( su* an employee if ! dep5d5t is eligible1 b n enroll$1 = cov]age "u su* t]ms7 to enroll = cov]age "u ! t]ms ( ! plan ^u pregnancy1 ) ! special enrollm5t p]iod beg9n+ on ! date on :i* ! pregnancy is report$ to ! gr\p heal? plan or ! pregnancy is confirm$ by a heal? c>e provid]4 7,b7 ,! ,secret>y %all promulgate regulations ) respect to ! special enrollm5t p]iod "u subp>agraph 7,a71 includ+ e/abli%+ a "t p]iod = pregnant individuals to enroll 9 cov]age & effective date ( su* cov]age4 4 7#b7 ,,erisa ,section #gja7;f7 ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #aaha7;f77 is am5d$ by add+ at ! end ! foll[+3 7#d7 ,= pregnant individuals 7,a7 ,a gr\p heal? plan1 & a heal? insurance issu] (f]+ gr\p heal? insurance cov]age 9 connection ) a gr\p heal? plan1 %all p]mit an employee :o is eligible1 b n enroll$1 = cov]age "u ! t]ms ( ! plan 7or a dep5d5t ( su* an employee if ! dep5d5t is eligible1 b n enroll$1 = cov]age "u su* t]ms7 to enroll = cov]age "u ! t]ms ( ! plan ^u pregnancy1 ) ! special enrollm5t p]iod beg9n+ on ! date on :i* ! pregnancy is report$ to ! gr\p heal? plan or heal? insurance issu] or ! pregnancy is confirm$ by a heal? c>e provid]4 7,b7 ,! ,secret>y %all promulgate regulations ) respect to ! special enrollm5t p]iod "u subp>agraph 7,a71 includ+ e/abli%+ a "t p]iod = pregnant individuals to enroll 9 cov]age & effective date ( su* cov]age4 4 7d7 ,effective date ,! am5dm5ts made by ?is section %all apply ) respect to plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbb4 #dce4 ,cov]age ( mat]nity c>e = dep5d5t *ildr5 ,section #bgai;,a ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ai;a7 is am5d$ by add+ at ! end ! foll[+3 7e7 ,cov]age ( mat]nity c>e ,a gr\p heal? plan1 or heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age1 t provides cov]age = dep5dants %all ensure t su* plan or cov]age includes cov]age = mat]nity c>e associat$ ) pregnancy1 *ildbir?1 & po/p>tum c>e = all p>ticipants1 b5efici>ies1 or enrollees1 includ+ dep5dants1 includ+ cov]age ( labor & deliv]y4 ,su* cov]age %all be provid$ to all pregnant dep5d5ts reg>dless ( age4 4 #dcf4 ,f$]al ,employee ,heal? ,b5efit ,plans 7a7 ,cov]age ( pregnancy 7#a7 ,9 g5]al ,! ,director ( ! ,(fice ( ,p]sonnel ,managem5t %all issue su* regulations z are necess>y to ensure t pregnancy is consid]$ a *ange 9 family /atus & a qualify+ life ev5t = an individual :o is eligible to enroll1 b is n enroll$1 9 a heal? b5efit plan "u *apt] #hi ( title #e1 ,unit$ ,/ates ,code4 7#b7 ,effective date ,! requirem5t 9 p>agraph 7#a7 %all apply ) respect to any contract ent]$ into "u section #hijb ( su* title beg9n+ #ab mon?s aft] ! date ( enactm5t ( ?is ,act4 7b7 ,designat+ c]ta9 ,,fehbp-,relat$ s]vices z except$ s]vices "u ! anti-,defici5cy act 7#a7 ,9 g5]al ,section #hije ( title #e1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+3 7i7 ,any s]vices by an (fic] or employee "u ?is *apt] relat+ to enroll+ individuals 9 a heal? b5efits plan "u ?is *apt]1 or *ang+ ! enrollm5t ( an individual already s enroll$ due to an ev5t describ$ 9 section #dcf7;a77#a7 ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbj1 %all be deem$1 = purposes ( section #acdb ( title #ca1 s]vices = em]g5cies involv+ ! safety ( human life or ! protection ( prop]ty4 4 7#b7 ,application ,! am5dm5t made by p>agraph 7#a7 %all apply to any lapse 9 appropriations beg9n+ on or aft] ! date ( enactm5t ( ?is ,act4 #dcg4 ,cont9uation ( ,m$icaid income eligibility /&>d = pregnant individuals & infants ,section #aijb7l77#b77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7l77#b77;,a77 is am5d$-- 7#a7 9 clause 7i71 by /rik+ & n m ?an #ahe p]c5t2 7#b7 9 clause 7ii7-- 7,a7 9 subclause 7,i71 by /rik+ & aft] ! comma2 7,b7 9 subclause 7,,ii71 by /rik+ ! p]iod at ! end & ins]t+ 1 &2 & 7,c7 by add+ at ! end ! foll[+3 7,,iii7 ,janu>y #a1 #bjba1 is ! p]c5tage provid$ "u clause 7v74 2 & 7#c7 by add+ at ! end ! foll[+ new clause3 7v7 ,! p]c5tage provid$ "u clause 7ii7 = m$ical assi/ance provid$ on or aft] ,janu>y #a1 #bjba1 ) respect to individuals describ$ 9 subp>agraph 7,a7 or 7,b7 ( p>agraph 7#a7 %all n be less ?an-- 7,i7 ! p]c5tage specifi$ = su* individuals by ! ,/ate 9 an am5dm5t to its ,/ate plan 7:e!r approv$ or n7 z ( ,janu>y #a1 #bjad2 or 7,,ii7 if no su* p]c5tage is specifi$ z ( ,janu>y #a1 #bjad1 ! p]c5tage e/abli%$ = su* individuals "u ! ,/ate's au?oriz+ legislation or provid$ = "u ! ,/ate's appropriations z ( t date4 4 ,c ,advanc+ ,heal? ,equity ,?r\gh ,paym5t & ,deliv]y ,re=m #dda4 ,s5se ( ,congress ,x is ! s5se ( ,congress t-- 7#a7 ! su/a9ability ( ! heal? c>e sy/em 9 ! ,unit$ ,/ates h+es on re/ructur+ h[ heal? c>e is paid =1 %ift+ away f pay+ = ! volume ( s]vices provid$ to ! value ! s]vices provide2 7#b7 high value c>e is c>e t provides high] quality c>e m effici5tly1 a*iev+ great] heal? improvem5t & bett] heal? outcomes at l[] co/ 7p] pati5t & ov]all72 7#c7 a high value heal? c>e sy/em mu/ deliv] timely1 accessible1 well-coord9at$1 high-quality1 culturally c5t]$1 & language-appropriate c>e to ev]yone2 7#d7 elim9at+ heal? disp>ities & a*iev+ heal? equity mu/ be c5tral to ef=ts to a*ieve a high value heal? c>e sy/em2 7#e7 elim9at+ su* disp>ities & a*iev+ su* equity w require tailor$ int]v5tions & t>get$ inve/m5ts to address inequities 9 heal? & heal? c>e to make sure t heal? c>e deliv]y & paym5t ef=ts are responsive to & inclusive ( ! ne$s ( communities ( color & o!r communities exp]i5c+ disp>ities2 & 7#f7 new models ( value-bas$ paym5t & c>e deliv]y %\ld consid] ! holi/ic ne$s ( & o!r factors ) respect to ! pati5t population1 includ+ ) respect to behavioral heal?1 oral heal?1 hi/ory ( adv]se *ildhood exp]i5ces & adv]se community environm5ts1 social det]m9ants ( heal?1 social risk factors1 unmet social ne$s1 & ! burd5 ( int]g5]ational racial & o!r inequities4 #ddb4 ,c5t]s = ,m$ic>e ,m$icaid ,s]vices report+ & value bas$ programs 7a7 ,advanc+ ,heal? ,equity 9 ,report+ & ,value ,bas$ ,paym5t ,programs 7#a7 ,9 g5]al ,! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 79 ?is section ref]r$ to z ! ,adm9i/rator7 %all require t a cl9ician or o!r pr(essional p>ticipat+ 9 any pay-=-report+ or value bas$ paym5t program /ratify cl9ical quality measures by disp>ity v>iables1 includ+ race1 e?nicity1 sex1 prim>y language1 disability /atus1 sexual ori5tation1 g5d] id5tity1 & socioeconomic /atus4 ,a cl9ician or o!r pr(essional may use exi/+ demographic data collection fields 9 c]tifi$ electronic heal? record te*nology 7z def9$ 9 section #ahdh7o77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#d777 to c>ry out su* data /ratification "u ! prec$+ s5t5ce4 ,su* /ratifi$ data w assi/ cl9icians & o!r pr(essionals 9 ! id5tification ( disp>ities obscur$ 9 aggregat$ data & assi/ ) ! provision ( int]v5tions t t>get r$uc+ ^? disp>ities4 7#b7 ,cl9ician ,9 assess+ p]=mance 9 any value-bas$ paym5t program1 ! ,adm9i/rator %all incorporate a cl9ician or o!r pr(essional's p]=mance 9 r$uc+ disp>ities across race1 e?nicity1 sex1 prim>y language1 disability /atus1 sexual ori5tation1 g5d] id5tity1 & socioeconomic /atus4 ,l9k+ p]=mance paym5ts to ! r$uction ( heal? c>e disp>ities across su* v>iables w assi/ 9 hold+ cl9icians & o!r pr(essionals acc\ntable = provid+ quality c>e t c lead to decreas$ heal? inequities4 7#c7 ,requirem5t ( adoption ( c]t ,all entities1 cl9icians1 or o!r pr(essionals p>ticipat+ 9 ! ,quality ,paym5t ,program ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices %all be requir$ to adopt #bjae c]tifi$ electronic heal? record te*nology 7z s def9$7 z a condition ( p>ticipat+ 9 su* program4 7b7 ,quality improvem5t activities ,! ,adm9i/rator1 ^u ye>ly review ( ! ,quality ,paym5t ,program1 %all add quality improvem5t activities t implem5t ! ,culturally & ,l+ui/ically ,accessible ,/&>ds 7,,clas7 z ,improvem5t ,activities "u ! ,quality ,paym5t ,program4 #ddc4 ,developm5t & te/+ ( disp>ity r$uc+ deliv]y & paym5t models 7a7 ,9 g5]al ,! ,c5t] = ,m$ic>e & ,m$icaid ,innovation e/abli%$ "u section #aaae;,a ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7 79 ?is section ref]r$ to z ! ,,cmi7 %all e/abli% a d$icat$ fund to id5tify1 te/1 evaluate1 & scale deliv]y & paym5t models "u ! applicable titles 7z def9$ 9 subsection 7a77#d77;,b7 ( su* section7 t t>get heal? disp>ities among racial & e?nic m9orities1 includ+ models t support high-value non-m$ical s]vices t address socially det]m9$ b>ri]s to heal?1 includ+ ,engli% pr(ici5cy /atus1 l[ heal? lit]acy1 case managem5t1 transportation1 enrollm5t assi/ance ne$s1 /able & af=dable h\s+1 utility assi/ance1 employm5t & c>e] developm5t1 & nutrition & food security :i* w help to r$uce disp>ities & impact ! ov]all co/ ( c>e4 7b7 ,am5dm5t to ,social ,security ,act ,! second s5t5ce ( section #aaae;,a7a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7a77#a77 is am5d$ by ins]t+ & improve heal? equity aft] exp5ditures4 7c7 ,pilot programs ,! ,,cmi %all prioritize ! te/+ ( models "u su* section #aaae;,a t include p>tn]%ips ) entities1 includ+ community bas$ organizations or o!r nonpr(it entities1 to help address socially det]m9$ b>ri]s to heal? & heal? c>e4 7d7 ,alt]natives ,any model te/$ by ! ,,cmi "u su* #aaae;,a %all include measures to assess & track ! impact ( ! model on heal? disp>ities1 us+ exi/+ measures su* z ! ,heal?c>e ,disp>ities & ,cultural ,compet5cy ,measures endors$ by ! entity ) a contract "u section #ahij7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7a771 & /ratifi$ by race1 e?nicity1 ,engli% pr(ici5cy1 g5d] id5tity1 sexual ori5tation1 & disability /atus4 #ddd4 ,div]sity 9 ,c5t]s = ,m$ic>e & ,m$icaid consultation 7a7 ,9 g5]al ,9 c>ry+ out ! duties "u ?is section1 ! ,,cmi %all consult repres5tatives ( relevant ,f$]al ag5cies1 & cl9ical & analytical exp]ts ) exp]tise 9 m$ic9e & heal? c>e managem5t1 specifically su* exp]ts ) exp]tise 9-- 7#a7 ! heal? c>e ne$s ( m9ority1 rural1 & und]s]v$ populations2 & 7#b7 ! f9ancial ne$s ( safety net1 community bas$1 rural1 & critical access provid]s1 includ+ f$]ally qualifi$ heal? c5t]s4 7b7 ,op5 door =ums ,! ,,cmi %all use op5 door =ums or o!r me*anisms to seek ext]nal fe$back f int]e/$ p>ties & incorporate t fe$back into ! developm5t ( models4 #dde4 ,support+ safety net & community-bas$ provid]s to compete 9 value-bas$ paym5t sy/ems 7a7 ,9 g5]al ,any pay-=-p]=mance or alt]native paym5t model t is develop$ & te/$ by ! ,c5t] = ,m$ic>e & ,m$icaid ,innovation e/abli%$ "u section #aaae;,a ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae;a71 or any o!r ag5cy ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices ) respect to ! programs "u titles ,,xviii1 ,,xix1 or ,,xxi ( su* ,act1 %all be assess$ = pot5tial impact on safety net1 community bas$1 & critical access provid]s1 includ+ ,f$]ally qualifi$ heal? c5t]s4 7b7 ,new models ,! roll\t ( any su* models %all include tra9+ & additional up front res\rces = community bas$ & safety net provid]s to enable ^? provid]s to p>ticipate 9 ! model4 ,d ,heal? ,emp[]m5t ,zones #dea4 ,%ort title ,?is subtitle may be cit$ z ! ,heal? ,emp[]m5t ,zone ,act ( #bjbj4 #deb4 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,num]\s /udies & reports1 includ+ ! #bjae ,national ,heal?c>e ,quality & ,disp>ities ,report ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality & ! #bjjb report ( ! ,in/itute ( ,m$ic9e entitl$ ,unequal ,treatm5t3 ,confront+ ,racial & ,e?nic ,disp>ities 9 ,heal? ,c>e1 docum5t ! ext5siv5ess to :i* heal? disp>ities exi/ across ! c\ntry4 7#b7 ,^! /udies h f\nd t1 on av]age1 racial & e?nic m9orities are disproportionately afflict$ ) *ronic & acute conditions--su* z canc]1 diabetes1 musculoskeletal disease1 obesity1 & hyp]t5sion--& suff] worse heal? outcomes1 worse heal? /atus1 & high] mortality rates ?an _! ,:ite c\nt]p>ts4 7#c7 ,sev]al rec5t /udies also %[ t heal? disp>ities are a function ( n only access to heal? c>e1 b also ! social det]m9ants ( heal?--includ+ ! environm5t1 ! physical /ructure ( communities1 nutrition & food options1 educational atta9m5t & heal? lit]acy1 employm5t1 race1 e?nicity1 immigration /atus1 geography1 & language pref]5ce--t directly & indirectly affect ! heal?1 heal? c>e1 & wellness ( individuals & communities4 7#d7 ,integrally involv+ & fully support+ ! communities mo/ affect$ by heal? inequities 9 ! assessm5t1 plann+1 laun*1 & evaluation ( heal? disp>ity elim9ation ef=ts are among ! lead+ recomm5dations made to adequately address & ultimately r$uce heal? disp>ities4 7#e7 ,recomm5dations also include support+ ! ef=ts ( community /akehold]s f a broad cross section--includ+ local bus9esses1 local dep>tm5ts ( comm]ce1 education1 labor1 urban plann+1 & transportation1 & community-bas$ & o!r nonpr(it organizations1 includ+ national & regional int]m$i>ies ) demon/rat$ capacity to s]ve l[-income urban communities--to f9d areas ( common gr\nd ar\nd heal? disp>ity elim9ation & collaborate to improve ! ov]all heal? & wellness ( a community & its resid5ts4 #dec4 ,designation ( heal? emp[]m5t zones 7a7 ,9 g5]al ,! ,secret>y may1 at ! reque/ ( an eligible community p>tn]%ip describ$ 9 subsection 7b77#a71 designate an eligible area describ$ 9 subsection 7b77#b7 z a heal? emp[]m5t zone = ! purpose ( eligibility = a grant "u section #dee4 7b7 ,eligibility crit]ia 7#a7 ,eligible community p>tn]%ip ,a community p>tn]%ip is eligible to submit a reque/ "u ?is section if ! p>tn]%ip-- 7,a7 demon/rates widespread public support f key individuals & entities 9 ! eligible area1 includ+ memb]s ( ! t>get community1 ,/ate & local gov]nm5ts1 nonpr(it organizations includ+ national & regional int]m$i>ies ) demon/rat$ capacity to s]ve l[-income urban communities1 & community & indu/ry lead]s1 = designation ( ! eligible area z a heal? emp[]m5t zone2 & 7,b7 includes repres5tatives (-- 7i7 a broad cross section ( /akehold]s & resid5ts f communities 9 ! eligible area exp]i5c+ disproportionate disp>ities 9 heal? /atus & heal? c>e2 & 7ii7 organizations1 facilities1 & in/itutions t h a hi/ory ( work+ )9 & s]v+ su* communities4 7#b7 ,eligible area ,an area is eligible to be designat$ z a heal? emp[]m5t zone "u ?is section if "o or m communities 9 ! area exp]i5ce disproportionate disp>ities 9 heal? /atus & heal? c>e4 ,9 det]m9+ :e!r a community exp]i5ces su* disp>ities1 ! ,secret>y %all consid] data collect$ by ! ,dep>tm5t ( ,heal? & ,human ,s]vices focus+ on ! foll[+ areas3 7,a7 ,access to af=dable1 high-quality heal? s]vices4 7,b7 ,! preval5ce ( disproportionate rates ( c]ta9 illnesses or diseases includ+ ! foll[+3 7i7 ,ar?ritis1 o/eoporosis1 *ronic back conditions1 & o!r musculoskeletal diseases4 7ii7 ,canc]4 7iii7 ,*ronic kidney disease4 7iv7 ,diabetes4 7v7 ,injury 7int5tional & un9t5tional74 7vi7 ,viol5ce 7intimate & non9timate74 7vii7 ,mat]nal & pat]nal illnesses & diseases4 7viii7 ,infant mortality4 7ix7 ,m5tal illness & o!r disabilities4 7x7 ,sub/ance use disord] treatm5t & prev5tion1 includ+ und]age dr9k+4 7xi7 ,nutrition1 obesity1 & ov]weight conditions4 7xii7 ,he>t disease4 7xiii7 ,hyp]t5sion4 7xiv7 ,c]ebrovascul> disease or /roke4 7xv7 ,tub]culosis4 7xvi7 ,,hiv_/,,aids & o!r sexually transmitt$ infections4 7xvii7 ,viral hepatitis4 7xviii7 ,a/hma4 7xix7 ,too? decay & o!r oral heal? issues4 7,c7 ,)9 ! community1 ! hi/orical & p]si/5t pres5ce ( conditions t h be5 f\nd to contribute to heal? disp>ities includ+ any su* conditions respect+ any ( ! foll[+3 7i7 ,pov]ty4 7ii7 ,educational /atus & ! quality ( community s*ools4 7iii7 ,income4 7iv7 ,access to high-quality af=dable heal? c>e4 7v7 ,"w & "w environm5t4 7vi7 ,environm5tal conditions 9 ! community1 includ+ ) respect to clean wat]1 clean air1 & ! pres5ce or abs5ce ( pollutants4 7vii7 ,language & ,engli% pr(ici5cy4 7viii7 ,access to af=dable heal?y food4 7ix7 ,access to e?nically & culturally div]se heal? & human s]vice provid]s & practition]s4 7x7 ,access to culturally & l+ui/ically compet5t heal? & human s]vices & heal? & human s]vice provid]s4 7xi7 ,heal?-support+ infra/ructure4 7xii7 ,heal? insurance t is adequate & af=dable4 7xiii7 ,race1 racism1 & bigotry 7consci\s & unconsci\s74 7xiv7 ,sexual ori5tation4 7xv7 ,heal? lit]acy4 7xvi7 ,place ( resid5ce 7su* z urban areas1 rural areas1 & res]vations ( ,indian tribes74 7xvii7 ,/ress4 7c7 ,proc$ure 7#a7 ,reque/ ,a reque/ "u subsection 7a7 %all-- 7,a7 describe ! b\nds ( ! area to be designat$ z a heal? emp[]m5t zone & ! process us$ to select ^? b\nds2 7,b7 demon/rate t ! p>tn]%ip submitt+ ! reque/ is an eligible community p>tn]%ip describ$ 9 subsection 7b77#a72 7,c7 demon/rate t ! area is an eligible area describ$ 9 subsection 7b77#b72 7,d7 include a compreh5sive assessm5t ( disp>ities 9 heal? /atus & heal? c>e exp]i5ce by "o or m communities 9 ! area2 7,e7 set =?-- 7i7 a vision & a set ( values = ! area2 & 7ii7 a compreh5sive & holi/ic set ( goals to be a*iev$ 9 ! area ?r\gh designation z a heal? emp[]m5t zone2 & 7,f7 include a /rategic plan & an action plan = a*iev+ ! goals describ$ 9 subp>agraph 7,e77ii74 7#b7 ,approval ,n lat] ?an #fj days aft] ! receipt ( a reque/ = designation ( an area z a heal? emp[]m5t zone "u ?is section1 ! ,secret>y %all approve or disapprove ! reque/4 7d7 ,m9imum numb] ,! ,secret>y-- 7#a7 %all designate n m ?an #aaj heal? emp[]m5t zones "u ?is section2 & 7#b7 ( su* zones designat$ "u p>agraph 7#a71 %all designate at lea/ "o heal? emp[]m5t zone 9 ea* ( ! sev]al ,/ates1 ! ,di/rict ( ,columbia1 & ea* t]ritory or possession ( ! ,unit$ ,/ates4 #ded4 ,assi/ance to ^? seek+ designation ,at ! reque/ ( any organization or entity seek+ to submit a reque/ "u section #dec7;a71 ! ,secret>y %all provide te*nical assi/ance1 & may aw>d a grant1 to assi/ su* organization or entity-- 7#a7 to =m an eligible community p>tn]%ip describ$ 9 section #dec7;b77#a72 7#b7 to complete a heal? assessm5t1 includ+ an assessm5t ( heal? disp>ities "u section #dec7;c77#a77;,d72 or 7#c7 to prep>e & submit a reque/1 includ+ a /rategic plan1 9 accordance ) section #dec4 #dee4 ,b5efits ( designation 7a7 ,priority ,9 aw>d+ a grant "u subsection 7b71 a ,f$]al (ficial %all give priority to any applicant t-- 7#a7 meets ! eligibility crit]ia = ! grant2 7#b7 proposes to use ! grant = activities 9 a heal? emp[]m5t zone2 & 7#c7 demon/rates t su* activities w directly & significantly fur!r ! goals ( ! /rategic plan approv$ = su* zone "u section #dec4 7b7 ,grants = initial implem5tation ( /rategic plan 7#a7 ,9 g5]al ,^u designat+ an eligible area z a heal? emp[]m5t zone at ! reque/ ( an eligible community p>tn]%ip1 ! ,secret>y %all1 subject to ! availability ( appropriations1 make a grant to ! community p>tn]%ip = implem5tation ( ! /rategic plan = su* zone4 7#b7 ,grant p]iod ,a grant "u p>agraph 7#a7 = a heal? emp[]m5t zone %all be = a p]iod ( #b ye>s & may be r5ew$1 except t ! total p]iod ( grants "u p>agraph 7#a7 = su* zone may n exce$ #aj ye>s4 7#c7 ,limitation ,9 aw>d+ grants "u ?is subsection1 ! ,secret>y %all n give less priority to an applicant or r$uce ! am\nt ( a grant because ! ,secret>y r5d]$ te*nical assi/ance or made a grant to ! same applicant "u section #ded4 7#d7 ,report+ ,! ,secret>y %all e/abli% metrics = measur+ ! progress ( grantees "u ?is subsection &1 bas$ on su* metrics1 require ea* su* grantee to report to ! ,secret>y n less ?an e #f mon?s on ! progress 9 implem5t+ ! /rategic plan = ! heal? emp[]m5t zone4 #def4 ,def9ition ( ,secret>y ,9 ?is subtitle1 ! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration & ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 & 9 coop]ation ) ! ,director ( ! ,(fice ( ,community ,s]vices & ! ,director ( ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities4 #deg4 ,au?orization ( appropriations ,to c>ry out ?is subtitle1 !re is au?oriz$ to be appropriat$ #ajj1jjj1jjj = fiscal ye> #bjba4 ,v ,,improv+ ,,heal? ,,outcomes ,,= ,,wom51 ,,*ildr51 ,,& ,,families ,a ,9 ,g5]al #eja4 ,grants to promote heal? = und]s]v$ communities ,"p ,q ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhj;h et seq47 is am5d$ by add+ at ! end ! foll[+3 #cii,z-#c4 ,grants to promote heal? = und]s]v$ communities 7a7 ,grants ,au?oriz$ ,! ,secret>y1 9 collaboration ) ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration & o!r ,f$]al (ficials det]m9$ appropriate by ! ,secret>y1 is au?oriz$ to aw>d grants to eligible entities-- 7#a7 to promote heal? = und]s]v$ communities1 ) pref]5ce giv5 to projects t b5efit racial & e?nic m9ority wom51 racial & e?nic m9ority *ildr51 adolesc5ts1 & lesbian1 gay1 bisexual1 transg5d]1 que]1 or que/ion+ communities2 & 7#b7 to /r5g!n heal? outrea* initiatives 9 m$ically und]s]v$ communities1 includ+ l+ui/ically isolat$ populations4 7b7 ,use ( ,funds ,grants aw>d$ pursuant to subsection 7a7 may be us$ to support ! activities ( community heal? work]s1 includ+ su* activities-- 7#a7 to educate & provide outrea* reg>d+ enrollm5t 9 heal? insurance includ+ ! ,/ate ,*ildr5's ,heal? ,insurance ,program "u title ,,xxi ( ! ,social ,security ,act1 ,m$ic>e "u title ,,xviii ( su* ,act1 & ,m$icaid "u title ,,xix ( su* ,act2 7#b7 to educate & provide outrea* 9 a community sett+ reg>d+ heal? problems preval5t among und]s]v$ communities1 & especially among racial & e?nic m9ority wom51 racial & e?nic m9ority *ildr51 adolesc5ts1 & lesbian1 gay1 bisexual1 transg5d]1 que]1 or que/ion+ communities2 7#c7 to educate & provide exp]i5tial le>n+ opportunities & t>get risk factors & heal?y behaviors t imp$e or contribute to a*iev+ positive heal? outcomes1 includ+-- 7,a7 heal?y nutrition2 7,b7 physical activity2 7,c7 ov]weight or obesity2 7,d7 tobacco use1 includ+ ! use ( e-cig>ettes & vap+2 7,e7 alcohol & sub/ance use2 7,f7 injury & viol5ce2 7,g7 sexual heal?2 7,h7 m5tal heal?2 7,i7 musculoskeletal heal? & ar?ritis2 7,j7 pr5atal & po/natal c>e2 7,k7 d5tal & oral heal?2 7,l7 und]/&+ in=m$ cons5t2 7,m7 /igma2 & 7,n7 environm5tal haz>ds2 7#d7 to promote community wellness & aw>5ess2 & 7#e7 to educate & ref] t>get populations to appropriate heal? c>e ag5cies & community-bas$ programs & organizations 9 ord] to increase access to quality heal? c>e s]vices1 includ+ prev5tive heal? s]vices4 7c7 ,application 7#a7 ,9 g5]al ,ea* eligible entity t desires to receive a grant "u subsection 7a7 %all submit an application to ! ,secret>y1 at su* "t1 9 su* mann]1 & accompani$ by su* additional in=mation z ! ,secret>y may require4 7#b7 ,cont5ts ,ea* application submitt$ pursuant to p>agraph 7#a7 %all-- 7,a7 describe ! activities = :i* assi/ance "u ?is section is s\ght2 7,b7 conta9 an assurance t1 ) respect to ea* community heal? work] program receiv+ funds "u ! grant aw>d$1 su* program provides 9-language tra9+ & sup]vision to community heal? work]s to enable su* work]s to provide au?oriz$ program activities 9 7at lea/7 ! mo/ commonly us$ languages )9 a p>ticul> geographic region2 7,c7 conta9 an assurance t ! applicant w evaluate ! effectiv5ess ( community heal? work] programs receiv+ funds "u ! grant2 7,d7 conta9 an assurance t ea* community heal? work] program receiv+ funds "u ! grant w provide culturally compet5t s]vices 9 ! l+ui/ic context mo/ appropriate = ! individuals s]v$ by ! program2 7,e7 conta9 a plan to docum5t & dissem9ate project descriptions & results to o!r ,/ates & organizations z id5tifi$ by ! ,secret>y2 & 7,f7 describe plans to enhance ! capacity ( individuals to utilize heal? s]vices & heal?-relat$ social s]vices "u ,f$]al1 ,/ate1 & local programs by-- 7i7 assi/+ individuals 9 e/abli%+ eligibility "u ! programs & 9 receiv+ ! s]vices or o!r b5efits ( ! programs2 & 7ii7 provid+ o!r s]vices1 z ! ,secret>y det]m9es to be appropriate1 :i* may include transportation & translation s]vices4 7d7 ,priority ,9 aw>d+ grants "u subsection 7a71 ! ,secret>y %all give priority to ^? applicants-- 7#a7 :o propose to t>get geographic areas t-- 7,a7 7i7 h a high p]c5tage ( resid5ts :o are un9sur$ or und]9sur$ 7if ! t>get$ geographic area is locat$ 9 a ,/ate t has elect$ to make m$ical assi/ance available "u section #aijb7;a77#aj77;,a77i77,,viii7 ( ! ,social ,security ,act to individuals describ$ 9 su* section72 7ii7 h a high p]c5tage ( und]9sur$ resid5ts 9 a p>ticul> geographic area 7if ! t>get$ geographic area is locat$ 9 a ,/ate t has n s elect$72 or 7iii7 h a high numb] ( h\seholds exp]i5c+ extreme pov]ty2 & 7,b7 h a high p]c5tage ( families = :om ,engli% is n _! prim>y language or includ+ small] limit$ ,engli%-pr(ici5t communities )9 ! region t are n o!rwise rea*$ by l+ui/ically appropriate heal? s]vices2 7#b7 ) exp]i5ce 9 provid+ heal? or heal?-relat$ social s]vices to individuals :o are und]s]v$ ) respect to su* s]vices2 & 7#c7 ) docum5t$ community activity & exp]i5ce ) community heal? work]s4 7e7 ,collaboration ) academic in/itutions ,! ,secret>y %all enc\rage community heal? work] programs receiv+ funds "u ?is section to collaborate ) academic in/itutions1 includ+ m9ority-s]v+ in/itutions4 ,no?+ 9 ?is section %all be con/ru$ to require su* collaboration4 7f7 ,quality assurance & co/ effectiv5ess ,! ,secret>y %all e/abli% guidel9es = ensur+ ! quality ( ! tra9+ & sup]vision ( community heal? work]s "u ! programs fund$ "u ?is section & = ensur+ ! co/ effectiv5ess ( su* programs4 7g7 ,monitor+ ,! ,secret>y %all monitor community heal? work] programs id5tifi$ 9 approv$ applications & %all det]m9e :e!r su* programs are 9 compliance ) ! guidel9es e/abli%$ "u subsection 7f74 7h7 ,te*nical assi/ance ,! ,secret>y may provide te*nical assi/ance to community heal? work] programs id5tifi$ 9 approv$ applications ) respect to plann+1 develop+1 & op]at+ programs "u ! grant4 7i7 ,report to ,congress 7#a7 ,9 g5]al ,n lat] ?an #d ye>s aft] ! date on :i* ! ,secret>y fir/ aw>ds grants "u subsection 7a71 ! ,secret>y %all submit to ,congress a report reg>d+ ! grant project4 7#b7 ,cont5ts ,! report requir$ "u p>agraph 7#a7 %all include ! foll[+3 7,a7 ,a description ( ! programs = :i* grant funds 7 us$4 7,b7 ,! numb] ( individuals s]v$4 7,c7 ,an evaluation (-- 7i7 ! effectiv5ess ( ^! programs2 7ii7 ! co/ ( ^! programs2 & 7iii7 ! impact ( ^! programs on ! heal? outcomes ( ! community resid5ts4 7,d7 ,recomm5dations = su/a9+ ! community heal? work] programs develop$ or assi/$ "u ?is section4 7,e7 ,recomm5dations reg>d+ tra9+ to enhance c>e] opportunities = community heal? work]s4 7j7 ,def9itions ,9 ?is section3 7#a7 ,community heal? work] ,! t]m community heal? work] means an individual :o promotes heal? or nutrition )9 ! community 9 :i* ! individual resides-- 7,a7 by s]v+ z a liaison betwe5 communities & heal? c>e ag5cies2 7,b7 by provid+ guidance & social assi/ance to community resid5ts2 7,c7 by enhanc+ community resid5ts' ability to effectively communicate ) heal? c>e provid]s2 7,d7 by provid+ culturally & l+ui/ically appropriate heal? or nutrition education2 7,e7 by advocat+ = individual & community heal?1 includ+ d5tal1 oral1 m5tal1 & environm5tal heal?1 or nutrition ne$s2 7,f7 by tak+ into consid]ation ! ne$s ( ! communities s]v$1 includ+ ! preval5ce rates ( risk factors t imp$e a*iev+ positive heal?y outcomes among wom5 & *ildr51 especially among racial & e?nic m9ority wom5 & *ildr52 & 7,g7 by provid+ ref]ral & foll[up s]vices4 7#b7 ,community sett+ ,! t]m community sett+ means a home or a community organization t s]ves a population4 7#c7 ,eligible entity ,! t]m eligible entity means-- 7,a7 a unit ( ,/ate1 t]ritorial1 local1 or ,tribal gov]nm5t 7includ+ a f$]ally recogniz$ ,tribe or ,alaska ,native village72 or 7,b7 a community-bas$ organization4 7#d7 ,m$ically und]s]v$ community ,! t]m m$ically und]s]v$ community means a community-- 7,a7 t has a sub/antial numb] ( individuals :o are memb]s ( a m$ically und]s]v$ population1 z def9$ by section #ccj7;b77#c72 7,b7 a significant portion ( :i* is a heal? pr(essional %ortage area z designat$ "u section #ccb2 & 7,c7 t includes populations t are l+ui/ically isolat$1 su* z geographic areas ) a %ortage ( heal? pr(essionals able to provide l+ui/ically appropriate s]vices4 7#e7 ,support ,! t]m support means ! provision ( tra9+1 sup]vision1 & mat]ials ne$$ to effectively deliv] ! s]vices describ$ 9 subsection 7b71 reimbursem5t = s]vices1 & o!r b5efits4 7k7 ,au?orization ( ,appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section #ae1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 4 #ejb4 ,remov+ b>ri]s to heal? c>e & nutrition assi/ance = *ildr51 pregnant p]sons1 & lawfully pres5t individuals 7a7 ,m$icaid ,section #aijc7v7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7v77 is am5d$ by /rik+ p>agraph 7#d7 & ins]t+ ! foll[+ new p>agraph3 7#d7 7,a7 ,not)/&+ sections #dja7;a71 #djb7;b71 #djc1 & #dba ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif & p>agraph 7#a71 paym5t %all be made to a ,/ate "u ?is section = m$ical assi/ance furni%$ to an ali5 "u ?is title 7includ+ an ali5 describ$ 9 su* p>agraph7 :o meets any ( ! foll[+ conditions3 7i7 ,! ali5 is o!rwise eligible = su* assi/ance "u ! ,/ate plan approv$ "u ?is title 7o!r ?an ! requirem5t ( ! receipt ( aid or assi/ance "u title ,,iv1 supplem5tal security income b5efits "u title ,,xvi1 or a ,/ate supplem5t>y paym5t7 )9 ei!r or bo? ( ! foll[+ eligibility categories3 7,i7 ,*ildr5 "u #ba ye>s ( age1 includ+ any optional t>get$ l[-income *ild 7z su* t]m is def9$ 9 section #aije7u77#b77;,b774 7,,ii7 ,pregnant p]sons dur+ pregnancy & dur+ ! #ab-mon? p]iod beg9n+ on ! la/ day ( ! pregnancy4 7ii7 ,! ali5 is lawfully pres5t 9 ! ,unit$ ,/ates4 7,b7 ,no debt %all accrue "u an affidavit ( support aga9/ any sponsor ( an ali5 :o meets ! conditions specifi$ 9 subp>agraph 7,a7 on ! basis ( ! provision ( m$ical assi/ance to su* ali5 "u ?is p>agraph & ! co/ ( su* assi/ance %all n be consid]$ z an unreimburs$ co/4 4 7b7 ,,*ip ,subp>agraph 7,n7 ( section #bajg7;e77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77 is am5d$ to read z foll[s3 7,n7 ,p>agraph 7#d7 ( section #aijc7v7 7relat+ to cov]age ( categories ( *ildr51 pregnant p]sons1 & o!r lawfully pres5t individuals74 4 7c7 ,supplem5tal nutrition assi/ance = lawfully pres5t individuals 7#a7 ,9 g5]al ,section #djb7;a77#b77;,j7 ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#h ,u4,s4,c4 #afab7;a77#b77;,j77 is am5d$-- 7,a7 9 ! subp>agraph head+1 by /rik+ c]ta9 *ildr5 ins]t+ *ildr5 & lawfully pres5t individuals2 & 7,b7 by /rik+ :o is "u #ah ye>s ( age4 & ins]t+ 8:o is-- 7i7 "u #ba ye>s ( age2 or 7ii7 lawfully pres5t 9 ! ,unit$ ,/ates4 4 7#b7 ,con=m+ am5dm5ts 7,a7 ,section #djb7;a77#c7 ( su* ,act 7#h ,u4,s4,c4 #afab7;a77#c77 is am5d$ by /rik+ subp>agraph 7,b7 & ins]t+ ! foll[+3 7,b7 ,,snap 7food /amp program7 ,! supplem5tal nutrition assi/ance program e/abli%$ "u ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjaa et seq47 7ref]r$ to 9 ?is title z ,,snap or ! food /amp program74 4 7,b7 ,section #djc7;c77#b77,l7 ( su* ,act 7#db ,u4,s4,c4 #afac7;c77#b77,l77 is am5d$ by /rik+ #ah & all t foll[s ?r\gh ! p]iod & ins]t+ #ba1 or to individuals :o are lawfully pres5t 9 ! ,unit$ ,/ates1 "u ! supplem5tal nutrition assi/ance program e/abli%$ "u ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjaa et seq4744 7,c7 ,section #e7;i77#b77;,e7 ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjad7;i77#b77;,e77 is am5d$ by /rik+ #ah ye>s ( age4 & ins]t+ #ba ye>s ( age1 or :o is lawfully pres5t 9 ! ,unit$ ,/ates44 7d7 ,nonapplication ( sponsor deem+2 assur+ eligibility = families ,section #dba7;d7 ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#h ,u4,s4,c4 #afca7;d77 is am5d$ by /rik+ p>agraph 7#c7 & ins]t+ ! foll[+3 7#c7 ,?is section %all n apply to assi/ance or b5efits "u ! supplem5tal nutrition assi/ance program e/abli%$ "u ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjaa et seq47 = a qualifi$ ali5 :o is eligible "u section #djb7;a77#b77;,j7 & = any memb] ( ! h\sehold ( su* qualifi$ ali54 4 7e7 ,ensur+ prop] scre5+ ,section #aa7;e77#b77;,b7 ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjbj7;e77#b77;,b77 is am5d$-- 7#a7 by r$esignat+ clauses 7vi7 & 7vii7 z clauses 7vii7 & 7viii71 respectively2 & 7#b7 by ins]t+ aft] clause 7v7 ! foll[+3 7vi7 %all provide a me?od = implem5t+ section #dba ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#h ,u4,s4,c4 #afca7 t does n require any unnecess>y in=mation f applicants :o may be exempt f t provision2 4 #ejc4 ,repeal ( d5ial ( ,,snap b5efits ,section #aae ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#ba ,u4,s4,c4 #hfb;a7 is am5d$-- 7#a7 9 subsection 7a71 by /rik+ =-- & all t foll[s & ins]t+ = assi/ance "u any ,/ate program fund$ "u "p ,a ( title ,,iv ( ! ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq4742 7#b7 9 subsection 7b7-- 7,a7 by /rik+ 7#a7 ,program ( tempor>y assi/ance = ne$y families4--2 & 7,b7 by /rik+ p>agraph 7#b72 & 7#c7 9 subsection 7e71 by /rik+ x-- & all t foll[s & ins]t+ ! t]m 9 section #dai7e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #fai7e77 :5 ref]r+ to assi/ance provid$ "u a ,/ate program fund$ "u p>agraph ,a ( title ,,iv ( ! ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq4744 #ejd4 ,bir? defects prev5tion1 risk r$uction1 & aw>5ess 7a7 ,9 g5]al ,! ,secret>y %all e/abli% & implem5t a bir? defects prev5tion & public aw>5ess program1 consi/+ ( ! activities describ$ 9 subsections 7c7 & 7d74 7b7 ,def9itions ,9 ?is section3 7#a7 ,mat]nal ,! t]m mat]nal ref]s to p]sons :o are pregnant or brea/fe$+ ( all g5d] id5tities4 7#b7 ,pregnancy & brea/fe$+ in=mation s]vices ,! t]m pregnancy & brea/fe$+ in=mation s]vices includes only-- 7,a7 in=mation s]vices to provide accurate1 evid5ce-bas$1 cl9ical in=mation reg>d+ mat]nal exposures dur+ pregnancy t may be associat$ ) bir? defects or o!r heal? risks1 su* z exposures to m$ications1 *emicals1 infections1 foodborne pa?og5s1 illnesses1 nutrition1 or life/yle factors2 7,b7 in=mation s]vices to provide accurate1 evid5ce-bas$1 cl9ical in=mation reg>d+ mat]nal exposures dur+ brea/fe$+ t may be associat$ ) heal? risks to a brea/-f$ infant1 su* z exposures to m$ications1 *emicals1 infections1 foodborne pa?og5s1 illnesses1 nutrition1 life/yle1 or climate- & wea!r-relat$ factors2 7,c7 ! provision ( accurate1 evid5ce-bas$ in=mation weigh+ risks ( exposures dur+ brea/fe$+ aga9/ ! b5efits ( brea/fe$+2 & 7,d7 ! provision ( in=mation describ$ 9 subp>agraph 7,a71 7,b71 or 7,c7 ?r\gh c\nselors1 websites1 fact %eets1 telephonic or electronic communication1 community outrea* ef=ts1 or o!r appropriate means4 7#c7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion4 7c7 ,nationwide m$ia campaign ,9 c>ry+ out subsection 7a71 ! ,secret>y %all conduct or support a nationwide m$ia campaign to increase aw>5ess among heal? c>e provid]s & at-risk populations ab\t pregnancy & brea/fe$+ in=mation s]vices4 7d7 ,grants = pregnancy & brea/fe$+ in=mation s]vices 7#a7 ,9 g5]al ,9 c>ry+ out subsection 7a71 ! ,secret>y %all aw>d grants to ,/ate or regional ag5cies or organizations = any ( ! foll[+3 7,a7 ,in=mation s]vices ,! provision (1 or campaigns to increase aw>5ess ab\t1 pregnancy & brea/fe$+ in=mation s]vices4 7,b7 ,surveillance & rese>* ,! conduct or support (-- 7i7 surveillance ( or rese>* on-- 7,i7 mat]nal exposures & mat]nal heal? conditions t may influ5ce ! risk ( bir? defects1 prematurity1 or o!r adv]se pregnancy outcomes2 & 7,,ii7 mat]nal exposures t may influ5ce heal? risks to a brea/f$ infant2 or 7ii7 network+ to facilitate surveillance or rese>* describ$ 9 ?is subp>agraph4 7#b7 ,pref]5ce = c]ta9 ,/ates ,! ,secret>y1 9 mak+ any grant "u ?is subsection1 %all give pref]5ce to ,/ates1 o!rwise equally qualifi$1 t h a pregnancy & brea/fe$+ in=mation s]vice 9 place4 7#c7 ,mat*+ funds ,! ,secret>y may only aw>d a grant "u ?is subsection to a ,/ate or regional ag5cy or organization t agrees1 ) respect to ! co/s to be incurr$ 9 c>ry+ out ! grant activities1 to make available 7directly or ?r\gh donations f public or private entities7 non-,f$]al funds t[>d su* co/s 9 an am\nt equal to n less ?an #be p]c5t ( ! am\nt ( ! grant4 7#d7 ,coord9ation ,! ,secret>y %all ensure t activities fund$ ?r\gh a grant "u ?is subsection are coord9at$1 to ! maximum ext5t practicable1 ) o!r bir? defects prev5tion & environm5tal heal? activities ( ! ,f$]al ,gov]nm5t1 includ+ ) respect to p$iatric environm5tal heal? specialty units & *ildr5's environm5tal heal? c5t]s4 7e7 ,evaluation ,9 fur!rance ( ! program "u subsection 7a71 ! ,secret>y %all provide = an evaluation ( pregnancy & brea/fe$+ in=mation s]vices to id5tify effici5t & effective models (-- 7#a7 provid+ in=mation2 7#b7 rais+ aw>5ess & increas+ k ab\t bir? defects prev5tion measures & t>get+ education to at-risk gr\ps2 7#c7 modify+ risk behaviors2 or 7#d7 o!r outcome measures z det]m9$ appropriate by ! ,secret>y4 7f7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ #e1jjj1jjj = fiscal ye> #bjba1 #f1jjj1jjj = fiscal ye> #bjbb1 #g1jjj1jjj = fiscal ye> #bjbc1 #h1jjj1jjj = fiscal ye> #bjbd1 & #i1jjj1jjj = fiscal ye> #bjbe4 #eje4 ,,momma's ,act 7a7 ,%ort title ,?is section may be cit$ z ! ,mo!rs & ,(fspr+ ,mortality & ,morbidity ,aw>5ess ,act or ! ,,momma's ,act4 7b7 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,e ye>1 across ! ,unit$ ,/ates1 #d1jjj1jjj wom5 give bir?1 ab\t #gjj wom5 suff] fatal complications dur+ pregnancy1 :ile giv+ bir? or dur+ ! po/p>tum p]iod1 & #gj1jjj wom5 suff] ne>-fatal1 p>tum-relat$ complications4 7#b7 ,! mat]nal mortality rate is (t5 us$ z a proxy to measure ! ov]all heal? ( a population4 ,:ile ! infant mortality rate 9 ! ,unit$ ,/ates has rea*$ its l[e/ po9t1 ! risk ( dea? = wom5 9 ! ,unit$ ,/ates dur+ pregnancy1 *ildbir?1 or ! po/p>tum p]iod is high] ?an su* risk 9 _m o!r develop$ nations4 ,! e/imat$ mat]nal mortality rate 7p] #ajj1jjj live bir?s7 = ! #dh contigu\s ,/ates & ,wa%+ton1 ,,dc1 increas$ f #ah4h p]c5t 9 #bjjj1 to #bc4h p]c5t 9 #bjad1 to #bf4f p]c5t 9 #bjah4 ,?is e/imat$ rate is on p> ) su* rate = und]develop$ nations su* z ,iraq & ,afghani/an4 7#c7 ,x is e/imat$ t m ?an #fj p]c5t ( mat]nal dea?s 9 ! ,unit$ ,/ates are prev5table4 7#d7 ,accord+ to ! ,c5t]s = ,disease ,control & ,prev5tion1 ! mat]nal mortality rate v>ies dra/ically = wom5 by race & e?nicity4 ,!re are #ab4g dea?s p] #ajj1jjj live bir?s = ,:ite wom51 #dc4e dea?s p] #ajj1jjj live bir?s = ,african-,am]ican wom51 & #ad4d dea?s p] #ajj1jjj live bir?s = wom5 ( o!r e?nicities4 ,:ile mat]nal mortality disp>ately impacts ,african-,am]ican wom51 ?is urg5t public heal? crisis trav]ses race1 e?nicity1 socioeconomic /atus1 educational backgr\nd1 & geography4 7#e7 ,african-,am]ican wom5 are #c to #d times m likely to die f causes relat$ to pregnancy & *ildbir? comp>$ to non-,hispanic ,:ite wom54 7#f7 ,! f9d+s describ$ 9 p>agraphs 7#a7 ?r\gh 7#f7 are ( major conc]n to rese>*]s1 academics1 memb]s ( ! bus9ess community1 & provid]s across ! ob/etrical cont9uum repres5t$ by organizations su* z ,m>* ( ,dimes2 ! ,preeclampsia ,f\ndation2 ! ,am]ican ,college ( ,ob/etricians & ,gynecologi/s2 ! ,society = ,mat]nal-,fetal ,m$ic9e2 ! ,association ( ,wom5's ,heal?1 ,ob/etric1 & ,neonatal ,nurses2 ! ,cali=nia ,mat]nal ,quality ,c>e ,collaborative2 ,black ,wom5's ,heal? ,imp]ative2 ! ,national ,bir? ,equity ,collaborative2 ,black ,mamas ,matt] ,alliance2 ,ever,thrive ,ill9ois2 ! ,national ,association ( ,c]tifi$ ,pr(essional ,midwives2 ,,pcos ,*all5ge3 ,! ,national ,polycy/ic ,ov>y ,syndrome ,association2 & ! ,am]ican ,college ( ,nurse ,midwives4 7#g7 ,hemorrhage1 c>diovascul> & coron>y conditions1 c>diomyopa?y1 infection1 embolism1 m5tal heal? conditions1 preeclampsia & eclampsia1 polycy/ic ov>y syndrome1 infection & sepsis1 & ane/hesia complications are ! pr$om9ant m$ical causes ( mat]nal-relat$ dea?s & complications4 ,mo/ ( ^! conditions are l>gely prev5table or manageable4 7#h7 ,oral heal? is an important "p ( p]9atal heal?4 ,r$uc+ bact]ia 9 a woman's m\? dur+ pregnancy c significantly r$uce h] risk ( develop+ oral diseases & spread+ decay-caus+ bact]ia to h] baby4 ,moreov]1 "s evid5ce sugge/s t wom5 ) p]iodontal disease dur+ pregnancy c\ld be at great] risk = poor bir? outcomes1 su* z preeclampsia1 pre-t]m bir?1 & l[-bir? weight4 ,fur!rmore1 a woman's oral heal? dur+ pregnancy is a good pr$ictor ( h] newborn's oral heal?1 & s9ce mo!rs c un9t5tionally spread oral bact]ia to _! babies1 putt+ _! *ildr5 at high] risk = too? decay1 prev5tion ef=ts %\ld happ5 ev5 be=e *ildr5 are born1 z a matt] ( pre-pregnancy heal? & pr5atal c>e dur+ pregnancy4 7#i7 ,! ,unit$ ,/ates has n be5 able to submit a =mal mat]nal mortality rate to int]national data repositories s9ce #bjjg4 ,?us1 no (ficial mat]nal mortality rate exi/s = ! ,unit$ ,/ates4 ,!re c be no mat]nal mortality rate )\t /reaml9+ mat]nal mortality-relat$ data f ! ,/ate level & extrapolat+ su* data to ! ,f$]al level4 7#aj7 ,9 ! ,unit$ ,/ates1 dea? report+ & analysis is a ,/ate function r ?an a ,f$]al process4 ,/ates report all dea?s--includ+ mat]nal dea?s--on a semi-volunt>y basis1 )\t /&>dization across ,/ates4 ,:ile ! ,c5t]s = ,disease ,control & ,prev5tion has ! capacity & sy/em = collect+ dea?-relat$ data bas$ on dea? c]tificates1 ^! data are n suffici5tly report$ by ,/ates 9 an organiz$ & /&>d =mat across ,/ates su* t ! ,c5t]s = ,disease ,control & ,prev5tion is able to id5tify causes ( mat]nal dea? & be/ practices = ! prev5tion ( su* dea?4 7#aa7 ,vital /ati/ics sy/ems (t5 und]e/imate mat]nal mortality & are insuffici5t data s\rces f :i* to d]ive a full scope ( m$ical & social det]m9ant factors contribut+ to mat]nal dea?s4 ,:ile ! addition ( pregnancy *eckboxes on dea? c]tificates s9ce #bjjc h likely improv$ ,/ates' abilities to id5tify pregnancy-relat$ dea?s1 !y are n g5]ally complet$ by ob/etrical provid]s or p]sons tra9$ to recognize pregnancy-relat$ mortality4 ,?us1 ^! vital =ms may be miss+ in=mation or may capture inconsi/5t data4 ,due to v>y+ mat]nal mortality-relat$ analyses1 lack ( reliability1 & granul>ity 9 data1 curr5t mat]nal mortality in=matics d n fully encapsulate ! myriad m$ical & socially det]m9ant factors t contribute to su* high mat]nal mortality rates )9 ! ,unit$ ,/ates comp>$ to o!r develop$ nations4 ,lack ( /&>dization ( data & data %>+ across ,/ates & betwe5 ,f$]al entities1 heal? networks1 & rese>* in/itutions keep ! ,nation 9 ! d>k ab\t ways to prev5t mat]nal dea?s4 7#ab7 ,hav+ reliable & valid ,/ate data aggregat$ at ! ,f$]al level are critical to ! ,nation's ability to quell surges 9 mat]nal dea? & imp]ative = rese>*]s to id5tify long-la/+ int]v5tions4 7#ac7 ,lead]s 9 mat]nal wellness highly recomm5d t mat]nal dea?s be inve/igat$ at ! ,/ate level fir/1 & t /&>diz$1 /reaml9$1 de-id5tifi$ data reg>d+ mat]nal dea?s be s5t annually to ! ,c5t]s = ,disease ,control & ,prev5tion4 ,su* data /&>dization & collection w\ld be simil> 9 op]ation & effect to ! ,national ,program ( ,canc] ,regi/ries ( ! ,c5t]s = ,disease ,control & ,prev5tion & ak9 to ! ,confid5tial ,enquiry 9 ,mat]nal ,dea?s ,programme 9 ! ,unit$ ,k+dom4 ,su* a mat]nal mortalities & morbidities regi/ry & surveillance sy/em w\ld help provid]s1 academicians1 lawmak]s1 & ! public to address que/ions conc]n+ ! types (1 causes (1 & be/ practices to ?w>t1 pregnancy-relat$ or pregnancy-associat$ mortality & morbidity4 7#ad7 ,! ,unit$ ,nations ,mill5nium ,developm5t ,goal #e;a aim$ to r$uce by #ge p]c5t1 betwe5 #aiij & #bjae1 ! mat]nal mortality rate1 yet ?is metric has n be5 a*iev$4 ,9 fact1 ! mat]nal mortality rate 9 ! ,unit$ ,/ates has be5 e/imat$ to h m ?an d\bl$ betwe5 #bjjj & #bjad4 ,yet1 because national data are n fully available1 ! ,unit$ ,/ates does n h an (ficial mat]nal mortality rate4 7#ae7 ,_m ,/ates h /ruggl$ to e/abli% or ma9ta9 ,mat]nal ,mortality ,review ,committees 7ref]r$ to 9 ?is section z ,,mmrc74 ,on ! ,/ate level1 ,m,m,r,cs h lagg$ because ,/ates h n _h ! res\rces to m\nt local reviews4 ,/ate-level reviews are necess>y z only ! ,/ate dep>tm5ts ( heal? h ! au?ority to reque/ m$ical records1 autopsy reports1 & police reports critical to ! function ( ! ,,mmrc4 7#af7 ,! ,unit$ ,k+dom reg>ds mat]nal dea?s z a heal? sy/ems failure & a national committee ( ob/etrics exp]ts review ea* mat]nal dea? or ne>-fatal *ildbir? complication4 ,su* committee also e/abli%es ! pr$om9ant c\rse ( mat]nal-relat$ dea?s f conditions su* z preeclampsia4 ,consequ5tly1 ! ,unit$ ,k+dom has be5 able to r$uce its incid5ce ( preeclampsia to less ?an "o 9 #aj1jjj wom5--its l[e/ rate s9ce #aieb4 7#ag7 ,! ,unit$ ,/ates has no comp>able1 coord9at$ ,f$]al process by :i* to review cases ( mat]nal mortality1 sy/ems failures1 or be/ practices4 ,_m ,/ates h active ,m,m,r,cs & lev]age _! "w to impact mat]nal wellness4 ,= example1 ! ,/ate ( ,cali=nia has work$ ext5sively ) _! ,/ate heal? dep>tm5ts1 heal? & hospital sy/ems1 & rese>* collaborative organizations1 includ+ ! ,cali=nia ,mat]nal ,quality ,c>e ,collaborative & ! ,alliance = ,innovation on ,mat]nal ,heal?1 to e/abli% ,m,m,r,cs1 :]e9 su* ,/ate has det]m9$ ! mo/ preval5t causes ( mat]nal mortality & record$ & %>$ data ) provid]s & rese>*]s1 :o h develop$ & implem5t$ safety bundles & c>e protocols relat$ to preeclampsia1 mat]nal hemorrhage1 & ! l4 ,9 ?is way1 ! ,/ate ( ,cali=nia has be5 able to lev]age its mat]nal mortality review bo>d sy/em1 g5]ate data1 & apply ^? data to effect *anges 9 mat]nal c>e-relat$ protocol4 ,to date1 ! ,/ate ( ,cali=nia has r$uc$ its mat]nal mortality rate1 :i* is n[ comp>able to ! l[ rates ( ! ,unit$ ,k+dom4 7#ah7 ,hospitals & heal? sy/ems across ! ,unit$ ,/ates lack /&>dization ( em]g5cy ob/etrical protocols be=e1 dur+1 & aft] deliv]y4 ,consequ5tly1 _m provid]s are delay$ 9 recogniz+ critical signs indicat+ mat]nal di/ress t quickly escalate into fatal or ne>-fatal incid5ces4 ,moreov]1 any attempt to address an ob/etrical em]g5cy t does n consid] bo? cl9ical & public heal? approa*es falls woefully "u ! m>k ( excell5t c>e deliv]y4 ,/ate-bas$ mat]nal quality collaborative organizations1 su* z ! ,cali=nia ,mat]nal ,quality ,c>e ,collaborative or entities p>ticipat+ 9 ! ,alliance = ,innovation on ,mat]nal ,heal? 7,,aim71 h =m$ ob/etrical protocols1 tool kits1 & o!r res\rces to improve sy/em c>e & response z !y relate to mat]nal complications & w>n+ signs = su* conditions z mat]nal hemorrhage1 hyp]t5sion1 & preeclampsia4 7#ai7 ,! ,c5t]s = ,disease ,control & ,prev5tion reports t ne>ly half ( all mat]nal dea?s occur 9 ! imm$iate po/p>tum p]iod--! #db days foll[+ a pregnancy--:]eas m ?an "o-?ird ( pregnancy-relat$ or pregnancy-associat$ dea?s occur :ile a p]son is /ill pregnant4 ,yet1 = wom5 eligible = ! ,m$icaid program on ! basis ( pregnancy1 su* ,m$icaid cov]age lapses at ! end ( ! mon? on :i* ! #fj? po/p>tum day l&s4 7#bj7 ,! exp]i5ce ( s]i\s traumatic ev5ts1 su* z be+ expos$ to dome/ic viol5ce1 sub/ance use disord]1 or p]vasive racism1 c ov]-activate ! body's /ress-response sy/em4 ,kn[n z toxic /ress1 ! repetition ( high doses ( cortisol to ! bra91 c h>m heal?y neurological developm5t1 :i* c h cascad+ physical & m5tal heal? consequ5ces1 z docum5t$ 9 ! ,adv]se ,*ildhood ,exp]i5ces /udy ( ! ,c5t]s = ,disease ,control & ,prev5tion4 7#ba7 ,a gr[+ body ( evid5ce-bas$ rese>* has %[n ! correlation betwe5 ! /ress associat$ ) "o's race--! /ress ( racism--& "o's bir?+ outcomes4 ,! /ress ( sex & race discrim9ation & in/itutional racism has be5 demon/rat$ to contribute to a high] risk ( mat]nal mortality1 irrespective ( "o's ge/ational age1 mat]nal age1 socioeconomic /atus1 or individual-level heal? risk factors1 includ+ pov]ty1 limit$ access to pr5atal c>e1 & poor physical & m5tal heal? 7al?\gh ^! are n nom9al factors74 ,african-,am]ican wom5 rema9 ! mo/ at risk = pregnancy-associat$ or pregnancy-relat$ causes ( dea?4 ,:5 x comes to preeclampsia1 = example1 :i* is relat$ to obesity1 ,african-,am]ican wom5 ( normal weight rema9 ! mo/ at risk ( dy+ dur+ ! p]9atal p]iod comp>$ to non-,african-,am]ican obese wom54 7#bb7 ,! ris+ mat]nal mortality rate 9 ! ,unit$ ,/ates is driv5 pr$om9antly by ! disproportionately high rates ( ,african-,am]ican mat]nal mortality4 7#bc7 ,comp>$ to wom5 f o!r racial & e?nic demographics1 ,african-,am]ican wom5 across ! socioeconomic spectrum exp]i5ce prolong$1 unrel5t+ /ress relat$ to racial & g5d] discrim9ation1 contribut+ to high] rates ( mat]nal mortality1 giv+ bir? to l[-weight babies1 & exp]i5c+ pre-t]m bir?4 ,racism is a risk factor = ^! a=em5tion$ exp]i5ces4 ,?is cumulative /ress (t5 ext5ds across ! life c\rse & is situat$ 9 ev]yday spaces :]e ,african-,am]ican wom5 e/abli% livelihood4 ,/ructural b>ri]s1 lack ( access to c>e1 & g5etic pr$ispositions to heal? vuln]abilities exac]bate ,african-,am]ican wom5's likelihood to exp]i5ce poor or fatal bir?+ outcomes1 b d n fully acc\nt = ! great disp>ity4 7#bd7 ,african-,am]ican wom5 are twice z likely to exp]i5ce po/p>tum depression1 & disproportionately high] rates ( preeclampsia comp>$ to ,:ite wom54 7#be7 ,racism is deeply +ra9$ 9 ,unit$ ,/ates sy/ems1 includ+ 9 heal? c>e deliv]y sy/ems betwe5 pati5ts & provid]s1 (t5 result+ 9 disp>ate treatm5t = pa91 irrev]5ce = cultural norms ) respect to heal?1 & dismissiv5ess4 ,rese>* has demon/rat$ t pati5ts respond m w>mly & adh]e to m$ical treatm5t plans at a high] degree ) provid]s ( ! same race or e?nicity or ) provid]s ) great ability to ex]cise empa?y4 ,h[ev]1 ! provid] pool is n prim$ ) _m p ( color1 nor are provid]s 7:e!r /ud5t-doctors 9 tra9+ or lic5s$ practition]s7 consi/5tly requir$ to und]go implicit bias1 cultural compet5cy1 or empa?y tra9+ on a consi/5t1 ongo+ basis4 7c7 ,improv+ ,f$]al ef=ts ) respect to prev5tion ( mat]nal mortality 7#a7 ,te*nical assi/ance = ,/ates ) respect to report+ mat]nal mortality ,n lat] ?an "o ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion 7ref]r$ to 9 ?is subsection z ! ,director71 9 consultation ) ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all provide te*nical assi/ance to ,/ates t elect to report compreh5sive data on mat]nal mortality1 includ+ oral1 m5tal1 & brea/fe$+ heal? in=mation1 = ! purpose ( enc\rag+ uni=mity 9 ! report+ ( su* data & to enc\rage ! %>+ ( su* data among ! respective ,/ates4 7#b7 ,be/ practices relat+ to prev5tion ( mat]nal mortality 7,a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( enactm5t ( ?is ,act-- 7i7 ! ,director1 9 consultation ) relevant pati5t & provid] gr\ps1 %all issue be/ practices to ,/ate mat]nal mortality review committees on h[ be/ to id5tify & review mat]nal mortality cases1 tak+ into acc\nt any data made available by ,/ates relat+ to mat]nal mortality1 includ+ data on oral1 m5tal1 & brea/fe$+ heal?1 & utilization ( any em]g5cy s]vices2 & 7ii7 ! ,director1 work+ 9 collaboration ) ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all issue be/ practices to hospitals1 ,/ate pr(essional society gr\ps1 & p]9atal quality collaboratives on h[ be/ to prev5t mat]nal mortality4 7,b7 ,au?orization ( appropriations ,= purposes ( c>ry+ out ?is p>agraph1 !re is au?oriz$ to be appropriat$ #e1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 7#c7 ,alliance = ,innovation on ,mat]nal ,heal? ,grant ,program 7,a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is p>agraph z ! ,secret>y71 act+ ?r\gh ! ,associate ,adm9i/rator ( ! ,mat]nal & ,*ild ,heal? ,bureau ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all e/abli% a grant program to be kn[n z ! ,alliance = ,innovation on ,mat]nal ,heal? ,grant ,program 7ref]r$ to 9 ?is subsection z ,,aim7 "u :i* ! ,secret>y %all aw>d grants to eligible entities = ! purpose (-- 7i7 direct+ widespread adoption & implem5tation ( mat]nal safety bundles ?r\gh collaborative ,/ate-bas$ teams2 & 7ii7 collect+ & analyz+ process1 /ructure1 & outcome data to drive cont9u\s improvem5t 9 ! implem5tation ( su* safety bundles by su* ,/ate-bas$ teams ) ! ultimate goal ( elim9at+ prev5table mat]nal mortality & sev]e mat]nal morbidity 9 ! ,unit$ ,/ates4 7,b7 ,eligible entities ,9 ord] to be eligible = a grant "u subp>agraph 7,a71 an entity %all-- 7i7 submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require2 & 7ii7 demon/rate 9 su* application t ! entity is an int]discipl9>y1 multi-/akehold]1 national organization ) a national data-driv5 mat]nal safety & quality improvem5t initiative bas$ on implem5tation approa*es t h be5 prov5 to improve mat]nal safety & outcomes 9 ! ,unit$ ,/ates4 7,c7 ,use ( funds ,an eligible entity t receives a grant "u subp>agraph 7,a7 %all use su* grant funds-- 7i7 to develop & implem5t1 ?r\gh a robu/1 multi-/akehold] process1 mat]nal safety bundles to assi/ ,/ates & heal? c>e sy/ems 9 align+ national1 ,/ate1 & hospital-level quality improvem5t ef=ts to improve mat]nal heal? outcomes1 specifically ! r$uction ( mat]nal mortality & sev]e mat]nal morbidity2 7ii7 to ensure1 9 develop+ & implem5t+ mat]nal safety bundles "u clause 7i71 t su* mat]nal safety bundles-- 7,i7 satisfy ! quality improvem5t ne$s ( a ,/ate or heal? c>e sy/em by factor+ 9 ! results & f9d+s ( relevant data reviews1 su* z reviews conduct$ by a ,/ate mat]nal mortality review committee2 & 7,,ii7 address topics su* z-- 7aa7 ob/etric hemorrhage2 7bb7 mat]nal m5tal heal?2 7cc7 ! mat]nal v5\s sy/em2 7dd7 ob/etric c>e = wom5 ) sub/ance use disord]s1 includ+ opioid use disord]2 7ee7 po/p>tum c>e basics = mat]nal safety2 7ff7 r$uction ( p]ip>tum racial & e?nic disp>ities2 7gg7 r$uction ( prim>y caes>ean bir?2 7hh7 sev]e hyp]t5sion 9 pregnancy2 7ii7 sev]e mat]nal morbidity reviews2 7jj7 support aft] a sev]e mat]nal morbidity ev5t2 7kk7 ?romboembolism2 7ll7 optimization ( support = brea/fe$+2 & 7mm7 mat]nal oral heal?2 & 7iii7 to provide ongo+ te*nical assi/ance at ! national & ,/ate levels to support implem5tation ( mat]nal safety bundles "u clause 7i74 7,d7 ,mat]nal safety bundle def9$ ,= purposes ( ?is p>agraph1 ! t]m mat]nal safety bundle means /&>diz$1 evid5ce-in=m$ processes = mat]nal heal? c>e4 7,e7 ,au?orization ( appropriations ,= purposes ( c>ry+ out ?is p>agraph1 !re is au?oriz$ to be appropriat$ #aj1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 7#d7 ,fund+ = ,/ate-,bas$ p]9atal quality collaboratives developm5t & su/a9ability 7,a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is p>agraph z ! ,secret>y71 act+ ?r\gh ! ,division ( ,reproductive ,heal? ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all e/abli% a grant program to be kn[n z ! ,/ate-,bas$ ,p]9atal ,quality ,collaborative grant program "u :i* ! ,secret>y aw>ds grants to eligible entities = ! purpose ( developm5t & su/a9ability ( p]9atal quality collaboratives 9 e ,/ate1 ! ,di/rict ( ,columbia1 & eligible t]ritories1 9 ord] to measurably improve p]9atal c>e & p]9atal heal? outcomes = pregnant & po/p>tum wom5 & _! infants4 7,b7 ,grant am\nts ,grants aw>d$ "u ?is p>agraph %all be 9 am\nts n to exce$ #bej1jjj p] ye>1 = ! duration ( ! grant p]iod4 7,c7 ,/ate-bas$ p]9atal quality collaborative def9$ ,= purposes ( ?is p>agraph1 ! t]m ,/ate-bas$ p]9atal quality collaborative means a network ( multidiscipl9>y teams t-- 7i7 "w to improve measurable outcomes = mat]nal & infant heal? by advanc+ evid5ce-in=m$ cl9ical practices us+ quality improvem5t pr9ciples2 7ii7 "w ) hospital-bas$ or outpati5t facility-bas$ cl9ical teams1 exp]ts1 & /akehold]s1 includ+ pati5ts & families1 to spread be/ practices & optimize res\rces to improve p]9atal c>e & outcomes2 7iii7 employ /rategies t include ! use ( ! collaborative le>n+ model to provide opportunities = hospitals & cl9ical teams to collaborate on improvem5t /rategies1 rapid-response data to provide timely fe$back to hospital & o!r cl9ical teams to track progress1 & quality improvem5t sci5ce to provide support & coa*+ to hospital & cl9ical teams2 & 7iv7 h ! goal ( improv+ population-level outcomes 9 mat]nal & infant heal?4 7,d7 ,au?orization ( appropriations ,= purposes ( c>ry+ out ?is p>agraph1 !re is au?oriz$ to be appropriat$ #ad1jjj1jjj p] ye> = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 7#e7 ,expansion ( ,m$icaid & ,,*ip cov]age = pregnant & po/p>tum wom5 7,a7 ,requir+ cov]age ( c]ta9 oral heal? s]vices = pregnant & po/p>tum wom5 7i7 ,m$icaid ,subsection 7gg7 ( section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 z add$ by section #dcc7;d71 is am5d$-- 7,i7 9 p>agraph 7#a71 by /rik+ p>agraphs 7#b7 & 7#c7 & ins]t+ p>agraphs 7#b71 7#c71 & 7#d72 & 7,,ii7 by add+ at ! end ! foll[+ new p>agraph3 7#d7 ,su* t]m %all include1 9 ! case ( a woman :o is pregnant 7or dur+ ! #a-ye> p]iod beg9n+ on ! la/ day ( h] pregnancy7 prev5tive1 diagno/ic1 p]iodontal1 & re/orative s]vices recomm5d$ = p]9atal oral heal? c>e & d5tal c>e dur+ pregnancy by ! ,am]ican ,academy ( ,p$iatric ,d5ti/ry & ! ,am]ican ,college ( ,ob/etricians & ,gynecologi/s4 4 7ii7 ,,*ip ,section #bajc7;c77#e77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7c77#e77;,a77 is am5d$ by ins]t+ or a t>get$ l[-income pregnant woman aft] t>get$ l[-income *ild4 7,b7 ,ext5d+ ,m$icaid cov]age = pregnant & po/p>tum wom5 ,section #aijb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is am5d$-- 7i7 9 subsection 7e7-- 7,i7 9 p>agraph 7#e7-- 7aa7 by ins]t+ 7includ+ oral heal? s]vices 7z def9$ 9 section #aije7;gg7 & includ+ s]vices = pregnant & po/p>tum wom5 describ$ 9 p>agraph 7#d7 ( su* section7 aft] po/p>tum m$ical assi/ance "u ! plan2 & 7bb7 by /rik+ #fj-;day & ins]t+ #a-ye>2 & 7,,ii7 9 p>agraph 7#f71 by /rik+ #fj-;day & ins]t+ #a-ye>2 & 7ii7 9 subsection 7l77#a77;,a71 by /rik+ #fj-;day & ins]t+ #a-ye>4 7,c7 ,ext5d+ ,m$icaid cov]age = lawful resid5ts ,section #aijc7v77#d77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7v77#d77;,a77 is am5d$ by /rik+ #fj-;day & ins]t+ #a-ye>4 7,d7 ,ext5d+ ,,*ip cov]age = pregnant & po/p>tum wom5 ,section #baab7;d77#b77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acigll7d77#b77;,a77 is am5d$ by /rik+ #fj-;day & ins]t+ #a-ye>4 7,e7 ,ma9t5ance ( ef=t 7i7 ,m$icaid ,section #aijb7l7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7l77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#e7 ,dur+ ! p]iod t beg9s on ! date ( enactm5t ( ?is p>agraph & ends on ! date t is #e ye>s aft] su* date ( enactm5t1 z a condition = receiv+ any ,f$]al paym5ts "u section #aijc7;a7 = cal5d> qu>t]s occurr+ dur+ su* p]iod1 a ,/ate %all n h 9 effect1 ) respect to wom5 :o are eligible = m$ical assi/ance "u ! ,/ate plan or "u a waiv] ( su* plan on ! basis ( be+ pregnant or hav+ be5 pregnant1 eligibility /&>ds1 me?odologies1 or proc$ures "u ! ,/ate plan or waiv] t are m re/rictive ?an ! eligibility /&>ds1 me?odologies1 or proc$ures1 respectively1 "u su* plan or waiv] t are 9 effect on ! date ( enactm5t ( ?is p>agraph4 4 7ii7 ,,*ip ,section #baje7;d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7d77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#d7 ,ineligibility /&>ds = t>get$ l[-income pregnant wom5 ,dur+ ! p]iod t beg9s on ! date ( enactm5t ( ?is p>agraph & ends on ! date t is #e ye>s aft] su* date ( enactm5t1 z a condition ( receiv+ paym5ts "u subsection 7a7 & section #aijc7;a71 a ,/ate t elects to provide assi/ance to wom5 on ! basis ( be+ pregnant 7includ+ pregnancy-relat$ assi/ance provid$ to t>get$ l[-income pregnant wom5 7z def9$ 9 section #baab7;d771 pregnancy-relat$ assi/ance provid$ to wom5 :o are eligible = su* assi/ance ?r\gh application ( section #aijb7v77#d77;,a77i7 "u section #bajg7;e77#a71 or any o!r assi/ance "u ! ,/ate *ild heal? plan 7or a waiv] ( su* plan7 :i* is provid$ to wom5 on ! basis ( be+ pregnant7 %all n h 9 effect1 ) respect to su* wom51 eligibility /&>ds1 me?odologies1 or proc$ures "u su* plan 7or waiv]7 t are m re/rictive ?an ! eligibility /&>ds1 me?odologies1 or proc$ures1 respectively1 "u su* plan 7or waiv]7 t are 9 effect on ! date ( enactm5t ( ?is p>agraph4 4 7,f7 ,in=mation on b5efits ,! ,secret>y ( ,heal? & ,human ,s]vices %all make publicly available on ! int]net website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 in=mation reg>d+ b5efits available to pregnant & po/p>tum wom5 & "u ! ,m$icaid program & ! ,*ildr5's ,heal? ,insurance ,program1 includ+ in=mation on-- 7i7 b5efits t ,/ates are requir$ to provide to pregnant & po/p>tum wom5 "u su* programs2 7ii7 optional b5efits t ,/ates may provide to pregnant & po/p>tum wom5 "u su* programs2 & 7iii7 ! availability ( diff]5t k9ds ( b5efits = pregnant & po/p>tum wom51 includ+ oral heal? & m5tal heal? b5efits1 "u su* programs4 7,g7 ,f$]al fund+ = co/ ( ext5d$ ,m$icaid & ,,*ip cov]age = po/p>tum wom5 7i7 ,m$icaid ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 z am5d$ by section #dcc7;d71 is fur!r am5d$-- 7,i7 9 subsection 7b71 by /rik+ & 7ff7 & ins]t+ 7ff71 & 7hh72 & 7,,ii7 by add+ at ! end ! foll[+3 7hh7 ,increas$ ,,fmap = ext5d$ m$ical assi/ance = po/p>tum wom5 ,not)/&+ subsection 7b71 ! ,f$]al m$ical assi/ance p]c5tage = a ,/ate1 ) respect to am\nts exp5d$ by su* ,/ate = m$ical assi/ance = a woman :o is eligible = su* assi/ance on ! basis ( be+ pregnant or hav+ be5 pregnant t is provid$ dur+ ! #cje-;day p]iod t beg9s on ! #fj? day aft] ! la/ day ( h] pregnancy 7includ+ any su* assi/ance provid$ dur+ ! mon? 9 :i* su* p]iod ends71 %all be equal to-- 7#a7 #ajj p]c5t = ! fir/ #bj cal5d> qu>t]s dur+ :i* ?is subsection is 9 effect2 & 7#b7 #ij p]c5t = cal5d> qu>t]s !reaft]4 4 7ii7 ,,*ip ,section #baje7;c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7c77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#ab7 ,enhanc$ paym5t = ext5d$ assi/ance provid$ to pregnant wom5 ,not)/&+ subsection 7b71 ! enhanc$ ,,fmap1 ) respect to paym5ts "u subsection 7a7 = exp5ditures "u ! ,/ate *ild heal? plan 7or a waiv] ( su* plan7 = assi/ance provid$ "u ! plan 7or waiv]7 to a woman :o is eligible = su* assi/ance on ! basis ( be+ pregnant 7includ+ pregnancy-relat$ assi/ance provid$ to a t>get$ l[-income pregnant woman 7z def9$ 9 section #baab7;d771 pregnancy-relat$ assi/ance provid$ to a woman :o is eligible = su* assi/ance ?r\gh application ( section #aijb7v77#d77;,a77i7 "u section #bajg7;e77#a71 or any o!r assi/ance "u ! plan 7or waiv]7 provid$ to a woman :o is eligible = su* assi/ance on ! basis ( be+ pregnant7 dur+ ! #cje-;day p]iod t beg9s on ! #fj? day aft] ! la/ day ( h] pregnancy 7includ+ any su* assi/ance provid$ dur+ ! mon? 9 :i* su* p]iod ends71 %all be equal to-- 7,a7 #ajj p]c5t = ! fir/ #bj cal5d> qu>t]s dur+ :i* ?is p>agraph is 9 effect2 & 7,b7 #ij p]c5t = cal5d> qu>t]s !reaft]4 4 7,h7 ,effective date 7i7 ,9 g5]al ,subject to subp>agraph 7,b71 ! am5dm5ts made by ?is subsection %all take effect on ! fir/ day ( ! fir/ cal5d> qu>t] t beg9s on or aft] ! date t is "o ye> aft] ! date ( enactm5t ( ?is ,act4 7ii7 ,exception = ,/ate legislation ,9 ! case ( a ,/ate plan "u title ,,xix ( ! ,social ,security ,act or a ,/ate *ild heal? plan "u title ,,xxi ( su* ,act t ! ,secret>y ( ,heal? & ,human ,s]vices det]m9es requires ,/ate legislation 9 ord] = ! respective plan to meet any requirem5t impos$ by am5dm5ts made by ?is subsection1 ! respective plan %all n be reg>d$ z fail+ to comply ) ! requirem5ts ( su* title solely on ! basis ( its failure to meet su* an additional requirem5t be=e ! fir/ day ( ! fir/ cal5d> qu>t] beg9n+ aft] ! close ( ! fir/ regul> session ( ! ,/ate legislature t beg9s aft] ! date ( enactm5t ( ?is ,act4 ,= purposes ( ! previ\s s5t5ce1 9 ! case ( a ,/ate t has a #b-ye> legislative session1 ea* ye> ( ! session %all be consid]$ to be a sep>ate regul> session ( ! ,/ate legislature4 7#f7 ,regional c5t]s ( excell5ce ,"p ,p ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhj;g et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #cii,v-#g4 ,regional c5t]s ( excell5ce address+ implicit bias & cultural compet5cy 9 pati5t-provid] int]actions education 7a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( enactm5t ( ?is section1 ! ,secret>y1 9 consultation ) su* o!r ag5cy heads z ! ,secret>y det]m9es appropriate1 %all aw>d coop]ative agreem5ts = ! e/abli%m5t or support ( regional c5t]s ( excell5ce address+ implicit bias & cultural compet5cy 9 pati5t-provid] int]actions education = ! purpose ( enhanc+ & improv+ h[ heal? c>e pr(essionals are educat$ 9 implicit bias & deliv]+ culturally compet5t heal? c>e4 7b7 ,eligibility ,to be eligible to receive a coop]ative agreem5t "u subsection 7a71 an entity %all-- 7#a7 be a public or o!r nonpr(it entity specifi$ by ! ,secret>y t provides educational & tra9+ opportunities = /ud5ts & heal? c>e pr(essionals1 :i* may be a heal? sy/em1 tea*+ hospital1 community heal? c5t]1 m$ical s*ool1 s*ool ( public heal?1 d5tal s*ool1 social "w s*ool1 s*ool ( pr(essional psy*ology1 or any o!r heal? pr(essional s*ool or program at an in/itution ( high] education 7z def9$ 9 section #aja ( ! ,high] ,education ,act ( #aife7 focus$ on ! prev5tion1 treatm5t1 or recov]y ( heal? conditions t contribute to mat]nal mortality & ! prev5tion ( mat]nal mortality & sev]e mat]nal morbidity2 7#b7 demon/rate community engagem5t & p>ticipation1 su* z ?r\gh p>tn]%ips ) home visit+ & case managem5t programs2 & 7#c7 provide to ! ,secret>y su* in=mation1 at su* "t & 9 su* mann]1 z ! ,secret>y may require4 7c7 ,div]sity ,9 aw>d+ a coop]ative agreem5t "u subsection 7a71 ! ,secret>y %all take into acc\nt any regional diff]5ces among eligible entities & make an ef=t to ensure geographic div]sity among aw>d recipi5ts4 7d7 ,dissem9ation ( in=mation 7#a7 ,public availability ,! ,secret>y %all make publicly available on ! int]net website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices in=mation submitt$ to ! ,secret>y "u subsection 7b77#c74 7#b7 ,evaluation ,! ,secret>y %all evaluate ea* regional c5t] ( excell5ce e/abli%$ or support$ pursuant to subsection 7a7 & dissem9ate ! f9d+s result+ f ea* su* evaluation to ! appropriate public & private entities4 7#c7 ,di/ribution ,! ,secret>y %all %>e evaluations & ov]all f9d+s ) ,/ate dep>tm5ts ( heal? & o!r relevant ,/ate level (fices to in=m ,/ate & local be/ practices4 7e7 ,mat]nal mortality def9$ ,9 ?is section1 ! t]m mat]nal mortality means dea? ( a woman t occurs dur+ pregnancy or )9 ! "o-ye> p]iod foll[+ ! end ( su* pregnancy4 7f7 ,au?orization ( appropriations ,= purposes ( c>ry+ out ?is section1 !re is au?oriz$ to be appropriat$ #e1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 4 7#g7 ,special supplem5tal nutrition program = wom51 infants1 & *ildr5 7,a7 ,def9ition ( brea/fe$+ woman ,section #ag7;b7 ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aghf7;b77 is am5d$ by /rik+ p>agraph 7#a7 & ins]t+ ! foll[+3 7#a7 ,brea/fe$+ woman ,! t]m brea/fe$+ woman means a woman :o is n m ?an #b ye>s po/p>tum & is brea/fe$+ ! infant ( ! woman4 4 7,b7 ,c]tification ,section #ag7;d77#c77;,a77ii7 ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aghf7;d77#c77;,a77ii77 is am5d$-- 7i7 by /rik+ ! clause designation & head+ & all t foll[s ?r\gh ,a ,/ate & ins]t+ ! foll[+3 7ii7 ,wom5 7,i7 ,brea/fe$+ wom5 ,a ,/ate 2 7ii7 9 subclause 7,i7 7z s designat$71 by /rik+ #a ye> & all t foll[s ?r\gh e>li] & ins]t+ #b ye>s po/p>tum2 & 7iii7 by add+ at ! end ! foll[+3 7,,ii7 ,po/p>tum wom5 ,a ,/ate may elect to c]tify a po/p>tum woman = a p]iod ( #b ye>s4 4 7#h7 ,def9itions ,9 ?is section3 7,a7 ,mat]nal mortality ,! t]m mat]nal mortality means dea? ( a woman t occurs dur+ pregnancy or )9 ! "o-ye> p]iod foll[+ ! end ( su* pregnancy4 7,b7 ,sev]e mat]nal morbidity ,! t]m sev]e mat]nal morbidity includes unexpect$ outcomes ( labor & deliv]y t result 9 significant %ort-t]m or long-t]m consequ5ces to a woman's heal?4 7d7 ,increas+ excise taxes on cig>ettes & e/abli%+ excise tax equity among all tobacco product tax rates 7#a7 ,tax p>ity = roll-,y\r-,own tobacco ,section #egja7;g7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ #bd4gh & ins]t+ #di4ef4 7#b7 ,tax p>ity = pipe tobacco ,section #egja7;f7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ #b4hcaa c5ts & ins]t+ #di4ef4 7#c7 ,tax p>ity = smokeless tobacco 7,a7 ,section #egja7;e7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7i7 9 p>agraph 7#a71 by /rik+ #a4ea & ins]t+ #bf4hd2 7ii7 9 p>agraph 7#b71 by /rik+ #ej4cc c5ts & ins]t+ #aj4gd2 & 7iii7 by add+ at ! end ! foll[+3 7#c7 ,smokeless tobacco sold 9 discrete s+le-use units ,on discrete s+le-use units1 #ajj4ff p] ?\s&4 4 7,b7 ,section #egjb7m7 ( su* ,code is am5d$-- 7i7 9 p>agraph 7#a71 by /rik+ or *ew+ tobacco & ins]t+ 1 *ew+ tobacco1 or discrete s+le-use unit2 7ii7 9 p>agraphs 7#b7 & 7#c71 by ins]t+ t is n a discrete s+le-use unit be=e ! p]iod 9 ea* su* p>agraph2 & 7iii7 by add+ at ! end ! foll[+3 7#d7 ,discrete s+le-use unit ,! t]m discrete s+le-use unit means any product conta9+ tobacco t-- 7,a7 is n int5d$ to be smok$2 & 7,b7 is 9 ! =m ( a loz5ge1 tablet1 pill1 p\*1 dissolvable /rip1 or o!r discrete s+le-use or s+le-dose unit4 4 7#d7 ,tax p>ity = small cig>s ,p>agraph 7#a7 ( section #egja7;a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ #ej4cc & ins]t+ #ajj4ff4 7#e7 ,tax p>ity = l>ge cig>s 7,a7 ,9 g5]al ,p>agraph 7#b7 ( section #egja7;a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ #eb4ge p]c5t & all t foll[s ?r\gh ! p]iod & ins]t+ ! foll[+3 #di4ef p] p\nd & a proportionate tax at ! l rate on all fractional p>ts ( a p\nd b n less ?an #aj4jff c5ts p] cig>44 7,b7 ,guidance ,! ,secret>y ( ! ,treasury1 or ! ,secret>y's delegate1 may issue guidance reg>d+ ! appropriate me?od = det]m9+ ! weight ( l>ge cig>s = purposes ( calculat+ ! applicable tax "u section #egja7;a77#b7 ( ! ,int]nal ,rev5ue ,code ( #aihf4 7#f7 ,tax p>ity = roll-,y\r-,own tobacco & c]ta9 process$ tobacco ,subsection 7o7 ( section #egjb ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ 1 & includes process$ tobacco t is remov$ = deliv]y or deliv]$ to a p]son o!r ?an a p]son ) a p]mit provid$ "u section #egac1 b does n include removals ( process$ tobacco = exportation aft] wrapp]s !re(4 7#g7 ,cl>ify+ tax rate = o!r tobacco products 7,a7 ,9 g5]al ,section #egja ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new subsection3 7i7 ,o!r tobacco products ,any product n o!rwise describ$ "u ?is section t has be5 det]m9$ to be a tobacco product by ! ,food & ,drug ,adm9i/ration ?r\gh its au?orities "u ! ,family ,smok+ ,prev5tion & ,tobacco ,control ,act %all be tax$ at a level ( tax equival5t to ! tax rate = cig>ettes on an e/imat$ p] use basis z det]m9$ by ! ,secret>y4 4 7,b7 ,e/abli%+ p] use basis ,= purposes ( section #egja7;i7 ( ! ,int]nal ,rev5ue ,code ( #aihf1 n lat] ?an #ab mon?s aft] ! lat] ( ! date ( ! enactm5t ( ?is ,act or ! date t a product has be5 det]m9$ to be a tobacco product by ! ,food & ,drug ,adm9i/ration1 ! ,secret>y ( ! ,treasury 7or ! ,secret>y ( ! ,treasury's delegate7 %all issue f9al regulations e/abli%+ ! level ( tax = su* product t is equival5t to ! tax rate = cig>ettes on an e/imat$ p] use basis4 7#h7 ,cl>ify+ def9ition ( tobacco products 7,a7 ,9 g5]al ,subsection 7c7 ( section #egjb ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ to read z foll[s3 7c7 ,tobacco products ,! t]m tobacco products means-- 7#a7 cig>s1 cig>ettes1 smokeless tobacco1 pipe tobacco1 & roll-y\r-own tobacco1 & 7#b7 any o!r product subject to tax pursuant to section #egja7;i74 4 7,b7 ,con=m+ am5dm5ts ,subsection 7d7 ( section #egjb ( su* ,code is am5d$ by /rik+ cig>s1 cig>ettes1 smokeless tobacco1 pipe tobacco1 or roll-y\r-own tobacco ea* place x appe>s & ins]t+ tobacco products4 7#i7 ,increas+ tax on cig>ettes 7,a7 ,small cig>ettes ,section #egja7;b77#a7 ( su* ,code is am5d$ by /rik+ #ej4cc & ins]t+ #ajj4ff4 7,b7 ,l>ge cig>ettes ,section #egja7;b77#b7 ( su* ,code is am5d$ by /rik+ #aje4fi & ins]t+ #baa4ch4 7#aj7 ,tax rates adju/$ = inflation ,section #egja ( su* ,code1 z am5d$ by subsection 7g71 is am5d$ by add+ at ! end ! foll[+ new subsection3 7j7 ,inflation adju/m5t 7#a7 ,9 g5]al ,9 ! case ( any cal5d> ye> beg9n+ aft] #bjah1 ! doll> am\nts provid$ "u ?is *apt] %all ea* be increas$ by an am\nt equal to-- 7,a7 su* doll> am\nt1 multipli$ by 7,b7 ! co/-(-liv+ adju/m5t det]m9$ "u section #a7;f77#c7 = ! cal5d> ye>1 det]m9$ by sub/itut+ #8cal5d> ye> #bjag' = #8cal5d> ye> #bjaf' 9 subp>agraph 7,a77ii7 !re(4 7#b7 ,r\nd+ ,if any am\nt z adju/$ "u p>agraph 7#a7 is n a multiple ( #j4ja1 su* am\nt %all be r\nd$ to ! next highe/ multiple ( #j4ja4 4 7#aa7 ,floor ,/ocks ,taxes 7,a7 ,imposition ( tax ,on tobacco products manufactur$ 9 or import$ into ! ,unit$ ,/ates :i* are remov$ be=e any tax increase date & held on su* date = sale by any p]son1 !re is h]eby impos$ a tax 9 an am\nt equal to ! excess (-- 7i7 ! tax :i* w\ld be impos$ "u section #egja ( ! ,int]nal ,rev5ue ,code ( #aihf on ! article if ! article _h be5 remov$ on su* date1 ov] 7ii7 ! prior tax 7if any7 impos$ "u section #egja ( su* ,code on su* article4 7,b7 ,cr$it aga9/ tax ,ea* p]son %all be all[$ z a cr$it aga9/ ! taxes impos$ by p>agraph 7#a7 an am\nt equal to #ejj4 ,su* cr$it %all n exce$ ! am\nt ( taxes impos$ by p>agraph 7#a7 on su* date = :i* su* p]son is liable4 7,c7 ,liability = tax & me?od ( paym5t 7i7 ,liability = tax ,a p]son hold+ tobacco products on any tax increase date to :i* any tax impos$ by p>agraph 7#a7 applies %all be liable = su* tax4 7ii7 ,me?od ( paym5t ,! tax impos$ by p>agraph 7#a7 %all be paid 9 su* mann] z ! ,secret>y %all prescribe by regulations4 7iii7 ,"t = paym5t ,! tax impos$ by p>agraph 7#a7 %all be paid on or be=e ! date t is #abj days aft] ! effective date ( ! tax rate increase4 7,d7 ,articles 9 =eign trade zones ,not)/&+ ! ,act ( ,june #ah1 #aicd 7commonly kn[n z ! ,=eign ,trade ,zone ,act1 #dh ,/at4 #iih1 #ai ,u4,s4,c4 #ha;a et seq471 or any o!r provision ( law1 any article :i* is locat$ 9 a =eign trade zone on any tax increase date %all be subject to ! tax impos$ by p>agraph 7#a7 if-- 7i7 int]nal rev5ue taxes h be5 det]m9$1 or cu/oms duties liquidat$1 ) respect to su* article be=e su* date pursuant to a reque/ made "u ! #a/ proviso ( section #c7;a7 ( su* ,act2 or 7ii7 su* article is held on su* date "u ! sup]vision ( an (fic] ( ! ,unit$ ,/ates ,cu/oms & ,bord] ,protection ( ! ,dep>tm5t ( ,homel& ,security pursuant to ! #b;d proviso ( su* section #c7;a74 7,e7 ,def9itions ,= purposes ( ?is subsection-- 7i7 ,9 g5]al ,any t]m us$ 9 ?is subsection :i* is also us$ 9 section #egjb ( su* ,code %all h ! same mean+ z su* t]m has 9 su* section4 7ii7 ,tax increase date ,! t]m tax increase date means ! effective date ( any increase 9 any tobacco product excise tax rate pursuant to ! am5dm5ts made by ?is section 7o!r ?an subsection 7j7 !re(74 7iii7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ! ,treasury or ! ,secret>y's delegate4 7,f7 ,controll$ gr\ps ,rules simil> to ! rules ( section #ejfa7;e77#c7 ( su* ,code %all apply = purposes ( ?is subsection4 7,g7 ,o!r laws applicable ,all provisions ( law1 includ+ p5alties1 applicable ) respect to ! taxes impos$ by section #egja ( su* ,code %all1 ins(> z applicable & n inconsi/5t ) ! provisions ( ?is subsection1 apply to ! floor /ocks taxes impos$ by p>agraph 7#a71 to ! same ext5t z if su* taxes 7 impos$ by su* section #egja4 ,! ,secret>y may treat any p]son :o bore ! ultimate burd5 ( ! tax impos$ by p>agraph 7#a7 z ! p]son to :om a cr$it or refund "u su* provisions may be all[$ or made4 7#ab7 ,effective dates 7,a7 ,9 g5]al ,except z provid$ 9 p>agraphs 7#b7 ?r\gh 7#d71 ! am5dm5ts made by ?is section %all apply to articles remov$ 7z def9$ 9 section #egjb7;j7 ( ! ,int]nal ,rev5ue ,code ( #aihf7 aft] ! la/ day ( ! mon? :i* includes ! date ( ! enactm5t ( ?is ,act4 7,b7 ,discrete s+le-use units & process$ tobacco ,! am5dm5ts made by subsections 7c77#a77;,c71 7c77#b71 & 7f7 %all apply to articles remov$ 7z def9$ 9 section #egjb7;j7 ( ! ,int]nal ,rev5ue ,code ( #aihf7 aft] ! date t is #f mon?s aft] ! date ( ! enactm5t ( ?is ,act4 7,c7 ,l>ge cig>s ,! am5dm5ts made by subsection 7e7 %all apply to articles remov$ aft] ,decemb] #ca1 #bjba4 7,d7 ,o!r tobacco products ,! am5dm5ts made by subsection 7g77#a7 %all apply to products remov$ aft] ! la/ day ( ! mon? :i* includes ! date t ! ,secret>y ( ! ,treasury 7or ! ,secret>y ( ! ,treasury's delegate7 issues f9al regulations e/abli%+ ! level ( tax = su* product4 #ejf4 ,rural mat]nal & ob/etric mod]nization ( s]vices 7a7 ,%ort title ,?is section may be cit$ z ! ,rural ,mat]nal & ,ob/etric ,mod]nization ( ,s]vices ,act or ! ,rural ,,moms ,act4 7b7 ,improv+ rural mat]nal & ob/etric c>e data 7#a7 ,mat]nal mortality & morbidity activities ,section #cja ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bda7 is am5d$-- 7,a7 by r$esignat+ subsections 7e7 ?r\gh 7h7 z subsections 7f7 ?r\gh 7i71 respectively2 & 7,b7 by ins]t+ aft] subsection 7d71 ! foll[+3 7e7 ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all exp&1 int5sify1 & coord9ate ! activities ( ! ,c5t]s = ,disease ,control & ,prev5tion ) respect to mat]nal mortality & morbidity4 4 7#b7 ,(fice ( ,wom5's ,heal? ,section #caj;,a7b77#a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdbs7b77#a77 is am5d$ by /rik+ & sociocultural contexts & ins]t+ sociocultural 7includ+ race1 e?nicity1 language1 class1 & income7 contexts1 includ+ among ,indians 7z def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act71 & geographic contexts1 aft] biological14 7#c7 ,safe mo!rhood ,section #cag,k7b77#b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;b77#b77 is am5d$-- 7,a7 9 subp>agraph 7,l71 by /rik+ & at ! end2 7,b7 by r$esignat+ subp>agraph 7,m7 z subp>agraph 7,n72 & 7,c7 by ins]t+ aft] subp>agraph 7,l71 ! foll[+3 7,m7 an exam9ation ( ! relation%ip betwe5 mat]nal heal? s]vices 9 rural areas & outcomes 9 deliv]y & po/p>tum c>e2 & 4 7#d7 ,(fice ( ,rese>* on ,wom5's ,heal? ,section #dhf ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhg;d7 is am5d$-- 7,a7 9 subsection 7b7-- 7i7 by r$esignat+ p>agraphs 7#d7 ?r\gh 7#i7 z p>agraphs 7#e7 ?r\gh 7#aj71 respectively2 7ii7 by ins]t+ aft] p>agraph 7#c7 ! foll[+3 7#d7 c>ry out p>agraphs 7#a7 & 7#b7 ) respect to pregnancy1 ) priority giv5 to dea?s relat$ to pregnancy2 2 & 7iii7 9 p>agraph 7#e7 7z s r$esignat$71 by /rik+ ?r\gh 7#c7 & ins]t+ ?r\gh 7#d72 & 7,b7 9 subsection 7d77#d77;,a77iv71 by ins]t+ 1 includ+ mat]nal mortality & o!r mat]nal morbidity outcomes be=e ! semicolon4 7c7 ,rural ,ob/etric ,network ,grants ,! ,public ,heal? ,s]vice ,act is am5d$ by ins]t+ aft] section #cag,l-#a 7#db ,u4,s4,c4 #bdg;b-#ac;a7 ! foll[+3 #cag,l-#b4 ,rural ,ob/etric ,network ,grants 7a7 ,9 g5]al ,= ! purpose ( enabl+ ! ,secret>y 7?r\gh grants1 contracts1 or o!rwise71 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 to e/abli% collaborative improvem5t & innovation networks 7ref]r$ to 9 ?is section z rural ob/etric networks7 to improve outcomes 9 bir? & mat]nal morbidity & mortality1 !re is appropriat$ to ! ,secret>y1 out ( any money 9 ! ,treasury n o!rwise appropriat$1 #c1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 ,su* am\nts %all rema9 available until exp5d$4 7b7 ,use ( funds ,am\nts appropriat$ "u subsection 7a7 %all be us$ = ! e/abli%m5t ( collaborative improvem5t & innovation networks to improve mat]nal heal? 9 rural areas by improv+ outcomes 9 bir? & mat]nal morbidity & mortality4 ,rural ob/etric networks e/abli%$ 9 accordance ) ?is section %all-- 7#a7 assi/ pregnant wom5 & o!r individuals 9 rural areas 9 connect+ ) pr5atal1 labor & bir?1 & po/p>tum c>e to improve outcomes 9 bir? & mat]nal mortality & morbidity2 7#b7 id5tify successful pr5atal1 labor & bir?1 & po/p>tum heal? deliv]y models = individuals 9 rural areas1 includ+ evid5ce-bas$ home visit+ programs & successful1 culturally compet5t models ) positive mat]nal heal? outcomes t advance heal? equity2 7#c7 develop a model = collaboration betwe5 heal? facilities t h an ob/etric heal? unit & heal? facilities t d n h an ob/etric heal? unit2 7#d7 provide tra9+ & guidance = heal? facilities t d n h ob/etric heal? units2 7#e7 collaborate ) academic in/itutions t c provide regional exp]tise & rese>* on access1 outcomes1 ne$s assessm5ts1 & o!r id5tifi$ data2 & 7#f7 measure & address inequities 9 bir? outcomes among rural resid5ts1 ) an emphasis on ,black resid5ts & resid5ts :o are ,indians 7z def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act74 7c7 ,requirem5ts = e/abli%m5t ,n lat] ?an #f mon?s aft] ! date ( enactm5t ( ?is section1 ! ,secret>y %all e/abli% rural ob/etric heal? networks 9 at lea/ #e regions4 7d7 ,def9itions ,9 ?is section3 7#a7 ,fronti] area ,! t]m fronti] area means a fronti] c\nty1 z def9$ 9 section #ahhf7;d77#c77;,e77iii77,,iii7 ( ! ,social ,security ,act4 7#b7 ,indian2 ,indian tribe ,! t]ms ,indian & ,indian tribe h ! mean+s giv5 su* t]ms 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act4 7#c7 ,region ,! t]m region means a ,/ate1 ,indian tribe1 rural area1 or fronti] area4 7#d7 ,rural area ,! t]m rural area has ! mean+ giv5 t t]m 9 section #ahhf7;d77#b77;,d7 ( ! ,social ,security ,act4 7#e7 ,/ate ,! t]m ,/ate has ! mean+ giv5 t t]m = purposes ( title ,v ( ! ,social ,security ,act4 4 7d7 ,teleheal? network & teleheal? res\rce c5t]s grant programs ,section #ccj;,i ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;c-#ad7 is am5d$-- 7#a7 9 subsection 7f77#c71 by add+ at ! end ! foll[+3 7,m7 ,provid]s ( mat]nal c>e s]vices1 includ+ pr5atal1 labor & bir?1 & po/p>tum c>e s]vices1 & entities op]at+ ob/etric c>e units4 2 7#b7 9 subsection 7h77#a77;,b71 by /rik+ or pr5atal & ins]t+ or pr5atal1 labor & bir?1 or po/p>tum2 & 7#c7 9 subsection 7j77#a77;,b71 by ins]t+ equipm5t useful = c>+ = pregnant individuals1 includ+ ultras\nd ma*9es & fetal monitor+ equipm5t1 & o!r be=e equipm5t4 7e7 ,rural mat]nal & ob/etric c>e tra9+ demon/ration ,"p ,d ( title ,,vii ( ! ,public ,heal? ,s]vice ,act is am5d$ by ins]t+ aft] section #gfj 7#db ,u4,s4,c4 #bidk7 ! foll[+3 #gfj;,a4 ,rural mat]nal & ob/etric c>e tra9+ demon/ration 7a7 ,9 g5]al ,! ,secret>y %all e/abli% a tra9+ demon/ration program to aw>d to eligible entities-- 7#a7 grants to support tra9+ = physicians1 m$ical resid5ts1 & fell[s 7includ+ physicians1 resid5ts1 & fell[s 9 family m$ic9e & ob/etrics & gynecology7 to practice mat]nal & ob/etric m$ic9e 9 rural community-bas$ sett+s2 7#b7 grants to support tra9+ = lic5s$ & accr$it$ nurse practition]s1 physician assi/ants1 c]tifi$ nurse midwives1 c]tifi$ midwives1 c]tifi$ pr(essional midwives1 home visit+ nurses1 or non-cl9ical pr(essionals su* z d\las & community heal? work]s1 to provide mat]nal c>e s]vices 9 rural community-bas$ sett+s2 & 7#c7 grants to-- 7,a7 support e/abli%+1 ma9ta9+1 or improv+ academic units or programs t provide tra9+ = /ud5ts or faculty1 includ+ ?r\gh cl9ical exp]i5ces & rese>*1 to improve mat]nal c>e 9 rural areas2 or 7,b7 develop evid5ce-bas$ practices or recomm5dations = ! design ( ! units or programs describ$ 9 subp>agraph 7,a71 includ+ curriculum cont5t /&>ds4 7b7 ,activities 7#a7 ,tra9+ = physicians1 m$ical resid5ts1 & fell[s ,a recipi5t ( a grant "u subsection 7a77#a7-- 7,a7 %all use ! grant funds to plan1 develop1 & op]ate a tra9+ program = ! physicians1 m$ical resid5ts1 & fell[s describ$ 9 subsection 7a77#a7 to provide mat]nal & ob/etric heal? c>e s]vices 9 rural community-bas$ sett+s2 & 7,b7 may use ! grant funds to provide additional support = ! adm9i/ration ( ! program or to meet ! co/s ( projects to e/abli%1 ma9ta91 or improve faculty developm5t1 or dep>tm5ts1 divisions1 or o!r units necess>y to implem5t su* tra9+4 7#b7 ,tra9+ = o!r provid]s ,a recipi5t ( a grant "u subsection 7a77#b7-- 7,a7 %all use ! grant funds to plan1 develop1 or op]ate a tra9+ program = ! individuals describ$ 9 subsection 7a77#b7 to provide mat]nal heal? c>e s]vices 9 rural1 community-bas$ sett+s2 & 7,b7 may use ! grant funds to provide additional support = ! adm9i/ration ( ! program or to meet ! co/s ( projects to e/abli%1 ma9ta91 or improve faculty developm5t1 or dep>tm5ts1 divisions1 or o!r units necess>y to implem5t su* program4 7#c7 ,academic units or programs ,a recipi5t ( a grant "u subsection 7a77#c7 %all ent] into a p>tn]%ip ) organizations su* z an education accr$it+ organization 7su* z ! ,liaison ,committee on ,m$ical ,education1 ! ,accr$itation ,c\ncil = ,graduate ,m$ical ,education1 ! ,commission on ,o/eopa?ic ,college ,accr$itation1 ! ,accr$itation ,commission = ,education 9 ,nurs+1 ! ,commission on ,collegiate ,nurs+ ,education1 ! ,accr$itation ,commission = ,midwif]y ,education1 or ! ,accr$itation ,review ,commission on ,education = ! ,physician ,assi/ant7 to c>ry out activities "u subsection 7a77#c74 7#d7 ,tra9+ program requirem5ts ,! recipi5t ( a grant "u subsection 7a77#a7 or 7a77#b7 %all ensure t tra9+ programs c>ri$ out "u ! grant include in/ruction on-- 7,a7 mat]nal m5tal heal?1 includ+ p]9atal depression & anxiety & po/p>tum depression2 7,b7 mat]nal sub/ance use disord]2 7,c7 social det]m9ants ( heal? t impact individuals liv+ 9 rural communities1 includ+ pov]ty1 social isolation1 access to nutrition1 education1 transportation1 & h\s+2 & 7,d7 implicit bias4 7c7 ,eligible entities 7#a7 ,tra9+ = physicians1 m$ical resid5ts1 & fell[s ,to be eligible to receive a grant "u subsection 7a77#a71 an entity %all-- 7,a7 be a consortium consi/+ (-- 7i7 at lea/ "o tea*+ heal? c5t] 7z def9$ 9 section #gdi;,a7f772 or 7ii7 ! sponsor+ in/itution 7or p>5t in/itution ( ! sponsor+ in/itution7 (-- 7,i7 an ob/etrics & gynecology or family m$ic9e resid5cy program t is accr$it$ by ! ,accr$itation ,c\ncil = ,graduate ,m$ical ,education 7or ! p>5t in/itution ( su* a program72 or 7,,ii7 a fell[%ip 9 mat]nal or ob/etric m$ic9e1 z det]m9$ appropriate by ! ,secret>y2 or 7,b7 be an entity describ$ 9 subp>agraph 7,a77ii7 t provides opportunities = m$ical resid5ts or fell[s to tra9 9 rural community-bas$ sett+s4 7#b7 ,tra9+ = o!r provid]s ,to be eligible to receive a grant "u subsection 7a77#b71 an entity %all be-- 7,a7 a tea*+ heal? c5t] 7z def9$ 9 section #gdi;,a7f772 7,b7 a f$]ally qualifi$ heal? c5t] 7z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act72 7,c7 a community m5tal heal? c5t] 7z def9$ 9 section #ahfa7;ff77#c77;,b7 ( ! ,social ,security ,act72 7,d7 a rural heal? cl9ic 7z def9$ 9 section #ahfa7;aa7 ( ! ,social ,security ,act72 7,e7 a free/&+ bir? c5t] 7z def9$ 9 section #aije7l77#c7 ( ! ,social ,security ,act72 7,f7 a heal? c5t] op]at$ by-- 7i7 ! ,indian ,heal? ,s]vice1 an ,indian tribe1 or a tribal organization 7z su* t]ms are def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act72 or 7ii7 a ,native ,hawaiian ,heal? ,c>e ,sy/em 7z def9$ 9 section #ab ( ! ,native ,hawaiian ,heal? ,c>e ,improvem5t ,act72 or 7,g7 an entity ) a demon/rat$ record ( success 9 provid+ academic tra9+ = nurse practition]s1 physician assi/ants1 c]tifi$ nurse-midwives1 c]tifi$ midwives1 c]tifi$ pr(essional midwives1 home visit+ nurses1 or non-cl9ical pr(essionals1 su* z d\las & community heal? work]s4 7#c7 ,academic units or programs ,to be eligible to receive a grant "u subsection 7a77#c71 an entity %all be a s*ool ( m$ic9e or o/eopa?ic m$ic9e1 a nurs+ s*ool1 a physician assi/ant tra9+ program1 an accr$it$ public or nonpr(it private hospital1 an accr$it$ m$ical resid5cy program1 a s*ool accr$it$ by ! ,midwif]y ,education & ,accr$itation ,c\ncil1 or a public or private nonpr(it entity :i* ! ,secret>y has det]m9$ is capable ( c>ry+ out activities support$ by su* grant4 7#d7 ,application ,to be eligible to receive a grant "u subsection 7a71 an entity %all submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require1 includ+ an e/imate ( ! am\nt to be exp5d$ to conduct tra9+ activities "u ! grant 7includ+ ancill>y & adm9i/rative co/s74 7d7 ,duration ,grants aw>d$ "u ?is section %all be = a m9imum ( #e ye>s4 7e7 ,/udy & report 7#a7 ,/udy 7,a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all conduct a /udy on ! results ( ! demon/ration program "u ?is section4 7,b7 ,data submission ,n lat] ?an #ij days aft] ! completion ( ! fir/ ye> ( ! tra9+ program1 & ea* subsequ5t ye> = ! duration ( ! grant1 t ! program is 9 effect1 ea* recipi5t ( a grant "u subsection 7a7 %all submit to ! ,secret>y su* data z ! ,secret>y may require = analysis = ! report describ$ 9 p>agraph 7#b74 7#b7 ,report to ,congress ,n lat] ?an #a ye> aft] receipt ( ! data describ$ 9 p>agraph 7#a77;,b71 ! ,secret>y %all submit to ,congress a report t includes-- 7,a7 an analysis ( ! effect ( ! demon/ration program "u ?is section on ! quality1 quantity1 & di/ribution ( mat]nal1 includ+ pr5atal1 labor & bir?1 & po/p>tum c>e s]vices & ! demographics ( ! recipi5ts ( ^? s]vices2 7,b7 an analysis ( mat]nal & infant heal? outcomes 7includ+ quality ( c>e1 morbidity1 & mortality7 be=e & aft] implem5tation ( ! program 9 ! communities s]v$ by entities p>ticipat+ 9 ! demon/ration2 & 7,c7 recomm5dations on :e!r ! demon/ration program "u ?is section %\ld be exp&$4 7f7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section1 #e1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 4 7f7 ,,gao report ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ! appropriate committees ( ,congress a report on ! mat]nal1 includ+ pr5atal1 labor & bir?1 & po/p>tum1 c>e 9 rural areas4 ,su* report %all include ! foll[+3 7#a7 ,! location ( gaps 9 mat]nal & ob/etric cl9icians & heal? pr(essionals1 includ+ non-cl9ical pr(essionals su* z d\las & community heal? work]s4 7#b7 ,! location ( gaps 9 facilities able to provide mat]nal1 includ+ pr5atal1 labor & bir?1 & po/p>tum1 c>e 9 rural areas1 includ+ c>e = high-risk pregnancies4 7#c7 ,! gaps 9 data on mat]nal mortality & recomm5dations to /&>dize ! =mat on collect+ data relat$ to mat]nal mortality & morbidity4 7#d7 ,! gaps 9 mat]nal heal? by race & e?nicity 9 rural communities1 ) a focus on racial inequities = ,black resid5ts & among ,indian ,tribes & resid5ts :o are ,indian 7z su* t]ms are def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act74 7#e7 ,a li/ ( specific activities t ! ,secret>y ( ,heal? & ,human ,s]vices plans to conduct on mat]nal1 includ+ pr5atal1 labor & bir?1 & po/p>tum1 c>e4 7#f7 ,a plan = complet+ su* activities4 7#g7 ,an explanation ( ,f$]al ag5cy involvem5t & coord9ation ne$$ to conduct su* activities4 7#h7 ,a budget = conduct+ su* activities4 7#i7 ,o!r in=mation t ! ,comptroll] ,g5]al det]m9es appropriate4 #ejg4 ,decreas+ ! risk factors = sudd5 unexpect$ infant dea? & sudd5 unexpla9$ dea? 9 *ildhood 7a7 ,e/abli%m5t ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration & 9 consultation ) ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion & ! ,director ( ! ,national ,in/itutes ( ,heal? 79 ?is section ref]r$ to z ! ,secret>y71 %all e/abli% & implem5t a culturally & l+ui/ically compet5t public heal? aw>5ess & education campaign to provide in=mation t is focus$ on decreas+ ! risk factors = sudd5 unexpect$ infant dea? & sudd5 unexpla9$ dea? 9 *ildhood1 includ+ educat+ individuals ab\t safe sleep environm5ts1 sleep positions1 & r$uc+ exposure to smok+ dur+ pregnancy & aft] bir?4 7b7 ,t>get$ ,populations ,! campaign "u subsection 7a7 %all be design$ to r$uce heal? disp>ities ?r\gh ! t>get+ ( populations ) high rates ( sudd5 unexpect$ infant dea? & sudd5 unexpla9$ dea? 9 *ildhood4 7c7 ,consultation ,9 e/abli%+ & implem5t+ ! campaign "u subsection 7a71 ! ,secret>y %all consult ) national organizations repres5t+ heal? c>e provid]s1 includ+ nurses & physicians1 p>5ts1 *ild c>e provid]s1 *ildr5's advocacy & safety organizations1 mat]nal & *ild heal? programs1 nutrition pr(essionals focus+ on wom51 infants1 & *ildr51 & o!r individuals & gr\ps det]m9$ necess>y by ! ,secret>y = su* e/abli%m5t & implem5tation4 7d7 ,grants 7#a7 ,9 g5]al ,9 c>ry+ out ! campaign "u subsection 7a71 ! ,secret>y %all aw>d grants to national organizations1 ,/ate & local heal? dep>tm5ts1 & community-bas$ organizations = ! conduct ( education & outrea* programs = nurses1 p>5ts1 *ild c>e provid]s1 public heal? ag5cies1 & community organizations4 7#b7 ,application ,to be eligible to receive a grant "u p>agraph 7#a71 an entity %all submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7e7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #ejh4 ,r$uc+ un9t5d$ te5age pregnancies ,title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bda et seq47 is am5d$ by add+ at ! end ! foll[+3 ,w ,y\? ,access to ,sexual ,heal? ,s]vices #cii,,oo4 ,au?orization ( grants to support ! access ( m>g9aliz$ y\? to sexual heal? s]vices 7a7 ,grants ,! ,secret>y may aw>d grants on a competitive basis to eligible entities to support ! access ( m>g9aliz$ y\? to sexual heal? s]vices4 7b7 ,use ( funds ,an eligible entity t is aw>d$ a grant "u subsection 7a7 may use ! funds to-- 7#a7 provide m$ically accurate & complete & age-1 developm5tally1 & culturally appropriate sexual heal? in=mation to m>g9aliz$ y\?1 includ+ in=mation on h[ to access sexual heal? s]vices2 7#b7 promote effective communication reg>d+ sexual heal? among m>g9aliz$ y\?2 7#c7 promote & support bett] heal?1 education1 & economic opportunities = s*ool-age p>5ts2 & 7#d7 tra9 individuals :o "w ) m>g9aliz$ y\? to promote-- 7,a7 ! prev5tion ( un9t5d$ pregnancy2 7,b7 ! prev5tion ( sexually transmitt$ infections1 includ+ ! human immunodefici5cy virus 7,,hiv72 7,c7 heal?y relation%ips2 & 7,d7 ! developm5t ( safe & supportive environm5ts4 7c7 ,application ,to be aw>d$ a grant "u subsection 7a71 an eligible entity %all submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7d7 ,priority ,9 aw>d+ grants "u subsection 7a71 ! ,secret>y %all give priority to eligible entities-- 7#a7 ) a hi/ory ( support+ ! access ( m>g9aliz$ y\? to sexuality education or sexual heal? s]vices2 & 7#b7 t plan to s]ve m>g9aliz$ y\? t are n s]v$ by ,f$]al adolesc5t programs = ! prev5tion ( pregnancy1 ,,hiv1 & o!r sexually transmitt$ infections4 7e7 ,requirem5ts ,! ,secret>y may n aw>d a grant "u subsection 7a7 to an eligible entity unless-- 7#a7 su* eligible entity has =m$ a p>tn]%ip ) a community organization2 & 7#b7 su* eligible entity agrees-- 7,a7 to employ a sci5tifically effective /rategy2 7,b7 t all in=mation provid$ to m>g9aliz$ y\? w be-- 7i7 age- & developm5tally appropriate2 7ii7 m$ically accurate & complete2 7iii7 sci5tifically bas$2 & 7iv7 provid$ 9 ! language & cultural context t is mo/ appropriate = ! individuals s]v$ by ! eligible entity2 & 7,c7 t = ea* ye> ! eligible entity receives grant funds "u subsection 7a71 ! eligible entity w submit to ! ,secret>y an annual report t includes-- 7i7 ! use ( grant funds by ! eligible entity2 7ii7 h[ ! use ( grant funds has increas$ ! access ( m>g9aliz$ y\? to sexual heal? s]vices2 & 7iii7 su* o!r in=mation z ! ,secret>y may require4 7f7 ,publication & evaluations 7#a7 ,evaluations ,n less ?an once e two ye>s aft] ! date ( ! enactm5t ( ?is "p1 ! ,secret>y %all evaluate ! effectiv5ess ( :i*ev] ( ! foll[+ is great]3 7,a7 ,eight grants aw>d$ "u subsection 7a74 7,b7 ,t5 p]c5t ( ! grants aw>d$ "u subsection 7a74 7#b7 ,publication ,! ,secret>y %all make available to ! public-- 7,a7 ! evaluations requir$ "u p>agraph 7#a72 & 7,b7 ! reports requir$ "u subsection 7e77#b77;,c74 7g7 ,limitations ,no funds made available to an eligible entity "u ?is section may be us$ by su* entity to provide access to sexual heal? s]vices t-- 7#a7 )hold sexual heal?-promot+ or life-sav+ in=mation2 7#b7 are m$ically inaccurate or h be5 sci5tifically %[n to be ineffective2 7#c7 promote g5d] /]eotypes2 7#d7 are ins5sitive or unresponsive to ! ne$s ( "y p1 includ+-- 7,a7 y\? ) v>y+ g5d] id5tities1 g5d] expressions1 & sexual ori5tations2 7,b7 sexually active y\?2 7,c7 pregnant or p>5t+ y\?2 7,d7 survivors ( sexual abuse or assault2 & 7,e7 y\? ( all physical1 developm5tal1 & m5tal abilities2 or 7#e7 are inconsi/5t ) ! e?ical imp]atives ( m$ic9e & public heal?4 7h7 ,transf] ( funds ,any unobligat$ balance ( funds made available "u section #eaj7;f7 ( ! ,social ,security ,act 7z 9 effect on ! day be=e ! date ( ! enactm5t ( ?is "p7 are h]eby transf]r$ & made available to ! ,secret>y to c>ry out ?is section4 ,! am\nts transf]r$ & made available to c>ry out ?is section %all rema9 available until exp5d$4 7i7 ,def9itions ,9 ?is section3 7#a7 ,community organization ,! t]m community organization includes a ,/ate or local heal? or education ag5cy1 public s*ool1 y\?-focus$ organization t is fai?-bas$ & community-bas$1 juv5ile ju/ice entity1 or o!r organization t provides confid5tial & appropriate sexuality education or sexual heal? s]vices to m>g9aliz$ y\?4 7#b7 ,eligible entity ,! t]m eligible entity includes a ,/ate or local heal? or education ag5cy1 public s*ool1 nonpr(it organization1 hospital1 or an ,indian ,tribe or ,tribal organization 7z su* t]ms are def9$ 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #ecjd774 7#c7 ,m>g9aliz$ y\? ,! t]m m>g9aliz$ y\? means a p]son "u ! age ( #bf t is disadvantag$ by und]ly+ /ructural b>ri]s & social inequity4 7#d7 ,m$ically accurate & complete ,! t]m m$ically accurate & complete1 :5 us$ ) respect to in=mation1 means in=mation t-- 7,a7 is support$ by rese>* & recogniz$ z accurate1 objective1 & complete by lead+ m$ical1 psy*ological1 psy*iatric1 or public heal? organizations & ag5cies2 & 7,b7 does n )hold any in=mation relat+ to ! effectiv5ess & b5efits ( correct & consi/5t use ( condoms or o!r contraceptives & pregnancy prev5tion me?ods4 7#e7 ,sci5tifically effective /rategy ,! t]m sci5tifically effective /rategy means a /rategy t-- 7,a7 is widely recogniz$ by lead+ m$ical & public heal? ag5cies z effective 9 promot+ sexual heal? aw>5ess & heal?y behavior2 & 7,b7 ei!r-- 7i7 has be5 demon/rat$ to be effective on ! basis ( rigor\s sci5tific rese>*2 or 7ii7 incorporates *>act]i/ics ( effective programs4 7#f7 ,sexual heal? s]vices ,! t]m sexual heal? s]vices includes-- 7,a7 sexual heal? in=mation1 education1 & c\nsel+2 7,b7 contraception2 7,c7 em]g5cy contraception2 7,d7 condoms & o!r b>ri] me?ods to prev5t pregnancy or sexually transmitt$ infections2 7,e7 r\t9e gynecological c>e1 includ+ human papillomavirus 7,,hpv7 vacc9es & canc] scre5+s2 7,f7 pre-exposure prophylaxis or po/-exposure prophylaxis2 7,g7 m5tal heal? s]vices2 7,h7 sexual assault survivor s]vices2 & 7,i7 o!r prev5tion1 c>e1 or treatm5t4 4 #eji4 ,ge/ational diabetes ,"p ,b ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdc et seq47 is am5d$ by add+ aft] section #cag;,h ! foll[+3 #cag;,h-#a4 ,ge/ational diabetes 7a7 ,und]/&+ & monitor+ ge/ational diabetes 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 9 consultation ) ! ,diabetes ,mellitus ,int]ag5cy ,coord9at+ ,committee e/abli%$ "u section #dbi & repres5tatives ( appropriate national heal? organizations1 %all develop a multisite ge/ational diabetes rese>* project )9 ! diabetes program ( ! ,c5t]s = ,disease ,control & ,prev5tion to exp& & enhance surveillance data & public heal? rese>* on ge/ational diabetes4 7#b7 ,areas to be address$ ,! rese>* project develop$ "u p>agraph 7#a7 %all address-- 7,a7 proc$ures to e/abli% accurate & effici5t sy/ems = ! collection ( ge/ational diabetes data )9 ea* ,/ate & commonweal?1 t]ritory1 or possession ( ! ,unit$ ,/ates2 7,b7 ! progress ( collaborative activities ) ! ,national ,vital ,/ati/ics ,sy/em1 ! ,national ,c5t] = ,heal? ,/ati/ics1 & ,/ate heal? dep>tm5ts ) respect to ! /&>d bir? c]tificate1 9 ord] to improve surveillance ( ge/ational diabetes2 7,c7 po/p>tum me?ods ( track+ individuals ) ge/ational diabetes aft] deliv]y z well z t>get$ int]v5tions prov5 to l[] ! incid5ce ( type #b diabetes 9 t population2 7,d7 v>iations 9 ! di/ribution ( diagnos$ & undiagnos$ ge/ational diabetes1 & ( impair$ fa/+ glucose tol]ance & impair$ fa/+ glucose1 )9 & among gr\ps ( pregnant individuals2 & 7,e7 factors & culturally s5sitive int]v5tions t influ5ce risks & r$uce ! incid5ce ( ge/ational diabetes & relat$ complications dur+ *ildbir?1 includ+ cultural1 behavioral1 racial1 e?nic1 geographic1 demographic1 socioeconomic1 & g5etic factors4 7#c7 ,report ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is section1 & annually !reaft]1 ! ,secret>y %all g5]ate a report on ! f9d+s & recomm5dations ( ! rese>* project includ+ preval5ce ( ge/ational diabetes 9 ! multisite area & dissem9ate ! report to ! appropriate ,f$]al & non-,f$]al ag5cies4 7b7 ,expansion ( ge/ational diabetes rese>* 7#a7 ,9 ,g5]al ,! ,secret>y %all exp& & int5sify public heal? rese>* reg>d+ ge/ational diabetes4 ,su* rese>* may include-- 7,a7 develop+ & te/+ novel approa*es = improv+ po/p>tum diabetes te/+ or scre5+ & = prev5t+ type #b diabetes 9 individuals :o c become pregnant ) a hi/ory ( ge/ational diabetes2 & 7,b7 conduct+ public heal? rese>* to fur!r und]/&+ ( ! epidemiologic1 socio5vironm5tal1 behavioral1 translation1 & biom$ical factors & heal? sy/ems t influ5ce ! risk ( ge/ational diabetes & ! developm5t ( type #b diabetes 9 individuals :o c become pregnant ) a hi/ory ( ge/ational diabetes4 7#b7 ,au?orization ( ,appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is subsection #e1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 7c7 ,demon/ration grants ,to l[] ! rate ( ge/ational diabetes 7#a7 ,9 ,g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all aw>d grants1 on a competitive basis1 to eligible entities = demon/ration projects t implem5t evid5ce-bas$ int]v5tions to r$uce ! incid5ce ( ge/ational diabetes1 ! recurr5ce ( ge/ational diabetes 9 subsequ5t pregnancies1 & ! developm5t ( type #b diabetes 9 individuals :o c become pregnant ) a hi/ory ( ge/ational diabetes4 7#b7 ,priority ,9 mak+ grants "u ?is subsection1 ! ,secret>y %all give priority to projects focus+ on-- 7,a7 help+ individuals :o c become pregnant :o h #a or m risk factors = develop+ ge/ational diabetes2 7,b7 work+ ) individuals :o c become pregnant ) a hi/ory ( ge/ational diabetes dur+ a previ\s pregnancy2 7,c7 provid+ po/p>tum c>e = individuals :o c become pregnant ) ge/ational diabetes2 7,d7 track+ cases :]e individuals :o c become pregnant ) a hi/ory ( ge/ational diabetes develop$ type #b diabetes2 7,e7 educat+ mo!rs ) a hi/ory ( ge/ational diabetes ab\t ! increas$ risk ( _! *ild develop+ diabetes2 7,f7 work+ to prev5t ge/ational diabetes & prev5t or delay ! developm5t ( type #b diabetes 9 individuals :o c become pregnant ) a hi/ory ( ge/ational diabetes2 & 7,g7 a*iev+ outcomes design$ to assess ! efficacy & co/-effectiv5ess ( int]v5tions t c in=m decisions on long-t]m su/a9ability1 includ+ ?ird-p>ty reimbursem5t4 7#c7 ,application ,an eligible entity desir+ to receive a grant "u ?is subsection %all submit to ! ,secret>y-- 7,a7 an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require2 & 7,b7 a plan to-- 7i7 l[] ! rate ( ge/ational diabetes dur+ pregnancy2 or 7ii7 develop me?ods ( track+ individuals :o c become pregnant ) a hi/ory ( ge/ational diabetes & develop effective int]v5tions to l[] ! incid5ce ( ! recurr5ce ( ge/ational diabetes 9 subsequ5t pregnancies & ! developm5t ( type #b diabetes4 7#d7 ,uses ( ,funds ,an eligible entity receiv+ a grant "u ?is subsection %all use ! grant funds to c>ry out demon/ration projects describ$ 9 p>agraph 7#a71 includ+-- 7,a7 exp&+ community-bas$ heal? promotion education1 activities1 & inc5tives focus$ on ! prev5tion ( ge/ational diabetes & developm5t ( type #b diabetes 9 individuals :o c become pregnant ) a hi/ory ( ge/ational diabetes2 7,b7 aid+ ,/ate- & ,tribal-bas$ diabetes prev5tion & control programs to collect1 analyze1 dissem9ate1 & report surveillance data on individuals :o c become pregnant )1 & at risk =1 ge/ational diabetes1 ! recurr5ce ( ge/ational diabetes 9 subsequ5t pregnancies1 &1 = individuals :o c become pregnant ) a hi/ory ( ge/ational diabetes1 ! developm5t ( type #b diabetes2 & 7,c7 tra9+ & enc\rag+ heal? c>e provid]s-- 7i7 to promote risk assessm5t1 high-quality c>e1 & self-managem5t = ge/ational diabetes & ! recurr5ce ( ge/ational diabetes 9 subsequ5t pregnancies2 & 7ii7 to prev5t ! developm5t ( type #b diabetes 9 individuals :o c become pregnant ) a hi/ory ( ge/ational diabetes1 & its complications 9 ! practice sett+s ( ! heal? c>e provid]s4 7#e7 ,report ,n lat] ?an #d ye>s aft] ! date ( ! enactm5t ( ?is section1 ! ,secret>y %all prep>e & submit to ! ,congress a report conc]n+ ! results ( ! demon/ration projects conduct$ ?r\gh ! grants aw>d$ "u ?is subsection4 7#f7 ,def9ition ( ,eligible ,entity ,9 ?is subsection1 ! t]m eligible entity means a nonpr(it organization 7su* z a nonpr(it academic c5t] or community heal? c5t]7 or a ,/ate1 ,tribal1 or local heal? ag5cy4 7#g7 ,au?orization ( ,appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is subsection #e1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 7d7 ,po/p>tum foll[up reg>d+ ge/ational diabetes ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all "w ) ! ,/ate- & ,tribal-bas$ diabetes prev5tion & control programs assi/$ by ! ,c5t]s to enc\rage po/p>tum foll[up aft] ge/ational diabetes1 z m$ically appropriate1 = ! purpose ( r$uc+ ! incid5ce ( ge/ational diabetes1 ! recurr5ce ( ge/ational diabetes 9 subsequ5t pregnancies1 ! developm5t ( type #b diabetes 9 individuals ) a hi/ory ( ge/ational diabetes1 & relat$ complications4 4 #eaj4 ,em]g5cy contraception education & in=mation programs 7a7 ,em]g5cy ,contraception ,public ,education ,program 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all develop & dissem9ate to ! public m$ically accurate & complete in=mation on em]g5cy contraceptives4 7#b7 ,dissem9ation ,! ,secret>y may dissem9ate m$ically accurate & complete in=mation "u p>agraph 7#a7 directly or ?r\gh arrangem5ts ) nonpr(it organizations1 community heal? work]s includ+ promotores1 consum] gr\ps1 in/itutions ( high] education1 cl9ics1 ! m$ia1 & ,f$]al1 ,/ate1 & local ag5cies4 7#c7 ,in=mation ,! in=mation dissem9at$ "u p>agraph 7#a7 %all-- 7,a7 include1 at a m9imum1 a description ( em]g5cy contraceptives & an explanation ( ! use1 safety1 efficacy1 af=dability1 & availability1 includ+ ov]-!-c\nt] access1 ( su* contraceptives & options = access )\t co/-%>+ ?r\gh insurance & o!r programs2 & 7,b7 be pilot te/$ = consum] compreh5sion1 cultural & l+ui/ic appropriat5ess1 & acceptance ( ! messages across geographically1 racially1 e?nically1 & l+ui/ically div]se populations4 7b7 ,em]g5cy ,contraception ,in=mation ,program = ,heal? ,c>e ,provid]s 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration & 9 consultation ) major m$ical & public heal? organizations1 %all develop & dissem9ate to heal? c>e provid]s1 includ+ ph>maci/s1 in=mation on em]g5cy contraceptives4 7#b7 ,in=mation ,! in=mation dissem9at$ "u p>agraph 7#a7 %all include1 at a m9imum-- 7,a7 in=mation describ+ ! use1 safety1 efficacy1 & availability ( em]g5cy contraceptives1 & options = access )\t co/-%>+ ?r\gh insurance & o!r programs2 7,b7 a recomm5dation reg>d+ ! use ( su* contraceptives2 & 7,c7 in=mation expla9+ h[ to obta9 copies ( ! in=mation develop$ "u subsection 7a7 = di/ribution to ! pati5ts ( ! provid]s4 7c7 ,def9itions ,9 ?is section3 7#a7 ,heal? c>e provid] ,! t]m heal? c>e provid] means an individual :o is lic5s$ or c]tifi$ "u ,/ate law to provide heal? c>e s]vices & :o is op]at+ )9 ! scope ( su* lic5se4 ,su* t]m %all include a ph>maci/4 7#b7 ,in/itution ( high] education ,! t]m in/itution ( high] education has ! same mean+ giv5 su* t]m 9 section #aja7;a7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajja7;a774 7#c7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7d7 ,au?orization ( ,appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( ! fiscal ye>s #bjba ?r\gh #bjbe4 #eaa4 ,compreh5sive sex education programs 7a7 ,purposes2 f9d+2 s5se ( congress 7#a7 ,purposes ,! purposes ( ?is section are to provide "y p ) compreh5sive sex education programs t-- 7,a7 promote & uphold ! rights ( "y p to in=mation 9 ord] to make heal?y decisions ab\t _! sexual heal?2 7,b7 provide ! in=mation & skills all "y p ne$ to make in=m$1 responsible1 & heal?y decisions 9 ord] to become sexually heal?y adults & h heal?y relation%ips2 7,c7 provide in=mation ab\t ! prev5tion ( un9t5d$ pregnancy1 sexually transmitt$ infections1 includ+ ,,hiv1 dat+ viol5ce1 sexual assault1 bully+1 & h>assm5t2 & 7,d7 provide res\rces & in=mation on topics rang+ f g5d] /]eotyp+ & g5d] roles & /igma & socio-cultural influ5ces surr\nd+ sex & sexuality4 7#b7 ,f9d+ on requir$ res\rces ,9 ord] to provide ! compreh5sive sex education describ$ 9 p>agraph 7#a71 ,congress f9ds t increas$ res\rces are requir$ = sex education programs t-- 7,a7 sub/antially incorporate elem5ts ( evid5ce-bas$ programs or *>act]i/ics ( effective programs2 7,b7 cov] a broad range ( topics1 includ+ m$ically accurate & complete in=mation t is age & developm5tally appropriate ab\t all ! aspects ( sex1 sexual heal?1 & sexuality2 7,c7 are g5d] & g5d] id5tity-s5sitive1 emphasiz+ ! importance ( equality & ! social environm5t = a*iev+ sexual & reproductive heal? & ov]all well-be+2 7,d7 promote educational a*ievem5t1 critical ?9k+1 decision mak+1 self-e/eem1 & self-efficacy2 7,e7 help develop heal?y attitudes & insights necess>y = und]/&+ relation%ips betwe5 oneself & o!rs & society2 7,f7 fo/] lead]%ip skills & community engagem5t by-- 7i7 promot+ pr9ciples ( fairness1 human dignity1 & respect2 & 7ii7 engag+ "y p z p>tn]s 9 _! communities2 & 7,g7 are culturally & l+ui/ically appropriate1 reflect+ ! div]se circum/ances & realities ( "y p4 7#c7 ,s5se ( congress ,x is ! s5se ( ,congress t-- 7,a7 f$]ally fund$ sex education programs %\ld aim to-- 7i7 provide in=mation ab\t a range ( human sexuality topics1 includ+-- 7,i7 human developm5t1 heal?y relation%ips1 p]sonal skills2 7,,ii7 sexual behavior includ+ ab/95ce2 7,,iii7 sexual heal? includ+ prev5t+ un9t5d$ pregnancy2 7,,iv7 sexually transmitt$ infections includ+ ,,hiv2 & 7,v7 society & culture2 7ii7 promote safe & heal?y relation%ips2 7iii7 promote g5d] equity2 7iv7 use1 & be in=m$ by1 ! be/ sci5tific in=mation available2 7v7 be culturally appropriate & inclusive ( y\? ) v>y+ g5d] id5tities1 g5d] expressions1 & sexual ori5tations2 7vi7 be built on *>act]i/ics ( effective programs2 7vii7 exp& ! exi/+ body ( rese>* on compreh5sive sex education programs ?r\gh program evaluation2 7viii7 exp& tra9+ programs = tea*]s ( compreh5sive sex education2 7ix7 build on programs fund$ "u section #eac ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gac7 & ! ,(fice ( ,adolesc5t ,heal?'s ,te5 ,pregnancy ,prev5tion ,program1 fund$ "u title ,,ii ( ! ,consolidat$ ,appropriations ,act1 #bjaj 7,public ,law #aaa-aag2 #abc ,/at4 #cbec71 & on programs support$ ?r\gh ! ,c5t]s = ,disease ,control & ,prev5tion 7,,cdc72 & 7x7 promote & uphold ! rights ( "y p to in=mation 9 ord] to make heal?y & autonom\s decisions ab\t _! sexual heal?2 & 7,b7 no ,f$]al funds %\ld be us$ = heal? education programs t-- 7i7 )hold heal?-promot+ or life-sav+ in=mation ab\t sexuality-relat$ topics1 includ+ ,,hiv2 7ii7 are m$ically inaccurate or h be5 sci5tifically %[n to be ineffective2 7iii7 promote g5d] or racial /]eotypes2 7iv7 are ins5sitive & unresponsive to ! ne$s ( sexually active "y p2 7v7 are ins5sitive & unresponsive to ! ne$s ( survivors ( sexual viol5ce2 7vi7 are ins5sitive & unresponsive to ! ne$s ( y\? ( all physical1 developm5tal1 & m5tal abilities2 7vii7 are ins5sitive & unresponsive to ! ne$s ( y\? ) v>y+ g5d] id5tities1 g5d] expressions1 & sexual ori5tations2 or 7viii7 are inconsi/5t ) ! e?ical imp]atives ( m$ic9e & public heal?4 7b7 ,grants = compreh5sive sex education = adolesc5ts 7#a7 ,program au?oriz$ ,! ,secret>y ( ,heal? & ,human ,s]vices1 9 coord9ation ) ! ,associate ,commission] ( ! ,family & ,y\? ,s]vices ,bureau ( ! ,adm9i/ration on ,*ildr51 ,y\?1 & ,families ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 ! ,director ( ! ,(fice ( ,adolesc5t ,heal?1 ! ,director ( ! ,division ( ,adolesc5t & ,s*ool ,heal? )9 ! ,c5t]s = ,disease ,control & ,prev5tion & ! ,secret>y ( ,education1 %all aw>d grants1 on a competitive basis1 to eligible entities to enable su* eligible entities to c>ry out programs t provide adolesc5ts ) compreh5sive sex education1 z describ$ 9 p>agraph 7#f74 7#b7 ,duration ,grants aw>d$ "u ?is section %all be = a p]iod ( #e ye>s4 7#c7 ,eligible entity ,9 ?is section1 ! t]m eligible entity means a public or private entity t focuses on adolesc5t heal? & education or has exp]i5ce work+ ) adolesc5ts4 7#d7 ,applications ,an eligible entity desir+ a grant "u ?is subsection %all submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require1 includ+ an assurance to p>ticipate 9 ! evaluation describ$ 9 subsection 7e74 7#e7 ,priority ,9 aw>d+ grants "u ?is section1 ! ,secret>y %all give priority to eligible entities t-- 7,a7 are ,/ate or local public entities2 7,b7 are entities n curr5tly receiv+ funds "u-- 7i7 section #eac ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gac72 7ii7 ! ,(fice ( ,adolesc5t ,heal?'s ,te5 ,pregnancy ,prev5tion ,program1 fund$ "u title ,,ii ( ! ,consolidat$ ,appropriations ,act1 #bjaj 7,public ,law #aaa-aag2 #abc ,/at4 #cbec71 or any sub/antially simil> successive program2 or 7iii7 ! ,c5t]s = ,disease ,control & ,prev5tion's ,division ( ,adolesc5t & ,s*ool ,heal?2 & 7,c7 address heal? inequities among "y p t face sy/emic b>ri]s result+ 9 disproportionate rates ( n less ?an "o ( ! foll[+3 7i7 ,un9t5d$ pregnancies4 7ii7 ,sexually transmitt$ infections1 includ+ ,,hiv4 7iii7 ,dat+ viol5ce & sexual viol5ce4 7#f7 ,use ( funds 7,a7 ,9 g5]al ,ea* eligible entity t receives a grant "u ?is section %all use ! grant funds to c>ry out an education program t provides adolesc5ts ) compreh5sive sex education t-- 7i7 is age & developm5tally appropriate2 7ii7 is m$ically accurate & complete2 7iii7 sub/antially incorporates elem5ts ( evid5ce-bas$ sex education in/ruction2 or 7iv7 creates a demon/ration project bas$ on *>act]i/ics ( effective programs4 7,b7 ,cont5ts ( compreh5sive sex education programs ,! compreh5sive sex education programs fund$ "u ?is section %all include in/ruction & mat]ials t address-- 7i7 ! physical1 social1 & emotional *anges ( human developm5t includ+1 human anatomy1 reproduction1 & sexual developm5t2 7ii7 heal?y relation%ips1 includ+ fri5d%ips1 )9 families1 & society1 t are bas$ on mutual respect1 & ! ability to di/+ui% betwe5 heal?y & unheal?y relation%ips1 includ+-- 7,i7 effective communication1 negotiation & refusal skills1 includ+ ! skills to recognize & report inappropriate or abusive sexual advances2 7,,ii7 bodily autonomy1 sett+ & respect+ p]sonal b\nd>ies1 practic+ p]sonal safety1 & cons5t2 & 7,,iii7 ! limitations & h>m ( g5d]- role /]eotypes1 viol5ce1 co]cion1 bully+1 h>assm5t1 & intimidation 9 relation%ips2 7iii7 heal?y decision-mak+ skills ab\t sexuality & relation%ips t include-- 7,i7 critical ?9k+1 problem solv+1 self-efficacy1 /ress-managem5t1 self-c>e1 & decision mak+2 7,,ii7 individual values & attitudes2 7,,iii7 ! promotion ( positive body images2 7,,iv7 develop+ an und]/&+ t !re are a range ( body types & enc\rag+ positive feel+ ab\t /ud5ts' own body types2 7,v7 in=mation on h[ to respect o!rs & ensure safety on ! int]net & :5 us+ o!r =ms ( digital communication2 7,,vi7 in=mation on local s]vices & res\rces :]e /ud5ts c obta9 additional in=mation relat$ to bully+1 h>assm5t1 dat+ viol5ce & sexual assault1 suicide prev5tion1 & o!r relat$ c>e2 7,,vii7 enc\ragem5t = y\? to communicate ) _! p>5ts or gu>dians1 heal? & social s]vice pr(essionals1 & o!r tru/$ adults ab\t sexuality & intimate relation%ips2 7,,viii7 in=mation on h[ to create a safe environm5t = all /ud5ts & o!rs 9 society2 7,,ix7 examples ( v>y+ types ( relation%ips1 c\ples1 & family /ructures2 & 7,x7 affirmative repres5tation ( v>y+ g5d] id5tities1 g5d] expressions1 & sexual ori5tations1 includ+ individuals & relation%ips betwe5 same sex c\ples & _! families2 7iv7 ab/95ce1 delay+ age ( fir/ sexual activity1 ! use ( condoms1 prev5tive m$ication1 vacc9ation1 bir? control1 & o!r sexually transmitt$ infection prev5tion measures1 & ! options = pregnancy1 includ+ p>5t+1 adoption1 & abortion1 includ+-- 7,i7 ! importance ( effectively us+ condoms1 prev5tive m$ication1 & applicable vacc9ations to protect aga9/ sexually transmitt$ infections1 includ+ ,,hiv2 7,,ii7 ! b5efits ( effective contraceptive & condom use 9 avoid+ un9t5d$ pregnancy2 7,,iii7 ! relation%ip betwe5 sub/ance use & sexual heal? & behaviors2 & 7,,iv7 in=mation ab\t local heal? s]vices :]e /ud5ts c obta9 additional in=mation & s]vices relat$ to sexual & reproductive heal? & o!r relat$ c>e2 7v7 ?r\gh affirmative recognition1 ! roles t traditions1 values1 religion1 norms1 g5d] roles1 acculturation1 family /ructure1 heal? beliefs1 & political p[] play 9 h[ /ud5ts make decisions t affect _! sexual heal?1 us+ examples ( v>i\s types ( races1 e?nicities1 cultures1 & families1 includ+ s+le-p>5t h\seholds & "y families2 7vi7 in=mation ab\t g5d] id5tity1 g5d] expression1 & sexual ori5tation = all /ud5ts1 includ+-- 7,i7 affirmative recognition t p h diff]5t g5d] id5tities1 g5d] expressions1 & sexual ori5tations2 & 7,,ii7 community res\rces t c provide additional support = individuals ) v>y+ g5d] id5tities1 g5d] expressions1 & sexual ori5tations2 & 7vii7 opportunities to explore ! roles t race1 e?nicity1 immigration /atus1 disability /atus1 economic /atus1 homelessness1 fo/] c>e /atus1 & language )9 diff]5t communities affect sexual attitudes 9 society & culture & h[ ?is may impact /ud5t sexual heal?4 7c7 ,grants = compreh5sive sex education at in/itutions ( high] education 7#a7 ,program au?oriz$ ,! ,secret>y1 9 coord9ation ) ! ,secret>y ( ,education1 %all aw>d grants1 on a competitive basis1 to in/itutions ( high] education or consortia ( su* in/itutions to enable su* in/itutions to provide "y p ) compreh5sive sex education1 z describ$ 9 p>agraph 7#e77;,b74 7#b7 ,duration ,grants aw>d$ "u ?is subsection %all be = a p]iod ( #e ye>s4 7#c7 ,applications ,an in/itution ( high] education or consortium ( su* in/itutions desir+ a grant "u ?is subsection %all submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require1 includ+ an assurance to p>ticipate 9 ! evaluation describ$ 9 subsection 7e74 7#d7 ,priority ,9 aw>d+ grants "u ?is subsection1 ! ,secret>y %all give priority to an in/itution ( high] education t-- 7,a7 has an enrollm5t ( ne$y /ud5ts1 z def9$ 9 section #cah7;b7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajei;e7b772 7,b7 is a ,hispanic-s]v+ in/itution1 z def9$ 9 section #ejb7;a7 ( su* ,act 7#bj ,u4,s4,c4 #aaja;a7a772 7,c7 is a ,tribal ,college or ,univ]sity1 z def9$ 9 section #caf7;b7 ( su* ,act 7#bj ,u4,s4,c4 #ajei;c7b772 7,d7 is an ,alaska ,native-s]v+ in/itution1 z def9$ 9 section #cag7;b7 ( su* ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7,e7 is a ,native ,hawaiian-s]v+ in/itution1 z def9$ 9 section #cag7;b7 ( su* ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7,f7 is a ,pr$om9ately ,black ,in/itution1 z def9$ 9 section #cah7;b7 ( su* ,act 7#bj ,u4,s4,c4 #ajei;e7b772 7,g7 is a ,native ,am]ican-s]v+1 nontribal in/itution1 z def9$ 9 section #cai7;b7 ( su* ,act 7#bj ,u4,s4,c4 #ajei;f7b772 7,h7 is an ,asian ,am]ican & ,native ,am]ican ,pacific ,isl&]-s]v+ in/itution1 z def9$ 9 section #cbj7;b7 ( su* ,act 7#bj ,u4,s4,c4 #ajei;g7b772 or 7,i7 is a m9ority in/itution1 z def9$ 9 section #cfe ( su* ,act 7#bj ,u4,s4,c4 #ajfgk71 ) an enrollm5t ( ne$y /ud5ts1 z def9$ 9 section #cab ( su* ,act 7#bj ,u4,s4,c4 #ajeh74 7#e7 ,uses ( funds 7,a7 ,9 g5]al ,an in/itution ( high] education1 or a consortium1 receiv+ a grant "u ?is subsection %all use grant funds to integrate issues relat+ to compreh5sive sex education into ! in/itution ( high] education1 or consortium1 9 ord] to rea* a l>ge numb] ( /ud5ts1 by c>ry+ out #a or m ( ! foll[+ activities3 7i7 ,develop+ or adopt+ educational cont5t = issues relat+ to compreh5sive sex education t w be incorporat$ into /ud5t ori5tation1 g5]al education1 or core c\rses4 7ii7 ,develop+ or adopt+1 & implem5t+ s*oolwide educational programm+ outside ( class t deliv]s elem5ts ( compreh5sive sex education programs to /ud5ts1 faculty1 & /aff4 7iii7 ,develop+ or adopt+ innovative te*nology-bas$ approa*es to deliv] sex education to /ud5ts1 faculty1 & /aff4 7iv7 ,develop+ or adopt+1 & implem5t+ pe]-outrea* & education programs to g5]ate discussion1 educate1 & raise aw>5ess among /ud5ts ab\t issues relat+ to compreh5sive sex education4 7,b7 ,cont5ts ( sex education programs ,ea* in/itution ( high] education's program ( compreh5sive sex education fund$ "u ?is section %all include in/ruction & mat]ials t address ! cont5ts requir$ "u subsection 7b77#f74 7d7 ,grants = pre-,s]vice & 9-,s]vice tea*] tra9+ 7#a7 ,program au?oriz$ ,! ,secret>y1 9 coord9ation ) ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion & ! ,secret>y ( ,education1 %all aw>d grants1 on a competitive basis1 to eligible entities to enable su* eligible entities to c>ry out ! activities describ$ 9 p>agraph 7#e74 7#b7 ,duration ,grants aw>d$ "u ?is section %all be = a p]iod ( #e ye>s4 7#c7 ,eligible entity ,9 ?is section1 ! t]m eligible entity means-- 7,a7 a ,/ate educational ag5cy1 z def9$ 9 section #haja ( ! ,elem5t>y & ,second>y ,education ( #aife 7#bj ,u4,s4,c4 #ghja72 7,b7 a local educational ag5cy1 z def9$ 9 section #haja ( ! ,elem5t>y & ,second>y ,education ( #aife 7#bj ,u4,s4,c4 #ghja72 7,c7 an ,indian ,tribe or ,tribal organization1 z def9$ 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #ecjd72 7,d7 a ,/ate or local dep>tm5t ( heal?2 7,e7 a ,/ate or local dep>tm5t ( education2 7,f7 an educational s]vice ag5cy1 z def9$ 9 section #haja ( ! ,elem5t>y & ,second>y ,education ( #aife 7#bj ,u4,s4,c4 #ghja72 7,g7 a nonpr(it in/itution ( high] education1 z def9$ 9 section #aja ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajja72 7,h7 a national or /atewide nonpr(it organization t has z its prim>y purpose ! improvem5t ( provision ( compreh5sive sex education ?r\gh tra9+ & effective tea*+ ( compreh5sive sex education2 or 7,i7 a consortium ( nonpr(it organizations t has z its prim>y purpose ! improvem5t ( provision ( compreh5sive sex education ?r\gh tra9+ & effective tea*+ ( compreh5sive sex education4 7#d7 ,application ,an eligible entity desir+ a grant "u ?is subsection %all submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require1 includ+ an assurance to p>ticipate 9 ! evaluation describ$ 9 subsection 7e74 7#e7 ,au?oriz$ activities 7,a7 ,requir$ activity ,ea* eligible entity receiv+ a grant "u ?is section %all use grant funds = pr(essional developm5t & tra9+ ( relevant faculty1 s*ool adm9i/rators1 tea*]s1 & /aff1 9 ord] to increase effective tea*+ ( compreh5sive sex education /ud5ts4 7,b7 ,p]missible activities ,ea* eligible entity receiv+ a grant "u ?is section may use grant funds to-- 7i7 provide rese>*-bas$ tra9+ ( tea*]s = compreh5sive sex education = adolesc5ts z a means ( broad5+ /ud5t k ab\t issues relat$ to human developm5t1 heal?y relation%ips1 p]sonal skills1 & sexual behavior1 includ+ ab/95ce1 sexual heal?1 & society & culture2 7ii7 support ! dissem9ation ( in=mation on effective practices & rese>* f9d+s conc]n+ ! tea*+ ( compreh5sive sex education2 7iii7 support rese>* on-- 7,i7 effective compreh5sive sex education tea*+ practices2 & 7,,ii7 ! developm5t ( assessm5t in/rum5ts & /rategies to docum5t-- 7aa7 /ud5t und]/&+ ( compreh5sive sex education2 & 7bb7 ! effects ( compreh5sive sex education2 7iv7 conv5e national conf]5ces on compreh5sive sex education1 9 ord] to effectively tra9 tea*]s 9 ! provision ( compreh5sive sex education2 & 7v7 develop & dissem9ate appropriate rese>*-bas$ mat]ials to fo/] compreh5sive sex education4 7,c7 ,subgrants ,ea* eligible entity receiv+ a grant "u ?is subsection may aw>d subgrants to nonpr(it organizations t possess a demon/rat$ record ( provid+ tra9+ to faculty1 s*ool adm9i/rators1 tea*]s1 & /aff on compreh5sive sex education to-- 7i7 tra9 tea*]s 9 compreh5sive sex education2 7ii7 support int]net or di/ance le>n+ relat$ to compreh5sive sex education2 7iii7 promote rigor\s academic /&>ds & assessm5t te*niques to guide & measure /ud5t p]=mance 9 compreh5sive sex education2 7iv7 enc\rage replication ( be/ practices & model programs to promote compreh5sive sex education2 7v7 develop & dissem9ate effective1 rese>*-bas$ compreh5sive sex education le>n+ mat]ials2 7vi7 develop academic c\rses on ! p$agogy ( sex education at in/itutions ( high] education2 or 7vii7 conv5e ,/ate-bas$ conf]5ces to tra9 tea*]s 9 compreh5sive sex education & to id5tify /rategies = improvem5t4 7e7 ,impact evaluation & report+ 7#a7 ,multi-ye> evaluation 7,a7 ,9 g5]al ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all ent] into a contract ) a nonpr(it organization ) exp]i5ce 9 conduct+ impact evaluations1 to conduct a multi-ye> evaluation on ! impact ( ! grants "u subsections 7b71 7c71 & 7d71 & to report to ,congress & ! ,secret>y on ! f9d+s ( su* evaluation4 7,b7 ,evaluation ,! evaluation conduct$ "u ?is subsection %all-- 7i7 be conduct$ 9 a mann] consi/5t ) relevant1 nationally recogniz$ pr(essional & te*nical evaluation /&>ds2 7ii7 use s\nd /ati/ical me?ods & te*niques relat+ to ! behavioral sci5ces1 includ+ quasi-exp]im5tal designs1 inf]5tial /ati/ics1 & o!r me?odologies & te*niques t all[ = conclusions to be rea*$2 7iii7 be c>ri$ out by an indep5d5t organization t has n receiv$ a grant "u subsection 7b71 7c71 or 7d72 & 7iv7 be design$ to provide in=mation on-- 7,i7 output measures1 su* z ! numb] ( individuals s]v$ "u ! grant & ! numb] ( h\rs ( in/ruction2 7,,ii7 outcome measures1 includ+ measures relat+ to-- 7aa7 ! k t individuals p>ticipat+ 9 ! grant program h ga9$ 9 ea* ( ! foll[+ age & developm5tally appropriate areas-- 7,,aa7 gr[? & developm5t2 7,,bb7 relation%ip dynamics2 7,,cc7 ways to prev5t un9t5d$ pregnancy & sexually transmitt$ infections1 includ+ ,,hiv2 & 7,,dd7 sexual heal?2 7bb7 ! age & developm5tally appropriate skills t individuals p>ticipat+ 9 ! grant program h ga9$ reg>d+-- 7,,aa7 negotiation & communication2 7,,bb7 decision mak+ & goal sett+2 7,,cc7 int]p]sonal skills & heal?y relation%ips2 & 7,,dd7 condom use2 & 7cc7 ! behaviors ( adolesc5ts p>ticipat+ 9 ! grant program1 includ+ data ab\t-- 7,,aa7 age ( fir/ int]c\rse2 7,,bb7 condom & contraceptive use at fir/ int]c\rse2 7,,cc7 rec5t condom & contraceptive use2 7,,dd7 sub/ance use2 7,,ee7 dat+ abuse & lifetime hi/ory ( sexual assault1 dat+ viol5ce1 bully+1 h>assm5t1 /alk+2 & 7,,ff7 academic p]=mance2 & 7,,iii7 o!r measures necess>y to evaluate ! impact ( ! grant program4 7,c7 ,report ,n lat] ?an #f ye>s aft] ! date ( enactm5t ( ?is ,act1 ! organization conduct+ ! evaluation "u ?is subsection %all prep>e & submit to ! appropriate committees ( ,congress & ! ,secret>y an evaluation report4 ,su* report %all be made publicly available1 includ+ on ! website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7#b7 ,secret>y's report to congress ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 & annually !reaft] = a p]iod ( #e ye>s1 ! ,secret>y %all prep>e & submit to ! appropriate committees ( ,congress a report on ! activities to provide adolesc5ts & "y p ) compreh5sive sex education & pre-s]vice & 9-s]vice tea*] tra9+ fund$ "u ?is section4 ,! ,secret>y's report to ,congress %all include-- 7,a7 a /atem5t ( h[ grants aw>d$ by ! ,secret>y meet ! purposes describ$ 9 subsection 7a77#a72 & 7,b7 in=mation ab\t-- 7i7 ! numb] ( eligible entities & in/itutions ( high] education t are receiv+ grant funds "u subsections 7b71 7c71 & 7d72 7ii7 ! specific activities support$ by grant funds aw>d$ "u subsections 7b71 7c71 & 7d72 7iii7 ! numb] ( adolesc5ts s]v$ by grant programs fund$ "u subsection 7b72 7iv7 ! numb] ( "y p s]v$ by grant programs fund$ "u subsection 7c72 7v7 ! numb] ( faculty1 s*ool adm9i/rators1 tea*]s1 & /aff tra9$ "u subsection 7d72 & 7vi7 ! /atus ( ! evaluation requir$ "u p>agraph 7#a74 7f7 ,nondiscrim9ation ,programs fund$ "u ?is section %all n discrim9ate on ! basis ( actual or p]ceiv$ sex1 race1 color1 e?nicity1 national orig91 disability1 sexual ori5tation1 g5d] id5tity1 or religion4 ,no?+ 9 ?is section %all be con/ru$ to invalidate or limit rights1 rem$ies1 proc$ures1 or legal /&>ds available "u any o!r ,f$]al law or any law ( a ,/ate or a political subdivision ( a ,/ate1 includ+ ! ,civil ,rights ,act ( #aifd 7#db ,u4,s4,c4 #bjjj;a et seq471 title ,,ix ( ! ,education ,am5dm5ts ( #aigb 7#bj ,u4,s4,c4 #afha et seq471 section #ejd ( ! ,rehabilitation ,act ( #aigc 7#bi ,u4,s4,c4 #gid71 ! ,am]icans ) ,disabilities ,act ( #aiij 7#db ,u4,s4,c4 #abaja et seq471 & section #aeeg ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahaaf74 7g7 ,limitation ,no ,f$]al funds provid$ "u ?is section may be us$ = heal? education programs t-- 7#a7 )hold heal?-promot+ or life-sav+ in=mation ab\t sexuality-relat$ topics1 includ+ ,,hiv2 7#b7 are m$ically inaccurate or h be5 sci5tifically %[n to be ineffective2 7#c7 promote g5d] or racial /]eotypes2 7#d7 are ins5sitive & unresponsive to ! ne$s ( sexually active "y p2 7#e7 are ins5sitive & unresponsive to ! ne$s ( pregnant or p>5t+ "y p2 7#f7 are ins5sitive & unresponsive to ! ne$s ( survivors ( sexual abuse or assault2 7#g7 are ins5sitive & unresponsive to ! ne$s ( y\? ( all physical1 developm5tal1 or m5tal abilities2 7#h7 are ins5sitive & unresponsive to individuals ) v>y+ g5d] id5tities1 g5d] expressions1 & sexual ori5tations2 or 7#i7 are inconsi/5t ) ! e?ical imp]atives ( m$ic9e & public heal?4 7h7 ,am5dm5ts to o!r laws 7#a7 ,am5dm5t to ! ,public ,heal? ,s]vice ,act ,section #bejj ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;ee7 is am5d$ by /rik+ subsections 7b7 ?r\gh 7d7 & ins]t+ ! foll[+3 7b7 ,cont5ts ( programs ,all programs ( education & in=mation receiv+ funds "u ?is title %all include in=mation ab\t ! pot5tial effects ( intrav5\s sub/ance abuse4 4 7#b7 ,am5dm5ts to ! ,elem5t>y & ,second>y ,education ,act ( #aife ,section #hebf ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #gijf7 is am5d$-- 7,a7 by /rik+ p>agraph 7#c72 7,b7 by r$esignat+ p>agraphs 7#d7 & 7#e7 z p>agraphs 7#c7 & 7#d71 respectively2 7,c7 9 p>agraph 7#c71 z r$esignat$ by subp>agraph 7,b71 by ins]t+ or aft] ! semicolon2 7,d7 9 p>agraph 7#d71 z r$esignat$ by subp>agraph 7,b71 by /rik+ 2 or & ins]t+ a p]iod2 & 7,e7 by /rik+ p>agraph 7#f74 7i7 ,def9itions ,9 ?is section3 7#a7 ,adolesc5ts ,! t]m adolesc5ts means individuals :o are ages #aj ?r\gh #ai at ! "t ( comm5cem5t ( p>ticipation 9 a program support$ "u ?is section4 7#b7 ,age & developm5tally appropriate ,! t]m age & developm5tally appropriate means topics1 messages1 & tea*+ me?ods suitable to p>ticul> age1 age gr\p ( *ildr5 & adolesc5ts1 or developm5tal levels1 bas$ on cognitive1 emotional1 social1 & behavioral capacity ( mo/ /ud5ts at t age level4 7#c7 ,appropriate committees ( congress ,! t]m appropriate committees ( ,congress means ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate1 ! ,committee on ,appropriations ( ! ,s5ate1 ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives1 ! ,committee on ,education & ,labor ( ! ,h\se ( ,repres5tatives1 & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 7#d7 ,*>act]i/ics ( effective programs ,! t]m *>act]i/ics ( effective programs means ! aspects ( evid5ce-bas$ programs1 includ+ developm5t1 cont5t1 & implem5tation ( su* programs1 t-- 7,a7 h be5 %[n to be effective 9 t]ms ( increas+ k1 cl>ify+ values & attitudes1 increas+ skills1 & impact+ ^u behavior2 & 7,b7 are widely recogniz$ by lead+ m$ical & public heal? ag5cies to be effective 9 *ang+ sexual behaviors t lead to sexually transmitt$ infections1 includ+ ,,hiv1 un9t5d$ pregnancy1 & dat+ viol5ce & sexual assault among "y p4 7#e7 ,compreh5sive sex education ,! t]m compreh5sive sex education means in/ructional "p ( a compreh5sive s*ool heal? education approa* :i* addresses ! physical1 m5tal1 emotional1 & social dim5sions ( human sexuality2 design$ to motivate & assi/ /ud5ts to ma9ta9 & improve _! sexual heal?1 prev5t disease & r$uce sexual heal?-relat$ risk behaviors2 & enable & emp[] /ud5ts to develop & demon/rate age & developm5tally appropriate sexuality & sexual heal?-relat$ k1 attitudes1 skills1 & practices4 7#f7 ,cons5t ,! t]m cons5t means affirmative1 consci\s1 & volunt>y agreem5t to engage 9 int]p]sonal1 physical1 or sexual activity4 7#g7 ,culturally appropriate ,! t]m culturally appropriate means mat]ials & in/ruction t respond to culturally div]se individuals1 families & communities 9 an inclusive1 respectful & effective mann]2 includ+ mat]ials & in/ruction t are inclusive ( race1 e?nicity1 languages1 cultural backgr\nd1 religion1 sex1 g5d] id5tity1 sexual ori5tation1 & diff]5t abilities4 7#h7 ,evid5ce-bas$ ,! t]m evid5ce-bas$1 :5 us$ ) respect to sex education in/ruction1 means a sex education program t has be5 prov5 ?r\gh rigor\s evaluation to be effective 9 *ang+ sexual behavior or incorporates elem5ts ( o!r programs t h be5 prov5 to be effective 9 *ang+ sexual behavior4 7#i7 ,g5d] expression ,! t]m g5d] expression1 :5 us$ ) respect to a sex education program1 means ! expression ( "o's g5d]1 su* z ?r\gh behavior1 clo?+1 haircut1 or voice1 & :i* may or may n con=m to socially def9$ behaviors & *>act]i/ics typically associat$ ) be+ ei!r mascul9e or fem99e4 7#aj7 ,g5d] id5tity ,except ) respect to subsection 7f71 ! t]m g5d] id5tity1 :5 us$ ) respect to a sex education program1 means ! g5d]-relat$ id5tity1 appe>ance1 mann]isms1 or o!r g5d]-relat$ *>act]i/ics ( an individual1 reg>dless ( ! individual's designat$ sex at bir? includ+ a p]son's deeply held s5se or k ( _! own g5d]2 su* z male1 female1 bo? or nei!r4 7#aa7 ,inclusive ,! t]m inclusive1 :5 us$ ) respect to a sex education program1 means curriculum t ensures t /ud5ts f hi/orically m>g9aliz$ communities are reflect$ 9 classroom mat]ials & lessons4 7#ab7 ,in/itution ( high] education ,! t]m in/itution ( high] education has ! mean+ giv5 ! t]m 9 section #aja ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajja74 7#ac7 ,m$ically accurate & complete ,! t]m m$ically accurate & complete1 :5 us$ ) respect to a sex education program1 means t-- 7,a7 ! in=mation provid$ ?r\gh ! program is v]ifi$ or support$ by ! weight ( rese>* conduct$ 9 compliance ) accept$ sci5tific me?ods & is publi%$ 9 pe]-review$ j\rnals1 :]e applicable2 or 7,b7 7i7 ! program conta9s in=mation t lead+ pr(essional organizations & ag5cies ) relevant exp]tise 9 ! field recognize z accurate1 objective1 & complete2 & 7ii7 ! program does n )hold in=mation ab\t ! effectiv5ess & b5efits ( correct & consi/5t use ( condoms & o!r contraceptives4 7#ad7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7#ae7 ,sexual developm5t ,! t]m sexual developm5t means ! lifelong process ( physical1 behavioral1 cognitive1 & emotional gr[? & *ange z x relates to an individual's sexuality & sexual maturation1 includ+ pub]ty1 id5tity developm5t1 socio-cultural influ5ces1 & sexual behaviors4 7#af7 ,sexual ori5tation ,except ) respect to subsection 7f71 ! t]m sexual ori5tation1 :5 us$ ) respect to a sex education program1 means an individual's attraction1 includ+ physical or emotional1 to ! same or diff]5t g5d]4 7#ag7 ,"y p ,! t]m "y p means individuals :o are ages #aj ?r\gh #bd at ! "t ( comm5cem5t ( p>ticipation 9 a program support$ "u ?is section4 7j7 ,fund+ 7#a7 ,appropriation ,= ! purpose ( c>ry+ out ?is section1 !re is appropriat$ #ge1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbf4 ,am\nts appropriat$ "u ?is subsection %all rema9 available until exp5d$4 7#b7 ,res]vations ( funds 7,a7 ,! ,secret>y %all res]ve #ej p]c5t ( ! am\nt appropriat$ "u p>agraph 7#a7 = ! purposes ( aw>d+ grants = compreh5sive sex education = adolesc5ts "u subsection 7c74 7,b7 ,! ,secret>y %all res]ve #be p]c5t ( ! am\nt appropriat$ "u p>agraph 7#a7 = ! purposes ( aw>d+ grants = compreh5sive sex education at in/itutes ( high] education "u subsection 7d74 7,c7 ,! ,secret>y %all res]ve #bj p]c5t ( ! am\nt appropriat$ "u p>agraph 7#a7 = ! purposes ( aw>d+ grants = pre-s]vice & 9-s]vice tea*] tra9+ "u subsection 7e74 7,d7 ,! ,secret>y %all res]ve #b p]c5t ( ! am\nt appropriat$ "u p>agraph 7#a7 = ! purpose ( c>ry+ out ! impact evaluation & report+ requir$ "u subsection 7a74 7#c7 ,secret>ial responsibilities ,! ,secret>y %all res]ve #c p]c5t ( ! am\nt appropriat$ "u p>agraph 7#a7 = ea* fiscal ye> = exp5ditures by ! ,secret>y to provide1 directly or ?r\gh a competitive grant process1 rese>*1 tra9+1 & te*nical assi/ance1 includ+ dissem9ation ( rese>* & in=mation reg>d+ effective & promis+ practices1 provid+ consultation & res\rces1 & develop+ res\rces & mat]ials to support ! activities ( recipi5ts ( grants4 ,9 c>ry+ out su* functions1 ! ,secret>y %all collaborate ) a v>iety ( entities t h exp]tise 9 adolesc5t sexual heal? developm5t1 education1 & promotion4 7#d7 ,reprogramm+ ( ab/95ce only until m>riage program fund+ ,! unobligat$ balance ( funds made available to c>ry out section #eaj ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gaj7 7z 9 effect on ! day be=e ! date ( enactm5t ( ?is ,act7 are h]eby transf]r$ & %all be us$ by ! ,secret>y to c>ry out ?is section4 ,! am\nts transf]r$ & made available to c>ry out ?is section %all rema9 available until exp5d$4 7#e7 ,repeal ( ab/95ce only until m>riage program ,section #eaj ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gaj7 is repeal$4 #eab4 ,compassionate assi/ance = rape em]g5cies 7a7 ,m$ic>e 7#a7 ,limitation on paym5t ,section #ahff7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77 is am5d$-- 7,a7 by mov+ ! ind5tation ( subp>agraph 7,w7 #b ems to ! left2 7,b7 9 subp>agraph 7,x7-- 7i7 by mov+ ! ind5tation #b ems to ! left2 & 7ii7 by /rik+ & at ! end2 7,c7 9 subp>agraph 7,y71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,d7 by ins]t+ aft] subp>agraph 7,y7 ! foll[+ new subp>agraph3 7,z7 9 ! case ( a hospital or critical access hospital1 to adopt & en=ce a policy to ensure compliance ) ! requirem5ts ( subsection 7l7 & to meet ! requirem5ts ( su* subsection4 4 7#b7 ,assi/ance to victims ,section #ahff ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7l7 ,compassionate assi/ance = rape em]g5cies 7#a7 ,9 g5]al ,= purposes ( section #ahff7;a77#a77,z71 a hospital meets ! requirem5ts ( ?is subsection if ! hospital provides ea* ( ! s]vices describ$ 9 p>agraph 7#b7 to ea* individual1 :e!r or n eligible = b5efits "u ?is title or "u any o!r =m ( heal? insurance1 :o comes to ! hospital on or aft] ,janu>y #a1 #bjba1 &-- 7,a7 :o /ates to hospital p]sonnel t !y are victims ( sexual assault2 7,b7 :o is accompani$ by an individual :o /ates to hospital p]sonnel t ! individual is a victim ( sexual assault2 or 7,c7 :om hospital p]sonnel1 dur+ ! c\rse ( treatm5t & c>e = ! individual1 h reason to believe is a victim ( sexual assault4 7#b7 ,requir$ s]vices describ$ ,= purposes ( p>agraph 7#a71 ! s]vices describ$ 9 ?is subp>agraph are ! foll[+3 7,a7 ,provision ( m$ically & factually accurate & unbias$ writt5 & oral in=mation ab\t em]g5cy contraception t-- 7i7 is writt5 9 cle> & concise language2 7ii7 is readily compreh5sible2 7iii7 includes an explanation t em]g5cy contraceptives-- 7,i7 has be5 approv$ by ! ,food & ,drug ,adm9i/ration = individuals & is a safe & effective way to prev5t pregnancy aft] unprotect$ int]c\rse or contraceptive failure if tak5 9 a timely mann]2 7,,ii7 is m effective ! soon] x is tak52 & 7,,iii7 does n cause an abortion & _c int]rupt an e/abli%$ pregnancy2 7iv7 meets su* conditions reg>d+ ! provision ( su* in=mation 9 languages o!r ?an ,engli% z ! ,secret>y may e/abli%2 & 7v7 is provid$ )\t reg>d to ! ability ( ! individual or _! family to pay co/s associat$ ) ! provision ( su* in=mation to ! individual4 7,b7 ,imm$iate (f] to provide em]g5cy contraception to ! individual at ! hospital &1 9 ! case t ! individual accepts su* (f]1 imm$iate provision to ! individual ( su* contraception on ! same day x is reque/$ )\t reg>d to ! inability ( ! individual or _! family to pay co/s associat$ ) ! (f] & provision ( su* contraception4 7,c7 ,developm5t & implem5tation ( a writt5 policy to ensure t an individual is pres5t at ! hospital1 or on-call1 :o-- 7i7 has au?ority to disp5se or prescribe em]g5cy contraception1 indep5d5tly1 or "u a protocol prep>$ by a physician = ! adm9i/ration ( em]g5cy contraception at ! hospital to a victim ( sexual assault2 & 7ii7 is tra9$ to comply ) ! requirem5ts ( ?is section4 7,d7 ,provision ( m$ically & factually accurate & unbias$ writt5 & oral in=mation & c\nsel+ ab\t po/-exposure prophylaxis 7,,pep7 protocol = ! prev5tion ( ,,hiv4 7,e7 ,imm$iately (f] to beg9 ,,pep to ! individual at ! hospital except 9 cases :]e ! m$ical pr(essional's be/ judgem5t is t fur!r evaluation is requir$ or t su* a regim5 w be sub/antially detrim5tal to ! individual's heal?4 ,su* provision %all be (f]$ reg>dless ( ! individual's ability to pay4 ,hospitals %all be responsible = ensur+ adequate supply ( ,,pep m$ications to provide to pati5ts4 7#c7 ,hospital def9$ ,= purposes ( ?is p>agraph1 ! t]m hospital includes a critical access hospital1 z def9$ 9 section #ahfa7mm77#a74 4 7b7 ,limitation on paym5t "u ,m$icaid ,section #aijc7;i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7i77 is am5d$ by ins]t+ aft] p>agraph 7#h7 ! foll[+ new p>agraph3 7#i7 ) respect to any am\nt exp5d$ = c>e or s]vices furni%$ "u ! plan by a hospital on or aft] ,janu>y #a1 #bjba1 unless su* hospital meets ! requirem5ts specifi$ 9 section #ahff7l7 = purposes ( title ,,xviii2 4 #eac4 ,access to bir? control duties ( ph>macies to ensure provision ( ,,fda-approv$ contraception ,"p ,b ( title ,,ii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bch et seq47 is am5d$ by add+ at ! end ! foll[+3 #bdi4 ,duties ( ph>macies to ensure provision ( ,,fda-approv$ contraception 7a7 ,9 g5]al ,subject to subsection 7c71 a ph>macy t receives ,food & ,drug ,adm9i/ration-approv$ drugs or devices 9 int]/ate comm]ce %all ma9ta9 compliance ) ! foll[+3 7#a7 ,if a cu/om] reque/s a contraceptive or a m$ication relat$ to a contraceptive1 includ+ em]g5cy contraception1 t is 9 /ock1 ! ph>macy %all ensure t ! contraceptive is provid$ to ! cu/om] )\t delay4 7#b7 ,if a cu/om] reque/s a contraceptive or a m$ication relat$ to a contraceptive t is n 9 /ock & ! ph>macy 9 ! normal c\rse ( bus9ess /ocks contraception1 ! ph>macy %all imm$iately in=m ! cu/om] t ! contraceptive is n 9 /ock & )\t delay (f] ! cu/om] ! foll[+ options3 7,a7 ,if ! cu/om] pref]s to obta9 ! contraceptive or a m$ication relat$ to a contraceptive ?r\gh a ref]ral or transf]1 ! ph>macy %all-- 7i7 locate a ph>macy ( ! cu/om]'s *oice or ! close/ ph>macy confirm$ to h ! contraceptive or a m$ication relat$ to a contraceptive 9 /ock2 & 7ii7 ref] ! cu/om] or transf] ! prescription to t ph>macy4 7,b7 ,if ! cu/om] pref]s = ! ph>macy to ord] ! contraceptive or a m$ication relat$ to a contraceptive1 ! ph>macy %all obta9 ! contraceptive or m$ication "u ! ph>macy's /&>d proc$ure = exp$it$ ord]+ ( m$ication & notify ! cu/om] :5 ! contraceptive or m$ication arrives4 7#c7 ,! ph>macy %all ensure t-- 7,a7 ! ph>macy does n op]ate an environm5t 9 :i* cu/om]s are intimidat$1 ?reat5$1 or h>ass$ 9 ! deliv]y ( s]vices relat+ to a reque/ = contraception or a m$ication relat$ to a contraceptive2 7,b7 ! ph>macy's employees d n int]f]e ) or ob/ruct ! deliv]y ( s]vices relat+ to a reque/ = contraception or a m$ication relat$ to a contraceptive2 7,c7 ! ph>macy's employees d n int5tionally misrepres5t or deceive cu/om]s ab\t ! availability ( a contraceptive or a m$ication relat$ to a contraceptive1 or ! me*anism ( action ( su* contraceptive or m$ication2 7,d7 ! ph>macy's employees d n brea* m$ical confid5tiality ) respect to a reque/ = a contraceptive or a m$ication relat$ to a contraceptive or ?reat5 to brea* su* confid5tiality2 or 7,e7 ! ph>macy's employees d n refuse to return a valid1 lawful prescription = a contraceptive or a m$ication relat$ to a contraceptive ^u cu/om] reque/4 7b7 ,contraceptives n ord9>ily /ock$ ,no?+ 9 subsection 7a77#b7 %all be con/ru$ to require any ph>macy to comply ) su* subsection if ! ph>macy does n ord9>ily /ock contraceptives or a m$ication relat$ to a contraceptive 9 ! normal c\rse ( bus9ess4 7c7 ,refusals pursuant to /&>d ph>macy practice ,?is section does n prohibit a ph>macy f refus+ to provide a contraceptive or a m$ication relat$ to a contraceptive to a cu/om] 9 accordance ) any ( ! foll[+3 7#a7 ,if x is unlawful to disp5se ! contraceptive or a m$ication relat$ to a contraceptive to ! cu/om] )\t a valid1 lawful prescription & no su* prescription is pres5t$4 7#b7 ,if ! cu/om] is unable to pay = ! contraceptive or ! m$ication relat$ to a contraceptive4 7#c7 ,if ! employee ( ! ph>macy refuses to provide ! contraceptive or a m$ication relat$ to a contraceptive on ! basis ( a pr(essional cl9ical judgm5t4 7d7 ,relation to o!r law 7#a7 ,rule ( con/ruction ,no?+ 9 ?is section %all be con/ru$ to invalidate or limit rights1 rem$ies1 proc$ures1 or legal /&>ds "u title ,,vii ( ! ,civil ,rights ,act ( #aifd4 7#b7 ,c]ta9 claims ,! ,religi\s ,fre$om ,re/oration ,act ( #aiic %all n provide a basis = a claim conc]n+1 or a def5se to a claim "u1 ?is section1 or provide a basis = *all5g+ ! application or en=cem5t ( ?is section4 7e7 ,preemption ,?is section does n preempt any provision ( ,/ate law or any pr(essional obligation made applicable by a ,/ate bo>d or o!r entity responsible = lic5s+ or discipl9e ( ph>macies or ph>maci/s1 to ! ext5t t su* ,/ate law or pr(essional obligation provides protections = cu/om]s t are great] ?an ! protections provid$ by ?is section4 7f7 ,en=cem5t 7#a7 ,civil p5alty ,a ph>macy t violates a requirem5t ( subsection 7a7 is liable to ! ,unit$ ,/ates = a civil p5alty 9 an am\nt n exce$+ #a1jjj p] day ( violation1 n to exce$ #ajj1jjj = all violations adjudicat$ 9 a s+le proce$+4 7#b7 ,private cause ( action ,any p]son aggriev$ z a result ( a violation ( a requirem5t ( subsection 7a7 may1 9 any c\rt ( compet5t jurisdiction1 comm5ce a civil action aga9/ ! ph>macy involv$ to obta9 appropriate relief1 includ+ actual & punitive damages1 injunctive relief1 & a reasonable attorney's fee & co/4 7#c7 ,limitations ,a civil action "u p>agraph 7#a7 or 7#b7 may n be comm5c$ aga9/ a ph>macy aft] ! expiration ( ! #e-ye> p]iod beg9n+ on ! date on :i* ! ph>macy alleg$ly engag$ 9 ! violation involv$4 7g7 ,def9itions ,9 ?is section3 7#a7 ,contraception ,! t]m contraception or contraceptive means any drug or device approv$ by ! ,food & ,drug ,adm9i/ration to prev5t pregnancy4 7#b7 ,employee ,! t]m employee means a p]son hir$1 by contract or any o!r =m ( an agreem5t1 by a ph>macy4 7#c7 ,m$ication relat$ to a contraceptive ,! t]m m$ication relat$ to a contraceptive means any drug or device approv$ by ! ,food & ,drug ,adm9i/ration t a m$ical pr(essional det]m9es necess>y to use be=e or 9 conjunction ) a contraceptive4 7#d7 ,ph>macy ,! t]m ph>macy means an entity t-- 7,a7 is au?oriz$ by a ,/ate to engage 9 ! bus9ess ( sell+ prescription drugs at retail2 & 7,b7 employs "o or m employees4 7#e7 ,product ,! t]m product means a ,food & ,drug ,adm9i/ration-approv$ drug or device4 7#f7 ,pr(essional cl9ical judgm5t ,! t]m pr(essional cl9ical judgm5t means ! use ( pr(essional k & skills to =m a cl9ical judgm5t1 9 accordance ) prevail+ m$ical /&>ds4 7#g7 ,)\t delay ,! t]m )\t delay1 ) respect to a ph>macy provid+1 provid+ a ref]ral =1 or ord]+ contraception1 or transf]r+ ! prescription = contraception1 means )9 ! usual & cu/om>y timeframe at ! ph>macy = provid+1 provid+ a ref]ral =1 or ord]+ o!r products1 or transf]r+ ! prescription = o!r products1 respectively4 7h7 ,effective date ,?is section %all take effect on ! #ca/ day aft] ! date ( ! enactm5t ( ?is section1 )\t reg>d to :e!r ! ,secret>y has issu$ any guidance or f9al rule reg>d+ ?is section4 4 #ead4 ,additional focus area = ! ,(fice on ,wom5's ,heal? ,section #bbi7;b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bcg;a7b77 is am5d$-- 7#a7 9 p>agraph 7#f71 at ! end1 by /rik+ &2 7#b7 9 p>agraph 7#g71 at ! end1 by /rik+ ! p]iod & ins]t+ a semicolon2 & 7#c7 by add+ at ! end ! foll[+ new p>agraph3 7#h7 facilitate policymak]s1 heal? sy/em lead]s & provid]s1 consum]s1 & o!r /akehold]s 9 und]/&+ optimal mat]nity c>e & support = ! provision ( su* c>e1 includ+ ! priorities (-- 7,a7 protect+1 promot+1 & support+ ! innate capacities ( *ildbe>+ individuals & _! newborns = *ildbir?1 brea/fe$+1 & atta*m5t2 7,b7 us+ ob/etric int]v5tions only :5 su* int]v5tions are support$ by /rong1 high-quality evid5ce1 & m9imiz+ ov]use ( mat]nity practices t h be5 %[n to h b5efit 9 limit$ situations & t c expose wom51 infants1 or bo? to risk ( h>m if us$ r\t9ely & indiscrim9ately1 includ+ cont9u\s electronic fetal monitor+1 labor induction1 epidural analgesia1 prim>y ces>ean section1 & r\t9e repeat ces>ean bir?2 7,c7 reliably incorporat+ non9vasive1 evid5ce-bas$ practices t h docum5t$ correlation ) consid]able improvem5t 9 outcomes ) no detrim5tal side effects1 su* z smok+ cessation programs 9 pregnancy & prov5 models ( gr\p pr5atal c>e t integrate heal? assessm5t1 education1 & support into a unifi$ program & support+ evid5ce-bas$ brea/fe$+ promotion ef=ts ) respect = a brea/fe$+ individual's p]sonal decision mak+2 7,d7 a %>$ und]/&+ ( ! qualifications ( lic5s$ provid]s ( mat]nity c>e & ! be/ evid5ce ab\t ! safety1 satisfaction1 outcomes1 & co/s ( _! c>e1 & appropriate deploym5t ( su* c>egiv]s )9 ! mat]nity c>e work=ce to address ! ne$s ( *ildbe>+ individuals & newborns & ! gr[+ %ortage ( mat]nity c>egiv]s2 7,e7 a %>$ und]/&+ ( ! results ( ! be/ available rese>* comp>+ hospital1 bir? c5t]1 & plann$ home bir?s1 includ+ in=mation ab\t ea* sett+'s safety1 satisfaction1 outcomes1 & co/s2 7,f7 high-quality1 evid5ce-bas$ *ildbir? education t promotes a natural1 heal?y1 & safe approa* to pregnancy1 *ildbir?1 & e>ly p>5t+2 is taught by c]tifi$ educators1 pe] c\nselors1 & heal? pr(essionals2 & promotes in=m$ decision mak+ by *ildbe>+ individuals2 & 7,g7 develop+ measures t enable a m robu/1 balanc$ set ( /&>diz$ mat]nity c>e measures1 includ+ p]=mance & quality measures2 4 #eae4 ,int]ag5cy ,coord9at+ ,committee on ! ,promotion ( ,optimal ,mat]nity ,outcomes 7a7 ,9 g5]al ,"p ,a ( title ,,ii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bjb et seq47 is am5d$ by add+ at ! end ! foll[+3 #bbi;,a4 ,int]ag5cy ,coord9at+ ,committee on ! ,promotion ( ,optimal ,mat]nity ,outcomes 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,deputy ,assi/ant ,secret>y = ,wom5's ,heal? "u section #bbi & 9 collaboration ) ! ,f$]al (ficials specifi$ 9 subsection 7b71 %all e/abli% ! ,int]ag5cy ,coord9at+ ,committee on ! ,promotion ( ,optimal ,mat]nity ,outcomes 7ref]r$ to 9 ?is section z ! ,,iccpom74 7b7 ,o!r ag5cies ,! (ficials specifi$ 9 ?is subsection are ! ,secret>y ( ,labor1 ! ,secret>y ( ,def5se1 ! ,secret>y ( ,vet]ans ,affairs1 ! ,surgeon ,g5]al1 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 ! ,director ( ! ,indian ,heal? ,s]vice1 ! ,adm9i/rator ( ! ,sub/ance ,abuse & ,m5tal ,heal? ,s]vices ,adm9i/ration1 ! ,director ( ! ,national ,in/itute ( ,*ild ,heal? & ,human ,developm5t1 ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 ! ,assi/ant ,secret>y = ,*ildr5 & ,families1 ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 ! ,director ( ! ,(fice ( ,p]sonnel ,managem5t1 & su* o!r ,f$]al (ficials z ! ,secret>y ( ,heal? & ,human ,s]vices det]m9es to be appropriate4 7c7 ,*air ,! ,deputy ,assi/ant ,secret>y = ,wom5's ,heal? %all s]ve z ! *air ( ! ,,iccpom4 7d7 ,duties ,! ,,iccpom %all guide policy & program developm5t across ! ,f$]al ,gov]nm5t ) respect to promotion ( optimal mat]nity c>e1 provid$1 h[ev]1 t no?+ 9 ?is section %all be con/ru$ z transf]r+ regulatory or program au?ority f an ag5cy to ! ,,iccpom4 7e7 ,consultations ,! ,,iccpom %all actively seek ! input (1 & %all consult )1 all appropriate & int]e/$ /akehold]s1 includ+ ,/ate heal? dep>tm5ts1 public heal? rese>* & int]e/ gr\ps1 f\ndations1 *ildbe>+ individuals & _! advocates1 & mat]nity c>e pr(essional associations & organizations1 reflect+ racially1 e?nically1 demographically1 & geographically div]se communities4 7f7 ,annual report 7#a7 ,9 g5]al ,! ,secret>y1 on behalf ( ! ,,iccpom1 %all annually submit to ,congress a report t summ>izes-- 7,a7 all programs & policies ( ,f$]al ag5cies 7includ+ ! ,m$ic>e ,program "u title ,,xviii ( ! ,social ,security ,act & ! ,m$icaid program "u title ,,xix ( su* ,act7 design$ to promote optimal mat]nity c>e1 focus+ p>ticul>ly on programs & policies t support ! adoption ( evid5ce bas$ mat]nity c>e1 z def9$ by timely1 sci5tifically s\nd sy/ematic reviews2 7,b7 all programs & policies ( ,f$]al ag5cies 7includ+ ! ,m$ic>e ,program "u title ,,xviii ( ! ,social ,security ,act & ! ,m$icaid program "u title ,,xix ( su* ,act7 design$ to address ! problems ( mat]nal mortality & morbidity1 infant mortality1 prematurity1 & l[ bir? weight1 includ+ su* programs & policies design$ to address racial & e?nic disp>ities ) respect to ea* ( su* problems2 7,c7 ! ext5t ( progress 9 r$uc+ mat]nal mortality & infant mortality1 l[ bir? weight1 & prematurity at ,/ate & national levels2 & 7,d7 su* o!r in=mation reg>d+ optimal mat]nity c>e 7su* z quality & p]=mance measures7 z ! ,secret>y det]m9es to be appropriate4 ,! in=mation specifi$ 9 subp>agraph 7,c7 %all be includ$ 9 ea* su* report 9 a mann] t disaggregates su* in=mation by race1 e?nicity1 & indig5\s /atus 9 ord] to det]m9e ! ext5t ( progress 9 r$uc+ racial & e?nic disp>ities & disp>ities relat$ to indig5\s /atus4 7#b7 ,c]ta9 in=mation ,ea* report "u p>agraph 7#a7 %all include in=mation 7disaggregat$ by race1 e?nicity1 & indig5\s /atus1 z applicable7 on ! foll[+ rates & co/s by ,/ate3 7,a7 ,! rate ( prim>y ces>ean deliv]ies & repeat ces>ean deliv]ies4 7,b7 ,! rate ( vag9al bir?s aft] ces>ean4 7,c7 ,! rate ( vag9al bree* bir?s4 7,d7 ,! rate ( induction ( labor4 7,e7 ,! rate ( free/&+ bir? c5t] bir?s4 7,f7 ,! rate ( plann$ & unplann$ home bir?4 7,g7 ,! rate ( att5d$ bir?s by provid]1 includ+ by an ob/etrician-gynecologi/1 family practice physician1 ob/etrician-gynecologi/ physician assi/ant1 c]tifi$ nurse-midwife1 c]tifi$ midwife1 & c]tifi$ pr(essional midwife4 7,h7 ,! co/ ( mat]nity c>e disaggregat$ by place ( bir? & provid] ( c>e1 includ+-- 7i7 uncomplicat$ vag9al bir?2 7ii7 complicat$ vag9al bir?2 7iii7 uncomplicat$ ces>ean bir?2 & 7iv7 complicat$ ces>ean bir?4 7g7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$1 9 addition to am\nts au?oriz$ to be appropriat$ "u section #bbi7;e71 to c>ry out ?is section #a1jjj1jjj = ea* ( ! fiscal ye>s #bjba ?r\gh #bjbe4 4 7b7 ,con=m+ am5dm5ts 7#a7 ,inclusion z duty ( ,,hhs (fice on wom5's heal? ,section #bbi7;b7 ( su* ,act 7#db ,u4,s4,c4 #bcg;a7b771 z am5d$ by section #ead1 is fur!r am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#i7 e/abli% ! ,int]ag5cy ,coord9at+ ,committee on ! ,promotion ( ,optimal ,mat]nity ,outcomes 9 accordance ) section #bbi;,a2 & 4 7#b7 ,treatm5t ( bi5nial reports ,section #bbi7;d7 ( su* ,act 7#db ,u4,s4,c4 #bcg;a7d77 is am5d$ by ins]t+ 7o!r ?an "u subsection 7b77#i77 aft] "u ?is section4 #eaf4 ,consum] education campaign ,section #bbi7;b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bcg;a7b771 z am5d$ by sections #ead & #eae1 is fur!r am5d$ by add+ at ! end ! foll[+3 7#aj7 n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbj1 develop & implem5t a #d-ye> culturally & l+ui/ically appropriate multim$ia consum] education campaign t is design$ to promote und]/&+ & acceptance ( evid5ce-bas$ mat]nity practices & models ( c>e = optimal mat]nity outcomes among individuals ( *ildbe>+ ages & families ( su* individuals & t-- 7,a7 highlights ! importance ( protect+1 promot+1 & support+ ! innate capacities ( *ildbe>+ individuals & _! newborns = *ildbir?1 brea/fe$+1 & atta*m5t2 7,b7 promotes und]/&+ ( ! importance ( us+ ob/etric int]v5tions :5 m$ically necess>y & :5 support$ by /rong1 high-quality evid5ce2 7,c7 highlights ! widespread ov]use ( mat]nity practices t h be5 %[n to h b5efit :5 us$ appropriately 9 situations ( m$ical necessity1 b :i* c expose pregnant individuals1 infants1 or bo? to risk ( h>m if us$ r\t9ely & indiscrim9ately1 includ+ cont9u\s fetal monitor+1 labor induction1 epidural ane/hesia1 elective prim>y ces>ean section1 & repeat ces>ean deliv]y2 7,d7 emphasizes ! non9vasive mat]nity practices t h /rong prov5 correlation or may be associat$ ) consid]able improvem5t 9 outcomes ) no detrim5tal side effects1 & are significantly und]us$ 9 ! ,unit$ ,/ates1 includ+ smok+ cessation programs 9 pregnancy1 gr\p model pr5atal c>e1 cont9u\s labor support1 nonsup9e positions = bir?1 & ext]nal v]sion to turn bree* babies at t]m2 7,e7 educates consum]s ab\t ! qualifications ( lic5s$ provid]s ( mat]nity c>e & ! be/ evid5ce ab\t _! safety1 satisfaction1 outcomes1 & co/s2 7,f7 in=ms consum]s ab\t ! be/ available rese>* comp>+ bir? c5t] bir?s1 plann$ home bir?s1 & hospital bir?s1 includ+ in=mation ab\t ea* sett+'s safety1 satisfaction1 outcomes1 & co/s2 7,g7 fo/]s p>ticipation 9 high-quality1 evid5ce-bas$ *ildbir? education t promotes a natural1 heal?y1 & safe approa* to pregnancy1 *ildbir?1 & e>ly p>5t+2 is taught by c]tifi$ educators1 pe] c\nselors1 & heal? pr(essionals2 & promotes in=m$ decision mak+ by *ildbe>+ individuals2 & 7,h7 is pilot te/$ = consum] compreh5sion1 cultural s5sitivity1 & acceptance ( ! messages across geographically1 racially1 e?nically1 & l+ui/ically div]se populations4 4 #eag4 ,bibliographic database ( sy/ematic reviews = c>e ( *ildbe>+ individuals & newborns 7a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices1 ?r\gh ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 %all-- 7#a7 make publicly available an onl9e bibliographic database id5tify+ sy/ematic reviews1 includ+ an explanation ( ! level & quality ( evid5ce1 = c>e ( *ildbe>+ individuals & newborns2 & 7#b7 initiate regul> updates t incorporate newly issu$ & updat$ sy/ematic reviews4 7b7 ,s\rces ,to aim = a compreh5sive inv5tory ( sy/ematic reviews relevant to mat]nal & newborn c>e1 ! database %all id5tify reviews f div]se s\rces1 includ+-- 7#a7 sci5tific pe]-review$ j\rnals2 7#b7 databases1 includ+ ,co*rane ,database ( ,sy/ematic ,reviews1 ,cl9ical ,evid5ce1 & ,database ( ,ab/racts ( ,reviews ( ,effects2 & 7#c7 int]net websites ( ag5cies & organizations ?r\gh\t ! _w t produce su* sy/ematic reviews4 7c7 ,features ,! database %all-- 7#a7 provide bibliographic citations = ea* record )9 ! database1 & = ea* su* citation include an explanation ( ! level & quality ( evid5ce2 7#b7 include ab/racts1 z available2 7#c7 provide ref]5ce to companion docum5ts z may exi/ = ea* review1 su* z evid5ce tables & guidel9es or consum] educational mat]ials develop$ f ! review2 7#d7 provide l9ks to ! s\rce ( ! full review & to any companion docum5ts2 7#e7 provide l9ks to ! s\rce ( a previ\s v]sion or update ( ! review2 7#f7 be se>*able by int]v5tion or o!r topic ( ! review1 report$ outcomes1 au?or1 title1 & s\rce2 & 7#g7 (f] to us]s p]iodic electronic notification ( database updates relat+ to us]s' topics ( int]e/4 7d7 ,outrea* ,n lat] ?an ! fir/ date ! database is made publicly available & p]iodically !reaft]1 ! ,secret>y ( ,heal? & ,human ,s]vices %all publicize ! availability1 features1 & uses ( ! database "u ?is section to ! /akehold]s describ$ 9 subsection 7e74 7e7 ,consultation ,= purposes ( develop+ ! database "u ?is section & ma9ta9+ & updat+ su* database1 ! ,secret>y ( ,heal? & ,human ,s]vices %all conv5e & consult ) an advisory committee compos$ ( relevant /akehold]s1 includ+-- 7#a7 ,f$]al ,m$icaid adm9i/rators & ,/ate ag5cies adm9i/rat+ ,/ate plans "u title ,,xix ( ! ,social ,security ,act pursuant to section #aijb7;a77#e7 ( su* ,act 7#db ,u4,s4,c4 #acif;a7a77#e772 7#b7 provid]s ( mat]nity & newborn c>e f bo? academic & community-bas$ sett+s1 includ+ ob/etrician-gynecologi/s1 family physicians1 c]tifi$ nurse midwives1 c]tifi$ midwives1 c]tifi$ pr(essional midwives1 physician assi/ants1 p]9atal nurses1 p$iatricians1 & nurse practition]s2 7#c7 mat]nal-fetal m$ic9e speciali/s2 7#d7 neonatologi/s2 7#e7 *ildbe>+ individuals & advocates = su* individuals1 includ+ *ildbir? educators c]tifi$ by a nationally accr$it$ program1 repres5t+ communities t are div]se 9 t]ms ( race1 e?nicity1 indig5\s /atus1 & geographic area2 7#f7 employ]s & pur*as]s2 7#g7 heal? facility & sy/em lead]s1 includ+ bo? hospital & bir? c5t] facilities2 7#h7 j\rnali/s2 & 7#i7 bibliographic in=matics speciali/s4 7f7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ #b1ejj1jjj = ea* ( ! fiscal ye>s #bjba ?r\gh #bjbc = ! purpose ( develop+ ! database & su* sums z may be necess>y = ea* subsequ5t fiscal ye> = updat+ ! database & provid+ outrea* & notification to us]s1 z describ$ 9 ?is section4 #eah4 ,expansion ( ,,cdc ,prev5tion ,rese>* ,c5t]s ,program to include ,c5t]s on ,optimal ,mat]nity ,outcomes 7a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices1 %all support ! e/abli%m5t ( additional ,prev5tion ,rese>* ,c5t]s "u ! ,prev5tion ,rese>* ,c5t] ,program adm9i/]$ by ! ,c5t]s = ,disease ,control & ,prev5tion4 ,su* additional c5t]s %all ea* be kn[n z a ,c5t] = ,excell5ce on ,optimal ,mat]nity ,outcomes4 7b7 ,rese>* ,ea* ,c5t] = ,excell5ce on ,optimal ,mat]nity ,outcomes %all-- 7#a7 conduct at lea/ "o focus$ program ( rese>* to improve mat]nity outcomes1 includ+ ! r$uction ( ces>ean bir? rates1 elective inductions1 prematurity rates1 & l[ bir? weight rates )9 an und]s]v$ population t has a disproportionately l>ge burd5 ( suboptimal mat]nity outcomes1 includ+ mat]nal mortality & morbidity1 infant mortality1 prematurity1 or l[ bir? weight1 :i* su* program %all include develop+ p]=mance & quality measures = acc\ntability2 7#b7 "w ) p>tn]s on special int]e/ projects1 z specifi$ by ! ,c5t]s = ,disease ,control & ,prev5tion & o!r relevant ag5cies )9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 & on projects fund$ by o!r s\rces2 & 7#c7 involve a m9imum ( two di/9ct bir? sett+ models1 su* z-- 7,a7 a hospital labor & deliv]y model & free/&+ bir? c5t] model2 or 7,b7 a hospital labor & deliv]y model & plann$ home bir? model4 7c7 ,int]discipl9>y provid]s ,ea* ,c5t] = ,excell5ce on ,optimal ,mat]nity ,outcomes %all include ! foll[+ int]discipl9>y provid]s ( mat]nity c>e3 7#a7 ,ob/etrician-gynecologi/s4 7#b7 ,at lea/ two ( ! foll[+ provid]s3 7,a7 ,family practice physicians4 7,b7 ,nurse practition]s4 7,c7 ,physician assi/ants4 7,d7 ,c]tifi$ pr(essional midwives4 7d7 ,s]vices ,rese>* conduct$ by ea* ,c5t] = ,excell5ce on ,optimal ,mat]nity ,outcomes %all include at lea/ #b 7& pref]ably m7 ( ! foll[+ supportive provid] s]vices3 7#a7 ,m5tal heal?4 7#b7 ,d\la labor support4 7#c7 ,nutrition education4 7#d7 ,*ildbir? education4 7#e7 ,social "w4 7#f7 ,physical !rapy or occupation !rapy4 7#g7 ,sub/ance abuse s]vices4 7#h7 ,home visit+4 7e7 ,coord9ation ,! programs ( rese>* at ea* ( ! ,c5t]s ( ,excell5ce on ,optimal ,mat]nity ,outcomes %all complem5t & n replicate ! "w ( ! o!r4 7f7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #b1jjj1jjj = ea* ( ! fiscal ye>s #bjba ?r\gh #bjbe4 #eai4 ,exp&+ models all[$ to be te/$ by ,c5t] = ,m$ic>e ,m$icaid ,innovation to include mat]nity c>e models ,section #aaae;,a7b77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,b77 is am5d$ by add+ at ! end ! foll[+ new clause3 7xxviii7 ,promot+ evid5ce-bas$ models ( c>e t h be5 associat$ ) r$uctions 9 mat]nal & infant heal? disp>ities1 includ+ incorporat+ ! use ( d\la & promotoras support = pregnant & *ildbe>+ individuals into evid5ce-bas$ models ( pr5atal c>e1 labor & deliv]y1 & po/p>tum c>e1 & support+ ! appropriate use ( out-(-hospital bir? models1 includ+ bir?s at home & 9 free/&+ bir? c5t]s4 4 #ebj4 ,developm5t ( int]pr(essional mat]nity c>e educational models & tools 7a7 ,9 g5]al ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ 9 conjunction ) ! ,adm9i/rator ( ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all conv5e1 = a #a-ye> p]iod1 an ,int]pr(essional ,mat]nity ,provid] ,education ,commission to discuss & make recomm5dations =-- 7#a7 a cons5sus /&>d physiologic mat]nity c>e curriculum t takes into acc\nt ! core compet5cies = basic midwif]y practice su* z ^? develop$ by ! ,am]ican ,college ( ,nurse ,midwives & ! ,nor? ,am]ican ,regi/ry ( ,midwives1 & ! educational objectives = physicians practic+ 9 ob/etrics & gynecology z det]m9$ by ! ,c\ncil on ,resid5t ,education 9 ,ob/etrics & ,gynecology2 7#b7 sugge/ions = multidiscipl9>y use ( ! cons5sus physiologic curriculum2 7#c7 /rategies to integrate & coord9ate education across mat]nity c>e discipl9es1 includ+ recomm5dations to increase m$ical & midwif]y /ud5t exposure to out-(-hospital bir?2 & 7#d7 pilot demon/rations ( int]pr(essional educational models4 7b7 ,p>ticipants ,! ,commission %all include mat]nity c>e educators1 curriculum develop]s1 s]vice lead]s1 c]tification lead]s1 & accr$itation lead]s f ! v>i\s pr(essions t provide mat]nity c>e 9 ! ,unit$ ,/ates4 ,su* pr(essions %all include ob/etrician gynecologi/s1 c]tifi$ nurse midwives or c]tifi$ midwives1 family practice physicians1 nurse practition]s1 physician assi/ants1 c]tifi$ pr(essional midwives1 & p]9atal nurses4 ,additionally1 ! ,commission %all include repres5tation f mat]nity c>e consum] advocates4 7c7 ,curriculum ,! cons5sus /&>d physiologic mat]nity c>e curriculum describ$ 9 subsection 7a77#a7 %all-- 7#a7 h a public heal? focus ) a f\ndation 9 heal? promotion & disease prev5tion2 7#b7 fo/] physiologic *ildbe>+ & woman & family c5t]$ c>e2 7#c7 integrate /rategies to r$uce mat]nal & infant morbidity & mortality2 7#d7 incorporate recomm5dations to ensure respectful1 safe1 & seamless consultation1 ref]ral1 transport1 & transf] ( c>e :5 necess>y2 7#e7 include cultural s5sitivity & /rategies to decrease disp>ities 9 mat]nity outcomes2 & 7#f7 include implicit bias tra9+4 7d7 ,report ,n lat] ?an #f mon?s aft] ! f9al meet+ ( ! ,commission1 ! ,secret>y ( ,heal? & ,human ,s]vices %all-- 7#a7 submit to ,congress a report conta9+ ! recomm5dations made by ! ,commission "u ?is section2 & 7#b7 make su* report publicly available4 7e7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #a1jjj1jjj = ea* ( ! fiscal ye>s #bjba & #bjbb1 & su* sums z are necess>y = ea* ( ! fiscal ye>s #bjbc ?r\gh #bjbe4 #eba4 ,includ+ s]vices furni%$ by c]ta9 /ud5ts1 int]ns1 & resid5ts sup]vis$ by c]tifi$ nurse midwives )9 inpati5t hospital s]vices "u ,m$ic>e 7a7 ,9 g5]al ,section #ahfa7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7b77 is am5d$-- 7#a7 9 p>agraph 7#f71 by /rik+ 2 or at ! end & ins]t+ 1 or 9 ! case ( s]vices 9 a hospital or o/eopa?ic hospital by a /ud5t midwife or an int]n or resid5t-9-tra9+ "u a tea*+ program previ\sly describ$ 9 ?is p>agraph :o is 9 ! field ( ob/etrics & gynecology1 if su* /ud5t midwife1 int]n1 or resid5t-9-tra9+ is sup]vis$ by a c]tifi$ nurse-midwife to ! ext5t p]mitt$ "u applicable ,/ate law & z may be au?oriz$ by ! hospital22 7#b7 9 p>agraph 7#g71 by /rik+ ! p]iod at ! end & ins]t+ 2 or2 & 7#c7 by add+ at ! end ! foll[+ new p>agraph3 7#h7 a c]tifi$ nurse-midwife :]e ! hospital has a tea*+ program approv$ z specifi$ 9 p>agraph 7#f71 if-- 7,a7 ! hospital elects to receive any paym5t due "u ?is title = reasonable co/s ( su* s]vices2 & 7,b7 all c]tifi$ nurse-midwives 9 su* hospital agree n to bill *>ges = pr(essional s]vices r5d]$ 9 su* hospital to individuals cov]$ "u ! insurance program e/abli%$ by ?is title4 4 7b7 ,effective date ,! am5dm5ts made by subsection 7a7 %all apply to s]vices furni%$ on or aft] ! date ( ! enactm5t ( ?is ,act4 #ebb4 ,grants to pr(essional organizations to increase div]sity 9 mat]nal1 reproductive1 & sexual heal? pr(essionals 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices1 ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all c>ry out a grant program "u :i* ! ,secret>y may make to eligible organizations-- 7#a7 = fiscal ye> #bjba1 plann+ grants describ$ 9 subsection 7b72 & 7#b7 = ! subsequ5t #d-ye> p]iod1 implem5tation grants describ$ 9 subsection 7c74 7b7 ,plann+ grants 7#a7 ,9 g5]al ,plann+ grants describ$ 9 ?is subsection are grants = ! foll[+ purposes3 7,a7 ,to collect data & id5tify any work=ce disp>ities1 ) respect to a heal? pr(ession1 at ea* ( ! foll[+ areas along ! heal? pr(essional cont9uum3 7i7 ,pipel9e availability ) respect to /ud5ts at ! high s*ool & college or univ]sity levels consid]+ & work+ t[>d entrance 9 ! pr(ession1 includ+ b>ri]s trigg]$ by crim9al records4 7ii7 ,entrance into ! tra9+ program = ! pr(ession4 7iii7 ,graduation f su* tra9+ program4 7iv7 ,entrance into practice1 includ+ b>ri]s trigg]$ by crim9al records4 7v7 ,ret5tion 9 practice = m ?an a #e-ye> p]iod4 7,b7 ,to develop "o or m /rategies to address ! work=ce disp>ities )9 ! heal? pr(ession1 z id5tifi$ "u 7& 9 response to ! f9d+s pursuant to7 subp>agraph 7,a74 7#b7 ,application ,to be eligible to receive a grant "u ?is subsection1 an eligible heal? pr(essional organization %all submit to ! ,secret>y ( ,heal? & ,human ,s]vices an application 9 su* =m & mann] & conta9+ su* in=mation z specifi$ by ! ,secret>y4 7#c7 ,am\nt ,ea* grant aw>d$ "u ?is subsection %all be = an am\nt n to exce$ #cjj1jjj4 7#d7 ,report ,ea* recipi5t ( a grant "u ?is subsection %all submit to ! ,secret>y ( ,heal? & ,human ,s]vices a report conta9+-- 7,a7 in=mation on ! ext5t & di/ribution ( work=ce disp>ities id5tifi$ ?r\gh ! grant2 & 7,b7 reasonable objectives & /rategies develop$ to address su* disp>ities )9 a #e-1 #aj-1 & #be-ye> p]iod4 7c7 ,implem5tation grants 7#a7 ,9 g5]al ,implem5tation grants describ$ 9 ?is subsection are grants to implem5t "o or m ( ! /rategies develop$ pursuant to a plann+ grant aw>d$ "u subsection 7b74 7#b7 ,application ,to be eligible to receive a grant "u ?is subsection1 an eligible heal? pr(essional organization %all submit to ! ,secret>y ( ,heal? & ,human ,s]vices an application 9 su* =m & mann] z specifi$ by ! ,secret>y4 ,ea* su* application %all conta9 in=mation on ! capability ( ! organization to c>ry out a /rategy describ$ 9 p>agraph 7#a71 involvem5t ( p>tn]s or coalitions1 plans = develop+ su/a9ability ( ! ef=ts aft] ! culm9ation ( ! grant cycle1 & any o!r in=mation specifi$ by ! ,secret>y4 7#c7 ,am\nt ,ea* grant aw>d$ "u ?is subsection %all be = an am\nt n to exce$ #ejj1jjj ea* ye> dur+ ! #d-ye> p]iod ( ! grant4 7#d7 ,reports ,= ea* ( ! fir/ #c ye>s = :i* an eligible heal? pr(essional organization is aw>d$ a grant "u ?is subsection1 ! organization %all submit to ! ,secret>y ( ,heal? & ,human ,s]vices a report on ! activities c>ri$ out by su* organization ?r\gh ! grant dur+ su* ye> & objectives = ! subsequ5t ye>4 ,= ! f\r? ye> = :i* an eligible heal? pr(essional organization is aw>d$ a grant "u ?is subsection1 ! organization %all submit to ! ,secret>y a report t includes an analysis ( all ! activities c>ri$ out by ! organization ?r\gh ! grant & a detail$ plan = cont9uation ( out-rea* ef=ts4 7d7 ,eligible heal? pr(essional organization def9$ ,= purposes ( ?is section1 ! t]m eligible heal? pr(essional organization means a pr(essional organization repres5t+ ob/etrician-gynecologi/s1 c]tifi$ nurse midwives1 c]tifi$ midwives1 family practice physicians1 nurse practition]s ^: scope ( practice includes mat]nity or sexual & reproductive heal? c>e1 physician assi/ants ^: scope ( practice includes ob/etrical or sexual & reproductive heal? c>e1 or c]tifi$ pr(essional midwives1 adolesc5t m$ic9e speciali/s1 & p$iatricians :o provide sexual & reproductive heal? c>e4 7e7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #b1jjj1jjj = fiscal ye> #bjba & #c1jjj1jjj = ea* ( ! fiscal ye>s #bjbb ?r\gh #bjbe4 #ebc4 ,int]ag5cy update to ! quality family plann+ guidel9es 7a7 ,9 g5]al ,n lat] ?an six mon?s aft] ! date ( enactm5t ( ?is ,act1 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion & ! ,(fice ( ,population ,affairs %all review & exp& ! #bjad ,quality ,family ,plann+ ,guidel9es to address-- 7#a7 heal? disp>ities2 & 7#b7 ! importance ( pati5t-direct$ contraceptive decision mak+4 7b7 ,consultation ,9 c>ry+ out subsection 7a71 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion & ! ,(fice ( ,population ,affairs %all conv5e a meet+1 & solicit ! views (1 /akehold]s includ+ exp]ts on heal? disp>ities1 exp]ts on reproductive co]cion1 repres5tatives ( provid] organizations1 pati5t advocates1 reproductive ju/ice organizations1 organizations t repres5t racial & e?nic m9ority communities1 organizations t repres5t p ) disabilities1 organizations t repres5t ,,lgbtq p]sons1 & organizations t repres5t p ) limit$ ,engli% pr(ici5cy4 #ebd4 ,dissem9ation ( ! quality family plann+ guidel9es 7a7 ,9 g5]al ,n lat] ?an six mon?s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices & ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion %all-- 7#a7 develop a plan = outrea* to publicly fund$ heal? c>e provid]s1 includ+ f$]ally qualifi$ heal? c5t]s & bran*es ( ! ,indian ,heal? ,s]vice1 ab\t ! quality family plann+ guidel9es ref]r$ to 9 section #ebc2 & 7#b7 aw>d grants to eligible entities to implem5t ^! guidel9es = all pati5ts seek+ family plann+ s]vices4 7b7 ,def9ition ,9 ?is section1 ! t]m eligible entity means a publicly fund$ heal? c>e provid] t s]ves p]sons ( reproductive age4 ,b ,pregnancy ,scre5+ #eca4 ,pregnancy int5tion scre5+ initiative demon/ration program ,"p ,p ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhj;g et seq471 z am5d$ by section #eje7;c77#f71 is fur!r am5d$ by add+ at ! end ! foll[+3 #cii,v-#h4 ,pregnancy int5tion scre5+ initiative demon/ration program 7a7 ,program e/abli%m5t ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all e/abli% a demon/ration program to facilitate ! cl9ical adoption ( pregnancy int5tion scre5+ initiatives by heal? c>e & social s]vices provid]s4 7b7 ,grants ,! ,secret>y may c>ry out ! demon/ration program ?r\gh aw>d+ grants to eligible entities to implem5t pregnancy int5tion scre5+ initiatives1 collect data1 & evaluate su* initiatives4 7c7 ,eligible ,entities 7#a7 ,9 g5]al ,an eligible entity "u ?is section is an entity describ$ 9 p>agraph 7#b7 t provides non-directive1 compreh5sive1 m$ically accurate in=mation4 7#b7 ,entities describ$ ,= purposes ( p>agraph 7#a71 an entity describ$ 9 ?is p>agraph is a community-bas$ organization1 volunt>y heal? organization1 public heal? dep>tm5t1 community heal? c5t]1 or o!r int]e/$ public or private prim>y1 behavioral1 or o!r heal? c>e or social s]vice provid] or organization4 7d7 ,pregnancy int5tion scre5+ initiative ,= purposes ( ?is section1 ! t]m pregnancy int5tion scre5+ initiative means any initiative by an eligible entity to r\t9ely scre5 wom5 ) respect to _! pregnancy int5tions & goals to ei!r prev5t un9t5d$ pregnancies or improve ! likelihood ( heal?y pregnancies1 9 ord] to bett] provide heal? c>e t meets ! contraceptive or pre-pregnancy ne$s & goals ( su* wom54 7e7 ,evaluation 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all1 by grant or contract1 & aft] consultation z describ$ 9 p>agraph 7#b71 conduct an evaluation ( ! demon/ration program1 ) respect to pregnancy int5tion scre5+ initiatives1 conduct$ "u ?is section4 ,su* evaluation %all include3 7,a7 ,assessm5t ( ! implem5tation ( pregnancy int5tion scre5+ protocols among a div]se gr\p ( pati5ts & provid]s1 includ+ collect+ data on ! exp]i5ces & outcomes = div]se pati5t populations 9 a v>iety ( cl9ical sett+s4 7,b7 ,analysis ( outcome measures t w facilitate effective & widespread adoption ( su* protocols by heal? c>e provid]s = inquir+ ab\t & respond+ to pregnancy goals ( wom5 ) bo? contraceptive & pre-pregnancy c>e4 7,c7 ,consid]ation ( heal? disp>ities among ! population s]v$4 7,d7 ,assessm5t ( ! equitable & volunt>y application ( su* initiatives to m9ority & m$ically und]s]v$ communities4 7,e7 ,assessm5t ( ! tra9+1 capacity1 & ongo+ te*nical assi/ance ne$$ = provid]s to effectively implem5t su* pregnancy int5tion scre5+ protocols4 7,f7 ,assessm5t ( :e!r ref]ral sy/ems = select$ protocols foll[ evid5ce-bas$ /&>ds t ensure access to compreh5sive heal? s]vices & appropriate foll[-up c>e4 7,g7 ,measur+ ?r\gh rigor\s me?ods ! effect ( su* initiatives on key heal? outcomes4 7#b7 ,consultation ) indep5d5t1 exp]t advisory panel ,9 conduct+ ! evaluation "u p>agraph 7#a71 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion %all consult ) physicians1 physician assi/ants1 advanc$ practice regi/]$ nurses1 nurse midwives1 & o!r heal? c>e provid]s :o specialize 9 wom5's heal?1 & o!r exp]ts 9 public heal?1 cl9ical practice1 program evaluation1 & rese>*4 7#c7 ,report ,n lat] ?an "o ye> aft] ! la/ day ( ! demon/ration program "u ?is section1 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion %all submit to ,congress a report on ! results ( ! evaluation conduct$ "u p>agraph 7#a7 & %all make ! report publicly available4 7f7 ,fund+ 7#a7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re is au?oriz$ to be appropriat$ #aj1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 7#b7 ,limitation ,n m ?an #bj p]c5t ( funds appropriat$ to c>ry out ?is section pursuant to p>agraph 7#a7 = a fiscal ye> may be us$ = purposes ( ! evaluation "u subsection 7e74 4 ,,vi ,m5tal heal? #fja4 ,m5tal heal? f9d+s ,congress f9ds ! foll[+3 7#a7 ,despite ! exi/5ce ( effective treatm5ts1 inequities lie 9 ! availability1 accessibility1 & quality ( m5tal heal? s]vices = racial & e?nic m9orities & p ) disabilities4 7#b7 ,^! inequities h p[]ful significance = m9ority gr\ps & = society z a :ole4 7#c7 ,racial & e?nic m9orities & p ) disabilities be> a great] burd5 f unmet m5tal heal? ne$s & ?us suff] a great] loss to _! ov]all heal? & productivity4 7#d7 ,improv+ community conditions & "o's home environm5t1 pair$ ) high-quality1 accessible1 & culturally tailor$ m5tal heal? s]vices1 c r$uce ! likelihood1 frequ5cy1 & int5sity ( *all5ges to "o's m5tal heal?4 7#e7 ,! pres5ce ( /rong social connections & tru/1 opportunities to exp]i5ce & %>e cultural id5tity1 safe ga!r+ places1 & economic opportunity are community factors t b5efit m5tal heal?4 7#f7 ,! social1 physical1 & economic conditions 9 communities c h trem5d\s influ5ce on daily /ressors t %ape m5tal heal? outcomes4 7#g7 ,! =emo/ b>ri]s include ! co/ ( c>e1 societal /igma1 & ! fragm5t$ organization ( s]vices4 7#h7 ,p ) disabilities :o are racial or e?nic m9orities may h co-occurr+ m5tal heal? conditions :i*1 )\t prop] accommodations & support1 fur!r /igmatize !m & limit _! p>ticipation 9 society4 7#i7 ,african-,am]ican1 ,lat9x1 ,asian ,am]ican1 ,pacific ,isl&]1 ,native1 & o!r p ( color h attitudes t[>d m5tal heal? *all5ges t are ano!r b>ri] to seek+ m5tal heal? c>e4 7#aj7 ,m5tal illness reta9s consid]able /igma 9 _m communities ( color1 includ+ ^? ( ,asian ,am]icans & ,pacific ,isl&]s1 & seek+ treatm5t is n always enc\rag$4 7#aa7 ,address+ m5tal heal? /igma & increas+ culturally appropriate treatm5t modalities 9 communities w help to increase utilization ( m5tal heal? s]vices = p :o h tr\ble function+ because ( m5tal heal? *all5ges4 7#ab7 ,!re is a l9k betwe5 m5tal heal? diagnosis & ! likelihood ( an individual committ+ suicide4 7#ac7 ,a compreh5sive public heal? approa* to behavioral heal? fo/]s protective factors 9 racial & e?nic communities t support m5tal heal?4 7#ad7 ,approa*es to m5tal heal? & address+ trauma mu/ keep 9 m9d ! hi/orical & cultural trauma t has impact$ _m communities ( color4 7#ae7 ,treatm5t modalities mu/ keep approa*es ( individual communities to m5tal heal? 9 m9d1 includ+ by consid]+-- 7,a7 approa*es to cultural heal+ practices2 & 7,b7 ! m5tal heal? pr(essionals ne$$ = su* practices1 su* z pe] support speciali/s4 7#af7 ,approa*es to m5tal heal? & address+ trauma mu/ keep 9 m9d ! concept ( int]sectionality ( individuals2 t individuals may h _m inequities t %ape ! way !y process & exp]i5ce ev]yday life4 #fjb4 ,cov]age ( m>riage & family !rapi/ s]vices1 m5tal heal? c\nselor s]vices1 sub/ance abuse c\nselor s]vices1 & pe] support speciali/ s]vices "u "p ,b ( ! ,m$ic>e program 7a7 ,cov]age ( ,s]vices 7#a7 ,9 g5]al ,section #ahfa7s77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b771 z am5d$ by section #dca7;c71 is am5d$-- 7,a7 9 subp>agraph 7,,hh71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,,ii71 by add+ & aft] ! semicolon at ! end2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,,jj7 m>riage & family !rapi/ s]vices 7z def9$ 9 subsection 7nnn77#a771 m5tal heal? c\nselor s]vices 7z def9$ 9 subsection 7nnn77#c771 sub/ance abuse c\nselor s]vices 7z def9$ 9 subsection 7nnn77#e771 & pe] support speciali/ s]vices 7z def9$ 9 subsection 7nnn77#g772 4 7#b7 ,def9itions ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 z am5d$ by sections #bjg7;b77#a71 #dag7;a71 & #dcc7;c71 is am5d$ by add+ at ! end ! foll[+ new subsection3 7nnn7 ,m>riage & ,family ,!rapi/ ,s]vices2 ,m>riage & ,family ,!rapi/2 ,m5tal ,heal? ,c\nselor ,s]vices2 ,m5tal ,heal? ,c\nselor2 sub/ance abuse c\nselor s]vices2 sub/ance abuse c\nselor2 pe] support speciali/ s]vices2 pe] support speciali/ 7#a7 ,! t]m m>riage & family !rapi/ s]vices means s]vices p]=m$ by a m>riage & family !rapi/ 7z def9$ 9 p>agraph 7#b77 = ! diagnosis & treatm5t ( m5tal illnesses1 :i* ! m>riage & family !rapi/ is legally au?oriz$ to p]=m "u ,/ate law 7or ! ,/ate regulatory me*anism provid$ by ,/ate law7 ( ! ,/ate 9 :i* su* s]vices are p]=m$1 z w\ld o!rwise be cov]$ if furni%$ by a physician or z an incid5t to a physician's pr(essional s]vice1 b only if no facility or o!r provid] *>ges or is paid any am\nts ) respect to ! furni%+ ( su* s]vices4 7#b7 ,! t]m m>riage & family !rapi/ means an individual :o-- 7,a7 possesses a ma/]'s or doctoral degree t qualifies = lic5sure or c]tification z a m>riage & family !rapi/ pursuant to ,/ate law1 includ+ b n limit$ to1 cl9ical social work]s & occupational !rapi/s2 7,b7 aft] obta9+ su* degree has p]=m$ at lea/ #b ye>s ( cl9ical sup]vis$ exp]i5ce 9 m>riage & family !rapy2 & 7,c7 9 ! case ( an individual p]=m+ s]vices 9 a ,/ate t provides = lic5sure or c]tification ( m>riage & family !rapi/s1 is lic5s$ or c]tifi$ z a m>riage & family !rapi/ 9 su* ,/ate4 7#c7 ,! t]m m5tal heal? c\nselor s]vices means s]vices p]=m$ by a m5tal heal? c\nselor 7z def9$ 9 p>agraph 7#d77 = ! diagnosis & treatm5t ( m5tal illnesses t ! m5tal heal? c\nselor is legally au?oriz$ to p]=m "u ,/ate law 7or ! ,/ate regulatory me*anism provid$ by ! ,/ate law7 ( ! ,/ate 9 :i* su* s]vices are p]=m$1 z w\ld o!rwise be cov]$ if furni%$ by a physician or z incid5t to a physician's pr(essional s]vice1 b only if no facility or o!r provid] *>ges or is paid any am\nts ) respect to ! furni%+ ( su* s]vices4 7#d7 ,! t]m m5tal heal? c\nselor means an individual :o-- 7,a7 possesses a ma/]'s or doctor's degree 9 m5tal heal? c\nsel+ or a relat$ field1 includ+ cl9ical social work]s & occupational !rapi/s2 7,b7 aft] obta9+ su* a degree has p]=m$ at lea/ #b ye>s ( sup]vis$ m5tal heal? c\nselor practice2 & 7,c7 9 ! case ( an individual p]=m+ s]vices 9 a ,/ate t provides = lic5sure or c]tification ( m5tal heal? c\nselors or pr(essional c\nselors1 is lic5s$ or c]tifi$ z a m5tal heal? c\nselor or pr(essional c\nselor 9 su* ,/ate4 7#e7 ,! t]m sub/ance abuse c\nselor s]vices means s]vices p]=m$ by a sub/ance abuse c\nselor 7z def9$ 9 p>agraph 7#f77 = ! diagnosis & treatm5t ( sub/ance abuse & addiction t ! sub/ance abuse c\nselor is legally au?oriz$ to p]=m "u ,/ate law 7or ! ,/ate regulatory me*anism provid$ by ! ,/ate law7 ( ! ,/ate 9 :i* su* s]vices are p]=m$1 z w\ld o!rwise be cov]$ if furni%$ by a physician or z incid5t to a physician's pr(essional s]vice1 b only if no facility or o!r provid] *>ges or is paid any am\nts ) respect to ! furni%+ ( su* s]vices4 7#f7 ,! t]m sub/ance abuse c\nselor means an individual :o-- 7,a7 has p]=m$ at lea/ #b ye>s ( sup]vis$ sub/ance abuse c\nselor practice2 7,b7 9 ! case ( an individual p]=m+ s]vices 9 a ,/ate t provides = lic5sure or c]tification ( sub/ance abuse c\nselors or pr(essional c\nselors1 is lic5s$ or c]tifi$ z a sub/ance abuse c\nselor or pr(essional c\nselor 9 su* ,/ate2 or 7,c7 is a drug & alcohol c\nselor z def9$ 9 section #dj4bha ( title #di1 ,code ( ,f$]al ,regulations4 7#g7 ,! t]m pe] support speciali/ s]vices means s]vices p]=m$ by a pe] support speciali/ 7z def9$ 9 p>agraph 7#h77 = ! well-be+ ( individuals ne$+ m5tal heal? support t ! pe] support speciali/ is legally au?oriz$ to p]=m "u ,/ate law 7or ! ,/ate regulatory me*anism provid$ by ! ,/ate law7 ( ! ,/ate 9 :i* su* s]vices are p]=m$1 z w\ld o!rwise be cov]$ if furni%$ by a physician or z incid5t to a physician's pr(essional s]vice1 b only if no facility or o!r provid] *>ges or is paid any am\nts ) respect to ! furni%+ ( su* s]vices4 7#h7 ,! t]m pe] support speciali/ means an individual :o-- 7,a7 is an individual liv+ 9 recov]y ) m5tal illness1 addiction1 or sy/ems involvem5t2 7,b7 has skills le>n$ 9 =mal tra9+2 7,c7 uses assets-bas$ fram+ 9 speak+ ab\t m5tal heal?1 recov]y1 & well-be+2 & 7,d7 deliv]s s]vices 9 behavioral heal? sett+s to promote m9d-body recov]y & resili5cy4 4 7#c7 ,provision = paym5t "u "p ,b ,section #ahcb7;a77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciek7a77#b77;,b77 is am5d$-- 7,a7 by /rik+ & at ! end ( clause 7iv72 & 7,b7 by add+ at ! end ! foll[+ new clause3 7v7 m>riage & family !rapi/ s]vices1 m5tal heal? c\nselor s]vices1 sub/ance abuse c\nselor s]vices1 & pe] support speciali/ s]vices2 & 4 7#d7 ,am\nt ( paym5t ,section #ahcc7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a771 z am5d$ by section #dca7;c77#c71 is am5d$-- 7,a7 by /rik+ & be=e 7,,dd72 & 7,b7 by ins]t+ be=e ! semicolon at ! end ! foll[+3 1 & 7,,ee7 ) respect to m>riage & family !rapi/ s]vices1 m5tal heal? c\nselor s]vices1 sub/ance abuse c\nselor s]vices1 & pe] support speciali/ s]vices "u section #ahfa7s77#b77;,,jj71 ! am\nts paid %all be #hj p]c5t ( ! less] ( ! actual *>ge = ! s]vices or #ge p]c5t ( ! am\nt det]m9$ = paym5t ( a psy*ologi/ "u subp>agraph 7,l74 7#e7 ,exclusion ( m>riage & family !rapi/ s]vices1 m5tal heal? c\nselor s]vices1 & pe] support speciali/ s]vices f skill$ nurs+ facility prospective paym5t sy/em ,section #ahhh7;e77#b77;,a77ii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieyy7e77#b77;,a77ii77 is am5d$ by ins]t+ m>riage & family !rapi/ s]vices 7z def9$ 9 section #ahfa7nnn77#a771 m5tal heal? c\nselor s]vices 7z def9$ 9 section #ahfa7nnn77#c771 & pe] support speciali/ s]vices 7z def9$ 9 section #ahfa7nnn77#g77 aft] qualifi$ psy*ologi/ s]vices14 7#f7 ,inclusion ( m>riage & family !rapi/s1 m5tal heal? c\nselors1 & sub/ance abuse c\nselors z practition]s = assignm5t ( claims ,section #ahdb7;b77#ah77;,c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieu7b77#ah77;,c77 is am5d$ by add+ at ! end ! foll[+ new clauses3 7vii7 ,a m>riage & family !rapi/ 7z def9$ 9 section #ahfa7nnn77#b774 7viii7 ,a m5tal heal? c\nselor 7z def9$ 9 section #ahfa7nnn77#d774 7ix7 ,a sub/ance abuse c\nselor 7z def9$ 9 section #ahfa7nnn77#f774 7x7 ,a pe] support speciali/ 7z def9$ 9 section #ahfa7nnn77#h774 4 7b7 ,cov]age ( ,c]ta9 ,m5tal ,heal? ,s]vices ,provid$ 9 ,c]ta9 ,sett+s 7#a7 ,rural heal? cl9ics & f$]ally qualifi$ heal? c5t]s ,section #ahfa7;aa77#a77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#a77;,b77 is am5d$ by /rik+ or by a cl9ical social work] 7z def9$ 9 subsection 7hh77#a771 & ins]t+ 1 by a cl9ical social work] 7z def9$ 9 subsection 7hh77#a771 by a m>riage & family !rapi/ 7z def9$ 9 subsection 7nnn77#b771 or by a m5tal heal? c\nselor 7z def9$ 9 subsection 7nnn77#d771 or by a sub/ance abuse c\nselor 7z def9$ 9 section #ahfa 7nnn77#f771 or by a pe] support speciali/ 7z def9$ 9 section #ahfa7nnn77#h7744 7#b7 ,hospice programs ,section #ahfa7;dd77#b77;,b77i77,,iii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7dd77#b77;,b77i77,,iii77 is am5d$ by ins]t+ or "o m>riage & family !rapi/ 7z def9$ 9 subsection 7nnn77#b77 aft] social work]4 7c7 ,au?orization ( ,m>riage & ,family ,!rapi/s ,to ,develop ,dis*>ge ,plans = ,po/hospital ,s]vices ,section #ahfa7;ee77#b77;,g7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ee77#b77;,g77 is am5d$ by ins]t+ m>riage & family !rapi/ 7z def9$ 9 subsection 7nnn77#b771 aft] social work]14 7d7 ,effective ,date ,! am5dm5ts made by ?is section %all apply ) respect to s]vices furni%$ on or aft] ,janu>y #a1 #bjba4 #fjc4 ,integrat$ ,heal? ,c>e ,demon/ration ,program ,"p ,d ( title ,v ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bij;dd et seq47 is am5d$ by add+ at ! end ! foll[+3 #eec4 ,int]pr(essional heal? c>e teams = provision ( behavioral heal? c>e 9 prim>y c>e sett+s 7a7 ,grants ,! ,secret>y1 act+ ?r\gh ! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use1 %all aw>d grants to eligible entities = ! purpose ( e/abli%+ int]pr(essional heal? c>e teams t provide behavioral heal? c>e4 7b7 ,eligible entities ,to be eligible to receive a grant "u ?is section1 an entity %all be a ,f$]ally qualifi$ heal? c5t] 7z def9$ 9 section #ahfa7;aa7 ( ! ,social ,security ,act71 rural heal? cl9ic1 wom5's heal? cl9ic1 or behavioral heal? program 7includ+ any su* program op]at$ by a community-bas$ organization7 s]v+ a high proportion ( individuals f racial & e?nic m9ority gr\ps 7z def9$ 9 section #agjg7;g774 7c7 ,loan =giv5ess ,to enc\rage qualifi$ alli$ heal? pr(essionals to ent] ! m5tal heal? field1 an eligible entity receiv+ a grant "u ?is section %all agree to use n less ?an #aj1jjj ( ! grant funds on a loan =giv5ess program = practition]s :o commit to work+ 9 ! m5tal heal? field = a p]iod ( #b ye>s4 7d7 ,sci5tifically & culturally bas$ ,integrat$ heal? c>e fund$ ?r\gh ?is section %all be sci5tifically & culturally bas$1 tak+ into consid]ation ! results ( ! mo/ rec5t pe]-review$ rese>* available4 7e7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re is au?oriz$ to be appropriat$ #bj1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 4 #fjd4 ,address+ racial & e?nic m5tal heal? disp>ities rese>* gaps 7a7 ,9 g5]al ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,director ( ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities %all ent] into an arrangem5t ) ! ,national ,academy ( ,sci5ces to c>ry out ! activities "u subsection 7b71 or1 if ! ,national ,academy ( ,sci5ces decl9es to ent] into su* an arrangem5t1 ! ,director ( ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities1 9 coop]ation ) ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 %all c>ry out ! activities "u subsection 7b74 7b7 ,activities ,! applicable entity "u subsection 7a7 %all-- 7#a7 conduct a /udy ) respect to m5tal heal? disp>ities 9 racial & e?nic m9ority gr\ps 7z def9$ 9 section #agjg7;g7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f7;g7772 & 7#b7 submit to ,congress a report on ! results ( su* /udy1 includ+-- 7,a7 a compilation ( in=mation on ! dynamics ( m5tal heal? outcomes 9 su* racial & e?nic m9ority gr\ps2 7,b7 ! degree ( ! co-occurr5ce ( m5tal conditions ) o!r disabilities 9 su* racial & e?nic gr\ps1 includ+ physical disabilities1 m5tal disabilities1 & m5tal disord]s or m5tal heal? conditions :i* co-occur ) "o ano!r2 7,c7 a compilation ( in=mation on ! impact ( exposure to community viol5ce1 community trauma1 adv]se *ildhood exp]i5ces1 wea!r extremes wors5$ by climate *ange 7su* z heat waves1 hurricanes1 & wildfires71 sub/ance use1 & o!r psy*ological traumas1 on m5tal disord]s 9 su* racial & m9ority gr\ps1 /ratifi$ by h\sehold income level2 7,d7 a compilation ( in=mation on ! impact ( ! int]sectionality ( transg5d] individuals 9 racial & e?nic m9ority gr\ps2 & 7,e7 a description ( h[ protective factors contra/ & comp>e among diff]5t communities ( color1 id5tify+ cultural /r5g?s4 #fje4 ,heal? pr(essions compet5cies to address racial & e?nic m5tal heal? disp>ities 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use1 %all aw>d grants to qualifi$ national organizations = ! purposes (-- 7#a7 develop+1 & dissem9at+ to heal? pr(essional educational programs curricula or core compet5cies address+ m5tal heal? inequities among racial & e?nic m9ority gr\ps = use 9 ! tra9+ ( /ud5ts 9 ! pr(essions ( social "w1 psy*ology1 psy*iatry1 m>riage & family !rapy1 m5tal heal? c\nsel+1 pe] support1 & sub/ance abuse c\nsel+2 & 7#b7 c]tify+ community heal? work]s & pe] wellness speciali/s ) respect to su* curricula & core compet5cies & integrat+ & exp&+ ! use ( su* work]s & speciali/s into heal? c>e & community-bas$ sett+s to address m5tal heal? disp>ities among racial & e?nic m9ority gr\ps4 7b7 ,curricula2 core compet5cies ,organizations receiv+ funds "u subsection 7a7 may use ! funds to engage 9 ! foll[+ activities relat$ to ! developm5t & dissem9ation ( curricula or core compet5cies describ$ 9 subsection 7a77#a73 7#a7 ,=mation ( committees or work+ gr\ps compris$ ( exp]ts f accr$it$ heal? pr(essions s*ools to id5tify core compet5cies relat+ to m5tal heal? disp>ities among racial & e?nic m9ority gr\ps4 7#b7 ,plann+ ( work%ops 9 national =a to all[ = public input1 includ+ input f communities ( color ) liv$ exp]i5ce1 into ! educational ne$s associat$ ) m5tal heal? disp>ities among racial & e?nic m9ority gr\ps4 7#c7 ,dissem9ation & promotion ( ! use ( curricula or core compet5cies 9 und]graduate & graduate heal? pr(essions tra9+ programs nationwide4 7#d7 ,e/abli%+ ext]nal /akehold] advisory bo>ds to provide mean+ful input into policy & program developm5t & be/ practices to r$uce m5tal heal? inequities among racial & e?nic gr\ps1 includ+ p>ticipation f communities ( color ) liv$ exp]i5ce ( ! impacts ( m5tal heal? disp>ities4 7c7 ,def9itions ,9 ?is section3 7#a7 ,qualifi$ national organization ,! t]m qualifi$ national organization means a national organization t focuses on ! education ( /ud5ts 9 programs ( social "w1 occupational !rapy1 psy*ology1 psy*iatry1 & m>riage & family !rapy4 7#b7 ,racial & e?nic m9ority gr\p ,! t]m racial & e?nic m9ority gr\p has ! mean+ giv5 to su* t]m 9 section #agjg7;g7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f7;g774 7d7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #fjf4 ,geoaccess /udy ,! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use %all-- 7#a7 conduct a /udy to-- 7,a7 det]m9e :i* geographic areas ( ! ,unit$ ,/ates h %ortages ( specialty m5tal heal? provid]s2 & 7,b7 assess ! prep>$ness ( speciality m5tal heal? provid]s to deliv] culturally & l+ui/ically appropriate1 af=dable1 & accessible s]vices2 & 7#b7 submit a report to ,congress on ! results ( su* /udy4 #fjg4 ,asian ,am]ican1 ,native ,hawaiian1 ,pacific ,isl&]1 & ,hispanic & ,lat9o behavioral & m5tal heal? outrea* & education /rategies ,"p ,d ( title ,v ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bij;dd et seq471 z am5d$ by section #fjc1 is fur!r am5d$ by add+ at ! end ! foll[+ new section3 #eed4 ,behavioral & m5tal heal? outrea* & education /rategies 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use1 %all1 9 coord9ation ) advocacy & behavioral & m5tal heal? organizations s]v+ populations ( ,asian ,am]ican1 ,native ,hawaiian1 ,pacific ,isl&]1 & ,hispanic & ,lat9o individuals or communities1 develop & implem5t an outrea* & education /rategy to promote behavioral & m5tal heal?1 cl>ify t behavioral & m5tal heal? conditions are treatable & t reasonable accommodations are requir$ "u section #ejd ( ! ,rehabilitation ,act ( #aigc 7#bi ,u4,s4,c4 #gid7 & titles ,,ii & ,,iii ( ! ,am]icans ) ,disabilities ,act ( #aiij 7#db ,u4,s4,c4 #abaca et seq471 & r$uce /igma associat$ ) m5tal heal? conditions & sub/ance abuse among ! ,asian ,am]ican1 ,native ,hawaiian1 ,pacific ,isl&]1 & ,hispanic & ,lat9o populations4 ,su* /rategy %all-- 7#a7 be design$ to-- 7,a7 meet ! div]se cultural & language ne$s ( ! v>i\s ,asian ,am]ican1 ,native ,hawaiian1 ,pacific ,isl&]1 & ,hispanic & ,lat9o populations2 & 7,b7 ensure su* /rategies are developm5tally 7) respect to ! b5efici>y's relative age & exp]i5ce7 & age appropriate1 z well z cognitively accessible to p]sons ) cognitive disabilities2 7#b7 increase aw>5ess ( symptoms ( m5tal illnesses common among su* populations1 tak+ into acc\nt diff]5ces )9 subgr\ps 7su* z g5d]1 g5d] id5tity1 age1 sexual ori5tation1 disability1 & e?nicity7 ( su* populations2 7#c7 provide in=mation on evid5ce-bas$1 culturally & l+ui/ically appropriate & adapt$ int]v5tions & treatm5ts2 7#d7 ensure full p>ticipation (1 & engage1 bo? consum]s & community memb]s 9 ! developm5t & implem5tation ( mat]ials2 & 7#e7 seek to broad5 ! p]spective among bo? individuals 9 su* communities & /akehold]s s]v+ su* communities to use a compreh5sive public heal? approa* to promot+ behavioral heal? t addresses a holi/ic view ( heal? by focus+ on ! int]section betwe5 behavioral & physical heal?4 7b7 ,reports ,beg9n+ n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is section & annually !reaft]1 ! ,secret>y1 act+ ?r\gh ! ,assi/ant ,secret>y1 %all submit to ,congress1 & make publicly available1 a report on ! ext5t to :i* ! /rategy develop$ & implem5t$ "u subsection 7a7 increas$ behavioral & m5tal heal? outcomes associat$ ) m5tal heal? conditions & sub/ance abuse among ,asian ,am]ican1 ,native ,hawaiian1 ,pacific ,isl&]1 & ,hispanic & ,lat9o populations4 7c7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #cjj1jjj = fiscal ye> #bjba4 4 #fjh4 ,m5tal heal? 9 s*ools 7a7 ,purpose ,x is ! purpose ( ?is section to-- 7#a7 revise1 increase fund+ =1 & exp& ! scope ( ! ,project ,,aw>e ,/ate ,educational ,ag5cy ,grant ,program c>ri$ out by ! ,secret>y ( ,heal? & ,human ,s]vices1 9 ord] to provide access to m compreh5sive s*ool-bas$ m5tal heal? s]vices & supports2 7#b7 provide = compreh5sive /aff developm5t = s*ool & community s]vice p]sonnel work+ 9 ! s*ool2 7#c7 provide = compreh5sive tra9+ to improve heal? & academic outcomes = *ildr5 )1 or at risk =1 m5tal heal? conditions1 = p>5ts or gu>dians1 sibl+s1 & o!r family memb]s ( su* *ildr51 & = conc]n$ memb]s ( ! community2 7#d7 provide = compreh5sive1 univ]sal1 evid5ce-bas$ scre5+ to id5tify *ildr5 & adolesc5ts ) pot5tial m5tal heal? conditions or unmet emotional heal? ne$s2 7#e7 recognize be/ practices = ! deliv]y ( m5tal heal? c>e 9 s*ool-bas$ sett+s1 includ+ s*ool-bas$ heal? c5t]s2 7#f7 provide = compreh5sive tra9+ = p>5ts or gu>dians1 sibl+s1 o!r family memb]s1 & conc]n$ memb]s ( ! community on behalf ( *ildr5 & adolesc5ts exp]i5c+ m5tal heal? trauma1 disord]1 or disability2 & 7#g7 e/abli% =mal work+ relation%ips betwe5 heal?1 human s]vice1 & educational entities t support ! m5tal & emotional heal? ( *ildr5 & adolesc5ts 9 ! s*ool sett+4 7b7 ,te*nical am5dm5ts ,! second "p ,g 7relat+ to s]vices provid$ ?r\gh religi\s organizations7 ( title ,v ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bijkk et seq47 is am5d$-- 7#a7 by r$esignat+ su* "p z "p ,j2 & 7#b7 by r$esignat+ sections #eha ?r\gh #ehd z sections #eif ?r\gh #eif;,c1 respectively4 7c7 ,s*ool-,bas$ m5tal heal? & *ildr5 & viol5ce ,section #eha ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bij;hh7 7relat+ to *ildr5 & viol5ce7 is am5d$ to read z foll[s3 #eha4 ,s*ool-bas$ m5tal heal?2 *ildr5 & adolesc5ts 7a7 ,9 g5]al ,! ,secret>y1 9 consultation ) ! ,secret>y ( ,education1 %all1 ?r\gh grants1 contracts1 or coop]ative agreem5ts aw>d$ to eligible entities describ$ 9 subsection 7c71 provide compreh5sive s*ool-bas$ m5tal heal? s]vices & supports to assi/ *ildr5 9 local communities & s*ools 7includ+ s*ools fund$ by ! ,bureau ( ,indian ,education7 deal+ ) traumatic exp]i5ces1 grief1 b]eavem5t1 risk ( suicide1 & viol5ce4 ,su* s]vices & supports %all be-- 7#a7 developm5tally1 l+ui/ically1 & culturally appropriate2 7#b7 trauma-in=m$2 & 7#c7 incorporate positive behavioral int]v5tions & supports4 7b7 ,activities ,grants1 contracts1 or coop]ative agreem5ts aw>d$ "u subsection 7a71 %all1 z appropriate1 be us$ =-- 7#a7 implem5tation ( s*ool & community-bas$ m5tal heal? programs t-- 7,a7 build aw>5ess ( individual trauma & ! int]g5]ational1 cont9uum ( impacts ( trauma on populations2 7,b7 tra9 appropriate /aff to id5tify1 & scre5 =1 signs ( trauma exposure1 m5tal heal? disord]s1 or risk ( suicide2 & 7,c7 incorporate positive behavioral int]v5tions1 family engagem5t1 /ud5t treatm5t1 & multig5]ational supports to fo/] ! heal? & developm5t ( *ildr51 prev5t m5tal heal? disord]s1 & ameliorate ! impact ( trauma2 7#b7 te*nical assi/ance to local communities ) respect to ! developm5t ( programs describ$ 9 p>agraph 7#a72 7#c7 facilitat+ community p>tn]%ips among families1 /ud5ts1 law en=cem5t ag5cies1 education ag5cies1 m5tal heal? & sub/ance use disord] s]vice sy/ems1 family-bas$ m5tal heal? s]vice sy/ems1 *ild welf>e ag5cies1 heal? c>e provid]s 7includ+ prim>y c>e physicians1 m5tal heal? pr(essionals1 & o!r pr(essionals :o specialize 9 *ildr5's m5tal heal? su* z *ild & adolesc5t psy*iatri/s71 in/itutions ( high] education1 fai?-bas$ programs1 trauma networks1 & o!r community-bas$ sy/ems to address *ild & adolesc5t trauma1 m5tal heal? issues1 & viol5ce2 & 7#d7 e/abli%+ & promot+ be/ practices t are ei!r evid5ce- or culturally-bas$ = *ildr5 & adolesc5ts to %>e _! exp]i5ces ( individual & community trauma1 includ+ _! exposure to viol5ce1 ) tru/$ adults4 7c7 ,requirem5ts 7#a7 ,9 g5]al ,to be eligible = a grant1 contract1 or coop]ative agreem5t "u subsection 7a71 an entity %all be a p>tn]%ip t includes-- 7,a7 a ,/ate educational ag5cy1 z def9$ 9 section #haja ( ! ,elem5t>y & ,second>y ,education ,act ( #aife1 9 coord9ation ) "o or m local educational ag5cies1 z def9$ 9 section #haja ( ! ,elem5t>y & ,second>y ,education ,act ( #aife1 or a consortium ( any entities describ$ 9 subp>agraph 7,b71 7,c71 7,d71 or 7,e7 ( section #haja7cj7 ( su* ,act2 & 7,b7 at lea/ #a community-bas$ m5tal heal? provid]1 includ+ a public or private m5tal heal? entity1 heal? c>e entity1 family-bas$ m5tal heal? entity1 trauma network1 or o!r community-bas$ entity1 z det]m9$ by ! ,secret>y 7& :i* may include additional entities su* z a human s]vices ag5cy1 law en=cem5t or juv5ile ju/ice entity1 *ild welf>e ag5cy1 an in/itution ( high] education1 or ano!r entity1 z det]m9$ by ! ,secret>y74 7#b7 ,compliance ) ,,hipaa ,any pati5t records develop$ by cov]$ entities ?r\gh activities "u ! grant %all meet ! regulations promulgat$ "u section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif4 7#c7 ,compliance ) ,,f]pa ,section #ddd ( ! ,g5]al ,education ,provisions ,act 7commonly kn[n z ! ,family ,educational ,rights & ,privacy ,act ( #aigd7 %all apply to any entity t is a memb] ( ! p>tn]%ip 9 ! same mann] t su* section applies to an educational ag5cy or in/itution 7z t t]m is def9$ 9 su* section74 7d7 ,geographical di/ribution ,! ,secret>y %all ensure t grants1 contracts1 or coop]ative agreem5ts "u subsection 7a7 w be di/ribut$ equitably among ! regions ( ! c\ntry & among urban & rural areas4 7e7 ,duration ( aw>ds ,) respect to a grant1 contract1 or coop]ative agreem5t "u subsection 7a71 ! p]iod dur+ :i* paym5ts "u su* an aw>d w be made to ! recipi5t %all be #e ye>s1 ) options = r5ewal4 7f7 ,evaluation & measures ( outcomes 7#a7 ,developm5t ( process ,! ,assi/ant ,secret>y %all develop a fiscally appropriate process = evaluat+ activities c>ri$ out "u ?is section4 ,su* process %all include-- 7,a7 ! developm5t ( guidel9es = ! submission ( program data by grant1 contract1 or coop]ative agreem5t recipi5ts2 7,b7 ! developm5t ( measures ( outcomes 79 accordance ) p>agraph 7#b77 to be appli$ by su* recipi5ts 9 evaluat+ programs c>ri$ out "u ?is section2 & 7,c7 ! submission ( annual reports by su* recipi5ts conc]n+ ! effectiv5ess ( programs c>ri$ out "u ?is section4 7#b7 ,measures ( outcomes ,! ,assi/ant ,secret>y %all develop measures ( outcomes to be appli$ by recipi5ts ( assi/ance "u ?is section to evaluate ! effectiv5ess ( programs c>ri$ out "u ?is section1 includ+ outcomes relat$ to ! /ud5t1 family1 & local educational sy/ems support$ by ?is ,act4 7#c7 ,submission ( annual data ,an eligible entity describ$ 9 subsection 7c7 t receives a grant1 contract1 or coop]ative agreem5t "u ?is section %all annually submit to ! ,assi/ant ,secret>y a report t includes data to evaluate ! success ( ! program c>ri$ out by ! entity bas$ on :e!r su* program is a*iev+ ! purposes ( ! program4 ,su* reports %all utilize ! measures ( outcomes "u p>agraph 7#b7 9 a reasonable mann] to demon/rate ! progress ( ! program 9 a*iev+ su* purposes4 7#d7 ,evaluation by assi/ant secret>y ,bas$ on ! data submitt$ "u p>agraph 7#c71 ! ,assi/ant ,secret>y %all annually submit to ,congress a report conc]n+ ! results & effectiv5ess ( ! programs c>ri$ out ) assi/ance receiv$ "u ?is section4 7#e7 ,limitation ,an eligible entity %all use n m ?an #bj p]c5t ( am\nts receiv$ "u a grant "u ?is section to c>ry out evaluation activities "u ?is subsection4 7g7 ,in=mation & education ,! ,secret>y %all dissem9ate be/ practices bas$ on ! f9d+s ( ! k developm5t & application "u ?is section4 7h7 ,am\nt ( grants & au?orization ( appropriations 7#a7 ,am\nt ( grants ,a grant "u ?is section %all be 9 an am\nt t is n m ?an #b1jjj1jjj = ea* ( ! fir/ #e fiscal ye>s foll[+ ! date ( enactm5t ( ?is section4 ,! ,secret>y %all det]m9e ! am\nt ( ea* su* grant bas$ on ! population ( *ildr5 up to age #ba ( ! area to be s]v$ "u ! grant4 7#b7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section1 #acj1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbd4 4 7d7 ,con=m+ am5dm5t ,"p ,g ( title ,v ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bij;hh et seq471 z am5d$ by ?is section1 is fur!r am5d$ by /rik+ ! "p head+ & ins]t+ ! foll[+3 ,g ,s*ool-bas$ m5tal heal? 4 #fji4 ,build+ an effective work=ce 9 m5tal heal? 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices1 9 coord9ation ) ! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use1 ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 & ! ,secret>y ( ,labor1 %all1 9 coord9ation ) advocacy & behavioral & m5tal heal? organizations s]v+ p ( color-- 7#a7 develop1 /r5g!n1 & implem5t /rategies to bol/] c>e] pa?ways = m5tal heal? pr(essionals2 & 7#b7 id5tify ! bread? ( sett+s :]e m5tal & behavioral heal? c>e c take place4 7b7 ,cont5ts ,/rategies "u subsection 7a7 %all include-- 7#a7 ! v>iety ( sett+s :]e m5tal heal? pr(essionals are ne$$1 includ+ community-bas$ organizations1 wom5's c5t]s1 %elt]s1 organizations focus$ on y\? developm5t1 work=ce ag5cies1 job placem5t & developm5t c5t]s1 em]g5cy rooms1 ! special supplem5tal nutrition program = wom51 infants1 & *ildr5 "u section #ag ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aghf71 food banks1 legal aid1 & b5efit issu]s z def9$ 9 section #c ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjab72 7#b7 def9+ c>e] pa?ways 9 m5tal & behavioral heal?1 to help communities und]/& ! v>iety ( c>e]s 9 m5tal & behavioral heal? t are available2 7#c7 build+ c>e] pa?ways 9 m5tal & behavioral heal? z "p ( ! curriculum at ! po/second>y education level2 7#d7 provid+ accessible tra9+ & c]tification pa?ways = lay heal? work]s su* z community heal? work]s & o!r pe] support individuals to ensure t c>e]s pay a liv+ wage2 7#e7 creat+ inc5tives = /ud5ts 9 ! fields ( occupational !rapy1 social "w1 m$ic9e1 & nurs+ to le>n m ab\t m5tal heal?1 & to include a m5tal heal? rotation z a "p ( ! heal? pr(essional curricula2 7#f7 includ+ tra9+ & education = tea*]s ab\t ! basics ( section #ejd ( ! ,rehabilitation ,act ( #aigc 7#bi ,u4,s4,c4 #gid7 & individualiz$ education programs 7z def9$ 9 section #fad7;d7 ( ! ,individuals ) ,disabilities ,education ,act 7#bj ,u4,s4,c4 #adad7;d7772 7#g7 rese>*+1 develop+1 & implem5t+ programs = m5tal & behavioral heal? pr(essionals to prev5t burn\t2 & 7#h7 f9d+ bett] & increas$ av5ues to ensure equity by provid+ bett] loan =giv5ess programs1 includ+ a focus area )9 ! ,national ,heal? ,s]vice ,corps focus$ on community trauma4 #faj4 ,m5tal heal? at ! bord] 7a7 ,%ort title ,?is section may be cit$ z ! ,immigrants' ,m5tal ,heal? ,act ( #bjbj4 7b7 ,def9itions ,9 ?is section3 7#a7 ,=w>d op]at+ base ,! t]m =w>d op]at+ base means a p]man5t facility e/abli%$ by ,u4,s4 ,cu/oms & ,bord] ,protection 9 =w>d or remote locations1 & designat$ z su* by ,u4,s4 ,cu/oms & ,bord] ,protection4 7#b7 ,u4,s4 ,cu/oms & ,bord] ,protection facility ,! t]m ,u4,s4 ,cu/oms & ,bord] ,protection facility means any ( ! foll[+ facilities at :i* migrants are typically deta9$ on behalf ( ,u4,s4 ,cu/oms & ,bord] ,protection3 7,a7 ,u4,s4 ,bord] ,patrol /ations4 7,b7 ,ports ( entry4 7,c7 ,*eckpo9ts4 7,d7 ,=w>d op]at+ bases4 7,e7 ,second>y inspection areas4 7,f7 ,%ort-t]m cu/ody facilities4 7c7 ,tra9+ = c]ta9 ,,cbp p]sonnel 9 m5tal heal? issues 7#a7 ,tra9+ to id5tify risk factors & w>n+ signs 9 immigrants & refugees 7,a7 ,9 g5]al ,! ,commission] ( ,u4,s4 ,cu/oms & ,bord] ,protection1 9 consultation ) ! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use1 ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 & nongov]nm5tal exp]ts 9 ! deliv]y ( heal? c>e 9 humanit>ian crises & 9 ! deliv]y ( heal? c>e to *ildr51 %all develop & implem5t a tra9+ curriculum = ,u4,s4 ,cu/oms & ,bord] ,protection ag5ts & (fic]s assign$ to ,u4,s4 ,cu/oms & ,bord] ,protection facilities to enable su* ag5ts & (fic]s to id5tify ! risk factors & w>n+ signs 9 immigrants & refugees ( m5tal heal? issues relat+ to trauma4 7,b7 ,requirem5ts ,! tra9+ curriculum describ$ 9 subp>agraph 7,a7 %all-- 7i7 apply to all ,u4,s4 ,cu/oms & ,bord] ,protection ag5ts & (fic]s work+ at ,u4,s4 ,cu/oms & ,bord] ,protection facilities2 7ii7 provide = crisis int]v5tion us+ a trauma-in=m$ approa*2 & 7iii7 provide = m5tal heal? scre5+s = immigrants & refugees arriv+ at ! bord] 9 _! pref]r$ language or ) appropriate language assi/ance4 7#b7 ,tra9+ to address m5tal heal? & wellness ( ,,cbp ag5ts & (fic]s 7,a7 ,9 g5]al ,! ,commission] ( ,u4,s4 ,cu/oms & ,bord] ,protection1 9 consultation ) ! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use1 ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 & nongov]nm5tal exp]ts 9 ! deliv]y ( m5tal heal? c>e1 %all develop & implem5t a tra9+ curriculum = ,u4,s4 ,cu/oms & ,bord] ,protection ag5ts & (fic]s assign$ to ,u4,s4 ,cu/oms & ,bord] ,protection facilities to address ! m5tal heal? & wellness ( individuals work+ at su* facilities4 7,b7 ,requirem5ts ,! tra9+ curriculum describ$ 9 subp>agraph 7,a7 %all be design$ to help ,u4,s4 ,cu/oms & ,bord] ,protection ag5ts & (fic]s work+ at ,u4,s4 ,cu/oms & ,bord] ,protection facilities-- 7i7 to bett] manage _! own /ress & ! /ress ( _! c[ork]s2 & 7ii7 to be m aw>e ( ! psy*ological pressures exp]i5c$ dur+ _! jobs4 7#c7 ,annual review ( tra9+ ,beg9n+ ) respect to fiscal ye> #bjbb1 ! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use %all-- 7,a7 conduct an annual review ( ! tra9+ implem5t$ pursuant to p>agraphs 7#a7 & 7#b72 & 7,b7 submit ! results ( ea* su* review1 includ+ any recomm5dations = improvem5t ( su* tra9+1 to-- 7i7 ! ,commission] ( ,u4,s4 ,cu/oms & ,bord] ,protection2 7ii7 ! ,committee on ,appropriations ( ! ,s5ate2 7iii7 ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate2 7iv7 ! ,committee on ,homel& ,security & ,gov]nm5tal ,affairs ( ! ,s5ate2 7v7 ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives2 7vi7 ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives2 7vii7 ! ,committee on ,homel& ,security ( ! ,h\se ( ,repres5tatives2 & 7viii7 ! ,committee on ! ,judici>y ( ! ,h\se ( ,repres5tatives4 7#d7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$1 to c>ry out ?is subsection-- 7,a7 = fiscal ye> #bjba1 #ej1jjj to develop ! tra9+ requir$ "u p>agraphs 7#a7 & 7#b72 & 7,b7 = ea* ( ! fiscal ye>s #bjbb ?r\gh #bjbf-- 7i7 #bj1jjj to implem5t ! tra9+ requir$ "u p>agraphs 7#a7 & 7#b72 & 7ii7 su* sums z may be necess>y to review & make recomm5dations = su* tra9+ pursuant to p>agraph 7#c74 7d7 ,/aff+ bord] facilities & det5tion c5t]s 7#a7 ,9 g5]al ,! ,commission] ( ,u4,s4 ,cu/oms & ,bord] ,protection %all adequately evaluate ! m5tal heal? ne$s ( immigrants1 refugees1 bord] patrol ag5ts1 & /aff by assign+ n few] ?an #a qualifi$ m5tal or behavioral heal? exp]t to ea* ,u4,s4 ,cu/oms & ,bord] ,protection facility4 7#b7 ,qualifications ,a m5tal or behavioral heal? exp]t is qualifi$ = an assignm5t describ$ 9 p>agraph 7#a7 if ! exp]t-- 7,a7 is bil+ual2 7,b7 is well-v]s$ 9 culturally appropriate & trauma-in=m$ int]v5tions2 & 7,c7 has p>ticul> exp]tise 9 *ild or adolesc5t m5tal heal? or family m5tal heal?4 7#c7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ #c1jjj1jjj = ea* ( ! fiscal ye>s #bjba ?r\gh #bjbe to c>ry out ?is subsection4 7e7 ,prohibition aga9/ %>+ ,dep>tm5t ( ,heal? & ,human ,s]vices m5tal heal? in=mation = asylum det]m9ations1 immigration he>+s1 or deportation proce$+s ,! (fic]s1 employees1 & ag5ts ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 includ+ ! ,(fice ( ,refugee ,resettlem5t1 may n %>e ) ! ,dep>tm5t ( ,homel& ,security1 & ! (fic]s1 employees1 & ag5ts ( ! ,dep>tm5t ( ,homel& ,security may n reque/ or receive f ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 = ! purposes ( an asylum det]m9ation1 immigration he>+1 or deportation proce$+1 any in=mation or record t-- 7#a7 conc]ns ! m5tal heal? ( an ali52 & 7#b7 0 obta9$ or produc$ by a m5tal or behavioral heal? pr(essional :ile ! ali5 0 9 a %elt] or o!rwise 9 ! cu/ody ( ! ,f$]al ,gov]nm5t4 ,,vii ,address+ high impact m9ority diseases ,a ,canc] #gja4 ,lung canc] mortality r$uction 7a7 ,%ort title ,?is section may be cit$ z ! ,lung ,canc] ,mortality ,r$uction ,act ( #bjbj4 7b7 ,f9d+s ,congress makes ! foll[+ f9d+s3 7#a7 ,lung canc] is ! lead+ cause ( canc] dea? = bo? m5 & wom51 acc\nt+ = #be p]c5t ( all canc] dea?s4 7#b7 ,lung canc] kills m p annually ?an brea/ canc]1 pro/ate canc]1 colon canc]1 liv] canc]1 melanoma1 & kidney canc] comb9$4 7#c7 ,s9ce ! ,national ,canc] ,act ( #aiga 7,public ,law #ib-bah2 #he ,/at4 #ggh71 coord9at$ & compreh5sive rese>* has rais$ ! #e-ye> survival rates = brea/ canc] to #ij p]c5t1 = pro/ate canc] to #ii p]c5t1 & = colon canc] to #fd p]c5t4 7#d7 ,! #e-ye> survival rate = lung canc] is /ill only #ah p]c5t1 & a simil> coord9at$ & compreh5sive rese>* ef=t is requir$ to a*ieve increases 9 lung canc] survivability rates4 7#e7 ,sixty p]c5t ( lung canc] cases are n[ diagnos$ 9 nonsmok]s or =m] smok]s4 7#f7 ,two-?irds ( nonsmok]s diagnos$ ) lung canc] are wom54 7#g7 ,c]ta9 m9ority populations1 su* z ,african-,am]ican males1 h disproportionately high rates ( lung canc] incid5ce & mortality1 despite _! smok+ rate be+ simil> to o!r racial gr\ps4 7#h7 ,memb]s ( ! ,baby ,boom] ,g5]ation are ent]+ _! #fjs1 ! mo/ common age at :i* p develop lung canc]4 7#i7 ,tobacco addiction & exposure to o!r lung canc] c>c9og5s su* z ,ag5t ,orange & o!r h]bicides & battlefield emissions are s]i\s problems among milit>y p]sonnel & w> vet]ans4 7#aj7 ,significant & rapid improvem5ts 9 lung canc] mortality c be expect$ ?r\gh great] use & access to lung canc] scre5+ te/s = at-risk individuals4 7#aa7 ,rec5t rese>* has %[n t scre5+ ) l[-dose comput$ tomography scan r$uc$ lung canc] dea? mortality by #bj p]c5t = ^? ) a high risk ( lung canc] ?r\gh e>ly detection4 ,! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices supports annual lung canc] scre5+ = high-risk pati5ts ) l[-dose comput$ tomography4 7#ab7 ,additional /rategies are necess>y to fur!r enhance ! exi/+ te/s & !rapies available to diagnose & treat lung canc] 9 ! future4 7#ac7 ,! ,augu/ #bjja ,report ( ! ,lung ,canc] ,progress ,review ,gr\p ( ! ,national ,canc] ,in/itute /at$ t fund+ = lung canc] rese>* 0 f> bel[ ! levels *>act]iz$ = o!r common malignancies & f> out ( proportion to its massive heal? impact4 7#ad7 ,! ,report ( ! ,lung ,canc] ,progress ,review ,gr\p id5tifi$ z its highe/ priority ! creation ( integrat$1 multidiscipl9>y1 multi-in/itutional rese>* consortia organiz$ ar\nd ! problem ( lung canc] r ?an ar\nd specific rese>* discipl9es4 7#ae7 ,! ,unit$ ,/ates mu/ enhance its response to ! issues rais$ 9 ! ,report ( ! ,lung ,canc] ,progress ,review ,gr\p1 & ?is c be accompli%$ ?r\gh ! e/abli%m5t ( a coord9at$ ef=t design$ to r$uce ! lung canc] mortality rate by #ej p]c5t by #bjbj & t>get$ fund+ to support ?is coord9at$ ef=t4 7c7 ,s5se ( ,congress conc]n+ inve/m5t 9 lung canc] rese>* ,x is ! s5se ( ! ,congress t-- 7#a7 lung canc] mortality r$uction %\ld be made a national public heal? priority2 & 7#b7 a compreh5sive mortality r$uction program coord9at$ by ! ,secret>y ( ,heal? & ,human ,s]vices is ju/ifi$ & necess>y to adequately address & r$uce lung canc] mortality4 7d7 ,lung ,canc] ,mortality ,r$uction ,program 7#a7 ,9 ,g5]al ,subp>t #a ( "p ,c ( title ,,iv ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhe et seq47 is am5d$ by add+ at ! end ! foll[+3 #dag;,h4 ,lung ,canc] ,mortality ,r$uction ,program 7a7 ,9 ,g5]al ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbj1 ! ,secret>y1 9 consultation ) ! ,secret>y ( ,def5se1 ! ,secret>y ( ,vet]ans ,affairs1 ! ,director ( ! ,national ,in/itutes ( ,heal?1 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 ! ,commission] ( ,food & ,drugs1 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 ! ,director ( ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities1 & o!r memb]s ( ! ,lung ,canc] ,advisory ,bo>d e/abli%$ "u section #gja ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbj1 %all implem5t a compreh5sive program1 to be kn[n z ! ,lung ,canc] ,mortality ,r$uction ,program1 to a*ieve a r$uction ( at lea/ #be p]c5t 9 ! mortality rate ( lung canc] by #bjbj4 7b7 ,requirem5ts ,! ,program %all include at lea/ ! foll[+3 7#a7 ,) respect to ! ,national ,in/itutes ( ,heal?-- 7,a7 a /rategic review & prioritization by ! ,national ,canc] ,in/itute ( rese>* grants to a*ieve ! goal ( ! ,lung ,canc] ,mortality ,r$uction ,program 9 r$uc+ lung canc] mortality2 7,b7 ! provision ( funds to enable ! ,airway ,biology & ,disease ,bran* ( ! ,national ,he>t1 ,lung1 & ,blood ,in/itute to exp& its rese>* programs to include pr$ispositions to lung canc]1 ! int]relation%ip betwe5 lung canc] & o!r pulmon>y & c>diac disease1 & ! diagnosis & treatm5t ( ^? int]relation%ips2 7,c7 ! provision ( funds to enable ! ,national ,in/itute ( ,biom$ical ,imag+ & ,bio5g9e]+ to exp$ite ! developm5t ( comput]-assi/$ diagno/ic1 surgical1 treatm5t1 & drug-te/+ innovations to r$uce lung canc] mortality1 su* z ?r\gh expansion ( ! ,in/itute's ,quantum ,grant ,program & ,image-,guid$ ,int]v5tions programs2 & 7,d7 ! provision ( funds to enable ! ,national ,in/itute ( ,environm5tal ,heal? ,sci5ces to implem5t rese>* programs relative to ! lung canc] incid5ce4 7#b7 ,) respect to ! ,food & ,drug ,adm9i/ration-- 7,a7 activities "u section #ebi;,b ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act2 & 7,b7 activities "u section #efa ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act to exp& access to inve/igational drugs & devices = ! diagnosis1 monitor+1 or treatm5t ( lung canc]4 7#c7 ,) respect to ! ,c5t]s = ,disease ,control & ,prev5tion1 ! e/abli%m5t ( an e>ly disease rese>* & managem5t program "u section #aeaa4 7#d7 ,) respect to ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 ! conduct ( a biannual review ( lung canc] scre5+1 diagno/ic1 & treatm5t protocols1 & ! issuance ( updat$ guidel9es4 7#e7 ,! promotion 7includ+ education7 ( lung canc] scre5+ )9 m9ority & rural populations & ! /udy ( ! effectiv5ess ( ef=ts to increase su* scre5+4 7#f7 ,! coop]ation & coord9ation ( all m9ority & heal? disp>ity programs )9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices to ensure t all aspects ( ! ,lung ,canc] ,mortality ,r$uction ,program "u ?is section adequately address ! burd5 ( lung canc] on m9ority & rural populations4 7#g7 ,! coop]ation & coord9ation ( all tobacco control & cessation programs )9 ag5cies ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices to a*ieve ! goals ( ! ,lung ,canc] ,mortality ,r$uction ,program "u ?is section ) p>ticul> emphasis on ! coord9ation ( drug & o!r cessation treatm5ts ) e>ly detection protocols4 4 7#b7 ,f$]al ,food1 ,drug1 & ,cosmetic ,act ,sub*apt] ,b ( *apt] ,v ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act 7#ba ,u4,s4,c4 #cfj;aaa et seq47 is am5d$ by add+ at ! end ! foll[+3 #ebi;,b4 ,drugs relat+ to lung canc] 7a7 ,9 g5]al ,! provisions ( ?is sub*apt] %all apply to a drug describ$ 9 subsection 7b7 to ! same ext5t & 9 ! same mann] z su* provisions apply to a drug = a r>e disease or condition4 7b7 ,qualifi$ drugs ,a drug describ$ 9 ?is subsection is-- 7#a7 a *emoprev5tion drug = precanc]\s conditions ( ! lung2 7#b7 a drug = t>get$ !rapeutic treatm5ts1 includ+ any vacc9e1 = lung canc]2 or 7#c7 a drug to curtail or prev5t nicot9e addiction4 7c7 ,bo>d ,! ,bo>d e/abli%$ "u section #gja ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbj %all monitor ! program implem5t$ "u ?is section4 4 7#c7 ,access to ,unapprov$ ,!rapies ,section #efa7;e7 ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act 7#ba ,u4,s4,c4 #cfj;bbb7e77 is am5d$ by ins]t+ be=e ! p]iod ! foll[+3 & %all include exp&+ access to drugs "u section #ebi;,b1 ) sub/antial consid]ation be+ giv5 to :e!r ! totality ( in=mation available to ! ,secret>y reg>d+ ! safety & effectiv5ess ( an inve/igational drug1 z comp>$ to ! risk ( morbidity & dea? f ! disease1 indicates t a pati5t may obta9 m b5efit ?an risk if treat$ ) ! drug4 7#d7 ,,cdc ,title ,,xv ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjjk et seq47 is am5d$ by add+ at ! end ! foll[+3 #aeaa4 ,e>ly disease rese>* & managem5t program ,! ,secret>y %all e/abli% & implem5t an e>ly disease rese>* & managem5t program t>get$ at ! high incid5ce & mortality rates ( lung canc] among m9ority & l[-income populations4 4 7e7 ,dep>tm5t ( def5se & ! dep>tm5t ( vet]ans affairs ,! ,secret>y ( ,def5se & ! ,secret>y ( ,vet]ans ,affairs1 ea* 9 coord9ation ) ! ,secret>y ( ,heal? & ,human ,s]vices1 %all engage-- 7#a7 9 ! implem5tation )9 ! ,dep>tm5t ( ,def5se & ! ,dep>tm5t ( ,vet]ans ,affairs ( an e>ly detection & disease managem5t rese>* program = milit>y p]sonnel & vet]ans ^: smok+ hi/ory & exposure to c>c9og5s dur+ active duty s]vice has increas$ _! risk = lung canc]2 & 7#b7 9 ! implem5tation ( coord9at$ c>e programs = milit>y p]sonnel & vet]ans diagnos$ ) lung canc]4 7f7 ,lung canc] advisory bo>d 7#a7 ,9 ,g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices %all conv5e a ,lung ,canc] ,advisory ,bo>d 7ref]r$ to 9 ?is section z ! ,bo>d7-- 7,a7 to monitor ! programs e/abli%$ "u ?is section 7& ! am5dm5ts made by ?is section72 & 7,b7 to provide annual reports to ! ,congress conc]n+ b5*m>ks1 exp5ditures1 lung canc] /ati/ics1 & ! public heal? impact ( su* programs4 7#b7 ,composition ,! ,bo>d %all be compris$ (-- 7,a7 ! ,secret>y ( ,heal? & ,human ,s]vices2 7,b7 ! ,secret>y ( ,def5se2 7,c7 ! ,secret>y ( ,vet]ans ,affairs2 & 7,d7 #b repres5tatives ea* f ! fields ( cl9ical m$ic9e focus$ on lung canc]1 lung canc] rese>*1 imag+1 drug developm5t1 & lung canc] advocacy1 to be appo9t$ by ! ,secret>y ( ,heal? & ,human ,s]vices4 7g7 ,au?orization ( appropriations 7#a7 ,9 g5]al ,to c>ry out ?is section 7& ! am5dm5ts made by ?is section71 !re are au?oriz$ to be appropriat$ #ge1jjj1jjj = fiscal ye> #bjba & su* sums z may be necess>y = ea* ( fiscal ye>s #bjbb ?r\gh #bjbe4 7#b7 ,lung ,canc] ,mortality ,r$uction ,program ,! am\nts appropriat$ "u p>agraph 7#a7 %all be allocat$ z foll[s3 7,a7 #be1jjj1jjj = fiscal ye> #bjba1 & su* sums z may be necess>y = ea* ( fiscal ye>s #bjbb ?r\gh #bjbe1 = ! activities describ$ 9 section #dag;,h7b77#a77;,b7 ( ! ,public ,heal? ,s]vice ,act1 z add$ by subsection 7d72 7,b7 #be1jjj1jjj = fiscal ye> #bjba1 & su* sums z may be necess>y = ea* ( fiscal ye>s #bjbb ?r\gh #bjbe1 = ! activities describ$ 9 section #dag;,h7b77#a77;,c7 ( ! ,public ,heal? ,s]vice ,act2 7,c7 #aj1jjj1jjj = fiscal ye> #bjba1 & su* sums z may be necess>y = ea* ( fiscal ye>s #bjbb ?r\gh #bjbe1 = ! activities describ$ 9 section #dag;,h7b77#a77;,d7 ( ! ,public ,heal? ,s]vice ,act2 & 7,d7 #ae1jjj1jjj = fiscal ye> #bjba1 & su* sums z may be necess>y = ea* ( fiscal ye>s #bjbb ?r\gh #bjbe1 = ! activities describ$ 9 section #dag;,h7b77#c7 ( ! ,public ,heal? ,s]vice ,act4 #gjb4 ,exp&+ pro/ate canc] rese>*1 outrea*1 scre5+1 te/+1 access1 & treatm5t effectiv5ess 7a7 ,%ort title ,?is section may be cit$ z ! ,pro/ate ,rese>*1 ,outrea*1 ,scre5+1 ,te/+1 ,access1 & ,treatm5t ,effectiv5ess ,act ( #bjbj or ! ,,pro/ate ,act4 7b7 ,f9d+s ,congress makes ! foll[+ f9d+s3 7#a7 ,pro/ate canc] is ! second lead+ cause ( canc] dea? among m54 7#b7 ,9 #bjbj1 an e/imat$ #aia1icj individuals 9 ! ,unit$ ,/ates w be diagnos$ ) pro/ate canc] & approximately #cc1ccj w die f ! disease4 7#c7 ,r\ghly #b1jjj1jjj to #c1jjj1jjj p 9 ! ,unit$ ,/ates are liv+ ) a diagnosis ( pro/ate canc] & its consequ5ces4 7#d7 ,al?\gh pro/ate canc] g5]ally affects old] individuals1 y\ng] m5 are also at risk = ! disease1 & :5 pro/ate canc] appe>s 9 e>ly middle age1 x frequ5tly takes on a m aggressive =m4 7#e7 ,!re are significant racial & e?nic disp>ities t dem& att5tion1 = example1 ,african ,am]icans h pro/ate canc] mortality rates t are m ?an d\ble ^? 9 ! ,:ite population4 7#f7 ,und]s]v$ rural populations h high] rates ( mortality comp>$ to _! urban c\nt]p>ts1 & innovative & co/-effici5t me?ods to improve rural access to high-quality c>e %\ld take advantage ( advances 9 teleheal? to diagnose & treat pro/ate canc] :5 appropriate4 7#g7 ,c]ta9 populations ( vet]ans may h ne>ly twice ! incid5ce ( pro/ate canc] z ! g5]al population ( ! ,unit$ ,/ates4 7#h7 ,urologi/s may con/itute ! speciali/s :o diagnose & treat ! va/ majority ( pro/ate canc] pati5ts4 7#i7 ,al?\gh mu* basic & translational rese>* has be5 complet$ & mu* is curr5tly kn[n1 !re are /ill _m unansw]$ que/ions1 su* z ! ext5t to :i* kn[n disp>ities are attributable to disease etiology1 access to c>e1 or education & aw>5ess 9 ! community4 7#aj7 ,causes ( pro/ate canc] are n kn[n4 ,!re is n good in=mation reg>d+ h[ to diff]5tiate accurately1 e>ly on1 betwe5 aggressive & indol5t =ms ( ! disease4 ,z a result1 !re is significant ov]treatm5t 9 pro/ate canc]4 ,!re are no treatm5ts t c durably arre/ gr[? or cure pro/ate canc] once x has meta/asiz$4 7#aa7 ,a significant proportion ( cases may be cl9ically indol5t & ov]diagnos$1 result+ 9 significant ov]treatm5t4 ,m accurate te/s w all[ m5 & _! families to face less physical1 psy*ological1 f9ancial1 & emotional trauma1 & billions ( doll>s c\ld be sav$ 9 private & public heal? c>e sy/ems4 7#ab7 ,pro/ate canc] rese>* & heal? c>e programs across ,f$]al ag5cies %\ld be coord9at$ to improve acc\ntability & actively enc\rage ! translation ( rese>* into practice & to id5tify & implem5t be/ practices 9 ord] to fo/] an integrat$ & consi/5t focus on effective prev5tion1 diagnosis1 & treatm5t ( ! disease4 7c7 ,pro/ate canc] coord9ation & education 7#a7 ,int]ag5cy pro/ate canc] coord9ation & education task =ce ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs1 9 coop]ation ) ! ,secret>y ( ,def5se & ! ,secret>y ( ,heal? & ,human ,s]vices1 %all e/abli% an ,int]ag5cy ,pro/ate ,canc] ,coord9ation & ,education ,task ,=ce 79 ?is section ref]r$ to z ! ,pro/ate ,canc] ,task ,=ce74 7#b7 ,duties ,! ,pro/ate ,canc] ,task ,=ce %all-- 7,a7 develop a summ>y ( advances 9 pro/ate canc] rese>* support$ or conduct$ by ,f$]al ag5cies relevant to ! diagnosis1 prev5tion1 & treatm5t ( pro/ate canc]1 includ+ psy*osocial impairm5ts relat$ to pro/ate canc] treatm5t1 & compile a li/ ( be/ practices t w>rant broad] adoption 9 heal? c>e programs2 7,b7 consid] e/abli%+1 & advocat+ =1 a guidance to enable physicians to all[ scre5+ ( m5 :o are age #gd or old]1 on a case-by-case basis1 tak+ into acc\nt quality ( life & family hi/ory ( pro/ate canc]2 7,c7 %>e & coord9ate in=mation on rese>* & heal? c>e program activities by ! ,f$]al ,gov]nm5t1 includ+ activities relat$ to-- 7i7 det]m9+ h[ to improve rese>* & heal? c>e programs1 includ+ psy*osocial impairm5ts relat$ to pro/ate canc] treatm5t2 7ii7 id5tify+ any gaps 9 ! ov]all rese>* inv5tory & 9 heal? c>e programs2 7iii7 id5tify+ opportunities to promote translation ( rese>* into practice2 & 7iv7 maximiz+ ! effects ( ,f$]al ,gov]nm5t ef=ts by id5tify+ opportunities = collaboration & lev]ag+ ( res\rces 9 rese>* & heal? c>e programs t s]ve individuals :o are susceptible to or diagnos$ ) pro/ate canc]2 7,d7 develop a compreh5sive int]ag5cy /rategy & advise relevant ,f$]al ag5cies 9 ! solicitation ( proposals = collaborative1 multidiscipl9>y rese>* & heal? c>e programs1 includ+ proposals to evaluate factors t may be relat$ to ! etiology ( pro/ate canc]1 t w\ld-- 7i7 result 9 innovative approa*es to /udy em]g+ sci5tific opportunities or elim9ate k gaps 9 rese>* to improve ! pro/ate canc] rese>* portfolio ( ! ,f$]al ,gov]nm5t2 & 7ii7 outl9e key rese>* que/ions1 me?odologies1 & k gaps2 7,e7 develop a coord9at$ message relat$ to scre5+ & treatm5t = pro/ate canc] to be reflect$ 9 educational & b5efici>y mat]ials = ,f$]al heal? programs z su* docum5ts are updat$2 & 7,f7 n lat] ?an #b ye>s aft] ! date ( ! e/abli%m5t ( ! ,pro/ate ,canc] ,task ,=ce1 submit to ! exp]t advisory panels appo9t$ "u p>agraph 7#d7 to be review$ & return$ )9 #cj days1 & !n )9 #ij days submitt$ to ,congress1 recomm5dations-- 7i7 reg>d+ any appropriate *anges to rese>* & heal? c>e programs1 includ+ recomm5dations to improve ! rese>* portfolio ( ! ,dep>tm5t ( ,vet]ans ,affairs1 ! ,dep>tm5t ( ,def5se1 ! ,national ,in/itutes ( ,heal?1 & o!r ,f$]al ag5cies to ensure t sci5tifically bas$ /rategic plann+ is implem5t$ 9 support ( rese>* & heal? c>e program priorities2 7ii7 design$ to ensure t ! rese>* & heal? c>e programs & activities ( ! ,dep>tm5t ( ,vet]ans ,affairs1 ! ,dep>tm5t ( ,def5se1 ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 & o!r ,f$]al ag5cies are free ( unnecess>y duplication2 7iii7 reg>d+ public p>ticipation 9 decisions relat+ to pro/ate canc] rese>* & heal? c>e programs to increase ! involvem5t ( pati5t advocates1 community organizations1 & m$ical associations repres5t+ a broad geographical area2 7iv7 on h[ to be/ dissem9ate in=mation on pro/ate canc] rese>* & progress a*iev$ by heal? c>e programs2 7v7 ab\t h[ to exp& p>tn]%ips betwe5 public entities1 includ+ ,f$]al ag5cies1 & private entities to enc\rage collaborative1 cross-cutt+ rese>* & heal? c>e deliv]y2 7vi7 assess+ any co/ sav+s & effici5cies realiz$ ?r\gh ! ef=ts id5tifi$ & support$ 9 ?is subsection & recomm5d+ expansion ( ^? ef=ts t h prov$ mo/ promis+ :ile also ensur+ aga9/ any conflicts 9 directives 9 law2 7vii7 id5tify+ key priority action items f among ! recomm5dations2 & 7viii7 ) respect to ! level ( fund+ ne$$ by ea* ag5cy to implem5t ! recomm5dations conta9$ 9 ! report4 7#c7 ,memb]s ( ! ,pro/ate ,canc] ,task ,=ce ,! ,pro/ate ,canc] ,task ,=ce %all be compris$ ( repres5tatives f su* ,f$]al ag5cies1 z ! head ( ea* su* applicable ag5cy det]m9es necess>y1 s z to coord9ate a uni=m message relat+ to pro/ate canc] scre5+ & treatm5t :]e appropriate1 includ+ repres5tatives ( ! foll[+3 7,a7 ,! ,dep>tm5t ( ,vet]ans ,affairs1 includ+ repres5tatives ( ea* relevant program area ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7,b7 ,! ,pro/ate ,canc] ,rese>* ,program ( ! ,congressionally ,direct$ ,m$ical ,rese>* ,program ( ! ,dep>tm5t ( ,def5se4 7,c7 ,! ,dep>tm5t ( ,heal? & ,human ,s]vices1 includ+1 at a m9imum1 repres5tatives ( ea* ( ! foll[+3 7i7 ,! ,national ,in/itutes ( ,heal?4 7ii7 ,national rese>* in/itutes & c5t]s1 includ+ ! ,national ,canc] ,in/itute1 ! ,national ,in/itute ( ,all]gy & ,infecti\s ,diseases1 & ! ,(fice ( ,m9ority ,heal?4 7iii7 ,! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 7iv7 ,! ,food & ,drug ,adm9i/ration4 7v7 ,! ,c5t]s = ,disease ,control & ,prev5tion4 7vi7 ,! ,ag5cy = ,heal?c>e ,rese>* & ,quality4 7vii7 ,! ,heal? ,res\rces & ,s]vices ,adm9i/ration4 7#d7 ,appo9t+ exp]t advisory panels ,! ,pro/ate ,canc] ,task ,=ce %all appo9t exp]t advisory panels1 z ! task =ce det]m9es appropriate1 to provide input & concurr5ce f individuals & organizations f ! m$ical1 pro/ate canc] pati5t & advocate1 rese>*1 & deliv]y communities ) exp]tise 9 pro/ate canc] diagnosis1 treatm5t1 & rese>*1 includ+ practic+ urologi/s1 prim>y c>e provid]s1 & o!rs1 & individuals ) exp]tise 9 education & outrea* to und]s]v$ populations affect$ by pro/ate canc]4 7#e7 ,meet+s ,! ,pro/ate ,canc] ,task ,=ce %all conv5e n less frequ5tly ?an twice ea* ye>1 or m frequ5tly z ! ,secret>y ( ,vet]ans ,affairs det]m9es to be appropriate4 7#f7 ,f$]al ,advisory ,committee ,act ,! ,f$]al ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 %all apply to ! ,pro/ate ,canc] ,task ,=ce4 7#g7 ,sunset ,date ,! ,pro/ate ,canc] ,task ,=ce %all t]m9ate on ,septemb] #cj1 #bjbe4 7d7 ,pro/ate canc] rese>* 7#a7 ,rese>* coord9ation program 7,a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs1 9 coord9ation ) ! ,secret>y ( ,def5se & ! ,secret>y ( ,heal? & ,human ,s]vices1 %all e/abli% & c>ry out a program to coord9ate & int5sify pro/ate canc] rese>*4 7,b7 ,elem5ts ,! program e/abli%$ "u subp>agraph 7,a7 %all-- 7i7 develop advances 9 diagno/ic & progno/ic me?ods & te/s1 includ+ biom>k]s & an improv$ pro/ate canc] scre5+ blood te/1 includ+ improvem5ts or alt]natives to ! pro/ate specific antig5 te/ & additional te/s to di/+ui% indol5t f aggressive disease2 7ii7 develop bett] und]/&+ ( ! etiology ( ! disease 7includ+ an analysis ( life/yle factors prov5 to be involv$ 9 high] rates ( pro/ate canc]1 su* z obesity & diet1 & 9 diff]5t e?nic1 racial1 & socioeconomic gr\ps1 su* z ! ,african-,am]ican1 ,lat9o or ,hispanic1 & ,am]ican ,indian populations & m5 ) a family hi/ory ( pro/ate canc]7 to improve prev5tion ef=ts2 7iii7 exp& basic rese>* into pro/ate canc]1 includ+ /udies ( fundam5tal molecul> & cellul> me*anisms2 7iv7 id5tify & provide cl9ical te/+ ( novel ag5ts = ! prev5tion & treatm5t ( pro/ate canc]2 7v7 e/abli% cl9ical regi/ries = pro/ate canc]2 7vi7 use ! ,national ,in/itute ( ,biom$ical ,imag+ & ,bio5g9e]+ & ! ,national ,canc] ,in/itute = assessm5t ( appropriate imag+ modalities2 & 7vii7 address su* o!r matt]s relat+ to pro/ate canc] rese>* z may be id5tifi$ by ! ,f$]al ag5cies p>ticipat+ 9 ! program "u ?is subsection4 7,c7 ,und]s]v$ m9ority grant program ,9 c>ry+ out ! program e/abli%$ "u subp>agraph 7,a71 ! ,secret>y %all-- 7i7 aw>d grants to eligible entities to c>ry out compon5ts ( ! rese>* outl9$ 9 subp>agraph 7,b72 7ii7 integrate & build ^u exi/+ k ga9$ f comp>ative effectiv5ess rese>*2 & 7iii7 recognize & address-- 7,i7 ! racial & e?nic disp>ities 9 ! incid5ce & mortality rates ( pro/ate canc] & m5 ) a family hi/ory ( pro/ate canc]2 7,,ii7 any b>ri]s 9 access to c>e & p>ticipation 9 cl9ical trials t are specific to racial1 e?nic1 & o!r und]s]v$ m9orities & m5 ) a family hi/ory ( pro/ate canc]2 7,,iii7 outrea* & educational ef=ts to raise aw>5ess among ! populations describ$ 9 subclause 7,,ii72 & 7,,iv7 appropriate access & utilization ( imag+ modalities4 7#b7 ,pro/ate ,canc] ,advisory ,bo>d 7,a7 ,9 g5]al ,!re is e/abli%$ 9 ! ,(fice ( ! ,*ief ,sci5ti/ ( ! ,food & ,drug ,adm9i/ration a ,pro/ate ,canc] ,sci5tific ,advisory ,bo>d4 7,b7 ,duties ,! bo>d e/abli%$ "u subp>agraph 7,a7 %all be responsible = accel]at+ real-"t %>+ ( ! late/ rese>* data & accel]at+ movem5t ( new m$ic9es to pati5ts4 7e7 ,teleheal? & rural access pilot projects 7#a7 ,e/abli%m5t ( pilot projects 7,a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs1 9 coop]ation ) ! ,secret>y ( ,def5se & ! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is subsection collectively z ! ,secret>ies7 %all e/abli% #d-ye> teleheal? pilot projects = ! purpose ( analyz+ ! cl9ical outcomes & co/-effectiv5ess associat$ ) teleheal? s]vices 9 a v>iety ( geographic areas t conta9 high proportions ( m$ically und]s]v$ populations1 includ+ ,african ,am]icans1 ,lat9os or ,hispanics1 ,am]ican ,indians or ,alaska ,natives1 & ^? 9 rural areas4 7,b7 ,effici5t & effective c>e ,pilot projects e/abli%$ "u subp>agraph 7,a7 %all promote effici5t use ( speciali/ c>e ?r\gh bett] coord9ation ( prim>y c>e & physician ext5d] teams 9 und]s]v$ areas & m effectively employ tumor bo>ds to bett] c\nsel pati5ts4 7#b7 ,eligible entities 7,a7 ,9 g5]al ,! ,secret>ies %all select eligible entities to p>ticipate 9 ! pilot projects e/abli%$ "u ?is subsection4 7,b7 ,priority ,9 select+ eligible entities to p>ticipate 9 ! pilot projects "u ?is subsection1 ! ,secret>ies %all give priority to entities locat$ 9 m$ically und]s]v$ areas1 p>ticul>ly ^? t include ,african ,am]icans1 ,lat9os & ,hispanics1 & facilities ( ! ,indian ,heal? ,s]vice1 includ+ facilities op]at$ by ! ,indian ,heal? ,s]vice1 tribally op]at$ facilities1 & ,urban ,indian ,cl9ics1 & ^? 9 rural areas4 7#c7 ,evaluation ,! ,secret>ies %all1 ?r\gh ! pilot projects1 evaluate-- 7,a7 ! effective & economic deliv]y ( c>e 9 diagnos+ & treat+ pro/ate canc] ) ! use ( teleheal? s]vices 9 m$ically und]s]v$ & ,tribal areas includ+ collaborative uses ( heal? pr(essionals & integration ( ! range ( teleheal? & o!r te*nologies2 7,b7 ! effectiv5ess ( improv+ ! capacity ( nonm$ical provid]s & nonspecializ$ m$ical provid]s to provide heal? s]vices = pro/ate canc] 9 m$ically und]s]v$ & ,tribal areas1 includ+ ! exploration ( innovative m$ical home models ) collaboration betwe5 urologi/s1 o!r relevant m$ical speciali/s1 includ+ oncologi/s1 radiologi/s1 & prim>y c>e teams1 & coord9ation ( c>e ?r\gh ! effici5t use ( prim>y c>e teams & physician ext5d]s2 & 7,c7 ! effectiv5ess ( us+ teleheal? s]vices to provide pro/ate canc] treatm5t 9 m$ically und]s]v$ areas1 includ+ ! use ( tumor bo>ds to facilitate bett] pati5t c\nsel+4 7#d7 ,report ,n lat] ?an #a ye> aft] ! completion ( ! pilot projects "u ?is subsection1 ! ,secret>ies %all submit to ,congress a report describ+ ! outcomes ( su* pilot projects1 includ+ any co/ sav+s & effici5cies realiz$1 & provid+ recomm5dations1 if any1 = exp&+ ! use ( teleheal? s]vices4 7f7 ,education & aw>5ess 7#a7 ,campaign 7,a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all develop a national education campaign = pro/ate canc]4 7,b7 ,elem5ts ,! campaign develop$ "u subp>agraph 7,a7 %all involve ! use ( writt5 educational mat]ials & public s]vice ann\ncem5ts consi/5t ) ! f9d+s ( ! ,pro/ate ,canc] ,task ,=ce "u subsection 7c7 t are int5d$ to enc\rage m5 to seek pro/ate canc] scre5+ :5 appropriate4 7#b7 ,racial disp>ities & ! population ( m5 ) a family hi/ory ( pro/ate canc] ,9 develop+ ! campaign "u p>agraph 7#a71 ! ,secret>y %all ensure t educational mat]ials & public s]vice ann\ncem5ts us$ 9 ! campaign are m readily available 9 communities exp]i5c+ racial disp>ities 9 ! incid5ce & mortality rates ( pro/ate canc] & to m5 ( any race classification ) a family hi/ory ( pro/ate canc]4 7#c7 ,grants ,9 c>ry+ out ! campaign "u ?is subsection1 ! ,secret>y %all aw>d grants to nonpr(it private entities to enable su* entities to te/ alt]native outrea* & education /rategies4 7g7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section = ! p]iod ( fiscal ye>s #bjba ?r\gh #bjbe an am\nt equal to ! am\nt ( sav+s = ! ,f$]al ,gov]nm5t project$ to be a*iev$ ov] su* p]iod by implem5tation ( ?is section4 #gjc4 ,pro/ate rese>*1 imag+1 & m5's education 7,,prime7 7a7 ,%ort title ,?is section may be cit$ z ! ,pro/ate ,rese>*1 ,imag+1 & ,m5's ,education ,act ( #bjbj or ! ,,prime ,act ( #bjbj4 7b7 ,f9d+s ,congress makes ! foll[+ f9d+s3 7#a7 ,pro/ate canc] has rea*$ epidemic proportions1 p>ticul>ly among ,african-,am]ican m51 & /rikes & kills m5 9 numb]s comp>able to ! numb] ( wom5 :o lose _! lives f brea/ canc]4 7#b7 ,life-sav+ break?r\ghs 9 scre5+1 diagnosis1 & treatm5t ( brea/ canc] result$ f ! developm5t ( advanc$ imag+ te*nologies l$ by ! ,f$]al ,gov]nm5t4 7#c7 ,m5 %\ld h accurate & af=dable pro/ate canc] scre5+ exams & m9imally invasive treatm5t tools1 simil> to :at wom5 h = brea/ canc]4 7#d7 ,:ile x is important = m5 to take advantage ( curr5t pro/ate canc] scre5+ te*niques1 a rec5t ,,nci-fund$ /udy demon/rat$ t ! mo/ common available me?ods ( detect+ pro/ate canc] 7,,psa blood te/ & physical exams7 are n foolpro(1 caus+ num]\s false al>ms & false reassurances4 7#e7 ,! abs5ce ( advanc$ imag+ te*nologies = pro/ate canc] causes ! lack ( accurate in=mation critical = cl9ical decisions1 result+ 9 miss$ canc]s & lo/ lives1 z well z unnecess>y & co/ly m$ical proc$ures1 ) relat$ complications4 7#f7 ,) pro/ate imag+ tools1 m5 & _! families w\ld face less physical1 psy*ological1 f9ancial1 & emotional trauma & billions ( doll>s c\ld be sav$ 9 private & public heal? c>e sy/ems4 7c7 ,rese>* & developm5t ( pro/ate canc] imag+ te*nologies 7#a7 ,expansion ( ,rese>* ,! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is section z ! ,secret>y71 act+ ?r\gh ! ,director ( ! ,national ,in/itutes ( ,heal? & ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 & 9 consultation ) ! ,secret>y ( ,def5se1 %all c>ry out a program to exp& & int5sify rese>* to develop innovative advanc$ imag+ te*nologies = pro/ate canc] detection1 diagnosis1 & treatm5t comp>able to /ate-(-!-art mammography te*nologies4 7#b7 ,e>ly ,/age ,rese>* ,9 implem5t+ ! program "u p>agraph 7#a71 ! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all c>ry out a grant program to enc\rage ! e>ly /ages ( rese>* 9 pro/ate imag+ to develop & implem5t new ideas1 pro( ( concepts1 & pilot /udies = high-risk te*nologic innovation 9 pro/ate canc] imag+ t w\ld h a high pot5tial impact = improv+ pati5t c>e1 includ+ individualiz$ c>e1 quality ( life1 & co/-effectiv5ess4 7#c7 ,l>ge ,scale ,lat] ,/age ,rese>* ,9 implem5t+ ! program "u p>agraph 7#a71 ! ,secret>y1 act+ ?r\gh ! ,director ( ! ,national ,in/itutes ( ,heal?1 %all utilize ! ,national ,in/itute ( ,biom$ical ,imag+ & ,bio5g9e]+ & ! ,national ,canc] ,in/itute = advanc$ /ages ( rese>* 9 pro/ate imag+1 includ+ te*nology developm5t & cl9ical trials = projects det]m9$ by ! ,secret>y to h demon/rat$ promis+ prelim9>y results & pro( ( concept4 7#d7 ,int]discipl9>y private-,public p>tn]%ips ,9 develop+ ! program "u p>agraph 7#a71 ! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all e/abli% int]discipl9>y private-public p>tn]%ips to develop & implem5t rese>* /rategies = exp$it$ innovation 9 imag+ & image-guid$ treatm5t & to conduct su* rese>*4 7#e7 ,racial ,disp>ities ,9 develop+ ! program "u p>agraph 7#a71 ! ,secret>y %all recognize & address-- 7,a7 ! racial disp>ities 9 ! incid5ces ( pro/ate canc] & mortality rates ) respect to su* disease2 & 7,b7 any b>ri]s 9 access to c>e & p>ticipation 9 cl9ical trials t are specific to racial m9orities4 7#f7 ,au?orization ( ,appropriations 7,a7 ,9 g5]al ,subject to subp>agraph 7,b71 !re is au?oriz$ to be appropriat$ to c>ry out ?is section1 #ajj1jjj1jjj = ea* ( ! fiscal ye>s #bjba ?r\gh #bjbe4 7,b7 ,specific allocations ,( ! am\nt au?oriz$ to be appropriat$ "u subp>agraph 7,a7 = ea* ( ! fiscal ye>s describ$ 9 su* subp>agraph-- 7i7 no less ?an #aj p]c5t may be appropriat$ to c>ry out ! grant program "u p>agraph 7#b72 & 7ii7 no m ?an #a p]c5t may be appropriat$ to c>ry out p>agraph 7#d74 7d7 ,public aw>5ess & education campaign 7#a7 ,national campaign ,! ,secret>y %all c>ry out a national campaign to increase ! aw>5ess & k ( individuals 9 ! ,unit$ ,/ates ) respect to ! ne$ = pro/ate canc] scre5+ & = improv$ detection te*nologies4 7#b7 ,requirem5ts ,! national campaign conduct$ "u ?is subsection %all include-- 7,a7 roles = ! ,heal? ,res\rces ,s]vices ,adm9i/ration1 ! ,(fice ( ,m9ority ,heal? ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 ! ,c5t]s = ,disease ,control & ,prev5tion1 & ! ,(fice ( ,m9ority ,heal? & ,heal? ,equity ( ! ,c5t]s = ,disease ,control & ,prev5tion2 & 7,b7 ! developm5t & di/ribution ( writt5 educational mat]ials1 & ! developm5t & plac+ ( public s]vice ann\ncem5ts1 t are int5d$ to enc\rage m5 to seek pro/ate canc] scre5+ & to create aw>5ess ( ! ne$ = improv$ imag+ te*nologies = pro/ate canc] scre5+ & diagnosis1 includ+ 9 vitro blood te/+ & imag+ te*nologies4 7#c7 ,racial ,disp>ities ,9 develop+ ! national campaign "u p>agraph 7#a71 ! ,secret>y %all recognize & address-- 7,a7 ! racial disp>ities 9 ! incid5ces ( pro/ate canc] & mortality rates ) respect to su* disease2 & 7,b7 any b>ri]s 9 access to c>e & p>ticipation 9 cl9ical trials t are specific to racial m9orities4 7#d7 ,grants ,! ,secret>y %all e/abli% a program to aw>d grants to nonpr(it private entities to enable su* entities to te/ alt]native outrea* & education /rategies to increase ! aw>5ess & k ( individuals 9 ! ,unit$ ,/ates ) respect to ! ne$ = pro/ate canc] scre5+ & improv$ imag+ te*nologies4 7#e7 ,au?orization ( ,appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section1 #aj1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 7e7 ,improv+ pro/ate canc] scre5+ blood te/s 7#a7 ,9 ,g5]al ,! ,secret>y1 9 coord9ation ) ! ,secret>y ( ,def5se1 %all c>ry out rese>* to develop an improv$ pro/ate canc] scre5+ blood te/ us+ 9-vitro detection4 7#b7 ,au?orization ( ,appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section1 #bj1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 7f7 ,report+ & compliance 7#a7 ,report & /rategy ,n lat] ?an #ab mon?s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ,congress a report t details ! /rategy ( ! ,secret>y = implem5t+ ! requirem5ts ( ?is section & ! /atus ( su* ef=ts4 7#b7 ,full ,compliance ,n lat] ?an #cf mon?s aft] ! date ( ! enactm5t ( ?is ,act1 & annually !reaft]1 ! ,secret>y %all submit to ,congress a report t-- 7,a7 describes ! rese>* & developm5t & public aw>5ess & education campaigns fund$ "u ?is section2 7,b7 provides evid5ce t projects involv+ high-risk1 high impact te*nologic innovation1 pro( ( concept1 & pilot /udies are prioritiz$2 7,c7 provides evid5ce t ! ,secret>y recognizes & addresses any b>ri]s 9 access to c>e & p>ticipation 9 cl9ical trials t are specific to racial m9orities 9 ! implem5tation ( ?is section2 7,d7 conta9s assurances t all ! o!r provisions ( ?is section are fully implem5t$2 & 7,e7 c]tifies compliance ) ! provisions ( ?is section1 or 9 ! case ( a ,f$]al ag5cy t has n compli$ ) any ( su* provisions1 an explanation z to su* failure to comply4 #gjd4 ,pro/ate canc] detection rese>* & education 7a7 ,%ort title ,?is section may be cit$ z ! ,pro/ate ,canc] ,detection ,rese>* & ,education ,act4 7b7 ,plan ,to develop & validate a te/ or te/s = pro/ate canc] 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is section z ! ,secret>y71 act+ ?r\gh ! ,director ( ! ,national ,in/itutes ( ,heal?1 %all e/abli% an advisory c\ncil on pro/ate canc] 7ref]r$ to 9 ?is section z ! advisory c\ncil7 to draft a plan = ! developm5t & validation ( an accurate te/ or te/s1 su* z biom>k]s or imag+1 to detect & diagnose pro/ate canc]4 7#b7 ,advisory c\ncil 7,a7 ,memb]%ip 7i7 ,f$]al memb]s ,! advisory c\ncil %all be compris$ ( ! foll[+ exp]ts3 7,i7 ,a designee ( ! ,c5t]s = ,disease ,control & ,prev5tion4 7,,ii7 ,a designee ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 7,,iii7 ,a designee ( ! ,(fice ( ! ,director ( ! ,national ,canc] ,in/itute4 7,,iv7 ,a designee ( ! ,director ( ! ,dep>tm5t ( ,def5se ,congressionally ,direct$ ,m$ical ,rese>* ,programs4 7,v7 ,a designee ( ! ,director ( ! ,national ,in/itute ( ,biom$ical ,imag+ & ,bio5g9e]+4 7,,vi7 ,a designee ( ! ,director ( ! ,national ,in/itute ( ,g5]al ,m$ical ,sci5ces4 7,,vii7 ,a designee ( ! ,director ( ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities4 7,,viii7 ,a designee ( ! ,(fice ( ! ,director ( ! ,national ,in/itutes ( ,heal?4 7,,ix7 ,a designee ( ! ,food & ,drug ,adm9i/ration4 7,x7 ,a designee ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality4 7,,xi7 ,a designee ( ! ,director ( ! ,telem$ic9e & ,advanc$ ,te*nology ,rese>* ,c5t] ( ! ,dep>tm5t ( ,def5se4 7ii7 ,non-f$]al memb]s ,9 addition to ! memb]s describ$ 9 clause 7i71 ! advisory c\ncil %all include #h exp]t memb]s f outside ! ,f$]al ,gov]nm5t to be appo9t$ by ! ,secret>y1 :i* %all include-- 7,i7 #b pro/ate canc] pati5t advocates2 7,,ii7 #b heal? c>e provid]s ) a range ( exp]tise & exp]i5ce 9 pro/ate canc]2 & 7,,iii7 #d lead+ rese>*]s ) pro/ate canc]-relat$ exp]tise 9 a range ( cl9ical discipl9es4 7,b7 ,meet+s ,! advisory c\ncil %all meet qu>t]ly & su* meet+s %all be op5 to ! public4 7,c7 ,advice ,! advisory c\ncil %all advise ! ,secret>y1 or ! ,secret>y's designee4 7,d7 ,annual report ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! advisory c\ncil %all provide to ! ,secret>y1 or ! ,secret>y's designee1 & ,congress-- 7i7 an initial evaluation ( all f$]ally fund$ ef=ts 9 pro/ate canc] rese>* relat+ to ! developm5t & validation ( an accurate te/ or te/s to detect & diagnose pro/ate canc]2 7ii7 a plan = ! developm5t & validation ( a reliable te/ or te/s = ! detection & accurate diagnosis ( pro/ate canc]2 & 7iii7 a set ( /&>ds = pro/ate canc] scre5+1 develop$ 9 coord9ation ) ! ,unit$ ,/ates ,prev5tive ,s]vices ,task ,=ce1 to ensure t any tools = scre5+1 detection1 & diagnosis develop$ 9 accordance ) ! plan "u clause 7ii7 w meet ! requirem5ts ( ! ,task ,=ce = recomm5dation z a prov5 prev5tive or diagno/ic s]vice4 7,e7 ,t]m9ation ,! advisory c\ncil %all t]m9ate on ,decemb] #ca1 #bjbd4 7#c7 ,fund+ ,not)/&+ any o!r provision ( law1 ! ,secret>y may make available #a1jjj1jjj1 f any unobligat$ am\nts appropriat$ to ! ,national ,in/itutes ( ,heal?1 = ea* ( fiscal ye>s #bjba ?r\gh #bjbe to c>ry out ?is subsection4 7c7 ,coord9ation & int5sification ( pro/ate canc] rese>* 7#a7 ,9 g5]al ,! ,director ( ! ,national ,in/itutes ( ,heal?1 9 consultation ) ! ,secret>y ( ,def5se1 %all coord9ate & int5sify rese>* 9 accordance ) ! plan provid$ "u subsection 7b77#b77;,d77ii71 ) p>ticul> att5tion provid$ to lev]ag+ exi/+ rese>* to develop & validate a te/ or te/s1 su* z biom>k]s or imag+1 to detect & accurately diagnose pro/ate canc] 9 ord] to improve quality ( life = millions ( individuals 9 ! ,unit$ ,/ates1 & decrease heal? c>e sy/em co/s4 7#b7 ,fund+ ,not)/&+ any o!r provision ( law1 ! ,secret>y may make available #cj1jjj1jjj1 f any unobligat$ am\nts appropriat$ to ! ,national ,in/itutes ( ,heal?1 = ea* ( fiscal ye>s #bjbb ?r\gh #bjbf to c>ry out ?is subsection4 7d7 ,public aw>5ess & education campaign 7#a7 ,national campaign ,! ,secret>y1 9 coord9ation ) ! ,director ( ! ,national ,in/itutes ( ,heal? & ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all c>ry out a national campaign to increase ! aw>5ess & k ( pro/ate canc]4 7#b7 ,requirem5ts ,! national campaign conduct$ "u p>agraph 7#a7 %all include-- 7,a7 roles = ! ,national ,canc] ,in/itute1 ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities1 ! ,(fice ( ,m9ority ,heal? ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 & ! ,(fice ( ,m9ority ,heal? & ,heal? ,equity ( ! ,c5t]s = ,disease ,control & ,prev5tion2 & 7,b7 ! developm5t & di/ribution ( writt5 educational mat]ials1 & ! developm5t & plac+ ( public s]vice ann\ncem5ts1 t are int5d$ to enc\rage m5 to seek pro/ate canc] scre5+ :5 symptoms are pres5t1 :5 !y h a family hi/ory ( pro/ate canc]1 or if !y belong to a high-risk population4 7#c7 ,racial disp>ities ,9 develop+ ! national campaign "u p>agraph 7#a71 ! ,secret>y %all recognize & address-- 7,a7 ! racial disp>ities 9 ! incid5ces ( pro/ate canc] & mortality rates ) respect to su* disease2 & 7,b7 any b>ri]s 9 access to pati5t c>e & p>ticipation 9 cl9ical trials t are specific to racial m9orities4 7#d7 ,grants ,! ,secret>y %all e/abli% a program to aw>d grants to nonpr(it private entities to enable su* entities to te/ alt]native outrea* & education /rategies to increase ! aw>5ess & k ( individuals 9 ! ,unit$ ,/ates ) respect to pro/ate canc]4 7#e7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is subsection1 #e1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #gje4 ,national ,pro/ate ,canc] ,c\ncil 7a7 ,%ort title ,?is section may be cit$ z ! ,national ,pro/ate ,canc] ,plan ,act4 7b7 ,national pro/ate canc] c\ncil 7#a7 ,e/abli%m5t ,!re is e/abli%$ 9 ! ,(fice ( ! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is section z ! ,secret>y7 ! ,national ,pro/ate ,canc] ,c\ncil on ,scre5+1 ,e>ly ,detection1 ,assessm5t1 & ,monitor+ ( ,pro/ate ,canc] 7ref]r$ to 9 ?is section z ! ,c\ncil74 7#b7 ,purpose ( ! c\ncil ,! ,c\ncil %all-- 7,a7 develop & implem5t a national /rategic plan = ! accel]at$ creation1 advancem5t1 & te/+ ( diagno/ic tools to improve scre5+1 e>ly detection1 assessm5t1 & monitor+ ( pro/ate canc]1 includ+-- 7i7 e>ly detection ( aggressive pro/ate canc] to save lives2 7ii7 monitor+ ( tumor response to treatm5t1 includ+ recurr5ce & progression2 & 7iii7 accurate assessm5t & surveillance ( indol5t disease to r$uce unnecess>y biopsies & treatm5t2 7,b7 provide in=mation & coord9ation ( pro/ate canc] rese>* & s]vices across all ,f$]al ag5cies2 7,c7 review diagno/ic tools & _! ov]all effectiv5ess at scre5+1 detect+1 assess+1 & monitor+ ( pro/ate canc]2 7,d7 evaluate all programs 9 pro/ate canc] t are 9 exi/5ce on ! date ( enactm5t ( ?is ,act1 includ+ ,f$]al budget reque/s & approvals & public-private p>tn]%ips2 7,e7 submit an annual report to ! ,secret>y & ,congress on ! creation & implem5tation ( ! national /rategic plan "u subp>agraph 7,a72 & 7,f7 ensure ! inclusion ( m5 at high-risk = pro/ate canc]1 includ+ m5 f m9ority e?nic & racial populations & m5 :o are lea/ likely to receive c>e1 9 cl9ical1 rese>*1 & s]vice ef=ts1 ) ! purpose ( decreas+ heal? disp>ities4 7#c7 ,memb]%ip 7,a7 ,f$]al memb]s ,! ,c\ncil %all be l$ by ! ,secret>y or designee & compris$ ( ! foll[+ exp]ts3 7i7 ,two repres5tatives ( ! ,national ,in/itutes ( ,heal?1 includ+ #a repres5tative ( ! ,national ,in/itute ( ,biom$ical ,imag+ & ,bio5g9e]+ & #a repres5tative ( ! ,national ,canc] ,in/itute4 7ii7 ,a repres5tative ( ! ,c5t]s = ,disease ,control & ,prev5tion4 7iii7 ,a repres5tative ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 7iv7 ,a designee ( ! ,director ( ! ,dep>tm5t ( ,def5se ,congressionally ,direct$ ,m$ical ,rese>* ,programs4 7v7 ,a designee ( ! ,director ( ! ,(fice ( ,m9ority ,heal?4 7vi7 ,a repres5tative ( ! ,food & ,drug ,adm9i/ration4 7vii7 ,a repres5tative ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality4 7,b7 ,non-f$]al memb]s ,9 addition to ! memb]s describ$ 9 subp>agraph 7,a71 ! ,c\ncil %all include #ad exp]t memb]s f outside ! ,f$]al ,gov]nm5t1 :i* %all include-- 7i7 #f pro/ate canc] pati5t advocates1 includ+-- 7,i7 #b pati5t-survivors2 7,,ii7 #b c>egiv]s ( pro/ate canc] pati5ts2 & 7,,iii7 #b repres5tatives f national pro/ate canc] disease organizations t fund rese>* or h demon/rat$ exp]i5ce 9 provid+ assi/ance to pati5ts1 families1 & m$ical pr(essionals1 includ+ in=mation on heal? c>e options1 education1 & ref]ral2 & 7ii7 #h heal? c>e /akehold]s ) specific exp]tise 9 pro/ate canc] rese>* 9 ! critical areas ( cl9ical exp]tise1 includ+ m$ical oncology1 radiology1 radiation oncology1 urology1 & pa?ology4 7#d7 ,meet+s ,! ,c\ncil %all meet qu>t]ly & meet+s %all be op5 to ! public4 7#e7 ,advice ,! ,c\ncil %all advise ! ,secret>y1 or ! ,secret>y's designee4 7#f7 ,annual report ,! ,c\ncil %all submit annual reports1 beg9n+ n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 to ! ,secret>y or ! ,secret>y's designee & to ,congress4 ,! annual report %all include-- 7,a7 9 ! fir/ ye>-- 7i7 an evaluation ( all f$]ally fund$ ef=ts 9 pro/ate canc] rese>* & gaps relat+ to ! developm5t & validation ( diagno/ic tools = pro/ate canc]2 & 7ii7 recomm5dations = priority actions to exp&1 elim9ate1 coord9ate1 or cond5se programs bas$ on ! p]=mance1 mission1 & purpose ( ! programs2 & 7,b7 annually !reaft] = #e ye>s-- 7i7 an outl9e = ! developm5t & implem5tation ( a national rese>* plan = creation & validation ( accurate diagno/ic tools to improve pro/ate canc] c>e 9 accordance ) p>agraph 7#a72 7ii7 roles = ! ,national ,canc] ,in/itute1 ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities1 & ! ,(fice ( ,m9ority ,heal? ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices2 7iii7 an analysis ( ! disp>ities 9 ! incid5ce & mortality rates ( pro/ate canc] 9 m5 at high risk ( ! disease1 includ+ individuals ) family hi/ory1 increas+ age1 or ,african-,am]ican h]itage2 & 7iv7 a review ( ! progress t[>ds ! realization ( ! propos$ /rategic plan4 7#g7 ,t]m9ation ,! ,c\ncil %all t]m9ate on ,decemb] #ca1 #bjbe4 #gjf4 ,improv$ ,m$icaid cov]age = c]ta9 brea/ & c]vical canc] pati5ts 9 ! t]ritories 7a7 ,elim9ation ( fund+ limitations ,section #aajh7;g77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acjh7;g77#d77 is am5d$-- 7#a7 by /rik+ p>agraphs 7#a71 7#b71 7#c71 & 7#d7 ( 2 & 7#b7 by add+ at ! end ! foll[+3 ,) respect to fiscal ye>s beg9n+ ) fiscal ye> #bjba1 paym5t = m$ical assi/ance = individuals :o are eligible = su* assi/ance only on ! basis ( section #aijb7;a77#aj77;,a77ii77,,xviii7 %all n be tak5 into acc\nt 9 apply+ subsection 7f7 7z increas$ 9 accordance ) ?is subsection7 to ,pu]to ,rico1 ! ,virg9 ,isl&s1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 or ,am]ican ,samoa = su* fiscal ye>44 7b7 ,application ( enhanc$ ,,fmap = highe/ ,/ate ,section #aije7;b7 ( su* ,act 7#db ,u4,s4,c4 #acif;d7b77 is am5d$ by add+ at ! end ! foll[+3 ,not)/&+ ! fir/ s5t5ce ( ?is subsection1 ) respect to m$ical assi/ance describ$ 9 clause 7#d7 ( su* s5t5ce t is furni%$ 9 ,pu]to ,rico1 ! ,virg9 ,isl&s1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 or ,am]ican ,samoa 9 a fiscal ye>1 ! ,f$]al m$ical assi/ance p]c5tage is equal to ! highe/ su* p]c5tage appli$ "u su* clause = su* fiscal ye> = any ( ! #ej ,/ates or ! ,di/rict ( ,columbia t provides su* m$ical assi/ance = any portion ( su* fiscal ye>44 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply to paym5t = m$ical assi/ance = items & s]vices furni%$ on or aft] ,octob] #a1 #bjba4 #gjg4 ,canc] prev5tion & treatm5t demon/ration = e?nic & racial m9orities 7a7 ,demon/ration 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is section z ! ,secret>y7 %all conduct demon/ration projects = ! purpose ( develop+ models & evaluat+ me?ods t-- 7,a7 improve ! quality ( items & s]vices provid$ to t>get individuals 9 ord] to facilitate r$uc$ disp>ities 9 e>ly detection & treatm5t ( canc]2 7,b7 improve cl9ical outcomes1 satisfaction1 quality ( life1 appropriate use ( items & s]vices cov]$ "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 & ref]ral patt]ns ) respect to t>get individuals ) canc]2 7,c7 elim9ate disp>ities 9 ! rate ( prev5tive canc] scre5+ measures1 su* z ,pap sme>s1 pro/ate canc] scre5+s1 colon canc] scre5+s1 brea/ canc] scre5+s1 & comput$ tomography scans1 = lung canc] among t>get individuals2 7,d7 promote collaboration ) community-bas$ organizations to ensure cultural compet5cy ( heal? c>e pr(essionals & l+ui/ic access = t>get individuals :o are p]sons ) limit$ ,engli% pr(ici5cy2 & 7,e7 enc\rage ! incorporation ( community heal? work]s to increase ! effici5cy & appropriat5ess ( canc] scre5+ programs4 7#b7 ,community heal? work] def9$ ,9 ?is section1 ! t]m community heal? work] includes a community heal? advocate1 a lay heal? work]1 a community heal? repres5tative1 a pe] heal? promot]1 a community heal? outrea* work]1 & a promotore de salud1 :o promotes heal? or nutrition )9 ! community 9 :i* ! individual resides4 7#c7 ,t>get individual def9$ ,9 ?is section1 ! t]m t>get individual means an individual ( a racial & e?nic m9ority gr\p1 z def9$ 9 section #agjg7;g77#a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a771 :o is entitl$ to b5efits "u "p ,a1 & enroll$ "u "p ,b1 ( title ,,xviii ( ! ,social ,security ,act4 7b7 ,program design 7#a7 ,initial design ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all evaluate be/ practices 9 ! private sector1 community programs1 & academic rese>* ( me?ods t r$uce disp>ities among individuals ( racial & e?nic m9ority gr\ps 9 ! prev5tion & treatm5t ( canc] & %all design ! demon/ration projects bas$ on su* evaluation4 7#b7 ,numb] & project areas ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all implem5t at lea/ #i demon/ration projects1 includ+ ! foll[+3 7,a7 ,two projects1 ea* ( :i* %all t>get diff]5t e?nic subpopulations1 = ea* ( ! #d foll[+ major racial & e?nic m9ority gr\ps3 7i7 ,am]ican ,indians & ,alaska ,natives1 ,eskimos1 & ,aleuts4 7ii7 ,asian ,am]icans4 7iii7 ,blacks & ,african ,am]icans4 7iv7 ,lat9os & ,hispanics4 7v7 ,native ,hawaiians & o!r ,pacific ,isl&]s4 7,b7 ,"o project )9 ! ,pacific ,isl&s or ,unit$ ,/ates insul> areas4 7,c7 ,at lea/ "o project 9 a rural area4 7,d7 ,at lea/ "o project 9 an inn]-city area4 7#c7 ,expansion ( projects2 implem5tation ( demon/ration project results ,! ,secret>y %all cont9ue ! exi/+ demon/ration projects & may exp& ! numb] ( demon/ration projects if ! initial report "u subsection 7c7 conta9s an evaluation t demon/ration projects-- 7,a7 r$uce exp5ditures "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq472 or 7,b7 d n increase exp5ditures "u su* ,m$ic>e program & r$uce racial & e?nic heal? disp>ities 9 ! quality ( heal? c>e s]vices provid$ to t>get individuals & increase satisfaction ( ,m$ic>e b5efici>ies & heal? c>e provid]s4 7c7 ,report to ,congress 7#a7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date ! ,secret>y implem5ts ! initial demon/ration projects1 & biannually !reaft]1 ! ,secret>y %all submit to ,congress a report reg>d+ ! demon/ration projects4 7#b7 ,cont5t ( report ,ea* report "u p>agraph 7#a7 %all include ! foll[+3 7,a7 ,a description ( ! demon/ration projects4 7,b7 ,an evaluation (-- 7i7 ! co/-effectiv5ess ( ! demon/ration projects2 7ii7 ! quality ( ! heal? c>e s]vices provid$ to t>get individuals "u ! demon/ration projects2 & 7iii7 b5efici>y & heal? c>e provid] satisfaction "u ! demon/ration projects4 7,c7 ,any o!r in=mation reg>d+ ! demon/ration projects t ! ,secret>y det]m9es to be appropriate4 7d7 ,waiv] au?ority ,! ,secret>y %all waive compliance ) ! requirem5ts ( title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 to su* ext5t & = su* p]iod z ! ,secret>y det]m9es is necess>y to conduct demon/ration projects4 #gjh4 ,r$uc+ canc] disp>ities )9 ,m$ic>e 7a7 ,developm5t ( measures ( disp>ities 9 quality ( canc] c>e 7#a7 ,developm5t ( measures ,! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y7 %all ent] into an agreem5t ) an entity t specializes 9 develop+ quality measures = canc] c>e "u :i* ! entity %all develop a uni=m set ( measures to evaluate disp>ities 9 ! quality ( canc] c>e & annually update su* set ( measures4 7#b7 ,measures to be includ$ ,su* set ( measures %all include1 ) respect to ! treatm5t ( canc]1 measures ( pati5t outcomes1 ! process = deliv]+ m$ical c>e relat$ to su* treatm5t1 pati5t c\nsel+ & engagem5t 9 decision-mak+1 pati5t exp]i5ce ( c>e1 res\rce use1 & practice capabilities1 su* z c>e coord9ation4 7b7 ,e/abli%m5t ( report+ process 7#a7 ,9 g5]al ,! ,secret>y %all e/abli% a report+ process t requires & provides = a me?od = heal? c>e provid]s specifi$ "u p>agraph 7#b7 to submit to ! ,secret>y & make public data on ! p]=mance ( su* provid]s dur+ ea* report+ p]iod ?r\gh use ( ! measures develop$ pursuant to subsection 7a74 ,su* data %all be submitt$ 9 a =m & mann] & at a "t specifi$ by ! ,secret>y4 7#b7 ,specification ( provid]s to report on measures ,! ,secret>y %all specify ! classes ( ,m$ic>e provid]s ( s]vices & suppli]s1 includ+ hospitals1 canc] c5t]s1 physicians1 prim>y c>e provid]s1 & specialty provid]s1 t w be requir$ "u su* process to publicly report on ! measures specifi$ "u subsection 7a74 7#c7 ,assessm5t ( *anges ,"u su* report+ process1 ! ,secret>y %all e/abli% a =mat t assesses *anges 9 bo? ! absolute & relative disp>ities 9 canc] c>e ov] "t4 ,^! measures %all be pres5t$ 9 an easily compreh5sible =mat1 su* z ^? pres5t$ 9 ! f9al publications relat+ to ,heal?y ,p #bjaj or ! ,national ,heal?c>e ,disp>ities ,report4 7#d7 ,initial implem5tation ,! ,secret>y %all implem5t ! report+ process "u ?is subsection = report+ p]iods beg9n+ n lat] ?an #f mon?s aft] ! date t measures are fir/ e/abli%$ "u subsection 7a74 #gji4 ,canc] cl9ical trials 7a7 ,%ort title ,?is section may be cit$ z ! ,h5rietta ,lacks ,enhanc+ ,canc] ,rese>* ,act ( #bjbj4 7b7 ,f9d+s ,congress f9ds z foll[s3 7#a7 ,only a small p]c5t ( pati5ts p>ticipate 9 canc] cl9ical trials1 ev5 ?\gh mo/ express an int]e/ 9 cl9ical rese>*4 ,!re are sev]al ob/acles t re/rict individuals f p>ticipat+ includ+ lack ( available local trials1 re/rictive eligibility crit]ia1 transportation to trial sites1 tak+ "t (f f "w1 & pot5tially increas$ m$ical & nonm$ical co/s4 ,ultimately1 ab\t #a 9 #e canc] cl9ical trials fail because ( lack ( pati5t enrollm5t4 7#b7 ,gr\ps t are g5]ally und]repres5t$ 9 cl9ical trials include racial & e?nic m9orities & old]1 rural1 & l[]-income individuals4 7#c7 ,h5rietta ,lacks1 an ,african-,am]ican woman1 0 diagnos$ ) c]vical canc] at ! age ( #ca1 & despite receiv+ pa9ful radium treatm5ts1 pass$ away on ,octob] #d1 #aiea4 7#d7 ,m$ical rese>*]s took samples ( ,h5rietta ,lacks' tumor dur+ h] treatm5t & ! ,he,la cell l9e f h] tumor prov$ rem>kably resili5t4 7#e7 ,he,la cells 7 ! fir/ immortal l9e ( human cells4 ,h5rietta ,lacks' cells 7 unique1 gr[+ by ! millions1 comm]cializ$ & di/ribut$ worldwide to rese>*]s1 result+ 9 advances 9 m$ic9e4 7#f7 ,h5rietta ,lacks' prolific cells cont9ue to gr[ & contribute to rem>kable advances 9 m$ic9e1 includ+ ! developm5t ( ! polio vacc9e1 z well z drugs = treat+ ! effects ( canc]1 ,,hiv_/,,aids1 hemophilia1 leukemia1 & ,p>k9son's disease4 ,^! cells h be5 us$ 9 rese>* t has contribut$ to our und]/&+ ( ! effects ( radiation & z]o gravity on human cells4 ,^! immortal cells h in=m$ rese>* on *romosomal conditions1 canc]1 g5e mapp+1 & precision m$ic9e4 7#g7 ,h5rietta ,lacks & h] immortal cells h made a significant contribution to global heal?1 sci5tific rese>*1 quality ( life1 & pati5t rights4 7#h7 ,= m ?an #bj ye>s1 ! advances made possible by ,h5rietta ,lacks' cells 7 )\t h] or h] family's cons5t1 & ! rev5ues !y g5]at$ 7 n kn[n to or %>$ ) h] family4 7#i7 ,h5rietta ,lacks & h] family's exp]i5ce is fundam5tal to mod]n & future bioe?ics policies & in=m$ cons5t laws t b5efit pati5ts nationwide by build+ pati5t tru/2 promot+ e?ical rese>* t b5efits all individuals1 includ+ traditionally und]repres5t$ populations2 & protect+ rese>* p>ticipants4 7c7 ,,gao /udy on b>ri]s to p>ticipation 9 f$]ally fund$ canc] cl9ical trials by populations t h be5 traditionally und]repres5t$ 9 su* trials 7#a7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all-- 7,a7 complete a /udy t-- 7i7 reviews :at actions ,f$]al ag5cies h tak5 to help to address b>ri]s to p>ticipation 9 f$]ally fund$ canc] cl9ical trials by populations t h be5 traditionally und]repres5t$ 9 su* trials1 & id5tifies *all5ges1 if any1 9 implem5t+ su* actions2 & 7ii7 id5tifies additional actions t c be tak5 by ,f$]al ag5cies to address b>ri]s to p>ticipation 9 f$]ally fund$ canc] cl9ical trials by populations t h be5 traditionally und]repres5t$ 9 su* trials2 & 7,b7 submit a report to ! ,congress on ! results ( su* /udy1 includ+ recomm5dations on pot5tial *anges 9 practices & policies to improve p>ticipation 9 su* trials by su* populations4 7#b7 ,inclusion ( cl9ical trials ,! /udy "u p>agraph 7#a77;,a7 %all include review ( canc] cl9ical trials t are l>gely fund$ by ,f$]al ag5cies1 includ+ ! ,national ,in/itutes ( ,heal?1 ! ,dep>tm5t ( ,def5se1 ! ,dep>tm5t ( ,vet]ans ,affairs1 ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 ! ,food & ,drug ,adm9i/ration1 & su* o!r ,f$]al ag5cies z ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates may id5tify4 ,b ,viral ,hepatitis & ,liv] ,canc] ,control & ,prev5tion #gaa4 ,viral hepatitis & liv] canc] control & prev5tion 7a7 ,%ort title ,?is subtitle may be cit$ z ! ,viral ,hepatitis & ,liv] ,canc] ,control & ,prev5tion ,act ( #bjbj4 7b7 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,9 ! ,unit$ ,/ates1 ne>ly #e1jjj1jjj p]sons are liv+ ) ! hepatitis ,b virus 7ref]r$ to 9 ?is section z ,,hbv7 or ! hepatitis ,c virus 7ref]r$ to 9 ?is section z ,,hcv74 7#b7 ,9 ! ,unit$ ,/ates1 *ronic ,,hbv & ,,hcv are ! mo/ common causes ( liv] canc]1 ! second deadlie/ & fa/e/ gr[+ canc] 9 ?is c\ntry4 ,su* viruses are ! mo/ common cause ( *ronic liv] disease1 liv] cirrhosis1 & ! mo/ common indications = liv] transplantation4 ,at lea/ #ba1jjj dea?s p] ye> 9 ! ,unit$ ,/ates c be attribut$ to *ronic ,,hbv & ,,hcv4 ,*ronic ,,hcv is also a lead+ cause ( dea? 9 ,am]icans liv+ ) ,,hiv_/,,aids2 _m ( ^? liv+ ) ,,hiv_/,,aids are co9fect$ ) *ronic ,,hbv1 *ronic ,,hcv1 or bo?4 7#c7 ,accord+ to ! ,c5t]s = ,disease ,control & ,prev5tion 7ref]r$ to 9 ?is section z ! ,,cdc71 approximately #b p]c5t ( ! population ( ! ,unit$ ,/ates is liv+ ) *ronic ,,hbv1 *ronic ,,hcv1 or bo?4 ,! ,,cdc has recogniz$ ,,hcv z ! ,nation's mo/ common *ronic bloodborne virus infection & ,,hbv z ! deadlie/ vacc9e-prev5table disease4 7#d7 ,,hbv is transmitt$ ?r\gh contact ) infecti\s blood1 sem51 or o!r bodily fluids & is #ajj times m infecti\s ?an ,,hiv4 ,,hcv is transmitt$ by contact ) infecti\s blood1 p>ticul>ly ?r\gh p]cutane\s exposures 7su* z puncture ?r\gh ! sk974 7#e7 ,! ,,cdc e/imates t 9 #bjaf1 m ?an #da1jjj p 9 ! ,unit$ ,/ates 7 newly infect$ ) ,,hcv & ne>ly #ba1jjj p 9 ! ,unit$ ,/ates 7 newly infect$ ) ,,hbv4 ,^! e/imates c\ld be mu* high] due to _m reasons1 includ+ lack ( scre5+ education & aw>5ess1 & p]ceiv$ m>g9alization ( ! populations at risk4 7#f7 ,9 #bjab1 ,,cdc releas$ new guidel9es recomm5d+ e p]son born betwe5 #aide & #aife receive a "o-"t te/ = ,,hcv4 ,among ! e/imat$ #ajb1jjj1jjj 7#a1fjj1jjj *ronically ,,hcv-infect$7 eligible = scre5+1 bir?-cohort scre5+ leads to #hd1jjj few] cases ( decomp5sat$ cirrhosis1 #df1jjj few] cases ( hepatocellul> c>c9oma1 #aj1jjj few] liv] transplants1 & #gh1jjj few] ,,hcv-relat$ dea?s ga9$ v]sus risk-bas$ scre5+4 7#g7 ,9 #bjac1 ! ,unit$ ,/ates ,prev5tive ,s]vices ,task ,=ce 7ref]r$ to 9 ?is section z ! ,,usp/f7 issu$ a ,grade ,b rat+ = scre5+ = ,,hcv infection 9 p]sons at high risk = infection & adults born betwe5 #aide & #aife4 ,9 #bjad1 ! ,,usp/f issu$ a ,grade ,b = scre5+ = ,,hbv 9 p]sons at high-risk ( hepatitis ,b infection4 ,9 #bjji1 ! ,,usp/f issu$ a ,grade ,a = scre5+ pregnant wom5 = ,,hbv dur+ _! fir/ pr5atal visit1 & 9 #bjai1 reaffirm$ ?is grade4 7#h7 ,!re 7 #ei outbreaks 7#bd ( ,,hbv & #cf ( ,,hcv1 includ+ "o ( bo? ,,hbv & ,,hcv7 report$ to ,,cdc = inve/igation f #bjjh ?r\gh #bjaf relat$ to heal? c>e-associat$ infection ( ,,hbv & ,,hcv1 #ef ( :i* occurr$ 9 non-hospital sett+s4 ,!re 7 m ?an #aae1ihc pati5ts pot5tially expos$ to "o ( ! viruses4 7#i7 ,*ronic ,,hbv & *ronic ,,hcv usually d n cause symptoms e>ly 9 ! c\rse ( ! disease1 b aft] _m ye>s ( a cl9ically sil5t phase1 ,,cdc e/imates %[ m ?an #cc p]c5t ( infect$ individuals w develop cirrhosis1 end-/age liv] disease1 or liv] canc]4 ,s9ce mo/ individuals ) *ronic ,,hbv1 ,,hcv1 or bo? are unaw>e ( _! infection1 !y d n "k to take precautions to prev5t ! spread ( _! infection & c unkn[+ly exac]bate _! own disease progression4 7#aj7 ,,hbv & ,,hcv disproportionately affect c]ta9 populations 9 ! ,unit$ ,/ates4 ,al?\gh repres5t+ only ab\t #f p]c5t ( ! population1 ,asian ,am]icans & ,pacific ,isl&]s acc\nt = half ( all *ronic ,,hbv cases 9 ! ,unit$ ,/ates4 ,baby ,boom]s 7^? born betwe5 #aide & #aife7 acc\nt = approximately #ge p]c5t ( dome/ic *ronic ,,hcv cases4 ,9 addition1 ,african ,am]icans1 ,lat9os1 & ,am]ican ,indian & ,native ,alaskans are among ! gr\ps :i* h disproportionately high rates ( ,,hbv or ,,hcv infections 9 ! ,unit$ ,/ates4 7#aa7 ,= bo? *ronic ,,hbv & *ronic ,,hcv1 behavioral *anges & appropriate m$ical c>e c sl[ disease progression if diagnosis is made e>ly4 ,e>ly diagnosis1 :i* is det]m9$ ?r\gh simple blood te/s1 c r$uce ! risk ( transmission & disease progression ?r\gh education & vacc9ation ( h\sehold memb]s & o!r susceptible p]sons at risk4 7#ab7 ,advancem5ts h l$ to ! developm5t ( improv$ diagno/ic te/s = viral hepatitis4 ,^! te/s1 includ+ rapid1 po9t ( c>e te/+ & o!rs 9 developm5t1 c facilitate te/+1 notification ( results & po/-te/ c\nsel+1 & ref]ral to c>e at ! "t ( ! te/+ visit4 ,9 p>ticul>1 ^! te/s are also advantage\s because !y c be us$ simultane\sly ) ,,hiv rapid te/+ = p]sons at risk = bo? ,,hcv & ,,hiv infections4 7#ac7 ,= ^? *ronically infect$ ) ,,hbv or ,,hcv1 regul> monitor+ c lead to ! e>ly detection ( liv] canc] at a /age :]e a cure is /ill possible4 ,liv] canc] is ! second deadlie/ canc] 9 ! ,unit$ ,/ates2 h[ev]1 liv] canc] has receiv$ little fund+ = rese>*1 prev5tion1 or treatm5t4 7#ad7 ,treatm5t = *ronic ,,hcv c eradicate ! disease 9 approximately #ij p]c5t ( ^? curr5tly treat$4 ,:ile !re is no cure = *ronic ,,hbv1 available treatm5ts c effectively suppress viral replication 9 ! ov]:elm+ majority ( ^? treat$1 !reby r$uc+ ! risk ( transmission & progression to liv] sc>r+ or liv] canc]4 7#ae7 ,to combat ! viral hepatitis epidemic 9 ! ,unit$ ,/ates1 9 ,febru>y #bjag1 ! ,dep>tm5t ( ,heal? & ,human ,s]vices releas$ its ,national ,viral ,hepatitis ,action ,plan #bjag-bjbj 7ref]r$ to 9 ?is section z ! ,,hhs ,action ,plan74 ,9 ,m>* #bjag1 ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e releas$ a report entitl$1 ,a ,national ,/rategy = ! ,elim9ation ( ,hepatitis ,b & ,c3 ,phase ,two ,report 7ref]r$ to 9 ?is section z ! ,,nas report71 recomm5d+ specific actions to elim9ate viral hepatitis z public heal? problems 9 ! ,unit$ ,/ates by #bjcj4 7#af7 ,! annual heal? c>e co/s attributable to ,,hbv & ,,hcv 9 ! ,unit$ ,/ates are significant4 ,= ,,hbv1 x is e/imat$ to be approximately #b1ejj1jjj1jjj 7#b1jjj p] infect$ p]son74 ,9 #bjjj1 ! lifetime co/ ( ,,hbv--be=e ! availability ( mo/ curr5t !rapies--0 approximately #hj1jjj p] *ronically infect$ p]son1 total+ m ?an #ajj1jjj1jjj1jjj4 ,= ,,hcv1 m$ical co/s = pati5ts are expect$ to increase f #cj1jjj1jjj1jjj 9 #bjji to ov] #he1jjj1jjj1jjj 9 #bjbd4 ,avoid+ ^! co/s by scre5+ & diagnos+ individuals e>li]--& connect+ !m to appropriate treatm5t & c>e1 w save lives & critical heal? c>e doll>s4 ,curr5tly1 )\t a compreh5sive scre5+1 te/+1 & diagnosis program1 mo/ pati5ts are diagnos$ too late :5 !y ne$ a liv] transplant co/+ at lea/ #cad1jjj = uncomplicat$ cases or :5 !y h liv] canc] or end-/age liv] disease :i* co/s #cj1ihj to #aaj1egf p] hospital admission4 ,z heal? c>e co/s cont9ue to gr[1 x is critical t ! ,f$]al ,gov]nm5t inve/s 9 effective me*anisms to avoid docum5t$ co/ driv]s4 7#ag7 ,accord+ to ! ,,nas report 9 #bjaj1 *ronic ,,hbv & ,,hcv infections cause sub/antial morbidity & mortality despite be+ prev5table & treatable4 ,defici5cies 9 ! implem5tation ( e/abli%$ guidel9es = ! prev5tion1 diagnosis1 & m$ical managem5t ( *ronic ,,hbv & ,,hcv infections p]petuate p]sonal & economic burd5s4 ,exi/+ grants are n suffici5t = ! scale ( ! heal? burd5 pres5t$ by ,,hbv & ,,hcv4 7#ah7 ,scre5+ & te/+ = ,,hbv & ,,hcv is align$ ) ! goal ( ,heal?y ,p #bjbj to increase immunization rates & r$uce prev5table infecti\s diseases4 ,aw>5ess ( disease & access to prev5tion & treatm5t rema9 ess5tial compon5ts = r$uc+ infecti\s disease transmission4 7#ai7 ,f$]al support is necess>y to increase k & aw>5ess ( ,,hbv & ,,hcv & to assi/ ,/ate & local prev5tion & control ef=ts 9 r$uc+ ! morbidity & mortality ( ^! epidemics4 7#bj7 ,! ,c5t]s = ,disease ,control & ,prev5tion report$ a #bcc p]c5t increase 9 hepatitis ,c cases f #bjaj to #bjaf1 /emm+ f ! opioid1 h]o91 & ov]dose epidemics affect+ communities nationwide4 ,f #bjad to #bjae1 ! numb] ( report$ cases ( acute hepatitis ,b infection 9 ! ,unit$ ,/ates rose = ! fir/ "t s9ce #bjjf1 increas+ by #bj4g p]c5t1 :i* is also l>gely attributable to ! opioid epidemic4 7#ba7 ,! ,secret>y ( ,heal? & ,human ,s]vices has ! discretion to c>ry out ?is subtitle 7includ+ ! am5dm5ts made by ?is subtitle7 directly & ?r\gh :i*ev] ( ! ag5cies ( ! ,public ,heal? ,s]vice ! ,secret>y det]m9es to be appropriate1 :i* may 79 ! ,secret>y's discretion7 include ! ,c5t]s = ,disease ,control & ,prev5tion1 ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 ! ,sub/ance ,abuse & ,m5tal ,heal? ,s]vices ,adm9i/ration1 ! ,national ,in/itutes ( ,heal? 7includ+ ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities71 & o!r ag5cies ( su* ,s]vice4 7c7 ,bi5nial assessm5t ( ,,hhs hepatitis ,b & hepatitis ,c prev5tion1 education1 rese>*1 & m$ical managem5t plan ,title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bda et seq471 z am5d$ by title ,v1 is fur!r am5d$-- 7#a7 by /rik+ section #cag,n 7#db ,u4,s4,c4 #bdg;b-#ae72 & 7#b7 by add+ aft] "p ,w1 z add$ by section #ejh1 ! foll[+3 ,x ,bi5nial assessm5t ( ,,hhs ,hepatitis ,b & ,hepatitis ,c prev5tion1 education1 rese>*1 & m$ical managem5t plan #cii,,pp4 ,bi5nial ,update ( ! ,plan 7a7 ,9 g5]al ,! ,secret>y %all conduct a bi5nial assessm5t ( ! ,secret>y's plan = ! prev5tion1 control1 & m$ical managem5t (1 & education & rese>* relat+ to1 hepatitis ,b & hepatitis ,c1 = ! purposes (-- 7#a7 incorporat+ into su* plan new k or obs]vations relat+ to hepatitis ,b & hepatitis ,c 7su* z k & obs]vations t may be d]iv$ f cl9ical1 laboratory1 & epidemiological rese>* & disease detection1 prev5tion1 & surveillance outcomes72 7#b7 address+ gaps 9 ! cov]age or effectiv5ess ( ! plan2 & 7#c7 evaluat+ &1 if appropriate1 updat+ recomm5dations1 guidel9es1 or educational mat]ials ( ! ,c5t]s = ,disease ,control & ,prev5tion or ! ,national ,in/itutes ( ,heal? = heal? c>e provid]s or ! public on viral hepatitis 9 ord] to be consi/5t ) ! plan4 7b7 ,publication ( notice ( assessm5ts ,n lat] ?an ,octob] #a ( ! fir/ ev5-numb]$ ye> beg9n+ aft] ! date ( ! enactm5t ( ?is "p1 & ,octob] #a ( ea* ev5-numb]$ ye> !reaft]1 ! ,secret>y %all publi% 9 ! ,f$]al ,regi/] a notice ( ! results ( ! assessm5ts conduct$ "u p>agraph 7#a74 ,su* notice %all include-- 7#a7 a description ( any revisions to ! plan ref]r$ to 9 subsection 7a7 z a result ( ! assessm5t2 7#b7 an explanation ( ! basis = any su* revisions1 includ+ ! ways 9 :i* su* revisions c reasonably be expect$ to fur!r promote ! orig9al goals & objectives ( ! plan2 & 7#c7 9 ! case ( a det]m9ation by ! ,secret>y t ! plan does n ne$ revision1 an explanation ( ! basis = su* det]m9ation4 #cii,,pp-#a4 ,elem5ts ( program 7a7 ,education & aw>5ess programs ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 & ! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use1 & 9 accordance ) ! plan ref]r$ to 9 section #cii,,pp7a71 %all implem5t programs to increase aw>5ess & enhance k & und]/&+ ( hepatitis ,b & hepatitis ,c4 ,su* programs %all include-- 7#a7 ! conduct ( culturally & l+ui/ically appropriate heal? education 9 prim>y & second>y s*ools1 college campuses1 public aw>5ess campaigns1 & community outrea* activities 7especially to ! e?nic communities ) high rates ( *ronic hepatitis ,b & *ronic hepatitis ,c & o!r high-risk gr\ps7 to promote public aw>5ess & k ab\t ! value ( hepatitis ,a & hepatitis ,b immunization2 risk factors1 transmission1 & prev5tion ( hepatitis ,b & hepatitis ,c2 ! value ( scre5+ = ! e>ly detection ( hepatitis ,b & hepatitis ,c2 & options available = ! treatm5t ( *ronic hepatitis ,b & *ronic hepatitis ,c2 7#b7 ! promotion ( immunization programs t increase aw>5ess & access to hepatitis ,a & hepatitis ,b vacc9es = susceptible adults & *ildr52 7#c7 ! tra9+ ( heal? c>e pr(essionals reg>d+ ! importance ( vacc9at+ individuals infect$ ) hepatitis ,c & individuals :o are at risk = hepatitis ,c infection aga9/ hepatitis ,a & hepatitis ,b2 7#d7 ! tra9+ ( heal? c>e pr(essionals reg>d+ ! importance ( vacc9at+ individuals *ronically infect$ ) hepatitis ,b & individuals :o are at risk = *ronic hepatitis ,b infection aga9/ ! hepatitis ,a virus2 7#e7 ! tra9+ ( heal? c>e pr(essionals & heal? educators to make !m aw>e ( ! high rates ( *ronic hepatitis ,b & *ronic hepatitis ,c 9 c]ta9 adult e?nic populations1 & ! importance ( prev5tion1 detection1 & m$ical managem5t ( hepatitis ,b & hepatitis ,c & ( liv] canc] scre5+2 7#f7 ! developm5t & di/ribution ( heal? education curricula 7includ+ in=mation relat+ to ! special ne$s ( individuals infect$ ) or at risk ( hepatitis ,b & hepatitis ,c1 su* z ! importance ( prev5tion & e>ly int]v5tion1 regul> monitor+1 ! recognition ( psy*osocial ne$s1 appropriate treatm5t1 & liv] canc] scre5+7 = individuals provid+ hepatitis ,b & hepatitis ,c c\nsel+2 & 7#g7 support = ! implem5tation ( ! curricula describ$ 9 p>agraph 7#f7 by ,/ate & local public heal? ag5cies4 7b7 ,immunization1 prev5tion1 & control programs 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all support ! integration ( activities describ$ 9 p>agraph 7#c7 into exi/+ cl9ical & public heal? programs at ,/ate1 local1 t]ritorial1 & ,tribal levels 7includ+ community heal? cl9ics1 programs = ! prev5tion & treatm5t ( ,,hiv_/,,aids1 sexually transmitt$ infections1 & sub/ance abuse1 & programs = individuals 9 correctional sett+s74 7#b7 ,coord9ation ( developm5t ( ,f$]al scre5+ guidel9es 7,a7 ,ref]5ces ,= purposes ( ?is subsection1 ! t]m ,,cdc ,director means ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 & ! t]m ,,ahrq ,director means ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality4 7,b7 ,ag5cy = heal?c>e rese>* & quality ,due to ! rapidly evolv+ /&>d ( c>e associat$ ) diagnos+ & treat+ viral hepatitis infection1 ! ,,ahrq ,director %all conv5e ! ,prev5tive ,s]vices ,task ,=ce "u section #iae7;a7 to review its recomm5dation = scre5+ = ,,hbv & ,,hcv infection e #c ye>s4 7#c7 ,activities 7,a7 ,volunt>y te/+ programs 7i7 ,9 g5]al ,! ,secret>y %all e/abli% a me*anism by :i* to support & promote ! developm5t ( ,/ate1 local1 t]ritorial1 & tribal volunt>y hepatitis ,b & hepatitis ,c te/+ programs to scre5 ! high-preval5ce populations to aid 9 ! e>ly id5tification ( *ronically infect$ individuals4 7ii7 ,confid5tiality ( ! te/ results ,! ,secret>y %all prohibit ! use ( ! results ( a hepatitis ,b or hepatitis ,c te/ conduct$ by a te/+ program develop$ or support$ "u ?is subp>agraph = any ( ! foll[+3 7,i7 ,issues relat+ to heal? insurance4 7,,ii7 ,to scre5 or det]m9e suitability = employm5t4 7,,iii7 ,to dis*>ge a p]son f employm5t4 7,b7 ,c\nsel+ reg>d+ viral hepatitis ,! ,secret>y %all support ,/ate1 local1 t]ritorial1 & tribal programs 9 a wide v>iety ( sett+s1 includ+ ^? provid+ prim>y & specialty heal? c>e s]vices 9 nonpr(it private & public sectors1 to-- 7i7 provide individuals ) ongo+ risk factors = hepatitis ,b & hepatitis ,c infection ) cli5t-c5t]$ education & c\nsel+ :i* conc5trates on-- 7,i7 promot+ te/+ ( individuals t h be5 expos$ to _! blood1 family memb]s1 & _! sexual p>tn]s2 & 7,,ii7 *ang+ behaviors t place individuals at risk = infection2 7ii7 provide individuals *ronically infect$ ) hepatitis ,b or hepatitis ,c ) education1 heal? in=mation1 & c\nsel+ to r$uce _! risk (-- 7,i7 dy+ f end-/age liv] disease & liv] canc]2 & 7,,ii7 transmitt+ viral hepatitis to o!rs2 & 7iii7 provide wom5 *ronically infect$ ) hepatitis ,b or hepatitis ,c :o are pregnant or ( *ildbe>+ age ) culturally & l+ui/ically appropriate heal? in=mation1 su* z h[ to prev5t hepatitis ,b p]9atal infection1 & to alleviate fe>s associat$ ) pregnancy or rais+ a family4 7,c7 ,immunization ,! ,secret>y %all support ,/ate1 local1 t]ritorial1 & tribal ef=ts to exp& ! curr5t vacc9ation programs to protect e *ild 9 ! ,nation & all susceptible adults1 p>ticul>ly ^? infect$ ) hepatitis ,c & high-preval5ce e?nic populations & o!r high-risk gr\ps1 f ! risks ( acute & *ronic hepatitis ,b infection by-- 7i7 ensur+ cont9u$ fund+ = hepatitis ,b vacc9ation = all *ildr5 #ah ye>s ( age or y\ng] ?r\gh ! ,vacc9es = ,*ildr5 program2 7ii7 ensur+ t ! recomm5dations ( ! ,advisory ,committee on ,immunization ,practices ( ! ,c5t]s = ,disease ,control & ,prev5tion are foll[$ reg>d+ ! bir? dose ( hepatitis ,b vacc9ations = newborns2 7iii7 requir+ pro( ( hepatitis ,b vacc9ation = entry into public or private dayc>e1 pres*ool1 elem5t>y s*ool1 second>y s*ool1 & in/itutions ( high] education2 7iv7 exp&+ ! availability ( hepatitis ,b vacc9ation = all adults to protect !m f becom+ acutely or *ronically infect$1 includ+ e?nic & o!r populations ) high preval5ce rates ( *ronic hepatitis ,b infection2 7v7 exp&+ ! availability ( hepatitis ,b vacc9ation = all adults1 p>ticul>ly ^? ( reproductive age 7wom5 & m5 less ?an #de ye>s ( age71 to protect !m f ! risk ( hepatitis ,b infection2 7vi7 ensur+ ! vacc9ation ( individuals infect$1 or at risk = infection1 ) hepatitis ,c aga9/ hepatitis ,a1 hepatitis ,b1 & o!r infecti\s diseases1 z appropriate1 = :i* su* individuals may be at increas$ risk2 & 7vii7 ensur+ ! vacc9ation ( individuals infect$1 or at risk = infection1 ) hepatitis ,b aga9/ hepatitis ,a virus & o!r infecti\s diseases1 z appropriate1 = :i* su* individuals may be at increas$ risk4 7,d7 ,m$ical ref]ral ,! ,secret>y %all support ,/ate1 local1 t]ritorial1 & tribal programs t support-- 7i7 ref]ral ( p]sons *ronically infect$ ) hepatitis ,b or hepatitis ,c-- 7,i7 = m$ical evaluation to det]m9e ! appropriat5ess = antiviral treatm5t to r$uce ! risk ( progression to cirrhosis & liv] canc]2 & 7,,ii7 = ongo+ m$ical managem5t includ+ regul> monitor+ ( liv] function & scre5+ = liv] canc]2 & 7ii7 ref]ral ( p]sons infect$ ) acute or *ronic hepatitis ,b infection or acute or *ronic hepatitis ,c infection = drug & alcohol abuse treatm5t :]e appropriate4 7#d7 ,increas$ support = adult viral hepatitis prev5tion coord9ators ,! ,secret>y1 act+ ?r\gh ! ,,cdc ,director1 %all provide increas$ support to adult viral hepatitis prev5tion coord9ators 9 ,/ate1 local1 t]ritorial1 & tribal heal? dep>tm5ts 9 ord] to enhance ! additional managem5t1 network+1 & te*nical exp]tise ne$$ to ensure successful integration ( hepatitis ,b & hepatitis ,c prev5tion & control activities into exi/+ public heal? programs4 7c7 ,epidemiological surveillance 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all support ! e/abli%m5t & ma9t5ance ( a national *ronic & acute hepatitis ,b & hepatitis ,c surveillance program1 9 ord] to id5tify-- 7,a7 tr5ds 9 ! incid5ce ( acute & *ronic hepatitis ,b & acute & *ronic hepatitis ,c2 7,b7 tr5ds 9 ! preval5ce ( acute & *ronic hepatitis ,b & acute & *ronic hepatitis ,c infection among gr\ps t may be disproportionately affect$2 & 7,c7 tr5ds 9 liv] canc] & end-/age liv] disease incid5ce & dea?s1 caus$ by *ronic hepatitis ,b & *ronic hepatitis ,c 9 ! high-risk e?nic populations4 7#b7 ,s]opreval5ce & liv] canc] /udies ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all prep>e a report outl9+ ! population-bas$ s]opreval5ce /udies curr5tly und]way1 future plann$ /udies1 ! crit]ia involv$ 9 det]m9+ :i* s]opreval5ce /udies to conduct1 def]1 or susp5d1 & ! scope ( ^? /udies1 ! economic & cl9ical impact ( hepatitis ,b & hepatitis ,c1 & ! impact ( *ronic hepatitis ,b & *ronic hepatitis ,c infections on ! quality ( life4 ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is "p1 ! ,secret>y %all submit ! report to ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate & ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives4 7#c7 ,confid5tiality ,! ,secret>y %all n disclose any individually id5tifiable in=mation id5tifi$ "u p>agraph 7#a7 or d]iv$ ?r\gh /udies "u p>agraph 7#b74 7d7 ,rese>* ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 ! ,director ( ! ,national ,canc] ,in/itute1 & ! ,director ( ! ,national ,in/itutes ( ,heal?1 %all-- 7#a7 conduct epidemiologic & community-bas$ rese>* to develop1 implem5t1 & evaluate be/ practices = hepatitis ,b & hepatitis ,c prev5tion especially 9 ! e?nic populations ) high rates ( *ronic hepatitis ,b & *ronic hepatitis ,c & o!r high-risk gr\ps2 7#b7 conduct rese>* on hepatitis ,b & hepatitis ,c natural hi/ory1 pa?ophysiology1 improv$ treatm5ts & prev5tion 7su* z ! hepatitis ,c vacc9e71 & non9vasive te/s t help to pr$ict ! risk ( progression to liv] cirrhosis & liv] canc]2 7#c7 conduct rese>* t w lead to bett] non9vasive or blood te/s to scre5 = liv] canc]1 & m effective treatm5ts ( liv] canc] caus$ by *ronic hepatitis ,b & *ronic hepatitis ,c2 & 7#d7 conduct rese>* comp>+ ! effectiv5ess ( scre5+1 diagno/ic1 managem5t1 & treatm5t approa*es = *ronic hepatitis ,b1 *ronic hepatitis ,c1 & liv] canc] 9 ! affect$ communities4 7e7 ,und]s]v$ & disproportionately affect$ populations ,9 c>ry+ out ?is section1 ! ,secret>y %all provide exp&$ support = individuals ) limit$ access to heal? education1 te/+1 & heal? c>e s]vices & gr\ps t may be disproportionately affect$ by hepatitis ,b & hepatitis ,c4 7f7 ,evaluation ( program ,! ,secret>y %all develop b5*m>ks = evaluat+ ! effectiv5ess ( ! programs & activities conduct$ "u ?is section & make det]m9ations z to :e!r su* b5*m>ks h be5 a*iev$4 #cii,,pp-#b4 ,grants 7a7 ,9 g5]al ,! ,secret>y may aw>d grants to1 or ent] into contracts or coop]ative agreem5ts )1 ,/ates1 political subdivisions ( ,/ates1 t]ritories1 ,indian tribes1 or nonpr(it entities t h special exp]tise relat+ to hepatitis ,b1 hepatitis ,c1 or bo?1 to c>ry out activities "u ?is "p4 7b7 ,application ,to be eligible = a grant1 contract1 or coop]ative agreem5t "u subsection 7a71 an entity %all prep>e & submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 #cii,,pp-#c4 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is "p #ij1jjj1jjj = fiscal ye> #bjba1 #ij1jjj1jjj = fiscal ye> #bjbb1 #aaj1jjj1jjj = fiscal ye> #bjbc1 #acj1jjj1jjj = fiscal ye> #bjbd1 & #aej1jjj1jjj = fiscal ye> #bjbe4 4 ,c ,acquir$ ,bone ,m>r[ ,failure ,diseases #gba4 ,acquir$ bone m>r[ failure diseases 7a7 ,%ort title ,?is subtitle may be cit$ z ! ,bone ,m>r[ ,failure ,disease ,rese>* & ,treatm5t ,act ( #bjbj4 7b7 ,f9d+s ,! ,congress f9ds ! foll[+3 7#a7 ,betwe5 #bj1jjj & #cj1jjj p 9 ! ,unit$ ,/ates are diagnos$ ea* ye> ) myelodyspla/ic syndromes1 apla/ic anemia1 p>oxysmal nocturnal hemoglob9uria1 & o!r acquir$ bone m>r[ failure diseases4 7#b7 ,acquir$ bone m>r[ failure diseases h a debilitat+ & (t5 fatal impact on ^? diagnos$ ) ^! diseases4 7#c7 ,:ile "s treatm5ts = acquir$ bone m>r[ failure diseases c prolong & improve ! quality ( pati5ts' lives1 !re is no s+le cure = ^! diseases4 7#d7 ,! preval5ce ( acquir$ bone m>r[ failure diseases 9 ! ,unit$ ,/ates w cont9ue to gr[ z ! g5]al public ages4 7#e7 ,evid5ce exi/s sugge/+ t acquir$ bone m>r[ failure diseases occur m (t5 9 m9ority populations1 p>ticul>ly 9 ,asian-,am]ican & ,lat9o or ,hispanic populations4 7#f7 ,! ,national ,he>t1 ,lung1 & ,blood ,in/itute & ! ,national ,canc] ,in/itute h conduct$ important rese>* into ! causes ( & treatm5ts = acquir$ bone m>r[ failure diseases4 7#g7 ,! ,national ,m>r[ ,donor ,program ,regi/ry has made significant contributions to ! fight aga9/ bone m>r[ failure diseases by connect+ millions ( pot5tial m>r[ donors ) individuals & families suff]+ f ^! conditions4 7#h7 ,despite ^! advances1 a m compreh5sive ,f$]al /rategic ef=t among num]\s ,f$]al ag5cies is ne$$ to discov] a cure = acquir$ bone m>r[ failure disord]s4 7#i7 ,great] ,f$]al surveillance ( acquir$ bone m>r[ failure diseases is ne$$ to ga9 a bett] und]/&+ ( ! causes ( acquir$ bone m>r[ failure diseases4 7#aj7 ,! ,f$]al ,gov]nm5t %\ld increase its rese>* support = & engage ) public & private organizations 9 develop+ a compreh5sive approa* to combat & cure acquir$ bone m>r[ failure diseases4 7c7 ,national ,acquir$ ,bone ,m>r[ ,failure ,disease ,regi/ry ,title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bda et seq47 is am5d$ by ins]t+ aft] section #cag,v 7z add$ by section #aaj7 ! foll[+3 #cag,w4 ,national ,acquir$ ,bone ,m>r[ ,failure ,disease ,regi/ry 7a7 ,e/abli%m5t ( regi/ry 7#a7 ,9 g5]al ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is section1 ! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all-- 7,a7 develop a sy/em to collect data on acquir$ bone m>r[ failure diseases2 & 7,b7 e/abli% & ma9ta9 a national & publicly available regi/ry1 to be kn[n z ! ,national ,acquir$ ,bone ,m>r[ ,failure ,disease ,regi/ry1 9 accordance ) p>agraph 7#c74 7#b7 ,recomm5dations ( advisory committee ,9 c>ry+ out ?is subsection1 ! ,secret>y %all take into consid]ation ! recomm5dations ( ! ,advisory ,committee on ,acquir$ ,bone ,m>r[ ,failure ,diseases e/abli%$ "u subsection 7b74 7#c7 ,purposes ( regi/ry ,! ,national ,acquir$ ,bone ,m>r[ ,failure ,disease ,regi/ry %all-- 7,a7 id5tify ! incid5ce & preval5ce ( acquir$ bone m>r[ failure diseases 9 ! ,unit$ ,/ates2 7,b7 be us$ to collect & /ore data on acquir$ bone m>r[ failure diseases1 includ+ data conc]n+-- 7i7 ! age1 race or e?nicity1 g5]al geographic location1 sex1 & family hi/ory ( individuals :o are diagnos$ ) acquir$ bone m>r[ failure diseases1 & any o!r *>act]i/ics ( su* individuals det]m9$ appropriate by ! ,secret>y2 7ii7 ! g5etic & environm5tal factors t may be associat$ ) develop+ acquir$ bone m>r[ failure diseases2 7iii7 treatm5t approa*es = deal+ ) acquir$ bone m>r[ failure diseases2 7iv7 outcomes = individuals treat$ = acquir$ bone m>r[ failure diseases1 includ+ outcomes = recipi5ts ( /em cell !rapeutic products z conta9$ 9 ! database e/abli%$ pursuant to section #cgi;,a2 & 7v7 any o!r factors p]ta9+ to acquir$ bone m>r[ failure diseases det]m9$ appropriate by ! ,secret>y2 & 7,c7 be made available-- 7i7 to ! g5]al public2 & 7ii7 to rese>*]s to facilitate fur!r rese>* into ! causes (1 & treatm5ts =1 acquir$ bone m>r[ failure diseases 9 accordance ) /&>d practices ( ! ,c5t]s = ,disease ,control & ,prev5tion4 7b7 ,advisory committee 7#a7 ,e/abli%m5t ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is section1 ! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all e/abli% an advisory committee1 to be kn[n z ! ,advisory ,committee on ,acquir$ ,bone ,m>r[ ,failure ,diseases4 7#b7 ,memb]s ,! memb]s ( ! ,advisory ,committee on ,acquir$ ,bone ,m>r[ ,failure ,diseases %all be appo9t$ by ! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 & %all include at lea/ "o repres5tative f ea* ( ! foll[+3 7,a7 ,a national pati5t advocacy organization ) exp]i5ce advocat+ on behalf ( pati5ts suff]+ f acquir$ bone m>r[ failure diseases4 7,b7 ,! ,national ,in/itutes ( ,heal?1 includ+ at lea/ "o repres5tative f ea* (-- 7i7 ! ,national ,canc] ,in/itute2 7ii7 ! ,national ,he>t1 ,lung1 & ,blood ,in/itute2 & 7iii7 ! ,(fice ( ,r>e ,diseases4 7,c7 ,! ,c5t]s = ,disease ,control & ,prev5tion4 7,d7 ,cl9icians ) exp]i5ce 9-- 7i7 diagnos+ or treat+ acquir$ bone m>r[ failure diseases2 or 7ii7 m$ical data regi/ries4 7,e7 ,epidemiologi/s :o h exp]i5ce ) data regi/ries4 7,f7 ,publicly or privately fund$ rese>*]s :o h exp]i5ce rese>*+ acquir$ bone m>r[ failure diseases4 7,g7 ,! entity op]at+ ! ,c4,w4 ,bill ,"y ,cell ,transplantation ,program e/abli%$ pursuant to section #cgi & ! entity op]at+ ! ,c4,w4 ,bill ,"y ,cell ,transplantation ,program ,outcomes ,database4 7#c7 ,responsibilities ,! ,advisory ,committee on ,acquir$ ,bone ,m>r[ ,failure ,diseases %all provide recomm5dations to ! ,secret>y on ! e/abli%m5t & ma9t5ance ( ! ,national ,acquir$ ,bone ,m>r[ ,failure ,disease ,regi/ry1 includ+ recomm5dations on ! collection1 ma9t5ance1 & dissem9ation ( data4 7#d7 ,public availability ,! ,secret>y %all make ! recomm5dations ( ! ,advisory ,committee on ,acquir$ ,bone ,m>r[ ,failure ,disease publicly available4 7c7 ,grants ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 may aw>d grants to1 & ent] into contracts & coop]ative agreem5ts )1 public or private nonpr(it entities = ! managem5t (1 z well z ! collection1 analysis1 & report+ ( data to be includ$ 91 ! ,national ,acquir$ ,bone ,m>r[ ,failure ,disease ,regi/ry4 7d7 ,def9ition ,9 ?is section1 ! t]m acquir$ bone m>r[ failure disease means-- 7#a7 myelodyspla/ic syndromes2 7#b7 apla/ic anemia2 7#c7 p>oxysmal nocturnal hemoglob9uria2 7#d7 pure r$ cell aplasia2 7#e7 acute myeloid leukemia t has progress$ f myelodyspla/ic syndromes2 or 7#f7 l>ge granul> lymphocytic leukemia4 7e7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #c1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 4 7d7 ,pilot /udies ?r\gh ! ag5cy = toxic sub/ances & disease regi/ry 7#a7 ,pilot /udies ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,ag5cy = ,toxic ,sub/ances & ,disease ,regi/ry1 %all conduct pilot /udies to det]m9e :i* environm5tal factors1 includ+ exposure to tox9s1 may cause acquir$ bone m>r[ failure diseases4 7#b7 ,collaboration ) ! ,radiation ,injury ,treatm5t ,network ,9 c>ry+ out ! directives ( ?is section1 ! ,secret>y may collaborate ) ! ,radiation ,injury ,treatm5t ,network ( ! ,c4,w4 ,bill ,"y ,cell ,transplantation ,program e/abli%$ pursuant to section #cgi ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bgdk7 to-- 7,a7 augm5t data = ! pilot /udies au?oriz$ by ?is section2 7,b7 access te*nical assi/ance t may be provid$ by ! ,radiation ,injury ,treatm5t ,network2 or 7,c7 p]=m jo9t rese>* projects4 7#c7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #a1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 7e7 ,m9ority-,focus$ programs on acquir$ bone m>r[ failure diseases ,title ,,xvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju et seq47 is am5d$ by ins]t+ aft] section #agjg;,a ! foll[+3 #agjg;,b4 ,m9ority-focus$ programs on acquir$ bone m>r[ failure disease 7a7 ,in=mation & ref]ral s]vices 7#a7 ,9 g5]al ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is section1 ! ,secret>y1 act+ ?r\gh ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 %all e/abli% & coord9ate outrea* & in=mational programs t>get$ to m9ority populations affect$ by acquir$ bone m>r[ failure diseases4 7#b7 ,program requirem5ts ,m9ority-focus$ outrea* & in=mational programs au?oriz$ by ?is section at ! ,national ,m9ority ,heal? ,res\rce ,c5t] support$ "u section #agjg7;b77#h7 7includ+ by means ( ! ,c5t]'s website1 ?r\gh appropriate locations su* z ! ,c5t]'s k c5t]1 & ?r\gh appropriate programs su* z ! ,c5t]'s res\rce p]sons network7 & ?r\gh m9ority heal? consultants locat$ at ea* ,dep>tm5t ( ,heal? & ,human ,s]vices regional (fice-- 7,a7 %all make in=mation ab\t treatm5t options & cl9ical trials = acquir$ bone m>r[ failure diseases publicly available2 & 7,b7 %all provide ref]ral s]vices = treatm5t options & cl9ical trials4 7b7 ,hispanic & ,asian-,am]ican & pacific isl&] outrea* 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 %all und]take a coord9at$ outrea* ef=t to connect ,hispanic1 ,asian-,am]ican1 & ,pacific ,isl&] communities ) compreh5sive s]vices focus$ on treatm5t (1 & in=mation ab\t1 acquir$ bone m>r[ failure diseases4 7#b7 ,collaboration ,9 c>ry+ out ?is subsection1 ! ,secret>y may collaborate ) public heal? ag5cies1 nonpr(it organizations1 community gr\ps1 & onl9e entities to dissem9ate in=mation ab\t treatm5t options & cl9ical trials = acquir$ bone m>r[ failure diseases4 7c7 ,grants & coop]ative agreem5ts 7#a7 ,9 g5]al ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is section1 ! ,secret>y1 act+ ?r\gh ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 %all aw>d grants to1 or ent] into coop]ative agreem5ts )1 entities to p]=m rese>* on acquir$ bone m>r[ failure diseases4 7#b7 ,requirem5t ,grants & coop]ative agreem5ts au?oriz$ by ?is subsection %all be aw>d$ or ent]$ into on a competitive1 pe]-review$ basis4 7#c7 ,scope ( rese>* ,rese>* fund$ "u ?is section %all exam9e factors affect+ ! incid5ce ( acquir$ bone m>r[ failure diseases 9 m9ority populations4 7d7 ,def9ition ,9 ?is section1 ! t]m acquir$ bone m>r[ failure disease has ! mean+ giv5 to su* t]m 9 section #cag,w7d74 7e7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #b1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 4 7f7 ,diagnosis & quality ( c>e = acquir$ bone m>r[ failure diseases 7#a7 ,grants ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 %all aw>d grants to entities to improve diagno/ic practices & quality ( c>e ) respect to pati5ts ) acquir$ bone m>r[ failure diseases4 7#b7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #b1jjj1jjj = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 7g7 ,def9ition ,9 ?is section1 ! t]m acquir$ bone m>r[ failure disease has ! mean+ giv5 su* t]m 9 section #cag,w7d7 ( ! ,public ,heal? ,s]vice ,act1 z add$ by subsection 7c74 ,d ,c>diovascul> ,disease1 ,*ronic ,disease1 ,obesity1 & ,o!r ,disease ,issues #gca4 ,guidel9es = disease scre5+ = m9ority pati5ts 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 %all conv5e a s]ies ( meet+s to develop guidel9es = disease scre5+ = m9ority pati5t populations t h a high] ?an av]age risk = _m *ronic diseases & canc]s4 7b7 ,p>ticipants ,9 conv5+ meet+s "u subsection 7a71 ! ,secret>y %all ensure t meet+ p>ticipants include repres5tatives (-- 7#a7 pr(essional societies & associations2 7#b7 m9ority heal? organizations2 7#c7 heal? c>e rese>*]s & provid]s1 includ+ ^? ) exp]tise 9 m9ority heal?2 7#d7 ,f$]al heal? ag5cies1 includ+ ! ,(fice ( ,m9ority ,heal?1 ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities1 & ! ,national ,in/itutes ( ,heal?2 & 7#e7 o!r exp]ts z ! ,secret>y det]m9es appropriate4 7c7 ,diseases ,scre5+ guidel9es = m9ority populations %all be develop$ z appropriate "u subsection 7a7 =-- 7#a7 hyp]t5sion2 7#b7 hyp]*ole/]olemia2 7#c7 diabetes2 7#d7 c>diovascul> disease2 7#e7 canc]s1 includ+ brea/1 pro/ate1 colon1 c]vical1 & lung canc]2 7#f7 o!r pulmon>y problems includ+ sleep apnea2 7#g7 a/hma2 7#h7 kidney diseases2 7#i7 eye diseases & disord]s1 includ+ glaucoma2 7#aj7 ,,hiv_/,,aids & sexually transmitt$ infections2 7#aa7 ut]9e fibroids2 7#ab7 autoimmune disease2 7#ac7 m5tal heal? conditions2 7#ad7 d5tal heal? conditions & oral diseases1 includ+ oral canc]2 7#ae7 environm5tal & relat$ heal? illnesses & conditions2 7#af7 sickle cell disease & sickle cell trait2 7#ag7 viol5ce & injury prev5tion & control2 7#ah7 g5etic & relat$ conditions2 7#ai7 he>t disease & /roke2 7#bj7 tub]culosis2 7#ba7 *ronic ob/ructive pulmon>y disease2 7#bb7 musculoskeletal diseases1 ar?ritis1 & obesity2 & 7#bc7 o!r diseases det]m9$ appropriate by ! ,secret>y4 7d7 ,dissem9ation ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all publi% & dissem9ate to heal? c>e provid] organizations ! guidel9es develop$ "u subsection 7a74 7e7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #gcb4 ,,cdc ,wisewoman ,scre5+ ,program ,section #aeji ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjjn-#d;a7 is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 by /rik+ ! head+ & ins]t+ ,9 ,g5]al4--2 & 7,b7 9 ! matt] prec$+ p>agraph 7#a71 by /rik+ may make grants & all t foll[s ?r\gh purpose & ins]t+ ! foll[+3 may make grants to su* ,/ates = ! purpose2 & 7#b7 9 subsection 7d77#a71 by /rik+ !re are au?oriz$ & all t foll[s ?r\gh ! p]iod & ins]t+ !re are au?oriz$ to be appropriat$ #bc1jjj1jjj = fiscal ye> #bjba1 #be1cjj1jjj = fiscal ye> #bjbb1 #bg1hjj1jjj = fiscal ye> #bjbc1 #cj1hjj1jjj = fiscal ye> #bjbd1 & #cd1jjj1jjj = fiscal ye> #bjbe44 #gcc4 ,report on c>diovascul> c>e = wom5 & m9orities ,"p ,p ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhj;g et seq471 z am5d$ by section #eca1 is fur!r am5d$ by add+ at ! end ! foll[+3 #cii,v-#i4 ,report on c>diovascul> c>e = wom5 & m9orities ,n lat] ?an ,septemb] #cj1 #bjba1 & annually !reaft]1 ! ,secret>y %all prep>e & submit to ,congress a report on ! quality ( & access to c>e = wom5 & m9orities ) he>t disease1 /roke1 & o!r c>diovascul> diseases4 ,! report %all conta9 recomm5dations = elim9at+ disp>ities 91 & improv+ ! treatm5t (1 he>t disease1 /roke1 & o!r c>diovascul> diseases 9 wom51 racial & e?nic m9orities1 ^? = :om ,engli% is n _! prim>y language1 & individuals ) disabilities4 4 #gcd4 ,cov]age ( compreh5sive tobacco cessation s]vices 9 ,m$icaid & private heal? insurance 7a7 ,requir+ ,m$icaid cov]age ( c\nsel+ & ph>maco!rapy = cessation ( tobacco use ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is am5d$-- 7#a7 9 subsection 7a77#d77;,d71 by /rik+ by pregnant wom52 & 7#b7 9 subsection 7bb7-- 7,a7 by /rik+ by pregnant wom5 ea* place x appe>s2 7,b7 9 p>agraph 7#a71 9 ! matt] be=e subp>agraph 7,a71 by ins]t+ by individuals be=e :o use tobacco2 & 7,c7 9 p>agraph 7#b77;,a71 by /rik+ ) respect to pregnant wom54 7b7 ,exception f optional re/riction "u ,m$icaid prescription drug cov]age ,section #aibg7;d77#b77;,f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7;d77#b77;,f77 is am5d$-- 7#a7 by /rik+ 1 9 ! case ( pregnant wom52 & 7#b7 by /rik+ "u ! ov]-!-c\nt] monograph process4 7c7 ,/ate monitor+ & promot+ ( compreh5sive tobacco cessation s]vices "u ,m$icaid ,section #aijb7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a771 z am5d$ by section #dcc7;d77#b77;,a71 is am5d$-- 7#a7 by /rik+ & at ! end ( p>agraph 7#hf72 7#b7 by /rik+ ! p]iod at ! end ( p>agraph 7#hg7 & ins]t+ 2 &2 & 7#c7 by ins]t+ aft] p>agraph 7#hg7 ! foll[+ new p>agraph3 7#hh7 provide = ! ,/ate to monitor & promote ! use ( compreh5sive tobacco cessation s]vices "u ! ,/ate plan1 includ+ conduct+ an outrea* campaign to increase aw>5ess (1 & ! b5efits ( us+1 su* s]vices among-- 7,a7 individuals entitl$ to m$ical assi/ance "u ! ,/ate plan :o use tobacco products2 & 7,b7 cl9icians & o!rs :o provide s]vices to individuals entitl$ to m$ical assi/ance "u ! ,/ate plan4 4 7d7 ,f$]al reimbursem5t = m$icaid outrea* campaign ,to increase aw>5ess ,section #aijc7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77 is am5d$-- 7#a7 by /rik+ ! p]iod at ! end ( p>agraph 7#g7 & ins]t+ 2 plus2 & 7#b7 by ins]t+ aft] p>agraph 7#g7 ! foll[+ new p>agraph3 7#h7 an am\nt equal to #ij p]c5t ( ! sums exp5d$ dur+ ea* qu>t] :i* are attributable to ! developm5t1 implem5tation1 & evaluation ( an outrea* campaign to-- 7,a7 increase aw>5ess ( compreh5sive tobacco cessation s]vices cov]$ 9 ! ,/ate plan among-- 7i7 individuals :o are likely to be eligible = m$ical assi/ance "u ! ,/ate plan2 & 7ii7 cl9icians & o!rs :o provide s]vices to individuals :o are likely to be eligible = m$ical assi/ance "u ! ,/ate plan2 & 7,b7 increase aw>5ess ( ! b5efits ( us+ compreh5sive tobacco cessation s]vices cov]$ 9 ! ,/ate plan among-- 7i7 individuals :o are likely to be eligible = m$ical assi/ance "u ! ,/ate plan2 & 7ii7 cl9icians & o!rs :o provide s]vices to individuals :o are likely to be eligible = m$ical assi/ance "u ! ,/ate plan ab\t ! b5efits ( us+ compreh5sive tobacco cessation s]vices4 4 7e7 ,removal ( co/ %>+ = c\nsel+ & ph>maco!rapy = cessation ( tobacco use "u ,m$icaid 7#a7 ,g5]al co/ %>+ limitations ,section #aiaf ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifo7 is am5d$-- 7,a7 9 subsections 7a77#b77;,b7 & 7b77#b77;,b71 by /rik+ & c\nsel+ & ph>maco!rapy = cessation ( tobacco use by pregnant wom5 7z def9$ 9 section #aije7;bb77 & cov]$ outpati5t drugs 7z def9$ 9 subsection 7k77#b7 ( section #aibg & includ+ nonprescription drugs describ$ 9 subsection 7d77#b7 ( su* section7 t are prescrib$ = purposes ( promot+1 & :5 us$ to promote1 tobacco cessation by pregnant wom5 9 accordance ) ! ,guidel9e ref]r$ to 9 section #aije7;bb77#b77;,a7 ea* place x appe>s2 & 7,b7 9 ea* ( subsections 7a77#b77;,b7 & 7b77#b77;,b7 by ins]t+ & c\nsel+ & ph>maco!rapy = cessation ( tobacco use 7z def9$ 9 section #aije;d7bb77 & cov]$ outpati5t drugs 7z def9$ 9 subsection 7k77#b7 ( section #aibg & includ+ nonprescription drugs describ$ 9 subsection 7d77#b7 ( su* section7 t are prescrib$ = purposes ( promot+1 & :5 us$ to promote1 tobacco cessation 9 accordance ) ! ,guidel9e ref]r$ to 9 section #aije7;bb77#b77;,a7 aft] 7or at ! option ( ! ,/ate1 any s]vices furni%$ to pregnant wom54 7#b7 ,application to alt]native co/ %>+ ,section #aiaf;,a7b77#c77;,b7 ( su* ,act 7#db ,u4,s4,c4 #acifo-#a7;b77#c77;,b77 is am5d$-- 7,a7 9 clause 7iii71 by /rik+ 1 & c\nsel+ & ph>maco!rapy = cessation ( tobacco use by pregnant wom5 7z def9$ 9 section #aije7;bb772 & 7,b7 by add+ at ! end ! foll[+3 7xii7 ,c\nsel+ & ph>maco!rapy = cessation ( tobacco use 7z def9$ 9 section #aije7;bb77 & cov]$ outpati5t drugs 7z def9$ 9 subsection 7k77#b7 ( section #aibg & includ+ nonprescription drugs describ$ 9 subsection 7d77#b7 ( su* section7 t are prescrib$ = purposes ( promot+1 & :5 us$ to promote1 tobacco cessation 9 accordance ) ! ,guidel9e ref]r$ to 9 section #aije7;bb77#b77;,a74 4 7f7 ,no prior au?orization = tobacco cessation drugs "u m$icaid ,section #aibg7;d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7 is am5d$-- 7#a7 by /rik+ 9 p>agraph 7#a77;,a7 ,a ,/ate & ins]t+ ,except z o!rwise provid$ 9 p>agraph 7#f71 a ,/ate2 7#b7 by r$esignat+ p>agraphs 7#f7 & 7#g7 z p>agraphs 7#g7 & 7#h71 respectively2 & 7#c7 by ins]t+ aft] p>agraph 7#e7 ! foll[+3 7#f7 ,no prior au?orization programs = tobacco cessation drugs ,a ,/ate plan "u ?is title %all n require1 z a condition ( cov]age or paym5t = a cov]$ outpati5t drug = :i* ,f$]al f9ancial p>ticipation is available 9 accordance ) ?is section1 ! approval ( an ag5t :5 us$ to promote smok+ cessation1 includ+ ag5ts approv$ by ! ,food & ,drug ,adm9i/ration = ! purposes ( promot+1 & :5 us$ to promote1 tobacco cessation4 4 7g7 ,compreh5sive cov]age ( tobacco cessation cov]age 9 private heal? insurance ,section #bgac ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ac7 is am5d$ by add+ at ! end ! foll[+3 7d7 ,no prior au?orization ,a gr\p heal? plan & a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all n impose any prior au?orization requirem5t = tobacco cessation c\nsel+ & ph>maco!rapy t has 9 effect a rat+ ( ,a or ,b 9 ! curr5t recomm5dations ( ! ,unit$ ,/ates ,prev5tive ,s]vices ,task ,=ce4 4 7h7 ,effective date ,! am5dm5ts made by ?is section %all apply to items & s]vices furni%$ on or aft] ,janu>y #a1 #bjba4 #gce4 ,cl9ical rese>* fund+ = oral heal? 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices %all exp& & int5sify ! conduct & support ( ! rese>* activities ( ! ,national ,in/itutes ( ,heal? & ! ,national ,in/itute ( ,d5tal & ,crani(acial ,rese>* to improve ! oral heal? ( ! population ?r\gh ! prev5tion & managem5t ( oral diseases & conditions4 7b7 ,includ$ rese>* activities ,rese>* activities "u subsection 7a7 %all include-- 7#a7 comp>ative effectiv5ess rese>* & cl9ical disease managem5t rese>* address+ e>ly *ildhood c>ies & oral canc]2 & 7#b7 aw>d+ ( grants & contracts to support ! tra9+ & developm5t ( heal? s]vices rese>*]s1 comp>ative effectiv5ess rese>*]s1 & cl9ical rese>*]s ^: rese>* improves ! oral heal? ( ! population4 #gcf4 ,p>ticipation by ,m$icaid b5efici>ies 9 approv$ cl9ical trials 7a7 ,9 g5]al ,title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #aidg4 ,p>ticipation 9 an approv$ cl9ical trial 7a7 ,cov]age ( r\t9e pati5t co/s associat$ ) approv$ cl9ical trials 7#a7 ,inclusion ,subject to p>agraph 7#b71 r\t9e pati5t co/s %all include all items & s]vices consi/5t ) ! m$ical assi/ance provid$ "u ! ,/ate plan t w\ld o!rwise be provid$ to ! individual "u su* ,/ate plan if su* individual 0 n enroll$ 9 an approv$ cl9ical trial1 includ+ any items or s]vices relat$ to ! prev5tion1 detection1 & treatm5t ( any m$ical complications t arise z a result ( p>ticipation 9 ! approv$ cl9ical trial4 7#b7 ,exclusion ,= purposes ( p>agraph 7#a71 r\t9e pati5t co/s does n include-- 7,a7 ! inve/igational item1 device1 or s]vice itself2 7,b7 items & s]vices t are provid$ solely to satisfy data collection & analysis ne$s & t are n us$ 9 ! direct cl9ical managem5t ( ! pati5t2 or 7,c7 a s]vice t is cle>ly inconsi/5t ) widely accept$ & e/abli%$ /&>ds ( c>e = a p>ticul> diagnosis4 7#c7 ,in=mation conc]n+ cl9ical trials 7,a7 ,9 g5]al ,subject to subp>agraph 7,b71 ! ,secret>y1 9 consultation ) relevant /akehold]s1 %all develop a s+le /&>diz$ electronic =m = use by ! individual or ! ref]r+ heal? c>e provid] to submit to ! ,/ate ag5cy adm9i/]+ ! ,/ate plan 9 ord] to v]ify t ! cl9ical trial meets ! conditions e/abli%$ = an approv$ cl9ical trial 7z def9$ 9 subsection 7c774 7,b7 ,exclud$ in=mation ,= purposes ( subp>agraph 7,a7 or any su* reque/ by ! ,/ate ag5cy = in=mation reg>d+ a cl9ical trial1 an individual or ref]r+ heal? c>e provid] %all n be requir$ to submit-- 7i7 ! cl9ical protocol docum5t = ! cl9ical trial2 or 7ii7 subject to subp>agraph 7,c71 any additional in=mation o!r ?an su* in=mation z is requir$ pursuant to ! =m describ$ 9 subp>agraph 7,a74 7,c7 ,optional in=mation ,= purposes ( subp>agraphs 7,a7 & 7,b77ii71 ! =m may include a requirem5t t ! ref]r+ heal? c>e provid] atte/ t ! individual is eligible to p>ticipate 9 ! cl9ical trial pursuant to ! trial protocol & t individual p>ticipation 9 su* trial w\ld be appropriate4 7,d7 ,review ( in=mation 7i7 ,9 g5]al ,a ,/ate plan "u ?is title %all e/abli% a process = timely review by ! ,/ate ag5cy ( ! =m & in=mation submitt$ pursuant to subp>agraph 7,a7 &1 n lat] ?an #dh h\rs aft] receipt ( su* =m1 confirmation t ! in=mation provid$ 9 su* =m satisfies ! requirem5ts e/abli%$ "u su* subp>agraph1 ) su* process to include e/abli%m5t & op]ation ( a #bd-;h\r1 toll-free telephone numb] & email address to provide = exp$it$ communication4 7ii7 ,failure to respond ,if an individual or ! ref]r+ heal? c>e provid] does n receive a response or reque/ = additional in=mation f ! ,/ate ag5cy foll[+ ! #dh-;h\r p]iod describ$ 9 clause 7i71 ! in=mation provid$ 9 ! =m may be presum$ to satisfy ! requirem5ts e/abli%$ "u ?is p>agraph4 7b7 ,enc\ragem5t ( p>ticipation 9 approv$ cl9ical trials 7#a7 ,reasonably accessible provid] ,= purposes ( p>ticipation 9 an approv$ cl9ical trial by an individual eligible = m$ical assi/ance "u ?is title1 ! ,/ate ag5cy adm9i/]+ ! ,/ate plan %all make reasonable ef=ts to ensure t ! individual is provid$ ) access to a provid] :o is-- 7,a7 p>ticipat+ 9 ! approv$ cl9ical trial2 7,b7 locat$ n m ?an #be miles f ! resid5ce ( ! individual 7or1 if no su* provid] is available1 z close z possible to ! resid5ce ( ! individual72 & 7,c7 a p>ticipat+ provid] "u ! ,/ate plan or has be5 deem$ to be a p>ticipat+ provid] "u ! ,/ate plan = purposes ( provid+ m$ical assi/ance to ! individual dur+ _! p>ticipation 9 ! approv$ cl9ical trial4 7#b7 ,in=mational mat]ials ,! ,/ate ag5cy adm9i/]+ ! plan approv$ "u ?is title %all develop in=mational mat]ials & programs to enc\rage p>ticipat+ provid]s to make appropriate ref]rals to physicians & o!r appropriate heal? c>e pr(essionals :o c provide individuals ) access to approv$ cl9ical trials4 7c7 ,def9ition ( approv$ cl9ical trial ,! t]m approv$ cl9ical trial has ! same mean+ z provid$ "u subsection 7d7 ( ! section #bgji ( ! ,public ,heal? ,s]vice ,act t relates to cov]age = individuals p>ticipat+ 9 approv$ cl9ical trials4 4 7b7 ,con=m+ am5dm5t ,section #aijb7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a771 z am5d$ by section #gcd7;c71 is am5d$-- 7#a7 by /rik+ & at ! end ( p>agraph 7#hg72 7#b7 by /rik+ ! p]iod at ! end ( p>agraph 7#hh7 & ins]t+ 2 &2 & 7#c7 by ins]t+ aft] p>agraph 7#hh7 ! foll[+ new p>agraph3 7#hi7 provide t p>ticipation 9 an approv$ cl9ical trial & cov]age ( r\t9e pati5t co/s associat$ ) su* trial = an individual eligible = m$ical assi/ance "u ?is title is conduct$ 9 accordance ) ! requirem5ts "u section #aidg4 4 7c7 ,effective date 7#a7 ,9 g5]al ,except z provid$ 9 p>agraph 7#b71 ! am5dm5ts made by ?is section %all apply to cal5d> qu>t]s beg9n+ on or aft] ,octob] #a1 #bjba4 7#b7 ,delay p]mitt$ = /ate plan am5dm5t ,9 ! case ( a ,/ate plan = m$ical assi/ance "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 :i* ! ,secret>y ( ,heal? & ,human ,s]vices det]m9es requires ,/ate legislation 7o!r ?an legislation appropriat+ funds7 9 ord] = ! plan to meet ! additional requirem5ts impos$ by ! am5dm5ts made by ?is section1 ! ,/ate plan %all n be reg>d$ z fail+ to comply ) ! requirem5ts ( su* title solely on ! basis ( its failure to meet ^! additional requirem5ts be=e ! fir/ day ( ! fir/ cal5d> qu>t] beg9n+ aft] ! close ( ! fir/ regul> session ( ! ,/ate legislature t beg9s aft] ! date ( enactm5t ( ?is ,act4 ,= purposes ( ! previ\s s5t5ce1 9 ! case ( a ,/ate t has a #b-ye> legislative session1 ea* ye> ( su* session %all be deem$ to be a sep>ate regul> session ( ! ,/ate legislature4 #gcg4 ,guide on evid5ce-bas$ /rategies = public heal? dep>tm5t obesity prev5tion programs 7a7 ,developm5t & dissem9ation ( an evid5ce-,bas$ /rategies guide ,! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is section z ! ,secret>y71 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 %all-- 7#a7 develop a guide on evid5ce-bas$ /rategies = ,/ate1 t]ritorial1 & local heal? dep>tm5ts to use to build & ma9ta9 effective obesity prev5tion & r$uction programs1 &1 9 consultation ) /akehold]s t h exp]tise 9 ,tribal heal?1 a guide on su* evid5ce-bas$ /rategies ) respect to ,indian ,tribes & ,tribal organizations = su* ,indian ,tribes & ,tribal organizations to use = su* purpose1 bo? ( :i* guides %all-- 7,a7 describe an integrat$ program /ructure = implem5t+ int]v5tions prov5 to be effective 9 prev5t+ & r$uc+ ! incid5ce ( obesity2 & 7,b7 recomm5d-- 7i7 optimal res\rces1 includ+ /aff+ & infra/ructure1 = promot+ nutrition & obesity prev5tion & r$uction2 & 7ii7 /rategies = effective obesity prev5tion programs = ,/ate & local heal? dep>tm5ts1 ,indian ,tribes1 & ,tribal organizations1 includ+ /rategies relat$ to-- 7,i7 ! application ( evid5ce-bas$ & evid5ce-in=m$ practices to prev5t & r$uce obesity rates2 7,,ii7 ! developm5t1 implem5tation1 & evaluation ( obesity prev5tion & r$uction /rategies = specific communities & populations2 7,,iii7 demon/rat$ k ( obesity prev5tion practices t r$uce associat$ prev5table diseases1 heal? conditions1 dea?1 & heal? c>e co/s2 7,,iv7 be/ practices = ! coord9ation ( ef=ts to prev5t & r$uce obesity & relat$ *ronic diseases2 7,v7 address+ ! und]ly+ risk factors & social det]m9ants ( heal? t impact obesity rates2 & 7,,vi7 int]discipl9>y coord9ation betwe5 relevant public heal? (ficials specializ+ 9 fields su* z nutrition1 physical activity1 epidemiology1 communications1 & policy implem5tation1 & collaboration betwe5 public heal? (ficials & community-bas$ organizations2 & 7#b7 dissem9ate ! guides & curr5t rese>*1 evid5ce-bas$ practices1 tools1 & educational mat]ials relat$ to obesity prev5tion1 consi/5t ) ! guides1 to ,/ate & local heal? dep>tm5ts1 ,indian ,tribes1 & ,tribal organizations4 7b7 ,te*nical assi/ance ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all provide te*nical assi/ance to ,/ate & local heal? dep>tm5ts1 ,indian ,tribes1 & ,tribal organizations to support su* heal? dep>tm5ts 9 implem5t+ ! guides develop$ "u subsection 7a77#a74 7c7 ,indian ,tribes2 ,tribal organizations ,9 ?is section1 ! t]ms ,indian ,tribe & ,tribal organization h ! mean+s giv5 ! t]ms ,indian tribe & tribal organization1 respectively1 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #ecjd74 ,e ,,hiv_/,,aids #gda4 ,/atem5t ( policy ,x is ! policy ( ! ,unit$ ,/ates to a*ieve an ,,aids-free g5]ation1 & to-- 7#a7 exp& access to lifesav+ antiretroviral !rapy = p liv+ ) ,,hiv & imm$iately l9k p to cont9u\s & coord9at$ high-quality c>e :5 !y le>n !y are liv+ ) ,,hiv2 7#b7 exp& t>get$ ef=ts to prev5t ,,hiv infection us+ a comb9ation ( effective1 evid5ce-bas$ approa*es1 includ+ r\t9e ,,hiv scre5+1 & univ]sal access to ,,hiv prev5tion tools 9 communities disproportionately impact$ by ,,hiv1 p>ticul>ly communities ( color2 7#c7 ensure laws1 policies1 & regulations d n imp$e access to prev5tion1 treatm5t1 & c>e = p liv+ ) ,,hiv or disproportionately impact$ by ,,hiv2 7#d7 accel]ate rese>* = m efficaci\s ,,hiv prev5tion & treatm5ts tools1 a cure1 & a vacc9e2 & 7#e7 respect ! human rights & dignity ( p]sons liv+ ) ,,hiv4 #gdb4 ,f9d+s ,! ,congress f9ds ! foll[+3 7#a7 ,ov] #a1ajj1jjj p are e/imat$ to be liv+ ) ,,hiv 9 ! ,unit$ ,/ates accord+ to ! ,c5t]s = ,disease ,control & ,prev5tion1 #ad p]c5t ( :om are unaw>e !y are liv+ ) ,,hiv4 7#b7 ,annually !re are ab\t #cg1fjj new ,,hiv infections & #ae1hjj dea?s 9 p ) an ,,hiv diagnosis 9 #ej ,/ates & #f dep5d5t areas ( ! ,unit$ ,/ates4 7#c7 ,! ,c5t]s = ,disease ,control & ,prev5tion e/imates t1 9 #bjag1 !re 7 approximately #ch1gjj p newly diagnos$ ) ,,hiv4 ,! e/imat$ numb] ( annual new ,,hiv infections decl9$ #i p]c5t f #bjaj to #bjaf4 ,h[ev]1 ! numb] ( new infections is increas+ among c]ta9 populations1 su* z ,lat9o gay & bisexual m51 :]e annual infections increase #ba p]c5t4 7#d7 ,,hiv disproportionately affects c]ta9 populations 9 ! ,unit$ ,/ates4 ,?\gh ,african ,am]icans repres5t approximately #ab p]c5t ( ! population1 ,african ,am]icans acc\nt = almo/ half 7#db p]c5t7 ( all p liv+ ) ,,hiv 9 ! ,unit$ ,/ates4 ,african-,am]ican m5 :o h sex ) m5 acc\nt = #bf p]c5t ( all new ,,hiv infections & h rema9$ /able f #bjaj to #bjaf4 7#e7 ,disp>ities cont9ue to exi/ among ,lat9os & ,hispanics2 9 #bjag1 ,lat9os & ,hispanics made up #ah p]c5t ( ! ,unit$ ,/ates population & #bf p]c5t ( new infections4 7#f7 ,?\gh ! rate ( new infections among ,am]ican ,indians & ,alaska ,natives 7ref]r$ to 9 ?is section z ,,ai_/,,an7 is proportional to _! population size1 f #bjaj to #bjaf1 ! annual numb] ( ,,hiv diagnoses increas$ #df p]c5t among ,,ai_/,,an ov]all & #ha p]c5t among ,,ai_/,,an gay & bisexual m54 7#g7 ,asian ,am]icans acc\nt = ab\t #b p]c5t ( new ,,hiv infections1 b 9 #bjac1 #bb p]c5t 7 undiagnos$1 ! highe/ rate ( undiagnos$ ,,hiv among any race or e?nicity4 ,betwe5 #bjaj & #bjaf1 ! numb] ( ,asians receiv+ an ,,hiv diagnosis increas$ by #db p]c5t4 7#h7 ,! late/ data f ! ,c5t]s = ,disease ,control & ,prev5tion indicates t new infections among wom5 decl9$ #ba p]c5t betwe5 #bjaj & #bjaf4 7#i7 ,! hi/ory ( ,,hiv %[s t culturally relevant & g5d]-responsive supportive s]vices1 includ+ psy*osocial support1 treatm5t lit]acy1 case managem5t1 & transportation are necess>y /rategies to rea* & engage wom5 & girls 9 m$ical c>e4 7#aj7 ,among ! #c1jjj1jjj ,,hiv te/+ ev5ts report$ to ! ,c5t]s = ,disease ,control & ,prev5tion 9 #bjag1 ! p]c5tage ( transg5d] p :o receiv$ a new ,,hiv diagnosis 0 #c times ! national av]age4 ,a #bjai sy/ematic review & meta-analysis f\nd t an e/imat$ #ad p]c5t ( transg5d] wom5 h ,,hiv4 ,by race_/e?nicity1 an e/imat$ #dd p]c5t ( ,black_/,african-,am]ican transg5d] wom51 #bf p]c5t ( ,hispanic_/,lat9a transg5d] wom51 & #g p]c5t ( ,:ite transg5d] wom5 h ,,hiv4 ,! limit$ data available on transg5d] individuals po9t to a disproportionate burd5 ( ,,hiv infection4 7#aa7 ,/igma & discrim9ation contribute to su* disp>ities4 7#ab7 ,! ,c5t]s = ,disease ,control & ,prev5tion has det]m9$ t increas+ ! proportion ( p :o "k _! ,,hiv /atus is an ess5tial compon5t ( compreh5sive ,,hiv treatm5t & prev5tion ef=ts & t e>ly diagnosis is critical 9 ord] = p ) ,,hiv to receive life-ext5d+ !rapy4 ,additionally1 ! ,c5t]s = ,disease ,control & ,prev5tion recomm5d r\t9e ,,hiv scre5+ 9 heal? c>e sett+s = all pati5ts ag$ #ac to #fd1 reg>dless ( risk4 7#ac7 ,9 #aiih1 ,congress creat$ ! ,national ,m9ority ,,aids ,initiative to provide te*nical assi/ance1 build capacity1 & /r5g!n outrea* ef=ts among local in/itutions & community-bas$ organizations t s]ve racial & e?nic m9orities liv+ ) or vuln]able to ,,hiv4 7#ad7 ,to combat ! ,,hiv epidemic 9 ! ,unit$ ,/ates1 ! ,national ,,hiv_/,,aids ,/rategy 7ref]r$ to 9 ?is section z ,,nhas7 provides a framework ( increas+ access to c>e1 r$uc+ new infections1 & elim9at+ ,,hiv-relat$ heal? disp>ities4 ,! vision ( ,,nhas is ,! ,unit$ ,/ates w become a place :]e new ,,hiv infections are r>e & :5 !y d occur1 e p]son1 reg>dless ( age1 g5d]1 race_/e?nicity1 g5d] id5tity1 or socioeconomic circum/ance1 w h unfett]$ access to high quality1 life-ext5d+ c>e1 free f /igma & discrim9ation44 7#ae7 ,9 ,janu>y #bjai1 ! ,dep>tm5t ( ,heal? & ,human ,s]vices began implem5t+ ! initiative ,end+ ! ,,hiv ,epidemic3 ,a ,plan = ,am]ica4 ,! initiative seeks to r$uce ! numb] ( new ,,hiv infections 9 ! ,unit$ ,/ates by #ge p]c5t by #bjbe1 & !n by at lea/ #ij p]c5t by #bjcj1 = an e/imat$ #bej1jjj total ,,hiv infection av]t$4 7#af7 ,at pres5t1 _m ,/ates & ,unit$ ,/ates t]ritories h crim9al /atutes bas$ on exposure to ,,hiv4 ,mo/ ( ^! laws 7 adopt$ be=e ! availability ( effective antiretroviral treatm5t = ,,hiv_/,,aids4 7#ag7 ,rese>* %[s t /able h\s+ leads to bett] heal? outcomes = ^? liv+ ) ,,hiv4 ,inadequate or un/able h\s+ is n only a b>ri] to effective treatm5t1 b also increases ! likelihood ( engag+ 9 risky behaviors lead+ to ,,hiv infection4 ,insecure h\s+ puts p ) ,,hiv_/,,aids at risk ( premature dea? f exposure to o!r diseases1 poor nutrition1 & lack ( m$ical c>e4 7#ah7 ,due to advances 9 treatm5t1 _m p liv+ ) ,,hiv today are liv+ heal?y lives & h ! ability & desire to fully p>ticipate 9 all aspects ( community life1 includ+ employm5t4 ,rese>* associates be+ employ$ ) trem5d\s economic1 social1 & heal? b5efits = _m p liv+ ) ,,hiv4 7#ai7 ,! common b5efits associat$ ) employm5t include income1 autonomy1 productivity1 & /atus )9 society1 daily /ructure1 mak+ a contribution to "o's community1 & increas$ skills & self-e/eem4 ,rese>* also indicates t _m p ) disabilities1 includ+ p liv+ ) ,,hiv1 report p]ceiv+ !mselves z be+ less disabl$ or n disabl$ at all1 :5 work+4 ,fur!rmore1 "s /udies l9k work+ ) bett] physical & m5tal heal? outcomes = p liv+ ) ,,hiv :5 comp>$ to ^? :o are n work+4 ,prelim9>y data also sugge/ t transition+ to employm5t is associat$ ) r$uc$ ,,hiv-relat$ heal? risk behavior = _m p4 7#bj7 ,9 ,july #bjab1 ! ,food & ,drug ,adm9i/ration approv$ ! fir/ drug to be us$ z pre-exposure prophylaxis 7,pr,e,p74 ,pr,e,p r$uces ! risk ( ,,hiv infection 9 ,,hiv-negative individuals4 ,/udies h %[n t ,pr,e,p r$uces ,,hiv transmission f sex by ab\t #ii p]c5t :5 tak5 consi/5tly4 ,despite increases 9 ,pr,e,p uptake1 ,pr,e,p use rema9s l[ among gay & bisexual m5 ( color4 ,! ,c5t]s = ,disease ,control & ,prev5tion f\nd t uptake 0 l[] among ,african-,am]ican 7#bf p]c5t7 & ,lat9o 7#cj p]c5t7 m5 comp>$ ) ,:ite m5 7#db p]c5t74 ,simil>ly1 ,pr,e,p aw>5ess 0 l[] among ,african-,am]ican 7#hf p]c5t7 & ,lat9o 7#hg p]c5t7 m5 comp>$ ) ,:ite m5 7#ie p]c5t74 ,:ile cl9ical rese>* on transg5d] populations & ,pr,e,p is curr5tly limit$1 ! ,c5t]s = ,disease ,control & ,prev5tion recomm5ds ,pr,e,p use 9 transg5d] populations4 ,9 ,septemb] #bjai1 ! ,food & ,drug ,adm9i/ration approv$ ! second drug to be us$ z ,pr,e,p4 7#ba7 ,syr+e s]vice programs h be5 associat$ ) l[]$ ,,hiv infections1 l[] hepatitis ,c infections1 & increas$ l9kage to sub/ance use treatm5t4 7#bb7 ,!re is n[ conclusive sci5tific evid5ce t a p]son liv+ ) ,,hiv :o is on antiretroviral !rapy & is durably virally suppress$ 7def9$ z hav+ a consi/5t viral load ( less ?an #bjj copies_/ml7 does n sexually transmit ,,hiv4 ,! conclusive evid5ce ab\t ! highly effective prev5tative b5efits ( antiretroviral !rapy provides an unprec$5t$ opportunity to improve ! lives ( p liv+ ) ,,hiv1 improve treatm5t uptake & adh]5ce1 & advocate = exp&$ access to treatm5t & c>e4 #gdc4 ,additional fund+ = ,,aids drug assi/ance program treatm5ts ,section #bfbc ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;ff-#ca;b7 is am5d$ by add+ at ! end ! foll[+3 7c7 ,additional fund+ = ,,aids drug assi/ance program treatm5ts ,9 addition to am\nts o!rwise au?oriz$ to be appropriat$ = c>ry+ out ?is subp>t1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y to c>ry out sections #bfab7;b77#c77;,b7 & #bfaf = ea* ( fiscal ye>s #bjba ?r\gh #bjbd4 4 #gdd4 ,enhanc+ ! national ,,hiv surveillance sy/em 7a7 ,grants ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all make grants to ,/ates to support integration ( public heal? surveillance sy/ems into all electronic heal? records 9 ord] to all[ rapid communications betwe5 ! cl9ical sett+ & heal? dep>tm5ts1 by means t include-- 7#a7 provid+ te*nical assi/ance & policy guidance to ,/ate & local heal? dep>tm5ts1 cl9ical provid]s1 & o!r ag5cies s]v+ individuals ) ,,hiv to improve ! int]op]ability ( data sy/ems relevant to monitor+ ,,hiv c>e & supportive s]vices2 7#b7 captur+ longitud9al data p]ta9+ to ! initiation & ongo+ prescription or disp5s+ ( antiretroviral !rapy = individuals diagnos$ ) ,,hiv 7su* z ?r\gh ph>macy-bas$ report+72 7#c7 obta9+ in=mation-- 7,a7 on a volunt>y basis1 on sexual ori5tation & g5d] id5tity2 & 7,b7 on s\rces ( cov]age 7or ! lack ( cov]age7 = m$ical treatm5t 7includ+ cov]age ?r\gh ! ,m$icaid program1 ! ,m$ic>e program1 ! program "u title ,,xxvi ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;ff-#aa et seq472 commonly ref]r$ to z ! ,ryan ,:ite ,,hiv_/,,aids ,program71 o!r public fund+1 private insurance1 & heal? ma9t5ance organizations72 & 7#d7 obta9+ & us+ curr5t geographic m>k]s ( resid5ce 7su* z curr5t address1 zip code1 p>tial zip code1 & c5sus block74 7b7 ,privacy & security safegu>ds ,9 c>ry+ out ?is section1 ! ,secret>y ( ,heal? & ,human ,s]vices %all ensure t appropriate privacy & security safegu>ds are met to prev5t unau?oriz$ disclosure ( protect$ heal? in=mation & compliance ) ! ,,hipaa privacy & security law 7z def9$ 9 section #cjji ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj-#ai77 & o!r relevant laws & regulations4 7c7 ,prohibition aga9/ improp] use ( data ,no grant "u ?is section may be us$ to all[ or facilitate ! collection or use ( surveillance or cl9ical data or records-- 7#a7 = punitive measures ( any k9d1 civil or crim9al1 aga9/ ! subject ( su* data or records2 or 7#b7 = impos+ any requirem5t or re/riction ) respect to an individual )\t ! individual's writt5 cons5t4 7d7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbd4 #gde4 ,evid5ce-bas$ /rategies = improv+ l9kage to & ret5tion 9 appropriate c>e 7a7 ,/rategies ,! ,secret>y ( ,heal? & ,human ,s]vices1 9 collaboration ) ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 ! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use1 ! ,director ( ! ,(fice ( ,,aids ,rese>*1 ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 & ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 %all-- 7#a7 id5tify evid5ce-bas$ /rategies mo/ effective at address+ ! multifacet$ issues t imp$e disease /atus aw>5ess & l9kage to & ret5tion 9 appropriate c>e1 tak+ into consid]ation heal? c>e sy/ems issues1 cl9ic & provid] issues1 & individual psy*osocial1 environm5tal1 & o!r contextual factors2 7#b7 support ! wide-scale implem5tation ( ! evid5ce-bas$ /rategies id5tifi$ pursuant to p>agraph 7#a71 includ+ ?r\gh incorporat+ su* /rategies into heal? c>e cov]age support$ by ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 ! program "u title ,,xxvi ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;ff-#aa et seq42 commonly ref]r$ to z ! ,ryan ,:ite ,,hiv_/,,aids ,program71 & heal? plans pur*as$ ?r\gh an ,am]ican ,heal? ,b5efit ,ex*ange e/abli%$ pursuant to section #acaa ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca72 & 7#c7 n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 submit a report to ! ,congress on ! /atus ( activities "u p>agraphs 7#a7 & 7#b74 7b7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y = fiscal ye>s #bjba ?r\gh #bjbd4 #gdf4 ,improv+ entry into & ret5tion 9 c>e & antiretroviral adh]5ce = p]sons ) ,,hiv 7a7 ,s5se ( congress ,x is ! s5se ( ,congress t ,,aids rese>* has l$ to sci5tific advancem5ts t h-- 7#a7 sav$ ! lives ( millions ( p liv+ ) ,,hiv2 7#b7 prev5t$ millions f new diagnoses2 & 7#c7 _h broad b5efits t ext5d f> beyond help+ p at risk = or liv+ ) ,,hiv4 7b7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,national ,in/itutes ( ,heal?1 %all exp&1 int5sify1 & coord9ate op]ational & translational rese>* & o!r activities ( ! ,national ,in/itutes ( ,heal? reg>d+ me?ods-- 7#a7 to increase adoption ( evid5ce-bas$ adh]5ce /rategies )9 ,,hiv c>e & treatm5t programs2 7#b7 to increase ,,hiv te/+ & case detection rates2 7#c7 to r$uce ,,hiv-relat$ heal? disp>ities2 7#d7 to ensure t rese>* to improve adh]5ce to ,,hiv c>e & treatm5t programs address ! unique conc]ns ( wom52 7#e7 to integrate ,,hiv prev5tion & c>e s]vices ) m5tal heal? & sub/ance use prev5tion & treatm5t deliv]y sy/ems2 7#f7 to increase k on ! implem5tation ( preexposure prophylaxis 7ref]r$ to 9 ?is section z ,pr,e,p71 includ+ ) respect to-- 7,a7 :o c b5efit mo/ f ,pr,e,p2 7,b7 h[ to provide ,pr,e,p safely & effici5tly2 7,c7 h[ to integrate ,pr,e,p ) o!r ess5tial prev5tion me?ods su* z condoms2 & 7,d7 h[ to ensure high levels ( adh]5ce2 & 7#g7 to increase k ( undetectable & untransmittable1 :5 a p]son liv+ ) ,,hiv :o is on antiretroviral !rapy & is durably virally suppress$ 7def9$ z hav+ a consi/5t viral load ( less ?an #bjj copies_/ml7 _c sexually transmit ,,hiv4 7c7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y = fiscal ye>s #bjba ?r\gh #bjbd4 #gdg4 ,s]vices to r$uce ,,hiv_/,,aids 9 racial & e?nic m9ority communities 7a7 ,9 g5]al ,= ! purpose ( r$uc+ new ,,hiv diagnoses 9 racial & e?nic m9ority communities1 ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 may make grants to public heal? ag5cies & fai?-bas$ organizations to conduct-- 7#a7 outrea* activities relat$ to ,,hiv prev5tion & te/+ activities2 7#b7 ,,hiv prev5tion activities2 & 7#c7 ,,hiv te/+ activities4 7b7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y = fiscal ye>s #bjba ?r\gh #bjbd4 #gdh4 ,m9ority ,,aids initiative 7a7 ,exp&$ fund+ ,! ,secret>y ( ,heal? & ,human ,s]vices1 9 collaboration ) ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 & ! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use1 %all provide funds & c>ry out activities to exp& ! ,m9ority ,,aids ,initiative4 7b7 ,use ( funds ,! additional funds made available "u ?is section may be us$1 ?r\gh ! ,m9ority ,,aids ,initiative1 to support ! foll[+ activities3 7#a7 ,provid+ te*nical assi/ance & infra/ructure support to r$uce ,,hiv_/,,aids 9 m9ority populations4 7#b7 ,increas+ m9ority populations' access to ,,hiv prev5tion & c>e s]vices4 7#c7 ,build+ /rong community programs & p>tn]%ips to address ,,hiv prev5tion & ! heal? c>e ne$s ( specific racial & e?nic m9ority populations4 7c7 ,priority int]v5tions ,)9 ! racial & e?nic m9ority populations ref]r$ to 9 subsection 7b71 priority 9 conduct+ int]v5tion s]vices %all be giv5 to-- 7#a7 m5 :o h sex ) m52 7#b7 y\?2 7#c7 p]sons :o engage 9 intrav5\s drug abuse2 7#d7 wom52 7#e7 homeless individuals2 & 7#f7 individuals inc>c]at$ or 9 ! p5al sy/em4 7d7 ,au?orization ( appropriations ,= c>ry+ out ?is section1 !re are au?oriz$ to be appropriat$ #faj1jjj1jjj = fiscal ye> #bjba & su* sums z may be necess>y = ea* ( fiscal ye>s #bjbb ?r\gh #bjbe4 #gdi4 ,heal? c>e pr(essionals treat+ individuals ) ,,hiv 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all exp&1 int5sify1 & coord9ate work=ce initiatives ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration to increase ! capacity ( ! heal? work=ce focus+ prim>ily on ,,hiv to meet ! dem& = culturally compet5t c>e1 & may aw>d grants = any ( ! foll[+3 7#a7 ,developm5t ( curricula = tra9+ prim>y c>e provid]s 9 ,,hiv_/,,aids prev5tion & c>e1 includ+ r\t9e ,,hiv te/+4 7#b7 ,support to exp& access to culturally & l+ui/ically accessible b5efits c\nselors1 tra9$ pe] navigators1 & m5tal & behavioral heal? pr(essionals ) exp]tise 9 ,,hiv4 7#c7 ,tra9+ heal? c>e pr(essionals to provide c>e to individuals liv+ ) ,,hiv4 7#d7 ,developm5t by grant recipi5ts "u title ,,xxvi ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;ff-#aa et seq42 commonly ref]r$ to z ! ,ryan ,:ite ,,hiv_/,,aids ,program7 & o!r p]sons1 ( policies = provid+ culturally relevant & s5sitive treatm5t to individuals liv+ ) ,,hiv1 ) p>ticul> emphasis on treatm5t to racial & e?nic m9orities1 m5 :o h sex ) m51 & wom51 "y p1 & *ildr5 liv+ ) ,,hiv4 7#e7 ,developm5t & implem5tation ( programs to increase ! use ( teleheal? to respond to ,,hiv-specific heal? c>e ne$s 9 rural & m9ority communities1 ) p>ticul> emphasis giv5 to m$ically und]s]v$ communities & insul> areas4 7#f7 ,evaluat+ int]discipl9>y m$ical provid] c>e team models t promote high-quality c>e1 ) p>ticul> emphasis on c>e to racial & e?nic m9orities4 7#g7 ,tra9+ heal? c>e pr(essionals to make !m aw>e ( ! high rates ( *ronic hepatitis ,b & *ronic hepatitis ,c 9 adult racial & e?nic populations1 & ! importance ( prev5tion1 detection1 & m$ical managem5t ( hepatitis ,b & hepatitis ,c & ( liv] canc] scre5+4 7#h7 ,developm5t ( curricula = tra9+ prim>y c>e provid]s t ,,hiv & tub]culosis are significant mutual comorbidities1 & t a pati5t :o te/s positive = "o disease %\ld be (f]$ & enc\rag$ to receive te/+ = ! o!r4 7b7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y = fiscal ye>s #bjba ?r\gh #bjbd4 #gej4 ,,hiv_/,,aids provid] loan repaym5t program 7a7 ,9 g5]al ,! ,secret>y may ent] into an agreem5t ) any physician1 nurse practition]1 or physician assi/ant "u :i*-- 7#a7 ! physician1 nurse practition]1 or physician assi/ant agrees to s]ve z a m$ical provid] = a p]iod ( n less ?an #b ye>s-- 7,a7 at a ,ryan ,:ite-fund$ or title ,x-fund$ facility ) a critical %ortage ( doctors 7z det]m9$ by ! ,secret>y72 or 7,b7 9 an area ) a high incid5ce ( ,,hiv_/,,aids2 & 7#b7 ! ,secret>y agrees to make paym5ts 9 accordance ) subsection 7b7 on ! pr(essional education loans ( ! physician1 nurse practition]1 or physician assi/ant4 7b7 ,mann] ( paym5ts ,! paym5ts describ$ 9 subsection 7a7 %all be made by ! ,secret>y z foll[s3 7#a7 ,^u completion by ! physician1 nurse practition]1 or physician assi/ant = :om ! paym5ts are to be made ( ! fir/ ye> ( ! s]vice specifi$ 9 ! agreem5t ent]$ into ) ! ,secret>y "u subsection 7a71 ! ,secret>y %all pay #cj p]c5t ( ! pr9cipal ( & ! int]e/ on ! individual's pr(essional education loans4 7#b7 ,^u completion by ! physician1 nurse practition]1 or physician assi/ant ( ! second ye> ( su* s]vice1 ! ,secret>y %all pay ano!r #cj p]c5t ( ! pr9cipal ( & ! int]e/ on su* loans4 7#c7 ,^u completion by t individual ( a ?ird ye> ( su* s]vice1 ! ,secret>y %all pay ano!r #be p]c5t ( ! pr9cipal ( & ! int]e/ on su* loans4 7c7 ,applicability ( c]ta9 provisions ,subp>t ,,iii ( "p ,d ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bedl et seq47 %all1 except z inconsi/5t ) ?is section1 apply to ! program c>ri$ out "u ?is section 9 ! same mann] & to ! same ext5t z su* provisions apply to ! ,national ,heal? ,s]vice ,corps loan repaym5t program4 7d7 ,reports ,n lat] ?an #ah mon?s aft] ! date ( ! enactm5t ( ?is ,act1 & annually !reaft]1 ! ,secret>y %all prep>e & submit to ,congress a report describ+ ! program c>ri$ out "u ?is section1 includ+ /atem5ts reg>d+ ! foll[+3 7#a7 ,! numb] ( physicians1 nurse practition]s1 & physician assi/ants enroll$ 9 ! program4 7#b7 ,! numb] & am\nt ( loan repaym5ts4 7#c7 ,! placem5t location ( loan repaym5t recipi5ts at facilities describ$ 9 subsection 7a77#a74 7#d7 ,! default rate & actions requir$4 7#e7 ,! am\nt ( out/&+ default funds4 7#f7 ,to ! ext5t t x c be det]m9$1 ! reason = ! default4 7#g7 ,! demographics ( individuals p>ticipat+ 9 ! program4 7#h7 ,an evaluation ( ! ov]all co/s & b5efits ( ! program4 7e7 ,def9itions ,9 ?is section3 7#a7 ,,hiv_/,,aids ,! t]m ,,hiv_/,,aids means human immunodefici5cy virus & acquir$ immune defici5cy syndrome4 7#b7 ,nurse practition] ,! t]m nurse practition] means a regi/]$ nurse :o has complet$ an accr$it$ graduate degree program 9 advanc$ nurse practice & has successfully pass$ a national c]tification exam4 7#c7 ,physician ,! t]m physician means a graduate ( a s*ool ( m$ic9e :o has complet$ po/graduate tra9+ 9 g5]al or p$iatric m$ic9e4 7#d7 ,physician assi/ant ,! t]m physician assi/ant means a m$ical provid] :o complet$ an accr$it$ physician assi/ant tra9+ program & successfully pass$ ! ,physician ,assi/ant ,national ,c]tify+ ,exam9ation4 7#e7 ,pr(essional education loan ,! t]m pr(essional education loan-- 7,a7 means a loan t is incurr$ = ! co/ ( att5dance 7includ+ tuition1 o!r reasonable educational exp5ses1 & reasonable liv+ co/s7 at a s*ool ( m$ic9e1 nurs+1 or physician assi/ant tra9+ program2 & 7,b7 includes only ! portion ( ! loan t is out/&+ on ! date ! physician1 nurse practition]1 or physician assi/ant involv$ beg9s ! s]vice specifi$ 9 ! agreem5t "u subsection 7a74 7#f7 ,ryan ,:ite-fund$ ,! t]m ,ryan ,:ite-fund$ means1 ) respect to a facility1 receiv+ funds "u title ,,xxvi ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;ff-#aa et seq474 7#g7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7#h7 ,s*ool ( ,m$ic9e ,! t]m s*ool ( m$ic9e has ! mean+ giv5 to t t]m 9 section #gii;,b ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #biep74 7#i7 ,title x-fund$ ,! t]m title ,x-fund$ means1 ) respect to a facility1 receiv+ funds "u title ,x ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj et seq474 7f7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y = fiscal ye>s #bjba ?r\gh #bjbd4 #gea4 ,d5tal education loan repaym5t program 7a7 ,9 g5]al ,! ,secret>y may ent] into an agreem5t ) any d5ti/ "u :i*-- 7#a7 ! d5ti/ agrees to s]ve z a d5ti/ = a p]iod ( n less ?an #b ye>s at a facility ) a critical %ortage ( d5ti/s 7z det]m9$ by ! ,secret>y7 9 an area ) a high incid5ce ( ,,hiv_/,,aids2 & 7#b7 ! ,secret>y agrees to make paym5ts 9 accordance ) subsection 7b7 on ! d5tal education loans ( ! d5ti/4 7b7 ,mann] ( paym5ts ,! paym5ts describ$ 9 subsection 7a7 %all be made by ! ,secret>y z foll[s3 7#a7 ,^u completion by ! d5ti/ = :om ! paym5ts are to be made ( ! fir/ ye> ( ! s]vice specifi$ 9 ! agreem5t ent]$ into ) ! ,secret>y "u subsection 7a71 ! ,secret>y %all pay #cj p]c5t ( ! pr9cipal ( & ! int]e/ on ! d5tal education loans ( ! d5ti/4 7#b7 ,^u completion by ! d5ti/ ( ! second ye> ( su* s]vice1 ! ,secret>y %all pay ano!r #cj p]c5t ( ! pr9cipal ( & ! int]e/ on su* loans4 7#c7 ,^u completion by t individual ( a ?ird ye> ( su* s]vice1 ! ,secret>y %all pay ano!r #be p]c5t ( ! pr9cipal ( & ! int]e/ on su* loans4 7c7 ,applicability ( c]ta9 provisions ,subp>t ,,iii ( "p ,d ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bedl et seq47 %all1 except z inconsi/5t ) ?is section1 apply to ! program c>ri$ out "u ?is section 9 ! same mann] & to ! same ext5t z su* provisions apply to ! ,national ,heal? ,s]vice ,corps ,loan ,repaym5t ,program4 7d7 ,reports ,n lat] ?an #ah mon?s aft] ! date ( ! enactm5t ( ?is ,act1 & annually !reaft]1 ! ,secret>y %all prep>e & submit to ! ,congress a report describ+ ! program c>ri$ out "u ?is section1 includ+ /atem5ts reg>d+ ! foll[+3 7#a7 ,! numb] ( d5ti/s enroll$ 9 ! program4 7#b7 ,! numb] & am\nt ( loan repaym5ts4 7#c7 ,! placem5t location ( loan repaym5t recipi5ts at facilities describ$ 9 subsection 7a77#a74 7#d7 ,! default rate & actions requir$4 7#e7 ,! am\nt ( out/&+ default funds4 7#f7 ,to ! ext5t t x c be det]m9$1 ! reason = ! default4 7#g7 ,! demographics ( individuals p>ticipat+ 9 ! program4 7#h7 ,an evaluation ( ! ov]all co/s & b5efits ( ! program4 7e7 ,def9itions ,9 ?is section3 7#a7 ,d5tal education loan ,! t]m d5tal education loan-- 7,a7 means a loan t is incurr$ = ! co/ ( att5dance 7includ+ tuition1 o!r reasonable educational exp5ses1 & reasonable liv+ co/s7 at a s*ool ( d5ti/ry2 & 7,b7 includes only ! portion ( ! loan t is out/&+ on ! date ! d5ti/ involv$ beg9s ! s]vice specifi$ 9 ! agreem5t "u subsection 7a74 7#b7 ,d5ti/ ,! t]m d5ti/ means a graduate ( a s*ool ( d5ti/ry :o has complet$ po/graduate tra9+ 9 g5]al or p$iatric d5ti/ry4 7#c7 ,,hiv_/,,aids ,! t]m ,,hiv_/,,aids means human immunodefici5cy virus & acquir$ immune defici5cy syndrome4 7#d7 ,s*ool ( d5ti/ry ,! t]m s*ool ( d5ti/ry has ! mean+ giv5 to t t]m 9 section #gii;,b ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #biep74 7#e7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7f7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbd4 #geb4 ,r$uc+ new ,,hiv infections among inject+ drug us]s 7a7 ,s5se ( congress ,x is ! s5se ( ,congress t provid+ /]ile syr+es & /]iliz$ equipm5t to inject+ drug us]s sub/antially r$uces risk ( ,,hiv infection1 increases ! probability t !y w initiate drug treatm5t1 & does n increase drug use4 7b7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices may provide grants & te*nical assi/ance = ! purpose ( r$uc+ ! rate ( ,,hiv infections among inject+ drug us]s ?r\gh a compreh5sive package ( s]vices = su* us]s1 includ+ ! provision ( /]ile syr+es1 education & outrea*1 access to infecti\s disease te/+1 ov]dose prev5tion1 & treatm5t = drug dep5d5ce4 7c7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y = fiscal ye>s #bjba ?r\gh #bjbd4 #gec4 ,report on impact ( ,,hiv_/,,aids 9 vuln]able populations 7a7 ,9 g5]al ,! ,secret>y %all submit to ,congress & ! ,presid5t an annual report on ! impact ( ,,hiv_/,,aids = racial & e?nic m9ority communities1 wom51 & y\? ag$ #bd & y\ng]4 7b7 ,cont5ts ,! report "u subsection 7a7 %all include in=mation on !-- 7#a7 progress t has be5 made 9 r$uc+ ! impact ( ,,hiv_/,,aids 9 su* communities2 7#b7 opportunities t exi/ to make additional progress 9 r$uc+ ! impact ( ,,hiv_/,,aids 9 su* communities2 7#c7 *all5ges t may imp$e su* additional progress2 & 7#d7 ,f$]al fund+ necess>y to a*ieve sub/antial r$uctions 9 ,,hiv_/,,aids 9 racial & e?nic m9ority communities4 #ged4 ,national ,,hiv_/,,aids obs]vance days 7a7 ,national obs]vance days ,x is ! s5se ( ,congress t national obs]vance days highlight+ ! impact ( ,,hiv on communities ( color include ! foll[+3 7#a7 ,national ,black ,,hiv_/,,aids ,aw>5ess ,day4 7#b7 ,national ,lat9o ,,aids ,aw>5ess ,day4 7#c7 ,national ,asian & ,pacific ,isl&] ,,hiv_/,,aids ,aw>5ess ,day4 7#d7 ,national ,native ,am]ican ,,hiv_/,,aids ,aw>5ess ,day4 7#e7 ,national ,y\? ,,hiv_/,,aids ,aw>5ess ,day4 7b7 ,call to action ,x is ! s5se ( ,congress t ! ,presid5t %\ld call on memb]s ( communities ( color-- 7#a7 to become involv$ at ! local community level 9 ,,hiv te/+1 policy1 & advocacy2 7#b7 to become aw>e1 engag$1 & emp[]$ on ! ,,hiv epidemic )9 _! communities2 & 7#c7 to urge memb]s ( _! communities to r$uce risk factors1 practice safe sex & o!r prev5tive measures1 be te/$ = ,,hiv1 & seek c>e :5 appropriate4 #gee4 ,review ( all ,f$]al & ,/ate laws1 policies1 & regulations reg>d+ ! crim9al prosecution ( individuals = ,,hiv-relat$ (f5ses 7a7 ,def9itions ,9 ?is section3 7#a7 ,,hiv ,! t]m ,,hiv has ! mean+ giv5 to ! t]m 9 section #bfhi ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;ff-#hh74 7#b7 ,/ate ,! t]m ,/ate includes ! ,di/rict ( ,columbia1 ,am]ican ,samoa1 ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 ,guam1 ,pu]to ,rico1 & ! ,unit$ ,/ates ,virg9 ,isl&s4 7b7 ,s5se ( ,congress reg>d+ laws or regulations direct$ at p liv+ ) ,,hiv ,x is ! s5se ( ,congress t ,f$]al & ,/ate laws1 policies1 & regulations reg>d+ p liv+ ) ,,hiv-- 7#a7 %\ld n place unique or additional burd5s on su* individuals solely z a result ( _! ,,hiv /atus2 & 7#b7 %\ld in/ead demon/rate a public heal?-ori5t$1 evid5ce-bas$1 m$ically accurate1 & contempor>y und]/&+ (-- 7,a7 ! multiple factors t lead to ,,hiv transmission2 7,b7 ! relative risk ( ,,hiv transmission r\tes2 7,c7 ! curr5t heal? implications ( liv+ ) ,,hiv2 7,d7 ! associat$ b5efits ( treatm5t & support s]vices = p liv+ ) ,,hiv2 7,e7 ! impact ( punitive ,,hiv-specific laws & policies on public heal?1 on p liv+ ) or affect$ by ,,hiv1 & on _! families & communities2 & 7,f7 ! curr5t sci5ce on ,,hiv prev5tion & treatm5t1 includ+ pre-exposure prophylaxis 7,pr,e,p71 po/-exposure prophylaxis 7,,pep71 & viral suppression4 7c7 ,review ( all ,f$]al & ,/ate laws1 policies1 & regulations reg>d+ ! crim9al prosecution ( individuals = ,,hiv-,relat$ (f5ses 7#a7 ,review ( ,f$]al & ,/ate laws 7,a7 ,9 g5]al ,n lat] ?an #ij days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,attorney ,g5]al1 ! ,secret>y ( ,heal? & ,human ,s]vices1 & ! ,secret>y ( ,def5se act+ jo9tly 79 ?is p>agraph & p>agraph 7#b7 ref]r$ to z ! designat$ (ficials7 %all initiate a national review ( ,f$]al & ,/ate laws1 policies1 regulations1 & judicial prec$5ts & decisions reg>d+ crim9al & relat$ civil commitm5t cases involv+ p liv+ ) ,,hiv1 includ+ 9 reg>ds to ! ,uni=m ,code ( ,milit>y ,ju/ice4 7,b7 ,consultation ,9 c>ry+ out ! review "u subp>agraph 7,a71 ! designat$ (ficials %all ensure div]se p>ticipation & consultation f ea* ,/ate1 includ+ )-- 7i7 ,/ate attorneys g5]al 7or _! repres5tatives72 7ii7 ,/ate public heal? (ficials 7or _! repres5tatives72 7iii7 ,/ate judicial & c\rt sy/em (fic]s1 includ+ judges1 di/rict attorneys1 prosecutors1 def5se attorneys1 law en=cem5t1 & correctional (fic]s2 7iv7 memb]s ( ! ,unit$ ,/ates ,arm$ ,=ces1 includ+ memb]s ( o!r ,f$]al s]vices subject to ! ,uni=m ,code ( ,milit>y ,ju/ice2 7v7 p liv+ ) ,,hiv1 p>ticul>ly ^? :o h be5 subject to ,,hiv-relat$ prosecution or :o are f communities ^: memb]s h be5 disproportionately subject to ,,hiv-specific arre/s & prosecutions2 7vi7 legal advocacy & ,,hiv s]vice organizations t "w ) p liv+ ) ,,hiv2 7vii7 nongov]nm5tal heal? organizations t "w on behalf ( p liv+ ) ,,hiv2 & 7viii7 trade organizations or associations repres5t+ p]sons or entities describ$ 9 clauses 7i7 ?r\gh 7vii74 7,c7 ,relation to o!r reviews ,9 c>ry+ out ! review "u subp>agraph 7,a71 ! designat$ (ficials may utilize o!r exi/+ reviews ( crim9al & relat$ civil commitm5t cases involv+ p liv+ ) ,,hiv1 includ+ any su* review conduct$ by any ,f$]al or ,/ate ag5cy or any public heal?1 legal advocacy1 or trade organization or association if ! designat$ (ficials det]m9e t su* reviews 7 conduct$ 9 accordance ) ! pr9ciples set =? 9 subsection 7b74 7#b7 ,report ,no lat] ?an #ahj days aft] initiat+ ! review requir$ by p>agraph 7#a71 ! ,attorney ,g5]al %all transmit to ,congress & make publicly available a report conta9+ ! results ( ! review1 :i* includes ! foll[+3 7,a7 ,= ea* ,/ate & = ! ,uni=m ,code ( ,milit>y ,ju/ice1 a summ>y ( ! relevant laws1 policies1 regulations1 & judicial prec$5ts & decisions reg>d+ crim9al cases involv+ p liv+ ) ,,hiv1 includ+1 if applicable1 ! foll[+3 7i7 ,a det]m9ation ( :e!r su* laws1 policies1 regulations1 & judicial prec$5ts & decisions place any unique or additional burd5s ^u p liv+ ) ,,hiv4 7ii7 ,a det]m9ation ( :e!r su* laws1 policies1 regulations1 & judicial prec$5ts & decisions demon/rate a public heal?-ori5t$1 evid5ce-bas$1 m$ically accurate1 & contempor>y und]/&+ (-- 7,i7 ! multiple factors t lead to ,,hiv transmission2 7,,ii7 ! relative risk ( ,,hiv transmission r\tes2 7,,iii7 ! curr5t heal? implications ( liv+ ) ,,hiv2 7,,iv7 ! associat$ b5efits ( treatm5t & support s]vices = p liv+ ) ,,hiv2 7,v7 ! impact ( punitive ,,hiv-specific laws & policies on public heal?1 on p liv+ ) or affect$ by ,,hiv1 & on _! families & communities2 & 7,,vi7 ! curr5t sci5ce on ,,hiv prev5tion & treatm5t1 includ+ pre-exposure prophylaxis 7,pr,e,p71 po/-exposure prophylaxis 7,,pep71 & viral suppression4 7iii7 ,an analysis ( ! public heal? & legal implications ( su* laws1 policies1 regulations1 & judicial prec$5ts1 includ+ an analysis ( ! consequ5ces ( hav+ a simil> p5al s*eme appli$ to comp>able situations involv+ o!r communicable diseases4 7iv7 ,an analysis ( ! proportionality ( puni%m5ts impos$ "u ,,hiv-specific laws1 policies1 regulations1 & judicial prec$5ts1 tak+ into consid]ation p5alties atta*$ to violation ( ,/ate laws aga9/ simil> degrees ( endang]m5t or h>m1 su* z driv+ :ile intoxicat$ or transmission ( o!r communicable diseases1 or m s]i\s h>ms1 su* z vehicul> manslaught] (f5ses4 7,b7 ,an analysis ( common elem5ts %>$ among ,/ate laws1 policies1 regulations1 & judicial prec$5ts4 7,c7 ,a set ( be/ practice recomm5dations direct$ to ,/ate gov]nm5ts1 includ+ ,/ate attorneys g5]al1 public heal? (ficials1 & judicial (fic]s1 9 ord] to ensure t laws1 policies1 regulations1 & judicial prec$5ts reg>d+ p liv+ ) ,,hiv are 9 accordance ) ! pr9ciples set =? 9 subsection 7b74 7,d7 ,recomm5dations = adju/m5ts to ! ,uni=m ,code ( ,milit>y ,ju/ice1 z may be necess>y1 9 ord] to ensure t laws1 policies1 regulations1 & judicial prec$5ts reg>d+ p liv+ ) ,,hiv are 9 accordance ) ! pr9ciples set =? 9 subsection 7b74 7#c7 ,guidance ,)9 #ij days ( ! release ( ! report requir$ by p>agraph 7#b71 ! ,attorney ,g5]al & ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ jo9tly1 %all develop & publicly release updat$ guidance = ,/ates bas$ on ! set ( be/ practice recomm5dations requir$ by p>agraph 7#b77;,c7 9 ord] to assi/ ,/ates deal+ ) crim9al & relat$ civil commitm5t cases reg>d+ p liv+ ) ,,hiv4 7#d7 ,monitor+ & evaluation sy/em ,)9 #fj days ( ! release ( ! guidance requir$ by p>agraph 7#c71 ! ,attorney ,g5]al & ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ jo9tly1 %all e/abli% an integrat$ monitor+ & evaluation sy/em :i* includes1 :]e appropriate1 objective & quantifiable p]=mance goals & indicators to measure progress t[>d /atewide implem5tation 9 ea* ,/ate ( ! be/ practice recomm5dations requir$ 9 p>agraph 7#b77;,c71 includ+ to monitor1 track1 & evaluate ! effectiv5ess ( assi/ance provid$ pursuant to subsection 7d74 7#e7 ,adju/m5ts to f$]al laws1 policies1 or regulations ,)9 #ij days ( ! release ( ! report requir$ by p>agraph 7#b71 ! ,attorney ,g5]al1 ! ,secret>y ( ,heal? & ,human ,s]vices1 & ! ,secret>y ( ,def5se1 act+ jo9tly1 %all develop & transmit to ! ,presid5t & ! ,congress1 & make publicly available1 su* proposals z may be necess>y to implem5t adju/m5ts to ,f$]al laws1 policies1 or regulations1 includ+ to ! ,uni=m ,code ( ,milit>y ,ju/ice1 bas$ on ! recomm5dations requir$ by p>agraph 7#b77;,d71 ei!r ?r\gh ,executive ord] or ?r\gh *anges to /atutory law4 7#f7 ,au?orization ( appropriations 7,a7 ,9 g5]al ,!re are au?oriz$ to be appropriat$ su* sums z may be necess>y = ! purpose ( c>ry+ out ?is subsection4 ,am\nts au?oriz$ to be appropriat$ by ! prec$+ s5t5ce are 9 addition to am\nts o!rwise au?oriz$ to be appropriat$ = su* purpose4 7,b7 ,availability ( funds ,am\nts appropriat$ pursuant to ! au?orization ( appropriations 9 subp>agraph 7,a7 are au?oriz$ to rema9 available until exp5d$4 7d7 ,au?orization ,to provide grants 7#a7 ,grants by attorney g5]al 7,a7 ,9 g5]al ,! ,attorney ,g5]al may provide assi/ance to eligible ,/ate & local entities & eligible nongov]nm5tal organizations = ! purpose ( incorporat+ ! be/ practice recomm5dations develop$ "u subsection 7c77#b77;,c7 )9 relevant ,/ate laws1 policies1 regulations1 & judicial decisions reg>d+ p liv+ ) ,,hiv4 7,b7 ,au?oriz$ activities ,! assi/ance au?oriz$ by subp>agraph 7,a7 may include-- 7i7 direct te*nical assi/ance to eligible ,/ate & local entities 9 ord] to develop1 dissem9ate1 or implem5t ,/ate laws1 policies1 regulations1 or judicial decisions t con=m ) ! be/ practice recomm5dations develop$ "u subsection 7c77#b77;,c72 7ii7 direct te*nical assi/ance to eligible nongov]nm5tal organizations 9 ord] to provide education & tra9+1 includ+ ?r\gh classes1 conf]5ces1 meet+s1 & o!r educational activities1 to eligible ,/ate & local entities2 & 7iii7 subcontract+ au?ority to all[ eligible ,/ate & local entities & eligible nongov]nm5tal organizations to seek te*nical assi/ance f legal & public heal? exp]ts ) a demon/rat$ und]/&+ ( ! pr9ciples und]ly+ ! be/ practice recomm5dations develop$ "u subsection 7c77#b77;,c74 7#b7 ,grants by ,secret>y ( ,heal? & ,human ,s]vices 7,a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 may provide assi/ance to ,/ate & local public heal? dep>tm5ts & eligible nongov]nm5tal organizations = ! purpose ( support+ eligible ,/ate & local entities to incorporate ! be/ practice recomm5dations develop$ "u subsection 7c77#b77;,c7 )9 relevant ,/ate laws1 policies1 regulations1 & judicial decisions reg>d+ p liv+ ) ,,hiv4 7,b7 ,au?oriz$ activities ,! assi/ance au?oriz$ by subp>agraph 7,a7 may include-- 7i7 direct te*nical assi/ance to ,/ate & local public heal? dep>tm5ts 9 ord] to support ! developm5t1 dissem9ation1 or implem5tation ( ,/ate laws1 policies1 regulations1 or judicial decisions t con=m ) ! set ( be/ practice recomm5dations develop$ "u subsection 7c77#b77;,c72 7ii7 direct te*nical assi/ance to eligible nongov]nm5tal organizations 9 ord] to provide education & tra9+1 includ+ ?r\gh classes1 conf]5ces1 meet+s1 & o!r educational activities1 to ,/ate & local public heal? dep>tm5ts2 & 7iii7 subcontract+ au?ority to all[ ,/ate & local public heal? dep>tm5ts & eligible nongov]nm5tal organizations to seek te*nical assi/ance f legal & public heal? exp]ts ) a demon/rat$ und]/&+ ( ! pr9ciples und]ly+ ! be/ practice recomm5dations develop$ "u subsection 7c77#b77;,c74 7#c7 ,limitation ,z a condition ( receiv+ assi/ance ?r\gh ?is subsection1 eligible ,/ate & local entities1 ,/ate & local public heal? dep>tm5ts1 & eligible nongov]nm5tal organizations %all agree-- 7,a7 n to place any unique or additional burd5s on p liv+ ) ,,hiv solely z a result ( _! ,,hiv /atus2 & 7,b7 t if ! entity1 dep>tm5t1 or organization promulgates any laws1 policies1 regulations1 or judicial decisions reg>d+ p liv+ ) ,,hiv1 su* actions %all demon/rate a public heal?-ori5t$1 evid5ce-bas$1 m$ically accurate1 & contempor>y und]/&+ (-- 7i7 ! multiple factors t lead to ,,hiv transmission2 7ii7 ! relative risk ( ,,hiv transmission r\tes2 7iii7 ! curr5t heal? implications ( liv+ ) ,,hiv2 7iv7 ! associat$ b5efits ( treatm5t & support s]vices = p liv+ ) ,,hiv2 7v7 ! impact ( punitive ,,hiv-specific laws & policies on public heal?1 on p liv+ ) or affect$ by ,,hiv1 & on _! families & communities2 & 7vi7 ! curr5t sci5ce on ,,hiv prev5tion & treatm5t1 includ+ pre-exposure prophylaxis 7,pr,e,p71 po/-exposure prophylaxis 7,,pep71 & viral suppression4 7#d7 ,report ,no lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 & annually !reaft]1 ! ,attorney ,g5]al & ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ jo9tly1 %all transmit to ,congress & make publicly available a report describ+1 = ea* ,/ate1 ! impact & effectiv5ess ( ! assi/ance provid$ ?r\gh ?is section4 ,ea* su* report %all include-- 7,a7 a detail$ description ( ! progress ea* ,/ate has made1 if any1 9 implem5t+ ! be/ practice recomm5dations develop$ "u subsection 7c77#b77;,c7 z a result ( ! assi/ance provid$ "u ?is subsection1 & bas$ on ! p]=mance goals & indicators e/abli%$ z "p ( ! monitor+ & evaluation sy/em 9 subsection 7c77#d72 7,b7 a brief summ>y ( any outrea* ef=ts und]tak5 dur+ ! prior ye> by ! ,attorney ,g5]al & ! ,secret>y ( ,heal? & ,human ,s]vices to enc\rage ,/ates to seek assi/ance "u ?is subsection 9 ord] to implem5t ! be/ practice recomm5dations develop$ "u subsection 7c77#b77;,c72 7,c7 a summ>y ( h[ assi/ance provid$ ?r\gh ?is subsection is be+ utiliz$ by eligible ,/ate & local entities1 ,/ate & local public heal? dep>tm5ts1 & eligible nongov]nm5tal organizations &1 if applicable1 any contractors1 includ+ ) respect to nongov]nm5tal organizations1 ! type ( te*nical assi/ance provid$1 & an evaluation ( ! impact ( su* assi/ance on eligible ,/ate & local entities2 & 7,d7 a summ>y & description ( eligible ,/ate & local entities1 ,/ate & local public heal? dep>tm5ts1 & eligible nongov]nm5tal organizations receiv+ assi/ance ?r\gh ?is subsection1 includ+ if applicable1 a summ>y & description ( any contractors select$ to assi/ 9 implem5t+ su* assi/ance4 7#e7 ,def9itions ,= ! purposes ( ?is subsection3 7,a7 ,eligible /ate & local entities ,! t]m eligible ,/ate & local entities means ! relevant individuals1 (fices1 or organizations t directly p>ticipate 9 ! developm5t1 dissem9ation1 or implem5tation ( ,/ate laws1 policies1 regulations1 or judicial decisions1 includ+-- 7i7 ,/ate gov]nm5ts1 includ+ ,/ate attorneys g5]al1 ,/ate dep>tm5ts ( ju/ice1 & ,/ate ,national ,gu>ds1 or _! equival5ts2 7ii7 ,/ate judicial & c\rt sy/ems1 includ+ trial c\rts1 appellate c\rts1 ,/ate supreme c\rts & c\rts ( appeal1 & ,/ate correctional facilities1 or _! equival5ts2 & 7iii7 local gov]nm5ts1 includ+ city & c\nty gov]nm5ts1 di/rict attorneys1 & local law en=cem5t dep>tm5ts1 or _! equival5ts4 7,b7 ,/ate & local public heal? dep>tm5ts ,! t]m ,/ate & local public heal? dep>tm5ts means ! foll[+3 7i7 ,/ate public heal? dep>tm5ts1 or _! equival5ts1 includ+ ! *ief (fic] ( su* dep>tm5ts & infecti\s disease & communicable disease speciali/s )9 su* dep>tm5ts4 7ii7 ,local public heal? dep>tm5ts1 or _! equival5ts1 includ+ city & c\nty public heal? dep>tm5ts1 ! *ief (fic] ( su* dep>tm5ts1 & infecti\s disease & communicable disease speciali/s )9 su* dep>tm5ts4 7iii7 ,public heal? dep>tm5ts or (ficials1 or _! equival5ts1 )9 ,/ate or local correctional facilities4 7iv7 ,public heal? dep>tm5ts or (ficials1 or _! equival5ts1 )9 ,/ate ,national ,gu>ds4 7v7 ,any o!r recogniz$ ,/ate or local public heal? organization or entity *>g$ ) c>ry+ out (ficial ,/ate or local public heal? duties4 7,c7 ,eligible nongov]nm5tal organizations ,! t]m eligible nongov]nm5tal organizations means ! foll[+3 7i7 ,nongov]nm5tal organizations1 includ+ trade organizations or associations t repres5t-- 7,i7 ,/ate attorneys g5]al1 or _! equival5ts2 7,,ii7 ,/ate public heal? (ficials1 or _! equival5ts2 7,,iii7 ,/ate judicial & c\rt (fic]s1 includ+ judges1 di/rict attorneys1 prosecutors1 def5se attorneys1 law en=cem5t1 & correctional (fic]s2 7,,iv7 ,/ate ,national ,gu>ds2 7,v7 p liv+ ) ,,hiv2 7,,vi7 legal advocacy & ,,hiv s]vice organizations t "w ) p liv+ ) ,,hiv2 & 7,,vii7 nongov]nm5tal heal? organizations t "w on behalf ( p liv+ ) ,,hiv4 7ii7 ,nongov]nm5tal organizations1 includ+ trade organizations or associations t demon/rate a public-heal? ori5t$1 evid5ce-bas$1 m$ically accurate1 & contempor>y und]/&+ (-- 7,i7 ! multiple factors t lead to ,,hiv transmission2 7,,ii7 ! relative risk ( ,,hiv transmission r\tes2 7,,iii7 ! curr5t heal? implications ( liv+ ) ,,hiv2 7,,iv7 ! associat$ b5efits ( treatm5t & support s]vices = p liv+ ) ,,hiv2 7,v7 ! impact ( punitive ,,hiv-specific laws & policies on public heal?1 on p liv+ ) or affect$ by ,,hiv1 & on _! families & communities2 & 7,,vi7 ! curr5t sci5ce on ,,hiv prev5tion & treatm5t1 includ+ pre-exposure prophylaxis 7,pr,e,p71 po/-exposure prophylaxis 7,,pep71 & viral suppression4 7#f7 ,au?orization ( appropriations 7,a7 ,9 g5]al ,9 addition to am\nts o!rwise made available1 !re are au?oriz$ to be appropriat$ to ! ,attorney ,g5]al & ! ,secret>y ( ,heal? & ,human ,s]vices su* sums z may be necess>y to c>ry out ?is subsection = ea* ( ! fiscal ye>s #bjba ?r\gh #bjbd4 7,b7 ,availability ( funds ,am\nts appropriat$ pursuant to ! au?orizations ( appropriations 9 subp>agraph 7,a7 are au?oriz$ to rema9 available until exp5d$4 #gef4 ,exp&+ support = condoms 9 prisons 7a7 ,def9itions ,9 ?is section3 7#a7 ,community organization ,! t]m community organization means a public heal? c>e facility or a nonpr(it organization t provides heal?- or ,,/i-relat$ s]vices accord+ to e/abli%$ public heal? /&>ds4 7#b7 ,compreh5sive sexuality education ,! t]m compreh5sive sexuality education means sexuality education-- 7,a7 t includes in=mation ab\t ab/95ce & ab\t ! prop] use & disposal ( sexual b>ri] protection devices2 & 7,b7 t is-- 7i7 evid5ce-bas$2 7ii7 m$ically accurate2 7iii7 age & developm5tally appropriate2 7iv7 g5d] & id5tity s5sitive2 7v7 culturally & l+ui/ically appropriate2 & 7vi7 /ructur$ to promote critical ?9k+1 self-e/eem1 respect = o!rs1 & ! developm5t ( heal?y attitudes & relation%ips4 7#c7 ,correctional facility ,! t]m correctional facility means any prison1 p5it5ti>y1 adult det5tion facility1 juv5ile det5tion facility1 jail1 or o!r facility to :i* individuals may be s5t aft] conviction ( a crime or act ( juv5ile del9qu5cy )9 ! ,unit$ ,/ates4 7#d7 ,inc>c]at$ individual ,! t]m inc>c]at$ individual means any individual :o is s]v+ a s5t5ce 9 a correctional facility aft] conviction ( a crime4 7#e7 ,sexual b>ri] protection device ,! t]m sexual b>ri] protection device means any physical device approv$ by ! ,food & ,drug ,adm9i/ration t has n be5 tamp]$ ) & :i* r$uces ! probability ( ,,/i transmission or infection betwe5 sexual p>tn]s1 includ+ female condoms1 male condoms1 & d5tal dams4 7#f7 ,sexually transmitt$ infection ,! t]m sexually transmitt$ infection or ,,/i means any disease or infection t is commonly transmitt$ ?r\gh sexual activity1 includ+ ,,hiv1 gonorrhea1 *lamydia1 syphilis1 g5ital h]pes1 viral hepatitis1 & human papillomavirus4 7#g7 ,/ate ,! t]m ,/ate includes ! ,di/rict ( ,columbia1 ,am]ican ,samoa1 ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 ,guam1 ,pu]to ,rico1 & ! ,unit$ ,/ates ,virg9 ,isl&s4 7b7 ,au?ority ,to all[ community organizations ,to provide ,,/i c\nsel+1 ,,/i prev5tion education1 & sexual b>ri] protection devices 9 ,f$]al correctional facilities 7#a7 ,directive to attorney g5]al ,n lat] ?an #cj days aft] ! date ( enactm5t ( ?is ,act1 ! ,attorney ,g5]al %all direct ! ,director ( ! ,bureau ( ,prisons to all[ community organizations to1 9 accordance ) all relevant ,f$]al laws & regulations t gov]n visitation 9 correctional facilities-- 7,a7 di/ribute sexual b>ri] protection devices 9 ,f$]al correctional facilities2 & 7,b7 engage 9 ,,/i c\nsel+ & ,,/i prev5tion education 9 ,f$]al correctional facilities4 7#b7 ,in=mation requirem5t ,any community organization p]mitt$ to di/ribute sexual b>ri] protection devices "u p>agraph 7#a7 %all ensure t ! individuals to :om ! devices are di/ribut$ are in=m$ ab\t ! prop] use & disposal ( sexual b>ri] protection devices 9 accordance ) e/abli%$ public heal? practices4 ,any community organization conduct+ ,,/i c\nsel+ or ,,/i prev5tion education "u p>agraph 7#a7 %all (f] compreh5sive sexuality education4 7#c7 ,possession ( device protect$ ,a ,f$]al correctional facility may n1 because ( ! possession or use ( a sexual b>ri] protection device-- 7,a7 take adv]se action aga9/ an inc>c]at$ individual2 or 7,b7 consid] possession or use z evid5ce ( prohibit$ activity = ! purpose ( any ,f$]al correctional facility adm9i/rative proce$+4 7#d7 ,implem5tation ,! ,attorney ,g5]al & ! ,director ( ! ,bureau ( ,prisons %all implem5t ?is section accord+ to e/abli%$ public heal? practices 9 a mann] t protects ! heal?1 safety1 & privacy ( inc>c]at$ individuals & ( correctional facility /aff4 7c7 ,s5se ( congress reg>d+ di/ribution ( sexual b>ri] protection devices 9 /ate prison sy/ems ,x is ! s5se ( ! ,congress t ,/ates %\ld all[ = ! legal di/ribution ( sexual b>ri] protection devices 9 ,/ate correctional facilities to r$uce ! preval5ce & spread ( ,s,t,is 9 ^? facilities4 7d7 ,survey ( & report on correctional facility programs aim$ at r$uc+ ! spread ( ,s,t,is 7#a7 ,survey ,n lat] ?an #ahj days aft] ! date ( enactm5t ( ?is ,act1 & annually !reaft] = #e ye>s1 ! ,attorney ,g5]al1 aft] consult+ ) ! ,secret>y ( ,heal? & ,human ,s]vices1 ,/ate (ficials1 & community organizations1 %all1 to ! maximum ext5t practicable1 conduct a survey ( all ,f$]al & ,/ate correctional facilities1 to det]m9e ! foll[+3 7,a7 ,c\nsel+1 treatm5t1 & supportive s]vices ,:e!r ! correctional facility-- 7i7 requires inc>c]at$ individuals to p>ticipate 9 c\nsel+1 treatm5t1 & supportive s]vices relat$ to ,s,t,is2 or 7ii7 (f]s su* programs to inc>c]at$ individuals4 7,b7 ,access to sexual b>ri] protection devices ,:e!r inc>c]at$ individuals c-- 7i7 possess sexual b>ri] protection devices2 7ii7 pur*ase sexual b>ri] protection devices2 7iii7 pur*ase sexual b>ri] protection devices at a r$uc$ co/2 or 7iv7 obta9 sexual b>ri] protection devices )\t co/4 7,c7 ,incid5ce ( sexual viol5ce ,! incid5ce ( sexual viol5ce & assault committ$ by inc>c]at$ individuals & by correctional facility /aff4 7,d7 ,prev5tion education (f]$ ,! type ( prev5tion education1 in=mation1 or tra9+ (f]$ to inc>c]at$ individuals & correctional facility /aff reg>d+ sexual viol5ce & ! spread ( ,s,t,is1 includ+ :e!r su* education1 in=mation1 or tra9+-- 7i7 con/itutes compreh5sive sexuality education2 7ii7 is compulsory = new inc>c]at$ individuals & = new /aff2 & 7iii7 is (f]$ on an ongo+ basis4 7,e7 ,,/i te/+ ,:e!r ! correctional facility te/s inc>c]at$ individuals = ,s,t,is or gives !m ! option to und]go su* te/+-- 7i7 at intake2 7ii7 on a regul> basis2 & 7iii7 prior to release4 7,f7 ,,/i te/ results ,! numb] ( inc>c]at$ individuals :o are te/$ = ,s,t,is & ! outcome ( su* te/s at ea* correctional facility1 disaggregat$ to include results =-- 7i7 ! type ( sexually transmitt$ infection te/$ =2 7ii7 ! race & e?nicity ( individuals te/$2 7iii7 ! age ( individuals te/$2 & 7iv7 ! g5d] ( individuals te/$4 7,g7 ,pr]elease ref]ral policy ,:e!r inc>c]at$ individuals are in=m$ prior to release ab\t ,,/i-relat$ s]vices or o!r heal? s]vices 9 _! communities1 includ+ free & l[-co/ c\nsel+ & treatm5t options4 7,h7 ,pr]elease ref]rals made ,! numb] ( ref]rals to community-bas$ organizations or public heal? facilities (f]+ ,,/i-relat$ or o!r heal? s]vices provid$ to inc>c]at$ individuals prior to release1 & ! type ( c\nsel+ or treatm5t = :i* ! ref]ral 0 made4 7,i7 ,re9/atem5t ( m$icaid b5efits ,:e!r ! correctional facility assi/s inc>c]at$ individuals t 7 enroll$ 9 ! ,/ate ,m$icaid program prior to _! inc>c]ation1 9 re9/at+ _! enrollm5t ^u release & :e!r su* individuals receive ref]rals z provid$ by subp>agraph 7,g7 to entities t accept ! ,/ate ,m$icaid program1 includ+ if applicable-- 7i7 ! numb] ( su* individuals1 includ+ ^? diagnos$ ) ,,hiv1 t h be5 re9/at$2 7ii7 a li/ ( ob/acles to re9/at+ enrollm5t or to mak+ det]m9ations ( eligibility = re9/atem5t1 if any2 & 7iii7 ! numb] ( individuals d5i$ enrollm5t4 7,j7 ,o!r actions tak5 ,:e!r ! correctional facility has tak5 any o!r action1 9 conjunction ) community organizations or o!rwise1 to r$uce ! preval5ce & spread ( ,s,t,is 9 t facility4 7#b7 ,privacy ,9 conduct+ ! survey "u p>agraph 7#a71 ! ,attorney ,g5]al %all n reque/ or reta9 ! id5tity ( any individual :o has s\ght or be5 (f]$ c\nsel+1 treatm5t1 te/+1 or prev5tion education in=mation reg>d+ an ,,/i 7includ+ in=mation ab\t sexual b>ri] protection devices71 or :o has te/$ positive = an ,,/i4 7#c7 ,report 7,a7 ,9 g5]al ,! ,attorney ,g5]al %all transmit to ,congress & make publicly available ! results ( ! survey requir$ "u p>agraph 7#a71 bo? = ! ,unit$ ,/ates z a :ole & disaggregat$ z to ea* ,/ate & ea* correctional facility4 7,b7 ,deadl9es ,to ! maximum ext5t possible1 ! ,attorney ,g5]al %all-- 7i7 issue ! fir/ report "u subp>agraph 7,a7 n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act2 & 7ii7 issue reports "u subp>agraph 7,a7 annually !reaft] = #e ye>s4 7e7 ,/rategy 7#a7 ,directive to attorney g5]al ,! ,attorney ,g5]al1 9 consultation ) ! ,secret>y ( ,heal? & ,human ,s]vices1 ,/ate (ficials1 & community organizations1 %all develop & implem5t a #e-ye> /rategy to r$uce ! preval5ce & spread ( ,s,t,is 9 ,f$]al & ,/ate correctional facilities4 ,to ! maximum ext5t possible1 ! /rategy %all be develop$1 transmitt$ to ,congress1 & made publicly available no lat] ?an #ahj days aft] ! transmission ( ! fir/ report requir$ "u subsection 7d77#c74 7#b7 ,cont5ts ( /rategy ,! /rategy develop$ "u p>agraph 7#a7 %all include ! foll[+3 7,a7 ,prev5tion education ,a plan = improv+ prev5tion education1 in=mation1 & tra9+ (f]$ to inc>c]at$ individuals & correctional facility /aff1 includ+ in=mation & tra9+ on sexual viol5ce & ! spread ( ,s,t,is1 & compreh5sive sexuality education4 7,b7 ,sexual b>ri] protection device access ,a plan = exp&+ access to sexual b>ri] protection devices 9 correctional facilities4 7,c7 ,sexual viol5ce r$uction ,a plan = r$uc+ ! incid5ce ( sexual viol5ce among inc>c]at$ individuals & correctional facility /aff1 develop$ 9 consultation ) ! ,national ,prison ,rape ,elim9ation ,commission4 7,d7 ,c\nsel+ & supportive s]vices ,a plan = exp&+ access to c\nsel+ & supportive s]vices relat$ to ,s,t,is 9 correctional facilities4 7,e7 ,te/+ ,a plan = te/+ inc>c]at$ individuals = ,s,t,is dur+ intake1 dur+ regul> heal? exams1 & prior to release1 & t-- 7i7 is conduct$ 9 accordance ) guidel9es e/abli%$ by ! ,c5t]s = ,disease ,control & ,prev5tion2 7ii7 includes prete/ c\nsel+2 7iii7 requires t inc>c]at$ individuals are notifi$ ( _! option to decl9e te/+ at any "t2 7iv7 requires t inc>c]at$ individuals are confid5tially notifi$ ( _! te/ results 9 a timely mann]2 & 7v7 ensures t inc>c]at$ individuals te/+ positive = ,s,t,is receive po/-te/ c\nsel+1 c>e1 treatm5t1 & supportive s]vices4 7,f7 ,treatm5t ,a plan = ensur+ t correctional facilities h ! necess>y m$ic9e & equipm5t to treat & monitor ,s,t,is & = ensur+ t inc>c]at$ individuals liv+ ) or te/+ positive = ,s,t,is receive & h access to c>e & treatm5t s]vices4 7,g7 ,/rategies = demographic gr\ps ,a plan = develop+ & implem5t+ culturally appropriate1 s5sitive1 & specific /rategies to r$uce ! spread ( ,s,t,is among demographic gr\ps heavily impact$ by ,s,t,is4 7,h7 ,l9kages ) communities & facilities ,a plan = e/abli%+ & /r5g!n+ l9kages to local communities & heal? facilities t-- 7i7 provide c\nsel+1 te/+1 c>e1 & treatm5t s]vices2 7ii7 may receive individuals rec5tly releas$ f inc>c]ation :o are liv+ ) ,s,t,is2 & 7iii7 accept paym5t ?r\gh ! ,/ate ,m$icaid program4 7,i7 ,enrollm5t 9 ,/ate ,m$icaid programs ,plans to ensure t-- 7i7 inc>c]at$ individuals :o 7 enroll$ 9 _! ,/ate ,m$icaid program prior to inc>c]ation 9 a correctional facility are automatically re5roll$ 9 su* program ^u _! release2 & 7ii7 inc>c]at$ individuals :o 7 n enroll$ 9 _! ,/ate ,m$icaid program prior to inc>c]ation1 & :o are diagnos$ ) ,,hiv :ile inc>c]at$ 9 a correctional facility1 are automatically enroll$ 9 su* program ^u _! release4 7,j7 ,o!r plans ,any o!r plans develop$ by ! ,attorney ,g5]al = r$uc+ ! spread ( ,s,t,is or improv+ ! quality ( heal? c>e 9 correctional facilities4 7,k7 ,monitor+ sy/em ,a monitor+ sy/em t e/abli%es p]=mance goals relat$ to r$uc+ ! preval5ce & spread ( ,s,t,is 9 correctional facilities & :i*1 :]e feasible1 expresses su* goals 9 quantifiable =m4 7,l7 ,monitor+ sy/em p]=mance indicators ,p]=mance indicators t measure or assess ! a*ievem5t ( ! p]=mance goals describ$ 9 subp>agraph 7,k74 7,m7 ,co/ e/imate ,a detail$ e/imate ( ! fund+ necess>y to implem5t ! /rategy at ! ,f$]al & ,/ate levels = all #e ye>s1 includ+ ! am\nt ( funds requir$ by community organizations to implem5t ! p>ts ( ! /rategy 9 :i* !y take "p4 7#c7 ,report ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 & annually !reaft]1 ! ,attorney ,g5]al %all transmit to ,congress & make publicly available an annual progress report reg>d+ ! implem5tation & effectiv5ess ( ! /rategy describ$ 9 p>agraph 7#a74 ,! progress report %all include an evaluation ( ! implem5tation ( ! /rategy us+ ! monitor+ sy/em & p]=mance indicators provid$ = 9 subp>agraphs 7,k7 & 7,l7 ( p>agraph 7#b74 7f7 ,au?orization ( appropriations 7#a7 ,9 g5]al ,!re are au?oriz$ to be appropriat$ su* sums z may be necess>y to c>ry out ?is section = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 7#b7 ,availability ( funds ,am\nts made available "u p>agraph 7#a7 are au?oriz$ to rema9 available until exp5d$4 #geg4 ,automatic re9/atem5t or enrollm5t 9 ,m$icaid = p :o te/ positive = ,,hiv be=e re5t]+ communities 7a7 ,9 g5]al ,section #aijb7;e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77 is am5d$ by add+ at ! end ! foll[+3 7#af7 ,enrollm5t ( ex-(f5d]s 7,a7 ,automatic enrollm5t or re9/atem5t 7i7 ,9 g5]al ,! ,/ate plan %all provide = ! automatic enrollm5t or re9/atem5t ( enrollm5t ( an eligible individual-- 7,i7 if su* individual is s*$ul$ to be releas$ f a public in/itution due to ! completion ( s5t5ce1 n less ?an #cj days prior to ! s*$ul$ date ( ! release2 & 7,,ii7 if su* individual is to be releas$ f a public in/itution on p>ole or on probation1 z soon z possible aft] ! date on :i* ! det]m9ation to release su* individual 0 made1 & be=e ! date su* individual is releas$4 7ii7 ,exception ,if a ,/ate makes a det]m9ation t an individual is n eligible to be enroll$ "u ! ,/ate plan-- 7,i7 on or be=e ! date by :i* ! individual w\ld be enroll$ "u clause 7i71 su* clause %all n apply to su* individual2 or 7,,ii7 aft] su* date1 ! ,/ate may t]m9ate ! enrollm5t ( su* individual4 7,b7 ,relation%ip ( enrollm5t to paym5t = s]vices 7i7 ,9 g5]al ,subject to subp>agraph 7,a77ii71 an eligible individual :o is enroll$1 or ^: enrollm5t is re9/at$1 "u subp>agraph 7,a7 %all be eligible = all s]vices = :i* m$ical assi/ance is provid$ "u ! ,/ate plan aft] ! date t ! eligible individual is releas$ f ! public in/itution4 7ii7 ,relation%ip to paym5t prohibition = inmates ,no provision ( ?is p>agraph may be con/ru$ to p]mit paym5t = c>e or s]vices = :i* paym5t is exclud$ "u subdivision 7,a7 foll[+ p>agraph 7#ca7 ( section #aije7;a74 7,c7 ,treatm5t ( cont9u\s eligibility 7i7 ,susp5sion = inmates ,any p]iod ( cont9u\s eligibility "u ?is title %all be susp5d$ on ! date an individual enroll$ "u ?is title becomes an inmate ( a public in/itution 7except z a pati5t ( a m$ical in/itution74 7ii7 ,det]m9ation ( rema9+ p]iod ,not)/&+ any *anges to ,/ate law relat$ to cont9u\s eligibility dur+ ! "t t an individual is an inmate ( a public in/itution 7except z a pati5t ( a m$ical in/itution71 subject to clause 7iii71 ) respect to an eligible individual :o 0 subject to a susp5sion "u clause 7i71 on ! date t su* individual is releas$ f a public in/itution ! susp5sion ( cont9u\s eligibility "u su* clause %all be lift$ = a p]iod t is equal to ! "t rema9+ 9 ! p]iod ( cont9u\s eligibility = su* individual on ! date t su* p]iod 0 susp5d$ "u su* clause4 7iii7 ,exception ,if a ,/ate makes a det]m9ation t an individual is n eligible to be enroll$ "u ! ,/ate plan-- 7,i7 on or be=e ! date t ! susp5sion ( cont9u\s eligibility is lift$ "u clause 7ii71 su* clause %all n apply to su* individual2 or 7,,ii7 aft] su* date1 ! ,/ate may t]m9ate ! enrollm5t ( su* individual4 7,d7 ,automatic enrollm5t or re9/atem5t ( enrollm5t def9$ ,= purposes ( ?is p>agraph1 ! t]m automatic enrollm5t or re9/atem5t ( enrollm5t means t ! ,/ate det]m9es eligibility = m$ical assi/ance "u ! ,/ate plan )\t a program application f1 or on behalf (1 ! eligible individual1 b an individual c only be automatically enroll$ 9 ! ,/ate ,m$icaid plan if ! individual affirmatively cons5ts to be+ enroll$ ?r\gh affirmation 9 writ+1 by telephone1 orally1 ?r\gh electronic signature1 or ?r\gh any o!r means specifi$ by ! ,secret>y4 7,e7 ,eligible individual def9$ ,= purposes ( ?is p>agraph1 ! t]m eligible individual means an individual :o is an inmate ( a public in/itution 7except z a pati5t 9 a m$ical in/itution7-- 7i7 :o 0 enroll$ "u ! ,/ate plan = m$ical assi/ance imm$iately be=e becom+ an inmate ( su* an in/itution2 or 7ii7 :o is diagnos$ ) human immunodefici5cy virus4 4 7b7 ,supplem5tal fund+ = /ate implem5tation ( automatic re9/atem5t ( m$icaid b5efits 7#a7 ,9 g5]al ,subject to p>agraph 7#c71 ) respect to a ,/ate1 = ea* ( ! fir/ #d cal5d> qu>t]s 9 :i* ! ,/ate plan meets ! requirem5ts ( p>agraph 7#af7 ( section #aijb7;e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77 7z add$ by subsection 7a771 ! ,f$]al mat*+ paym5ts 7includ+ paym5ts bas$ on ! ,f$]al m$ical assi/ance p]c5tage7 made to su* ,/ate "u section #aijc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 = ! ,/ate exp5ditures describ$ 9 p>agraph 7#b7 %all be increas$ by #e p]c5tage po9ts4 7#b7 ,exp5ditures ,! exp5ditures describ$ 9 ?is p>agraph are ! foll[+3 7,a7 ,exp5ditures = :i* paym5t is available "u section #aijc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 & :i* are attributable to /r5g!n+ ! ,/ate's enrollm5t & adm9i/rative res\rces = ! purpose ( improv+ processes = enroll+ 7or re9/at+ ! enrollm5t (7 eligible individuals 7z su* t]m is def9$ 9 subp>agraph 7,e7 ( p>agraph 7#af7 ( section #aijb7;e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77 7z am5d$ by subsection 7a7774 7,b7 ,exp5ditures = m$ical assi/ance 7z su* t]m is def9$ 9 section #aije7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a777 provid$ to su* eligible individuals4 7#c7 ,requirem5ts2 limitation 7,a7 ,report ,a ,/ate is n eligible = an increase 9 its ,f$]al mat*+ paym5ts "u p>agraph 7#a7 unless ! ,/ate agrees to submit to ! ,secret>y ( ,heal? & ,human ,s]vices1 & make publicly available1 a report t conta9s ! in=mation requir$ "u p>agraph 7#d7 by ! end ( ! #a-ye> p]iod dur+ :i* ! ,/ate receives increas$ ,f$]al mat*+ paym5ts 9 accordance ) t p>agraph4 7,b7 ,ma9t5ance ( eligibility 7i7 ,9 g5]al ,subject to clause 7ii71 a ,/ate is n eligible = an increase 9 its ,f$]al mat*+ paym5ts "u p>agraph 7#a7 if eligibility /&>ds1 me?odologies1 or proc$ures "u its ,/ate plan "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 or waiv] ( su* a plan1 are m re/rictive ?an ! eligibility /&>ds1 me?odologies1 or proc$ures1 respectively1 "u su* plan or waiv] z 9 effect on ! date ( enactm5t ( ?is ,act4 7ii7 ,/ate re9/atem5t ( eligibility p]mitt$ ,a ,/ate t has re/rict$ eligibility /&>ds1 me?odologies1 or proc$ures "u its ,/ate plan "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 or a waiv] ( su* plan1 aft] ! date ( enactm5t ( ?is ,act1 is no long] ineligible "u clause 7i7 beg9n+ ) ! fir/ cal5d> qu>t] 9 :i* ! ,/ate has re9/at$ eligibility /&>ds1 me?odologies1 or proc$ures t are no m re/rictive ?an ! eligibility /&>ds1 me?odologies1 or proc$ures1 respectively1 "u su* plan 7or waiv]7 z 9 effect on su* date4 7,c7 ,limitation ( mat*+ paym5ts to #ajj p]c5t ,9 no case %all an increase 9 ,f$]al mat*+ paym5ts "u p>agraph 7#a7 result 9 ,f$]al mat*+ paym5ts t exce$ #ajj p]c5t ( ,/ate exp5ditures4 7#d7 ,requir$ report in=mation ,! in=mation t is requir$ 9 ! report "u p>agraph 7#c77;,a7 %all include-- 7,a7 ! results ( an evaluation ( ! impact ( ! implem5tation ( ! requirem5ts ( p>agraph 7#af7 ( section #aijb7;e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77 on improv+ ! ,/ate's processes = enroll+ individuals :o are releas$ f public in/itutions "u ! ,/ate ,m$icaid plan2 7,b7 ! numb] ( individuals :o 7 automatically enroll$ 7or ^: enrollm5t 0 re9/at$7 "u su* p>agraph dur+ ! #a-ye> p]iod dur+ :i* ! ,/ate receiv$ increas$ paym5ts "u ?is subsection2 & 7,c7 any o!r in=mation t is requir$ by ! ,secret>y ( ,heal? & ,human ,s]vices4 7c7 ,effective date 7#a7 ,9 g5]al ,except z provid$ 9 p>agraph 7#b71 ! am5dm5ts made by subsection 7a7 %all take effect #ahj days aft] ! date ( ! enactm5t ( ?is ,act4 7#b7 ,rule = *anges requir+ ,/ate legislation ,9 ! case ( a ,/ate plan = m$ical assi/ance "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 :i* ! ,secret>y ( ,heal? & ,human ,s]vices det]m9es requires ,/ate legislation 7o!r ?an legislation appropriat+ funds7 9 ord] = ! plan to meet ! additional requirem5t impos$ by ! am5dm5ts made by subsection 7a71 ! ,/ate plan %all n be reg>d$ z fail+ to comply ) ! requirem5ts ( su* title solely on ! basis ( its failure to meet ?is additional requirem5t be=e ! fir/ day ( ! fir/ cal5d> qu>t] beg9n+ aft] ! close ( ! fir/ regul> session ( ! ,/ate legislature t beg9s aft] ! date ( ! enactm5t ( ?is ,act4 ,= purposes ( ! previ\s s5t5ce1 9 ! case ( a ,/ate t has a #b-ye> legislative session1 ea* ye> ( su* session %all be deem$ to be a sep>ate regul> session ( ! ,/ate legislature4 #geh4 ,/op ,,hiv 9 prison 7a7 ,%ort title ,?is section may be cit$ z ! ,/op ,,hiv 9 ,prison ,act4 7b7 ,9 g5]al ,! ,director ( ! ,bureau ( ,prisons 7ref]r$ to 9 ?is section z ! ,director7 %all develop a compreh5sive policy to provide ,,hiv te/+1 treatm5t1 & prev5tion = inmates )9 ! correctional sett+ & ^u re5try4 7c7 ,purpose ,! purposes ( ! policy requir$ to be develop$ "u subsection 7b7 %all be z foll[s3 7#a7 ,to /op ! spread ( ,,hiv among inmates4 7#b7 ,to protect prison gu>ds & o!r p]sonnel f ,,hiv infection4 7#c7 ,to provide compreh5sive m$ical treatm5t to inmates :o are liv+ ) ,,hiv4 7#d7 ,to promote ,,hiv aw>5ess & prev5tion among inmates4 7#e7 ,to enc\rage inmates to take p]sonal responsibility = _! heal?4 7#f7 ,to r$uce ! risk t inmates w transmit ,,hiv to o!r p]sons 9 ! community foll[+ _! release f prison4 7d7 ,consultation ,! ,director %all consult ) appropriate (ficials ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 ! ,(fice ( ,national ,drug ,control ,policy1 & ! ,c5t]s = ,disease ,control & ,prev5tion reg>d+ ! developm5t ( ! policy requir$ "u subsection 7b74 7e7 ,"t limit ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,director %all draft appropriate regulations to implem5t ! policy requir$ to be develop$ "u subsection 7b74 7f7 ,requirem5ts = policy ,! policy requir$ to be develop$ "u subsection 7b7 %all provide = ! foll[+3 7#a7 ,te/+ & c\nsel+ ^u intake 7,a7 ,heal? c>e p]sonnel %all provide r\t9e ,,hiv te/+ to all inmates z a "p ( a compreh5sive m$ical exam9ation imm$iately foll[+ admission to a facility4 ,heal? c>e p]sonnel ne$ n provide r\t9e ,,hiv te/+ to an inmate :o is transf]r$ to a facility f ano!r facility if ! inmate's m$ical records are transf]r$ ) ! inmate & indicate t ! inmate has be5 te/$ previ\sly4 7,b7 ,to all inmates admitt$ to a facility prior to ! effective date ( ?is policy1 heal? c>e p]sonnel %all provide r\t9e ,,hiv te/+ )9 no m ?an #f mon?s4 ,,hiv te/+ = ^! inmates may be p]=m$ 9 conjunction ) o!r heal? s]vices provid$ to ^! inmates by heal? c>e p]sonnel4 7,c7 ,all ,,hiv te/s "u ?is p>agraph %all comply ) ! opt-out provision4 7#b7 ,pre-te/ & po/-te/ c\nsel+ ,heal? c>e p]sonnel %all provide confid5tial pre-te/ & po/-te/ c\nsel+ to all inmates :o are te/$ = ,,hiv4 ,c\nsel+ may be includ$ ) o!r g5]al heal? c\nsel+ provid$ to inmates by heal? c>e p]sonnel4 7#c7 ,,hiv prev5tion education 7,a7 ,heal? c>e p]sonnel %all improve ,,hiv aw>5ess ?r\gh frequ5t educational programs = all inmates4 ,,hiv educational programs may be provid$ by community-bas$ organizations1 local heal? dep>tm5ts1 & inmate pe] educators4 7,b7 ,,hiv educational mat]ials %all be made available to all inmates at ori5tation1 at heal? c>e cl9ics1 at regul> educational programs1 & prior to release4 ,bo? writt5 & audiovisual mat]ials %all be made available to all inmates4 7,c7 7i7 ,! ,,hiv educational programs & mat]ials "u ?is p>agraph %all include in=mation on-- 7,i7 modes ( transmission1 includ+ transmission ?r\gh tattoo+1 sexual contact1 & intrav5\s drug use2 7,,ii7 prev5tion me?ods2 7,,iii7 treatm5t2 & 7,,iv7 disease progression4 7ii7 ,! programs & mat]ials %all be culturally s5sitive1 writt5 or design$ = l[-lit]acy levels1 available 9 a v>iety ( languages1 & pres5t sci5tifically accurate in=mation 9 a cle> & und]/&able mann]4 7#d7 ,,hiv te/+ ^u reque/ 7,a7 ,heal? c>e p]sonnel %all all[ inmates to obta9 ,,hiv te/s ^u reque/ once p] ye> or :5ev] an inmate has a reason to believe ! inmate may h be5 expos$ to ,,hiv4 ,heal? c>e p]sonnel %all1 bo? orally & 9 writ+1 in=m inmates1 dur+ ori5tation & p]iodically ?r\gh\t inc>c]ation1 ( _! "r to obta9 ,,hiv te/s4 7,b7 ,heal? c>e p]sonnel %all enc\rage inmates to reque/ ,,hiv te/s if ! inmate is sexually active1 has be5 rap$1 uses intrav5\s drugs1 receives a tattoo1 or if ! inmate is conc]n$ t ! inmate may h be5 expos$ to ,,hiv4 7,c7 ,an inmate's reque/ = an ,,hiv te/ %all n be consid]$ an indication t ! inmate has put him_/h]self at risk ( infection &_/or committ$ a violation ( prison rules4 7#e7 ,,hiv te/+ ( pregnant woman 7,a7 ,heal? c>e p]sonnel %all provide r\t9e ,,hiv te/+ to all inmates :o become pregnant4 7,b7 ,all ,,hiv te/s "u ?is p>agraph %all comply ) ! opt-out provision4 7#f7 ,compreh5sive treatm5t 7,a7 ,heal? c>e p]sonnel %all provide all inmates :o te/ positive = ,,hiv-- 7i7 timely1 compreh5sive m$ical treatm5t2 7ii7 confid5tial c\nsel+ on manag+ _! m$ical condition & prev5t+ its transmission to o!r p]sons2 & 7iii7 volunt>y p>tn] notification s]vices4 7,b7 ,heal? c>e provid$ "u ?is p>agraph %all be consi/5t ) curr5t ,dep>tm5t ( ,heal? & ,human ,s]vices guidel9es & /&>d m$ical practice4 ,heal? c>e p]sonnel %all discuss treatm5t options1 ! importance ( adh]5ce to antiretroviral !rapy1 & ! side effects ( m$ications ) inmates receiv+ treatm5t4 7,c7 ,heal? c>e p]sonnel & ph>macy p]sonnel %all ensure t ! facility =mul>y conta9s all ,food & ,drug ,adm9i/ration-approv$ m$ications necess>y to provide compreh5sive treatm5t = inmates liv+ ) ,,hiv1 & t ! facility ma9ta9s adequate supplies ( su* m$ications to meet inmates' m$ical ne$s4 ,heal? c>e p]sonnel & ph>macy p]sonnel %all also develop & implem5t automatic r5ewal sy/ems = ^! m$ications to prev5t int]ruptions 9 c>e4 7,d7 ,correctional /aff1 heal? c>e p]sonnel1 & ph>macy p]sonnel %all develop & implem5t di/ribution proc$ures to ensure timely & confid5tial access to m$ications4 7#g7 ,protection ( confid5tiality 7,a7 ,heal? c>e p]sonnel %all develop & implem5t proc$ures to ensure ! confid5tiality ( inmate te/s1 diagnoses1 & treatm5t4 ,heal? c>e p]sonnel & correctional /aff %all receive regul> tra9+ on ! implem5tation ( ^! proc$ures4 ,p5alties = violations ( inmate confid5tiality by heal? c>e p]sonnel or correctional /aff %all be specifi$ & /rictly en=c$4 7,b7 ,,hiv te/+1 c\nsel+1 & treatm5t %all be provid$ 9 a confid5tial sett+ :]e o!r r\t9e heal? s]vices are provid$ & 9 a mann] t all[s ! inmate to reque/ & obta9 ^! s]vices z r\t9e m$ical s]vices4 7#h7 ,te/+1 c\nsel+1 & ref]ral prior to re5try 7,a7 ,heal? c>e p]sonnel %all provide r\t9e ,,hiv te/+ to all inmates n e>li] ?an #c mon?s prior to _! release & re5try into ! community4 ,inmates :o are already kn[n to be infect$ ne$ n be te/$ aga94 ,?is requirem5t may be waiv$ if an inmate's release occurs )\t suffici5t notice to ! ,bureau to all[ heal? c>e p]sonnel to p]=m a r\t9e ,,hiv te/ & notify ! inmate ( ! results4 7,b7 ,all ,,hiv te/s "u ?is p>agraph %all comply ) ! opt-out provision4 7,c7 ,to all inmates :o te/ positive = ,,hiv & all inmates :o already are kn[n to h ,,hiv1 heal? c>e p]sonnel %all provide-- 7i7 confid5tial pr]elease c\nsel+ on manag+ _! m$ical condition 9 ! community1 access+ appropriate treatm5t & s]vices 9 ! community1 & prev5t+ ! transmission ( _! condition to family memb]s & o!r p]sons 9 ! community2 7ii7 ref]rals to appropriate heal? c>e provid]s & social s]vice ag5cies 9 ! community t meet ! inmate's individual ne$s1 includ+ volunt>y p>tn] notification s]vices & prev5tion c\nsel+ s]vices = p liv+ ) ,,hiv2 & 7iii7 a #cj-;day supply ( any m$ically necess>y m$ications ! inmate is curr5tly receiv+4 7#i7 ,opt-out provision ,inmates %all h ! "r to refuse r\t9e ,,hiv te/+4 ,inmates %all be in=m$ bo? orally & 9 writ+ ( ?is "r4 ,oral & writt5 disclosure ( ?is "r may be includ$ ) o!r g5]al heal? in=mation & c\nsel+ provid$ to inmates by heal? c>e p]sonnel4 ,if an inmate refuses a r\t9e te/ = ,,hiv1 heal? c>e p]sonnel %all make a note ( ! inmate's refusal 9 ! inmate's confid5tial m$ical records4 ,h[ev]1 ! inmate's refusal %all n be consid]$ a violation ( prison rules or result 9 discipl9>y action4 ,any ref]5ce 9 ?is section to ! opt-out provision %all be deem$ a ref]5ce to ! requirem5t ( ?is p>agraph4 7#aj7 ,exclusion ( te/s p]=m$ "u section #djad7;b7 f ! def9ition ( r\t9e ,,hiv ,te/+ ,,hiv te/+ ( an inmate "u section #djad7;b7 ( title #ah1 ,unit$ ,/ates ,code1 is n r\t9e ,,hiv te/+ = ! purposes ( ! opt-out provision4 ,heal? c>e p]sonnel %all docum5t ! reason = te/+ "u section #djad7;b7 ( title #ah1 ,unit$ ,/ates ,code1 9 ! inmate's confid5tial m$ical records4 7#aa7 ,timely notification ( te/ results ,heal? c>e p]sonnel %all provide timely notification to inmates ( ! results ( ,,hiv te/s4 7g7 ,*anges 9 exi/+ law 7#a7 ,scre5+ 9 ,g5]al ,section #djad7;a7 ( title #ah1 ,unit$ ,/ates ,code1 is am5d$-- 7,a7 by /rik+ = a p]iod ( #f mon?s or m2 7,b7 by /rik+ 1 z appropriate12 & 7,c7 by /rik+ if su* individual is det]m9$ to be at risk = infection ) su* virus 9 accordance ) ! guidel9es issu$ by ! ,bureau ( ,prisons relat+ to infecti\s disease managem5t & ins]t+ unless ! individual decl9es4 ,! ,attorney ,g5]al %all also cause su* individual to be s te/$ be=e release unless ! individual decl9es44 7#b7 ,inadmissibility ( ,,hiv ,te/ ,results 9 ,civil & ,crim9al ,proce$+s ,section #djad7;d7 ( title #ah1 ,unit$ ,/ates ,code1 is am5d$ by ins]t+ or "u ! ,/op ,,hiv 9 ,prison ,act aft] "u ?is section4 7#c7 ,scre5+ z ,"p ( ,r\t9e ,scre5+ ,section #djad7;e7 ( title #ah1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+3 ,su* rules %all also provide t ! initial te/ "u ?is section be p]=m$ z "p ( ! r\t9e heal? scre5+ conduct$ at intake44 7h7 ,report+ requirem5ts 7#a7 ,report on ,hepatitis1 liv]1 & ,o!r ,diseases ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,director %all provide a report to ! ,congress on ! policies & proc$ures ( ! ,bureau ( ,prisons to provide te/+1 treatm5t1 & prev5tion education programs = hepatitis1 liv] failure1 & o!r liv]-relat$ diseases transmitt$ ?r\gh sexual activity1 intrav5\s drug use1 or o!r means4 ,! ,director %all consult ) appropriate (ficials ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 ! ,(fice ( ,national ,drug ,control ,policy1 ! ,(fice ( ,national ,,aids ,policy1 & ! ,c5t]s = ,disease ,control & ,prev5tion reg>d+ ! developm5t ( ?is report4 7#b7 ,annual ,reports 7,a7 ,g5]ally ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 & !n annually !reaft]1 ! ,director %all report to ,congress on ! incid5ce among inmates ( diseases transmitt$ ?r\gh sexual activity & intrav5\s drug use4 7,b7 ,matt]s p]ta9+ to v>i\s diseases ,ea* report "u p>agraph 7#a7 %all discuss-- 7i7 ! incid5ce among inmates ( ,,hiv1 hepatitis1 & o!r diseases transmitt$ ?r\gh sexual activity & intrav5\s drug use2 & 7ii7 updates on ! te/+1 treatm5t1 & prev5tion education programs = ^! diseases conduct$ by ! ,bureau ( ,prisons4 7,c7 ,matt]s p]ta9+ to ,,hiv only ,ea* report "u p>agraph 7#a7 %all also include-- 7i7 ! numb] ( inmates :o te/$ positive = ,,hiv ^u intake2 7ii7 ! numb] ( inmates :o te/$ positive prior to re5try2 7iii7 ! numb] ( inmates :o 7 n te/$ prior to re5try because !y 7 releas$ )\t suffici5t notice2 7iv7 ! numb] ( inmates :o opt$-out ( tak+ ! te/2 7v7 ! numb] ( inmates :o 7 te/$ "u section #djad7;b7 ( title #ah1 ,unit$ ,/ates ,code2 & 7vi7 ! numb] ( inmates "u treatm5t = ,,hiv4 7,d7 ,consultation ,! ,director %all consult ) appropriate (ficials ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 ! ,(fice ( ,national ,drug ,control ,policy1 & ! ,c5t]s = ,disease ,control & ,prev5tion reg>d+ ! developm5t ( ea* report "u p>agraph 7#a74 #gei4 ,support data sy/em review & indicators = monitor+ ,,hiv c>e ,! ,secret>y ( ,heal? & ,human ,s]vices1 9 collaboration ) ! ,assi/ant ,secret>y = ,heal?1 ! ,director ( ! ,(fice ( ,infecti\s ,disease & ,,hiv_/,,aids ,policy1 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 ! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use1 ! ,director ( ! ,dep>tm5t ( ,h\s+ & ,urban ,developm5t1 ! ,director ( ! ,(fice ( ,,aids ,rese>*1 ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 & ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 %all exp& & coord9ate ef=ts to align metrics across ag5cies & modify ,f$]al data sy/ems1 to-- 7#a7 adopt ! ,national ,academy ( ,m$ic9e's cl9ical ,,hiv c>e indicators z ! core metrics = monitor+ ! quality ( ,,hiv c>e1 m5tal heal?1 sub/ance abuse1 & supportive s]vices2 7#b7 bett] enable assessm5t ( ! impact ( ! ,national ,,hiv_/,,aids ,/rategy & ! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh7 on improv+ ,,hiv c>e & access to supportive s]vices = individuals ) ,,hiv2 7#c7 exp& ! demographic data elem5ts to be captur$ by ,f$]al data sy/ems relevant to ,,hiv c>e to p]mit calculation ( ! indicators = subgr\ps ( ! population ( p ) diagnos$ ,,hiv infection1 includ+-- 7,a7 age2 7,b7 race2 7,c7 e?nicity2 7,d7 sex 7assign$ at bir?72 7,e7 g5d] id5tity2 7,f7 sexual ori5tation2 7,g7 curr5t geographic m>k] ( resid5ce2 7,h7 income or pov]ty level2 & 7,i7 prim>y means ( reimbursem5t = m$ical s]vices 7includ+ a ,/ate ,m$icaid program1 ! ,m$ic>e program1 ! ,ryan ,:ite ,,hiv_/,,aids ,program1 private insurance1 heal? ma9t5ance organizations1 & no cov]age72 & 7#d7 /reaml9e data collection & sy/ematically review all exi/+ report+ requirem5ts = f$]ally fund$ ,,hiv programs to ensure t only ess5tial data are collect$4 #gfj4 ,transf] ( funds = implem5tation ( end+ ! ,,hiv epidemic3 a plan = ,am]ica ,title ,,ii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bjb et seq47 is am5d$ by ins]t+ aft] section #bda ! foll[+3 #bda;,a4 ,transf] ( funds = implem5tation ( ,national ,,hiv_/,,aids ,/rategy 7a7 ,transf] au?orization ,( ! discretion>y appropriations made available to ! ,dep>tm5t ( ,heal? & ,human ,s]vices = any fiscal ye> = programs & activities t1 z det]m9$ by ! ,secret>y1 p]ta9 to ,,hiv1 ! ,secret>y may transf] up to #a p]c5t ( su* appropriations to ! ,(fice ( ! ,assi/ant ,secret>y = ,heal? = implem5tation ( ! ,end+ ! ,,hiv ,epidemic3 ,a ,plan = ,am]ica4 7b7 ,congressional notification ,n less ?an #cj days be=e mak+ any transf] "u ?is section1 ! ,secret>y %all give notice ( ! transf] to ! ,congress4 7c7 ,def9itions ,9 ?is section1 ! t]m ,end+ ! ,,hiv ,epidemic3 ,a ,plan = ,am]ica means ! initiative ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices t seeks to r$uce ! numb] ( new ,,hiv infections 9 ! ,unit$ ,/ates by #ge p]c5t by #bjbe1 & !n by at lea/ #ij p]c5t by #bjcj1 = an e/imat$ #bej1jjj total ,,hiv infections av]t$4 4 ,f ,diabetes #gga4 ,rese>*1 treatm5t1 & education ,subp>t #c ( "p ,c ( title ,,iv ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhe;c et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #dcd;,b4 ,diabetes 9 m9ority populations 7a7 ,9 g5]al ,! ,director ( ,,nih %all exp&1 int5sify1 & support ongo+ rese>* & o!r activities ) respect to pr$iabetes & diabetes1 p>ticul>ly type #b1 9 m9ority populations4 7b7 ,rese>* 7#a7 ,description ,rese>* "u subsection 7a7 %all include inve/igation into-- 7,a7 ! causes ( diabetes1 includ+ socioeconomic1 geographic1 cl9ical1 environm5tal1 g5etic1 & o!r factors t may contribute to increas$ rates ( diabetes 9 m9ority populations2 & 7,b7 ! causes ( increas$ incid5ce ( diabetes complications 9 m9ority populations1 & possible int]v5tions to decrease su* incid5ce4 7#b7 ,inclusion ( m9ority p>ticipants ,9 conduct+ & support+ rese>* describ$ 9 subsection 7a71 ! ,director ( ,,nih %all seek to include m9ority p>ticipants z /udy subjects 9 cl9ical trials4 7c7 ,report2 compreh5sive plan 7#a7 ,9 g5]al ,! ,diabetes ,mellitus ,int]ag5cy ,coord9at+ ,committee %all-- 7,a7 prep>e & submit to ! ,congress1 n lat] ?an #f mon?s aft] ! date ( enactm5t ( ?is section1 a report on ,f$]al rese>* & public heal? activities ) respect to pr$iabetes & diabetes 9 m9ority populations2 & 7,b7 develop & submit to ,congress1 n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is section1 an effective & compreh5sive ,f$]al plan 7includ+ all appropriate ,f$]al heal? programs7 to address pr$iabetes & diabetes 9 m9ority populations4 7#b7 ,cont5ts ,! report "u p>agraph 7#a77;,a7 %all at m9imum address ea* ( ! foll[+3 7,a7 ,rese>* on diabetes & pr$iabetes 9 m9ority populations1 includ+ su* rese>* on-- 7i7 g5etic1 behavioral1 & environm5tal factors2 & 7ii7 prev5tion & complications among individuals )9 ^! populations :o h already develop$ diabetes4 7,b7 ,surveillance & data collection on diabetes & pr$iabetes 9 m9ority populations1 includ+ ) respect to-- 7i7 ef=ts to bett] det]m9e ! preval5ce ( diabetes among ,asian-,am]ican & ,pacific ,isl&] subgr\ps2 & 7ii7 ef=ts to coord9ate data collection on ! ,am]ican ,indian population4 7,c7 ,community-bas$ int]v5tions to address diabetes & pr$iabetes t>get+ m9ority populations1 includ+-- 7i7 ! evid5ce base = su* int]v5tions2 7ii7 ! cultural appropriat5ess ( su* int]v5tions2 & 7iii7 ef=ts to educate ! public on ! causes & consequ5ces ( diabetes4 7,d7 ,education & tra9+ programs = heal? pr(essionals 7includ+ community heal? work]s7 on ! prev5tion & managem5t ( diabetes & its relat$ complications t is support$ by ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 includ+ su* programs support$ by-- 7i7 ! ,national ,heal? ,s]vice ,corps2 or 7ii7 ! community heal? c5t]s program "u section #ccj4 7d7 ,education ,! ,director ( ,,nih %all-- 7#a7 ?r\gh ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities & ! ,national ,diabetes ,education ,program-- 7,a7 make grants to programs fund$ "u section #dfdz-#d = ! purpose ( e/abli%+ a m5tor+ program = heal? c>e pr(essionals to be m involv$ 9 weight c\nsel+1 obesity rese>*1 & nutrition2 & 7,b7 provide = ! p>ticipation ( m9ority heal? pr(essionals 9 diabetes-focus$ rese>* programs2 & 7#b7 make grants = programs to e/abli% a pipel9e f high s*ool to pr(essional s*ool t w increase m9ority repres5tation 9 diabetes-focus$ heal? fields by exp&+ ,m9ority ,access to ,rese>* ,c>e]s program int]n%ips & m5tor+ opportunities = recruitm5t4 7e7 ,def9itions ,= purposes ( ?is section3 7#a7 ,diabetes ,mellitus ,int]ag5cy ,coord9at+ ,committee ,! ,diabetes ,mellitus ,int]ag5cy ,coord9at+ ,committee means ! ,diabetes ,mellitus ,int]ag5cy ,coord9at+ ,committee e/abli%$ "u section #dbi4 7#b7 ,m9ority population ,! t]m m9ority population means a racial & e?nic m9ority gr\p1 z def9$ 9 section #agjg4 4 #ggb4 ,rese>*1 education1 & o!r activities ,"p ,b ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdc et seq471 z am5d$ by section #gba1 is fur!r am5d$ by ins]t+ aft] section #cag,w ! foll[+ section3 #cag,x4 ,diabetes 9 m9ority populations 7a7 ,rese>* & o!r activities 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all conduct & support rese>* & public heal? activities ) respect to diabetes 9 m9ority populations4 7#b7 ,c]ta9 activities ,activities "u p>agraph 7#a7 reg>d+ diabetes 9 m9ority populations %all include ! foll[+3 7,a7 ,fur!r enhanc+ ! ,national ,heal? & ,nutrition ,exam9ation ,survey by ov]sampl+ ,asian ,am]icans1 ,native ,hawaiians1 & ,pacific ,isl&]s 9 appropriate geographic areas to bett] det]m9e ! preval5ce ( diabetes 9 su* populations z well z to improve ! data collection ( diabetes p5etration disaggregat$ into major e?nic gr\ps )9 su* populations4 ,! ,secret>y %all ensure t any su* ov]sampl+ does n r$uce ! ov]sampl+ ( o!r m9ority populations includ+ ,african-,am]ican & ,lat9o populations4 7,b7 ,?r\gh ! ,division ( ,diabetes ,translation-- 7i7 provid+ = prev5tion rese>* to bett] und]/& h[ to influ5ce heal? c>e sy/ems *anges to improve quality ( c>e be+ deliv]$ to su* populations2 7ii7 c>ry+ out model demon/ration projects to design1 implem5t1 & evaluate effective diabetes prev5tion & control int]v5tions = m9ority populations1 includ+ culturally appropriate community-bas$ int]v5tions2 7iii7 develop+ & implem5t+ a /rategic plan to r$uce diabetes 9 m9ority populations ?r\gh appli$ rese>* to r$uce disp>ities & culturally & l+ui/ically appropriate community-bas$ int]v5tions2 7iv7 support+1 ?r\gh ! national diabetes prev5tion program "u section #cii,v-#c1 diabetes prev5tion program sites 9 und]s]v$ regions highly impact$ by diabetes2 & 7v7 implem5t+1 ?r\gh ! national diabetes prev5tion program "u section #cii,v-#c1 a demon/ration program develop+ new metrics measur+ heal? outcomes relat$ to diabetes t c be /ratifi$ by specific m9ority populations4 7b7 ,education ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all direct ! ,division ( ,diabetes ,translation to conduct & support bo? programs to educate ! public on diabetes 9 m9ority populations & programs to educate m9ority populations ab\t ! causes & effects ( diabetes4 7c7 ,diabetes2 heal? promotion1 prev5tion activities1 & access ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion & ! ,national ,diabetes ,education ,program1 %all conduct & support programs to educate specific m9ority populations ?r\gh culturally appropriate & l+ui/ically appropriate in=mation campaigns ab\t prev5tion (1 & manag+1 diabetes4 7d7 ,def9ition ,= purposes ( ?is section1 ! t]m m9ority population means a racial & e?nic m9ority gr\p1 z def9$ 9 section #agjg4 4 #ggc4 ,programs to educate heal? provid]s on ! causes & effects ( diabetes 9 m9ority populations ,"p ,p ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhj;g et seq471 z am5d$ by section #gcc1 is fur!r am5d$ by add+ at ! end ! foll[+ new section3 #cii,v-#aj4 ,programs to educate heal? provid]s on ! causes & effects ( diabetes 9 m9ority populations 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all conduct & support programs describ$ 9 subsection 7b7 to educate heal? pr(essionals on ! causes & effects ( diabetes 9 m9ority populations4 7b7 ,programs ,programs describ$ 9 ?is subsection1 ) respect to education on diabetes 9 m9ority populations1 %all include ! foll[+3 7#a7 ,giv+ priority1 "u ! prim>y c>e tra9+ & enhancem5t program "u section #gdg-- 7,a7 to aw>d+ grants to focus on or address diabetes2 & 7,b7 to add+ m9ority populations to ! li/ ( vuln]able populations t %\ld be s]v$ by su* grants4 7#b7 ,provid+ additional funds = ! ,heal? ,c>e]s ,opportunity ,program1 ! ,c5t]s = ,excell5ce1 & ! ,m9ority ,faculty ,fell[%ip ,program to p>tn] ) ! ,(fice ( ,m9ority ,heal? "u section #agjg & ! ,national ,in/itutes ( ,heal? to /r5g!n programs = c>e] opportunities focus$ on diabetes treatm5t & c>e )9 und]s]v$ regions highly impact$ by diabetes4 7#c7 ,develop+ a diabetes focus )91 & provid+ additional funds =1 ! ,national ,heal? ,s]vice ,corps s*ol>%ip program-- 7,a7 to place individuals 9 areas t are disproportionately affect$ by diabetes & to provide diabetes treatm5t & c>e 9 su* areas2 & 7,b7 to provide su* individuals cont9u+ m$ical education specific to diabetes c>e4 4 #ggd4 ,rese>*1 education1 & o!r activities reg>d+ diabetes 9 ,am]ican ,indian populations ,"p ,p ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhj;g et seq471 z am5d$ by section #ggc1 is fur!r am5d$ by add+ at ! end ! foll[+ section3 #cii,v-#aa4 ,rese>*1 education1 & o!r activities reg>d+ diabetes 9 ,am]ican ,indian populations ,9 addition to activities "u sections #cag,x1 #cii,v-#aj1 & #dcd;,b1 ! ,secret>y1 act+ ?r\gh ! ,indian ,heal? ,s]vice & 9 collaboration ) o!r appropriate ,f$]al ag5cies1 %all-- 7#a7 conduct & support rese>* & o!r activities ) respect to diabetes2 & 7#b7 coord9ate ! collection ( data on cl9ically & culturally appropriate diabetes treatm5t1 c>e1 prev5tion1 & s]vices by heal? c>e pr(essionals to ! ,am]ican ,indian population4 4 #gge4 ,updat$ report on heal? disp>ities ,! ,secret>y ( ,heal? & ,human ,s]vices %all seek to ent] into an arrangem5t ) ! ,national ,academy ( ,m$ic9e "u :i* ! ,national ,academy w-- 7#a7 n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 submit to ,congress an updat$ v]sion ( ! #bjjc report entitl$ ,unequal ,treatm5t3 ,confront+ ,racial & ,e?nic ,disp>ities 9 ,heal? ,c>e2 & 7#b7 9 su* updat$ v]sion1 address h[ racial & e?nic heal? disp>ities h *ang$ s9ce ! publication ( ! orig9al report4 ,g ,lung ,disease #ggf4 ,expansion ( ! ,national ,a/hma ,education & ,prev5tion ,program 7a7 ,f9d+s ,congress f9ds z foll[s3 7#a7 ,! preval5ce ( a/hma has increas$ s9ce #aihj & affects m ?an #bf1jjj1jjj p 9 ! ,unit$ ,/ates4 7#b7 ,significant disp>ities 9 a/hma morbidity & mortality exi/ = bo? adults & *ildr5 p>ticul>ly = l[-income & m9ority populations1 p>ticul>ly ,african ,am]icans & ,pu]to ,ricans4 7#c7 ,african-,am]ican *ildr5 are twice z likely to h a/hma z ,:ite *ildr54 7#d7 ,9 #bjaf1 almo/ #d1ejj1jjj non-,hispanic ,african ,am]icans report$ hav+ a/hma4 ,african ,am]icans ) a/hma are #c times z likely to visit ! em]g5cy dep>tm5t & twice z likely to get hospitaliz$ z ,:ite pati5ts ) a/hma4 7#e7 ,pu]to ,ricans are #c4d times z likely to die f a/hma comp>$ ) all o!r ,hispanic or ,lat9o gr\ps4 ,ov]all ,hispanic ,am]icans are #cj p]c5t m likely to be hospitaliz$ = a/hma ?an non-,hispanic ,:ites4 7#f7 ,! majority ( adults ) a/hma are wom54 7b7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all conv5e a work+ gr\p compris$ ( pati5t gr\ps1 nonpr(it organizations1 m$ical societies1 & o!r relevant gov]nm5tal & nongov]nm5tal entities1 includ+ ^? t p>ticipate 9 ! ,national ,a/hma ,education & ,prev5tion ,program1 to develop a report to ,congress t-- 7#a7 catalogs1 ) respect to a/hma prev5tion1 managem5t1 & surveillance-- 7,a7 ! activities ( ! ,f$]al ,gov]nm5t1 includ+ id5tify+ all ,f$]al programs t c>ry out a/hma-relat$ activities1 z well z assessm5t ( ! progress ( ! ,f$]al ,gov]nm5t & ,/ates1 ) respect to a*iev+ ! goals ( ,heal?y ,p #bjbj2 & 7,b7 ! activities ( o!r entities t p>ticipate 9 ! program1 includ+ nonpr(it organizations1 pati5t advocacy gr\ps1 & m$ical societies2 & 7#b7 makes recomm5dations = ! future direction ( a/hma activities1 9 consultation ) rese>*]s f ! ,national ,in/itutes ( ,heal? & o!r memb] bodies ( ! ,national ,a/hma ,education & ,prev5tion ,program :o are qualifi$ to review & analyze data & evaluate int]v5tions1 includ+-- 7,a7 a description ( h[ ! ,f$]al ,gov]nm5t may bett] coord9ate & improve its response to a/hma includ+ id5tify+ any b>ri]s t may exi/2 7,b7 a description ( h[ ! ,f$]al ,gov]nm5t may cont9ue1 exp&1 & improve its private-public p>tn]%ips ) respect to a/hma includ+ id5tify+ any b>ri]s t may exi/2 7,c7 id5tification ( /eps t may be tak5 to r$uce !-- 7i7 morbidity1 mortality1 & ov]all preval5ce ( a/hma2 7ii7 f9ancial burd5 ( a/hma on society2 7iii7 burd5 ( a/hma on disproportionately affect$ areas1 p>ticul>ly ^? 9 m$ically und]s]v$ populations 7z def9$ 9 section #ccj7;b77#c7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;b7b77#c7772 & 7iv7 burd5 ( a/hma z a *ronic disease2 7,d7 id5tification ( programs & policies t h a*iev$ ! /eps describ$ 9 subp>agraph 7,c71 & /eps t may be tak5 to exp& su* programs & policies to b5efit l>g] populations2 & 7,e7 recomm5dations = future rese>* & int]v5tions4 7c7 ,report to ,congress ,at ! end ( ! #e-ye> p]iod foll[+ ! submission ( ! report "u ?is section1 ! ,national ,a/hma ,education & ,prev5tion ,program %all evaluate ! analyses & recomm5dations "u su* report & det]m9e :e!r a new report to ! ,congress is necess>y1 & make appropriate recomm5dations to ! ,congress4 #ggg4 ,a/hma-relat$ activities ( ! ,c5t]s = ,disease ,control & ,prev5tion ,section #cag;,i ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdg;b-#aj7 is am5d$ to read z foll[s3 #cag;,i4 ,a/hma-relat$ activities ( ! c5t]s = disease control & prev5tion 7a7 ,program = provid+ in=mation & education to ! public ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all collaborate ) ,/ate & local heal? dep>tm5ts to conduct activities1 includ+ ! provision ( in=mation & education to ! public reg>d+ a/hma includ+-- 7#a7 det]r+ ! h>mful consequ5ces ( uncontroll$ a/hma2 & 7#b7 dissem9at+ heal? education & in=mation reg>d+ prev5tion ( a/hma episodes & /rategies = manag+ a/hma4 7b7 ,developm5t ( ,/ate a/hma plans ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all collaborate ) ,/ate & local heal? dep>tm5ts to develop ,/ate plans incorporat+ public heal? responses to r$uce ! burd5 ( a/hma1 p>ticul>ly reg>d+ disproportionately affect$ populations4 7c7 ,compilation ( data ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all1 9 coop]ation ) ,/ate & local public heal? (ficials-- 7#a7 conduct a/hma surveillance activities to collect data on ! preval5ce & sev]ity ( a/hma1 ! effectiv5ess ( public heal? a/hma int]v5tions1 & ! quality ( a/hma managem5t1 includ+-- 7,a7 collection ( h\sehold data on ! local burd5 ( a/hma2 7,b7 surveillance ( heal? c>e facilities2 & 7,c7 collection ( data n conta9+ individually id5tifiable in=mation f electronic heal? records or o!r electronic communications2 7#b7 compile & annually publi% data reg>d+ ! preval5ce & incid5ce ( *ildhood a/hma1 ! *ild mortality rate1 & ! numb] ( hospital admissions & em]g5cy dep>tm5t visits by *ildr5 associat$ ) a/hma nationally & 9 ea* ,/ate & at ! c\nty level by age1 sex1 race1 & e?nicity1 z well z lifetime & curr5t preval5ce2 & 7#c7 compile & annually publi% data reg>d+ ! preval5ce & incid5ce ( adult a/hma1 ! adult mortality rate1 & ! numb] ( hospital admissions & em]g5cy dep>tm5t visits by adults associat$ ) a/hma nationally & 9 ea* ,/ate & at ! c\nty level by age1 sex1 race1 e?nicity1 indu/ry1 & occupation1 z well z lifetime & curr5t preval5ce4 7d7 ,coord9ation ( data collection ,! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 9 conjunction ) ,/ate & local heal? dep>tm5ts1 %all coord9ate data collection activities "u p>agraphs 7#b7 & 7#c7 ( subsection 7c7 s z to maximize comp>ability ( results4 7e7 ,collaboration ,! ,c5t]s = ,disease ,control & ,prev5tion are enc\rag$ to collaborate ) national1 ,/ate1 & local nonpr(it organizations to provide in=mation & education ab\t a/hma1 & to /r5g!n su* collaborations :5 possible4 7f7 ,additional fund+ ,9 addition to any o!r au?orization ( appropriations t is available to ! ,c5t]s = ,disease ,control & ,prev5tion = ! purpose ( c>ry+ out ?is section1 !re are au?oriz$ to be appropriat$ to su* ,c5t]s su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe = ! purpose ( c>ry+ out ?is section4 4 #ggh4 ,influ5za & pneumonia vacc9ation campaign 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices %all-- 7#a7 enhance ! annual campaign by ! ,dep>tm5t ( ,heal? & ,human ,s]vices to increase ! numb] ( p vacc9at$ ea* ye> = influ5za & pneumonia2 & 7#b7 include 9 su* campaign ! use ( writt5 educational mat]ials1 public s]vice ann\ncem5ts1 physician education1 & any o!r means :i* ! ,secret>y deems effective4 7b7 ,mat]ials & ann\ncem5ts ,9 c>ry+ out ! annual campaign describ$ 9 subsection 7a71 ! ,secret>y ( ,heal? & ,human ,s]vices %all ensure t-- 7#a7 educational mat]ials & public s]vice ann\ncem5ts are readily & widely available 9 communities exp]i5c+ disp>ities 9 ! incid5ce & mortality rates ( influ5za & pneumonia2 & 7#b7 ! campaign uses t>get$1 culturally appropriate messages & mess5g]s to rea* und]s]v$ communities4 7c7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 #ggi4 ,*ronic ob/ructive pulmon>y disease action plan 7a7 ,f9d+s ,congress f9ds z foll[s3 7#a7 ,*ronic ob/ructive pulmon>y disease 7ref]r$ to 9 ?is subsection z ,,copd7 ref]s to *ronic bron*itis & emphysema1 incurable diseases t make x difficult to exhale all ! air f "o's lungs1 & t c cause p]si/5t c\gh+1 %ortness ( brea?1 & sputum4 7#b7 ,,copd exac]bations--episodes ( acute difficulty brea?+ & mod]ate to sev]e fatigue--are dang]\s1 & _! treatm5t (t5 requires hospitalization4 7#c7 ,:ile smok+ is ! prim>y risk factor = ,,copd1 o!r risk factors include air pollution1 occupational exposures1 h]$ity1 a hi/ory ( *ildhood respiratory infections1 & socioeconomic /atus4 7#d7 ,x is e/imat$ t ov] #ac1ejj1jjj adults 9 ! ,unit$ ,/ates h ,,copd4 7#e7 ,,copd is ! ?ird-lead+ cause ( dea? 9 ! ,unit$ ,/ates1 claim+ ov] #acd1jjj lives 9 #bjaj4 7#f7 ,s9ce #bjjj1 dea?s = wom5 ) ,,copd h exce$$ dea?s 9 m54 7#g7 ,al?\gh ,african ,am]icans h a l[] preval5ce ( ,,copd 9 ! ,unit$ ,/ates1 rese>*]s h %[n t ,african ,am]icans may be und]diagnos$4 ,fur!rmore1 rese>* has %[n t ,african ,am]icans develop ,,copd ) less cumulative smoke exposure & at a y\ng] age4 7b7 ,9 g5]al ,! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion %all conduct1 support1 & exp& public heal? /rategies1 prev5tion1 diagnosis1 surveillance1 & public & pr(essional aw>5ess activities reg>d+ *ronic ob/ructive pulmon>y disease4 7c7 ,national action plan 7#a7 ,developm5t ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,director ( ! ,national ,he>t1 ,lung1 & ,blood ,in/itute1 9 consultation ) ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all develop a national action plan to address *ronic ob/ructive pulmon>y disease 9 ! ,unit$ ,/ates ) p>ticipation f pati5ts1 c>egiv]s1 heal? pr(essionals1 pati5t advocacy organizations1 rese>*]s1 provid]s1 public heal? pr(essionals1 & o!r /akehold]s4 7#b7 ,cont5ts ,at a m9imum1 su* plan %all include recomm5dations =-- 7,a7 public heal? int]v5tions = ! purpose ( implem5tation ( ! national plan2 7,b7 biom$ical1 heal? s]vices1 & public heal? rese>* on *ronic ob/ructive pulmon>y disease2 & 7,c7 inclusion ( *ronic ob/ructive pulmon>y disease 9 ! heal? data collections ( all ,f$]al ag5cies4 7#c7 ,consid]ation ,9 develop+ su* plan1 ! ,director ( ! ,national ,he>t1 ,lung1 & ,blood ,in/itute %all consid] ! recomm5dations & f9d+s ( ! ,national ,academy ( ,m$ic9e 9 ! report entitl$ ,a ,nationwide ,framework = ,surveillance ( ,c>diovascul> & ,*ronic ,lung ,diseases 7,july #bb1 #bjaa74 7d7 ,*ronic disease prev5tion programs ,! ,director ( ! ,national ,he>t1 ,lung1 & ,blood ,in/itute %all c>ry out ! foll[+3 7#a7 ,conduct public education & aw>5ess activities ) pati5t & pr(essional organizations to /imulate e>li] diagnosis & improve pati5t outcomes f treatm5t ( *ronic ob/ructive pulmon>y disease4 ,to ! ext5t kn[n & relevant1 su* public education & aw>5ess activities %all reflect diff]5ces 9 *ronic ob/ructive pulmon>y disease by cause 7tobacco1 environm5tal1 occupational1 biological1 & g5etic7 & include a focus on outrea* to undiagnos$ &1 z appropriate1 m9ority populations4 7#b7 ,supplem5t & exp& ^u ! activities ( ! ,national ,he>t1 ,lung1 & ,blood ,in/itute by mak+ grants to nonpr(it organizations1 ,/ate & local jurisdictions1 & ,indian tribes = ! purpose ( r$uc+ ! burd5 ( *ronic ob/ructive pulmon>y disease1 especially 9 disproportionately impact$ communities1 ?r\gh public heal? int]v5tions & relat$ activities4 7#c7 ,coord9ate ) ! ,c5t]s = ,disease ,control & ,prev5tion1 ! ,indian ,heal? ,s]vice1 ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 & ! ,dep>tm5t ( ,vet]ans ,affairs to develop pilot programs to demon/rate be/ practices = ! diagnosis & managem5t ( *ronic ob/ructive pulmon>y disease4 7#d7 ,develop improv$ te*niques & id5tify be/ practices1 9 coord9ation ) ! ,secret>y ( ,vet]ans ,affairs1 = assi/+ *ronic ob/ructive pulmon>y disease pati5ts to successfully /op smok+1 includ+ id5tification ( subpopulations ) diff]5t ne$s4 ,initiatives "u ?is p>agraph may include rese>* to det]m9e :e!r successful smok+ cessation /rategies are diff]5t = *ronic ob/ructive pulmon>y disease pati5ts comp>$ to su* /rategies = pati5ts ) o!r *ronic diseases4 7e7 ,environm5tal & occupational heal? programs ,! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion %all-- 7#a7 support rese>* into ! environm5tal & occupational causes & biological me*anisms t contribute to *ronic ob/ructive pulmon>y disease2 & 7#b7 develop & dissem9ate public heal? int]v5tions t w less5 ! impact ( environm5tal & occupational causes ( *ronic ob/ructive pulmon>y disease4 7f7 ,data ,collection ,n lat] ?an #ahj days aft] ! enactm5t ( ?is ,act1 ! ,director ( ! ,national ,he>t1 ,lung1 & ,blood ,in/itute & ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 act+ jo9tly1 %all assess ! dep? & quality ( in=mation on *ronic ob/ructive pulmon>y disease t is collect$ 9 surveys & population /udies conduct$ by ! ,c5t]s = ,disease ,control & ,prev5tion1 includ+ :e!r !re are additional opportunities = in=mation to be collect$ 9 ! ,national ,heal? & ,nutrition ,exam9ation ,survey1 ! ,national ,heal? ,int]view ,survey1 & ! ,behavioral ,risk ,factors ,surveillance ,sy/em surveys4 ,! ,director ( ! ,national ,he>t1 ,lung1 & ,blood ,in/itute %all include ! results ( su* assessm5t 9 ! national action plan "u subsection 7c74 7g7 ,au?orization ( ,appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbe4 ,h ,tub]culosis #gha4 ,elim9ation ( all =ms ( tub]culosis 7a7 ,%ort title ,?is subtitle may be cit$ z ! ,end ,tub]culosis ,act4 7b7 ,f9d+s ,congress makes ! foll[+ f9d+s3 7#a7 ,9 ! ,unit$ ,/ates1 #i1jbe p 7 diagnos$ ) tub]culosis 7ref]r$ to 9 ?is section z ,,tb7 9 #bjah4 7#b7 ,disp>ities 9 ,,tb exi/ & significantly impact m9ority communities 9 ! ,unit$ ,/ates4 ,! ,c5t]s = ,disease ,control & ,prev5tion 7ref]r$ to 9 ?is section z ,,cdc7 f9ds t #gj p]c5t ( p diagnos$ ) ,,tb 9 #bjah self-id5tifi$ z racial & e?nic m9orities4 7#c7 ,african ,am]icans compris$ #bj p]c5t ( p diagnos$ ) ,,tb dur+ #bjah4 ,! population-adju/$ rate ( ,,tb among ,african ,am]icans is #a4g times high] ?an ! national total1 & #h4j times high] ?an among ,:ites4 7#d7 ,asian ,am]icans1 ,native ,hawaiians1 & o!r ,pacific ,isl&]s compris$ #cg p]c5t ( p diagnos$ ) ,,tb dur+ #bjah4 ,! population-adju/$ rate ( ,,tb among ,asian ,am]icans is #f4b times high] ?an ! national total1 & #ca times high] ?an among ,:ites4 ,! population-adju/$ rate ( ,,tb among ,native ,hawaiians & o!r ,pacific ,isl&]s is #d4h times high] ?an ! national total1 & #bc4b times high] ?an among ,:ites4 7#e7 ,hispanics & ,lat9os compris$ #bf p]c5t ( p diagnos$ ) ,,tb dur+ #bjah4 ,! population-adju/$ rate ( ,,tb among ,hispanics & ,lat9os is #a4f times high] ?an ! national total1 & #h4j times high] ?an among ,:ites4 7#f7 ,,tb is bo? prev5table & curable1 b ! curr5t rate ( decl9e ( ,,tb 9 ! ,unit$ ,/ates rema9s too sl[ to a*ieve ,,tb elim9ation 9 ?is c5tury4 7#g7 ,,tb is transmitt$ ?r\gh ! air :5 a p]son :o has ,,tb disease 9 _! lungs c\ghs or sneezes4 ,p :o are 9 close proximity to ! p]son ) ,,tb c brea! 9 ! ,,tb bact]ia1 & ! bact]ia w initially settle 9 _! lungs4 ,)\t prop] & timely diagnosis & access to treatm5t1 ! ,,tb bact]ia may gr[ & spread to o!r p>ts ( _! body4 7#h7 ,z _m z #ac1jjj1jjj p 9 ! ,unit$ ,/ates may h lat5t ,,tb ,infection 7ref]r$ to 9 ?is section z ,,ltbi74 ,p ) ,,ltbi h ,,tb bact]ia 9 _! bodies1 b _! immune sy/em is conta9+ ! bact]ia1 & !y are n sick1 nor d !y h any curr5t risk ( spread+ ,,tb to o!rs4 ,,ltbi c activate into infecti\s1 life-?reat5+ ,,tb if n treat$4 ,model+ has %[n t elim9at+ ,,tb is n possible )\t address+ ,,ltbi4 7#i7 ,comorbidities associat$ ) ,,tb include canc]1 diabetes mellitus1 & ,,hiv4 ,p ) ^! m$ical conditions & compromis$ immune sy/ems are m likely to develop active ,,tb disease & to h worse outcomes f ,,tb4 7#aj7 ,=ms ( active ,,tb t d n %[ drug resi/ance are classifi$ z drug-susceptible ,,tb 7ref]r$ to 9 ?is section z ,,ds-,,tb74 ,drug-resi/ant ,,tb 7ref]r$ to 9 ?is section z ,,dr-,,tb7 is a ris+ ?reat to ! public heal? ( ! ,unit$ ,/ates4 ,,dr-,,tb t exhibits resi/ance to two or m fir/-l9e drugs is ref]r$ to z multi-drug resi/ant ,,tb 7ref]r$ to 9 ?is section z ,,mdr-,,tb74 ,,mdr-,,tb t also is resi/ant to at lea/ "o injectable second-l9e m$ication & at lea/ "o fluoroqu9olone is classifi$ z ext5sively drug-resi/ant ,,tb 7ref]r$ to 9 ?is section z ,,xdr-,,tb74 7#aa7 ,approximately #ig p 9 ! ,unit$ ,/ates 7 diagnos$ ) ,,mdr-,,tb 9 #bjah4 ,"o p]son 0 diagnos$ ) ,,xdr-,,tb 9 ! same ye>4 7#ab7 ,9 ! ,unit$ ,/ates1 #dhj1jjj1jjj 0 sp5t 9 #bjah to treat ,,tb2 direct treatm5t co/s av]age #ai1jjj to treat a pati5t ) ,,ds-,,tb1 #age1jjj to treat a pati5t ) ,,mdr-,,tb1 & #edd1jjj to treat a pati5t ) ,,xdr-,,tb4 ,:5 factor+ 9 productivity losses dur+ treatm5t1 ,,ds-,,tb av]ages #df1jjj1 ,,mdr-,,tb av]ages #bid1jjj & ,,xdr-,,tb av]ages #fid1jjj4 ,treatm5t is (t5 difficult1 ) daily complex multi-pill regim5s & injections1 ) side-effects rang+ f he>+ & vision loss to m5tal heal? issues4 7#ac7 ,recogniz+ ! public heal?1 economic & societal co/s to ! ?reat ( ,,mdr-,,tb1 ! ,national ,action ,plan to ,combat ,,mdr-,,tb 0 develop$ by ! ,:ite ,h\se to provide ! ,unit$ ,/ates ) a compreh5sive ?ree-prong$ /rategy to address ,,mdr-,,tb by /r5g!n+ dome/ic capacity to combat ,,mdr-,,tb2 improve int]national capacity & coop]ation to combat ,,mdr-,,tb2 accel]ate basic & appli$ rese>* & developm5t = new !rapies1 diagno/ics & prev5tion /rategies to combat ,,mdr-,,tb4 7#ad7 ,additional ,f$]al support is necess>y to exp& ,,tb control ef=ts 9 case f9d+ & treatm5t to address ,,ltbi 9 a national prev5tion initiative4 ,key policy & rese>* break?r\ghs increase ! success ( a ,,tb prev5tion initiative3 ! ,u4,s4 ,prev5tative ,s]vices ,task ,=ce recomm5dation's ,b rat+1 scre5+ = ,,ltbi among high-risk adults z a cov]$ s]vice increases ! likelihood t impact$ racial & e?nic m9ority gr\ps c get te/$ = ,,tb2 a new1 %ort] c\rse treatm5t regim5 r$uces ! l5g? ( treatm5t = ,,ltbi f e day = #f to #i mon?s to "o dose p] week = #ab weeks1 increas+ likelihood ( treatm5t completion2 & ! use ( blood-bas$ diagno/ic te/s1 ,int]f]on-gamma release assays or ,i,g,r,as1 increases ability to detect ,,ltbi among pati5ts 9 affect$ communities4 7#ae7 ,! "r to heal?1 & ! "r to sci5ce z a necess>y human "r to help a*ieve ! "r to heal?1 is en%r9$ 9 ,articles #be & #bg ( ! ,univ]sal ,decl>ation ( ,human ,rights4 ,^! fundam5tal human rights _c be a*iev$ :5 anyone lacks access to ,,tb prev5tion or treatm5t1 & :5 ! b5efits ( sci5tific innovation are n ext5d$ to p ) all =ms ( ,,tb4 #ghb4 ,additional fund+ = ,/ates 9 combat+ & elim9at+ tub]culosis ,section #cag;,e7h7 ( ! ,public ,heal? ,act 7#db ,u4,s4,c4 #bdg;b-#f7;h77 is am5d$ by add+ at ! end ! foll[+3 7#c7 ,additional fund+ = ,/ates 9 combat+ & elim9at+ tub]culosis ,9 addition to am\nts o!rwise au?oriz$ to be appropriat$ to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y to c>ry out ?is section = ea* ( fiscal ye>s #bjbj ?r\gh #bjba4 4 #ghc4 ,/r5g!n+ cl9ical rese>* fund+ = tub]culosis 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices %all exp& & int5sify support = curr5t & prospective rese>* activities ( ! ,national ,in/itutes ( ,heal?1 ! ,biom$ical ,advanc$ ,rese>* & ,developm5t ,au?ority1 & ! ,c5t]s = ,disease ,control & ,prev5tion ,division ( ,tub]culosis ,elim9ation to develop new !rapeutics1 diagno/ics1 vacc9es1 & o!r prev5tion modalities 9 address+ all =ms ( tub]culosis 7ref]r$ to 9 ?is section z ,,tb74 7b7 ,includ$ rese>* activities ,rese>* activities "u subsection 7a7 %all include-- 7#a7 rese>* & developm5t1 & pa?ways to approval1 = novel1 safe drugs & drug regim5s = ! treatm5t ( ,,tb1 includ+ 9 adolesc5t & p$iatric populations & 9 pregnant & lactat+ wom52 7#b7 rese>* to develop rapid diagno/ic te/s = all =ms ( ,,tb1 includ+ diagno/ics t c be us$ = p$iatric populations & p liv+ ) ,,hiv1 diagno/ics t c detect extra pulmon>y ,,tb & drug resi/ance1 & diagno/ics t c be us$ at ! po9t ( c>e2 7#c7 rese>* to advance basic k ( ! pa?og5esis ( ,,tb & its major comorbidities1 includ+ ,,hiv & diabetes mellitus2 7#d7 rese>* to improve k & und]/&+s ( ! role ( lat5cy 9 ,,tb & ! factors t increase ! risk ( lat5t ,,tb infection progress+ to active1 symptomatic ,,tb disease2 7#e7 aw>d+ grants & contracts to specifically develop new & ne$$ vacc9es to address ,,tb2 7#f7 aw>d+ grants & contracts to support ! tra9+ & developm5t ( cl9ical rese>*]s ^: rese>* improves ! l&scape ( tools to combat ,,tb2 & 7#g7 aw>d+ grants & contracts to support capacity-build+ & develop cl9ical trial site infra/ructure 9 ! ,unit$ ,/ates & 9 ,,tb endemic c\ntries to support ! a=em5tion$ rese>* activities4 ,i ,o/eo>?ritis & ,musculoskeletal ,diseases #ghe4 ,f9d+s ,congress f9ds z foll[s3 7#a7 ,eighty p]c5t ( ,african-,am]ican wom5 & ne>ly #gd p]c5t ( ,hispanic m5 are ei!r ov]weight or obese1 spe$+ ! onset & progression ( ar?ritis4 7#b7 ,ar?ritis affects #df1jjj1jjj p 9 ! ,unit$ ,/ates1 & t numb] w rise to #fg1jjj1jjj by ! ye> #bjcj4 7#c7 ,tw5ty-sev5 million p 9 ! ,unit$ ,/ates suff] f o/eo>?ritis1 ! mo/ common =m ( ar?ritis1 mak+ x ! lead+ cause ( disability 9 ! ,unit$ ,/ates4 ,o/eo>?ritis is sometimes ref]r$ to z deg5]ative jo9t disease4 7#d7 ,obesity accel]ates ! onset ( ar?ritis3 #gj p]c5t ( obese adults ) mild o/eo>?ritis ( ! knee at age #fj w develop advanc$ end-/age disease by age #hj4 ,9 contra/1 j #dc p]c5t ( non-obese adults w h end-/age disease ov] ! same "t p]iod4 7#e7 ,ar?ritis affects #a 9 #e p 9 ! ,unit$ ,/ates & is ! s+le greate/ cause ( *ronic pa9 & disability 9 ! ,unit$ ,/ates4 7#f7 ,wom51 ,african ,am]icans1 & ,hispanics h m sev]e ar?ritis & functional limitations4 ,^! same individuals are m likely to be obese1 diabetic1 & h high] incid5ce ( he>t disease--m$ical conditions t c be improv$ ) physical activity4 ,in/ead ( mov+1 h[ev]1 ^! gr\ps h an inactivity rate ( #dj to #ej p]c5t1 :i* cont9ues to increase4 7#g7 ,ar?ritis co/s #abh1jjj1jjj1jjj a ye>1 includ+ #ha1jjj1jjj1jjj 9 direct co/s 7m$ical7 & #dg1jjj1jjj1jjj 9 indirect co/s 7lo/ e>n+s74 ,ea* ye>1 #cji1jjj1jjj1jjj 9 direct & indirect co/s is lo/ due to disp>ities 9 o/eo>?ritis & musculoskeletal diseases4 7#h7 ,obesity & o!r *ronic heal? conditions exac]bate ! debilitat+ impact ( ar?ritis1 lead+ to inactivity1 loss ( indep5d5ce1 & a p]petual cycle ( comorbid *ronic conditions4 7#i7 ,sixty-"o p]c5t ( ar?ritis suff]]s are wom51 & wom5 repres5t #fd p]c5t ( an e/imat$ #dc1jjj1jjj annual visits to physicians' (fices & outpati5t cl9ics :]e ar?ritis 0 ! prim>y diagnosis4 ,wom5 also repres5t$ #fj p]c5t ( approximately #a1jjj1jjj hospitalizations t occurr$ 9 #bjjc = :i* ar?ritis 0 ! prim>y diagnosis4 7#aj7 ,wom5 ages #fe & old] h up to #b times m disabilities ?an m5 ( ! same age4 ,high] rates ( obesity & ar?ritis among ?is gr\p expla9$ up to #dh p]c5t ( ! g5d] gap 9 disability1 above all o!r common *ronic heal? conditions4 7#aa7 ,! prim>y indication = total knee ar?ropla/y 7ref]r$ to 9 ?is section z ,,tka71 also kn[n z knee replacem5t1 is relief ( significant1 disabl+ pa9 caus$ by sev]e ar?ritis4 7#ab7 ,knee replacem5t is surg]y = p ) sev]e knee damage4 ,knee replacem5t c relieve pa9 & all[ an individual to be m active4 ,! process = a total knee replacem5t involves ! surgeon remov+ damag$ c>tilage & bone f ! surface ( ! knee jo9t & replac+ ! c>tilage & bone ) a man-made surface ( metal & pla/ic4 ,9 a p>tial knee replacem5t1 ! surgeon only replaces "p ( ! knee jo9t4 7#ac7 ,total hip replacem5t1 also call$ total hip ar?ropla/y 7ref]r$ to 9 ?is section z ,,?a71 is us$ if hip pa9 int]f]es ) daily activities & m cons]vative treatm5ts h n help$4 ,ar?ritis damage is ! mo/ common reason to ne$ hip replacem5t4 7#ad7 ,! odds ( a family practice physician recomm5d+ ,,tka to a male pati5t ) mod]ate ar?ritis are twice t ( a female pati5t1 :ile ! odds ( an or?opa$ic surgeon recomm5d+ ,,tka to a male pati5t ) mod]ate ar?ritis are #bb times t ( a female pati5t4 7#ae7 ,african ,am]icans ) doctor-diagnos$ ar?ritis h a high] preval5ce ( sev]e pa9 attributable to ar?ritis1 comp>$ ) ,:ites 7#cd4j p]c5t v]sus #bb4f p]c5t74 ,african ,am]icans1 comp>$ to ,:ites1 report a high] proportion ( "w limitations 7#ci4e p]c5t v]sus #bh4j p]c5t7 & a high] preval5ce ( ar?ritis-attributable "w limitation 7#f4f p]c5t v]sus #d4f p]c5t74 7#af7 ,hispanics are #ej p]c5t m likely ?an non-,hispanic ,:ites to report ne$+ assi/ance ) at lea/ "o in/rum5tal activity ( daily liv+ & to h difficulty walk+4 7#ag7 ,african ,am]icans & ,hispanics 7 #a4c times m likely to h activity limitation1 #a4f times m likely to h "w limitations1 & #a4i times m likely to h sev]e jo9t pa9 ?an ,:ites4 7#ah7 ,9 #bjjc1 ! ,national ,academy ( ,m$ic9e report$ t ! rates ( ,,tka & ,,?a among ,african-,am]ican & ,hispanic pati5ts are significantly l[] ?an = ,:ites--ev5 = ^? ) equitable heal? c>e cov]age su* z ?r\gh ,m$ic>e or ! ,dep>tm5t ( ,vet]ans ,affairs4 7#ai7 ,accord+ to ! ,c5t]s = ,disease ,control & ,prev5tion1 9 #bjjj1 ,african-,am]ican ,m$ic>e enrollees 7 #cg p]c5t less likely ?an ,:ite ,m$ic>e enrollees to und]go total knee replacem5ts4 ,9 #bjjf1 ! disp>ity increas$ to #ci p]c5t4 7#bj7 ,ev5 aft] adju/+ = insurance & heal? access1 ,hispanics & ,african ,am]icans are almo/ #ej p]c5t less likely to und]go total knee replacem5t ?an ,:ites4 #ghf4 ,o/eo>?ritis & o!r musculoskeletal heal?-relat$ activities ( ! ,c5t]s = ,disease ,control & ,prev5tion 7a7 ,education & ,aw>5ess activities ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all direct ! ,national ,c5t] = ,*ronic ,disease ,prev5tion & ,heal? ,promotion to conduct & exp& ! ,heal? ,community ,program & ,ar?ritis ,program to educate ! public on-- 7#a7 ! causes (1 prev5tive heal? actions =1 & effects ( ar?ritis & o!r musculoskeletal conditions 9 m9ority pati5t populations2 & 7#b7 ! effects ( su* conditions on o!r comorbidities includ+ obesity1 hyp]t5sion1 & c>diovascul> disease4 7b7 ,programs on ar?ritis & musculoskeletal conditions ,education & aw>5ess programs ( ! ,c5t]s = ,disease ,control & ,prev5tion on ar?ritis & o!r musculoskeletal conditions 9 m9ority communities %all-- 7#a7 be culturally & l+ui/ically appropriate to m9ority pati5ts1 t>get+ musculoskeletal heal? promotion & prev5tion programs ( ea* major e?nic gr\p1 includ+-- 7,a7 ,native ,am]icans & ,alaska ,natives2 7,b7 ,asian ,am]icans2 7,c7 ,african ,am]icans & ,blacks2 7,d7 ,hispanic & ,lat9o ,am]icans2 & 7,e7 ,native ,hawaiians & ,pacific ,isl&]s2 & 7#b7 include public aw>5ess campaigns direct$ t[>d ^! pati5t populations t emphasize ! importance ( musculoskeletal heal?1 physical activity1 diet & heal?y life/yle1 & weight r$uction = ov]weight & obese pati5ts4 7c7 ,au?orization ( ,appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z are necess>y = fiscal ye> #bjba & ea* subsequ5t fiscal ye>4 #ghg4 ,grants = compreh5sive o/eo>?ritis & musculoskeletal disease heal? education )9 heal? pr(essions s*ools 7a7 ,program au?oriz$ ,! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y71 9 coord9ation ) ! ,secret>y ( ,education1 %all aw>d grants1 on a competitive basis1 to academic heal? sci5ce c5t]s1 heal? pr(essions s*ools1 & in/itutions ( high] education to enable su* c5t]s1 s*ools1 & in/itutions to provide p ) compreh5sive education on ar?ritis & musculoskeletal heal?1 p>ticul>ly-- 7#a7 obesity-relat$ musculoskeletal diseases2 7#b7 ar?ritis & o/eo>?ritis2 7#c7 ar?ritis & musculoskeletal heal? disp>ities2 & 7#d7 ! relation%ip betwe5 ar?ritis & musculoskeletal diseases & metabolic activity1 psy*ological heal?1 & comorbidities su* z diabetes1 c>diovascul> disease1 & hyp]t5sion4 7b7 ,duration ,grants aw>d$ "u ?is section %all be = a p]iod ( #e ye>s4 7c7 ,applications ,an academic heal? sci5ce c5t]1 heal? pr(essions s*ool1 or in/itution ( high] education seek+ a grant "u ?is section %all submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7d7 ,priority ,9 aw>d+ grants "u ?is section1 ! ,secret>y %all give priority to an in/itution ( high] education t-- 7#a7 has an enrollm5t ( ne$y /ud5ts1 z def9$ 9 section #cah7;b7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajei;e7b772 7#b7 is a ,hispanic-s]v+ in/itution1 z def9$ 9 section #ejb7;a7 ( su* ,act 7#bj ,u4,s4,c4 #aaja;a7a772 7#c7 is a ,tribal ,college or ,univ]sity1 z def9$ 9 section #caf7;b7 ( su* ,act 7#bj ,u4,s4,c4 #ajei;c7b772 7#d7 is an ,alaska ,native-s]v+ in/itution1 z def9$ 9 section #cag7;b7 ( su* ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7#e7 is a ,native ,hawaiian-s]v+ in/itution1 z def9$ 9 section #cag7;b7 ( su* ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7#f7 is a ,pr$om9ately ,black ,in/itution1 z def9$ 9 section #cah7;b7 ( su* ,act 7#bj ,u4,s4,c4 #ajei;e7b772 7#g7 is a ,native ,am]ican-s]v+1 non-,tribal in/itution1 z def9$ 9 section #cai7;b7 ( su* ,act 7#bj ,u4,s4,c4 #ajei;f7b772 7#h7 is an ,asian ,am]ican & ,native ,am]ican ,pacific ,isl&]-s]v+ in/itution1 z def9$ 9 section #cbj7;b7 ( su* ,act 7#bj ,u4,s4,c4 #ajei;g7b772 or 7#i7 is a m9ority in/itution1 z def9$ 9 section #cfe ( su* ,act 7#bj ,u4,s4,c4 #ajfgk71 ) an enrollm5t ( ne$y /ud5ts1 z def9$ 9 section #cab ( su* ,act 7#bj ,u4,s4,c4 #ajeh74 7e7 ,uses ( funds ,an academic heal? sci5ce c5t]1 heal? pr(essions s*ool1 or in/itution ( high] education receiv+ a grant "u ?is section may use grant funds to integrate issues relat+ to compreh5sive ar?ritis & musculoskeletal heal? into ! academic or support sectors ( ! c5t]1 s*ool1 or in/itution 9 ord] to rea* a l>ge numb] ( /ud5ts1 by c>ry+ out #a or m ( ! foll[+ activities3 7#a7 ,develop+ educational cont5t = issues relat+ to compreh5sive ar?ritis & musculoskeletal heal? education t w be incorporat$ into fir/-ye> ori5tation or core c\rses4 7#b7 ,creat+ innovative te*nology-bas$ approa*es to deliv] ar?ritis & musculoskeletal heal? education to /ud5ts1 faculty1 & /aff4 7#c7 ,develop+ & employ+ pe]-outrea* & education programs to g5]ate discussion1 educate1 & raise aw>5ess among /ud5ts ab\t issues relat+ to ar?ritis & musculoskeletal heal? disord]s1 & _! relation%ip to diabetes1 hyp]t5sion1 c>diovascul> disease1 psy*ological heal?1 & o!r comorbid conditions4 7f7 ,report to congress 7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 & annually !reaft] = a p]iod ( #e ye>s1 ! ,secret>y %all prep>e & submit to ! appropriate committees ( ,congress a report on ! activities to provide heal? pr(essions /ud5ts ) compreh5sive ar?ritis & musculoskeletal heal? education fund$ "u ?is section4 7#b7 ,report elem5ts ,! report describ$ 9 p>agraph 7#a7 %all include in=mation ab\t-- 7,a7 ! numb] ( entities t are receiv+ grant funds2 7,b7 ! specific activities support$ by grant funds2 7,c7 ! numb] ( /ud5ts s]v$ by grant programs2 & 7,d7 ! /atus ( program evaluations4 7g7 ,def9ition ( in/itution ( high] education ,9 ?is section1 ! t]m in/itution ( high] education has ! mean+ giv5 su* t]m 9 section #aja7;b7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajja7;b774 ,j ,sleep & ,circadian ,rhy?m ,disord]s #gia4 ,%ort title2 f9d+s 7a7 ,%ort title ,?is subtitle may be cit$ z ! ,sleep & ,circadian ,rhy?m ,disord]s ,heal? ,disp>ities ,act4 7b7 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,decrem5ts 9 sleep heal? su* z sleep apnea1 insuffici5t sleep "t1 & insomnia1 affect #ej1jjj1jjj to #gj1jjj1jjj adults 9 ! ,unit$ ,/ates4 ,twelve to eighte5 million ,unit$ ,/ates adults h sleep apnea1 a *ronic disord] *>act]iz$ by "o or m pauses 9 brea?+ :i* c la/ f a few seconds to m9utes4 ,!y may occur #cj times or m an h\r1 disrupt+ sleep & result+ 9 excessive daytime sleep9ess & loss 9 productivity4 7#b7 ,sev5ty p]c5t ( high s*ool /ud5ts are n gett+ en\gh sleep on s*ool nights1 :ile #cc p]c5t ( p 9 ! ,unit$ ,/ates get few] ?an #g h\rs ( sleep p] night1 & r\ghly #f1jjj fatal motor vehicle cra%es are caus$ by dr[sy driv]s4 7#c7 ,insuffici5t sleep & insomnia are m preval5t 9 wom54 ,wom5 :o are pregnant & h sleep apnea are at an increas$ risk ( c>diovascul> complications dur+ pregnancy4 ,! impact ( disp>ities 9 sleep heal? is associat$ ) a gr[+ numb] ( heal? problems1 includ+ ! foll[+3 7,a7 ,hyp]t5sion4 7,b7 ,canc]4 7,c7 ,/roke4 7,d7 ,c>diac arrhy?mia4 7,e7 ,*ronic he>t failure & he>t disease4 7,f7 ,diabetes4 7,g7 ,cognitive function+ & behavior4 7,h7 ,depression & bipol> disord]4 7,i7 ,sub/ance abuse4 7#d7 ,a sleep disp>ity exi/s 9 t poor sleep quality is /rongly associat$ ) pov]ty & race4 ,factors su* z employm5t1 education1 & heal? /atus1 among/ o!rs1 significantly m$iat$ ?is effect only 9 poor subjects1 sugge/+ a diff]5tial vuln]ability to ^! factors 9 poor relative to nonpoor individuals 9 ! context ( sleep quality4 7#e7 ,african ,am]icans sleep worse ?an ,caucasian ,am]icans4 ,african ,am]icans take long] to fall asleep1 report poor] sleep quality1 h m light & less deep sleep1 & nap m (t5 & long]4 7#f7 ,african ,am]icans & individuals 9 l[] socioeconomic /atus gr\ps may be at an increas$ risk = sleep di/urbances & associat$ heal? consequ5ces4 7#g7 ,among "y ,african ,am]icans1 ! likelihood ( hav+ sleep disord]$ brea?+ & exhibit+ risk factors = poor sleep is twice t 9 "y ,caucasians4 ,frequ5t snor+ is m common among ,african-,am]ican & ,hispanic wom5 & ,hispanic m5 comp>$ to non-,hispanic ,caucasians1 indep5d5t ( o!r factors includ+ obesity4 7#h7 ,african ,am]icans ) sleep-disord]$ brea?+ develop symptoms at a y\ng] age ?an ,caucasians b appe> less likely to be diagnos$ & treat$ 9 a timely mann]4 ,?is delay may at lea/ 9 "p be due to r$uc$ access to c>e4 7#i7 ,sleep loss contributes to increas$ risk = *ronic conditions su* z obesity1 diabetes1 & hyp]t5sion1 all ( :i* h increas$ preval5ce 9 und]s]v$1 und]repres5t$ m9orities4 ,racial & e?nic disp>ities relat$ to obesity may also contribute to disp>ities 9 heal? outcomes relat$ to sleep-disord]$ brea?+4 7#aj7 ,non-,caucasian adults report an insomnia rate ( #ab4i p]c5t comp>$ to only #f4f p]c5t = ,caucasians4 7#aa7 ,african-,am]ican wom5 h a high] incid5ce ( insomnia ?an ,african-,am]ican m51 p]haps relat$ 9 "p to high] risk = *ronic p]si/+ symptoms4 #gib4 ,sleep & circadian rhy?m disord]s rese>* activities ( ! ,national ,in/itutes ( ,heal? 7a7 ,9 g5]al ,! ,director ( ! ,national ,in/itutes ( ,heal?1 act+ ?r\gh ! ,director ( ! ,national ,he>t1 ,lung1 & ,blood ,in/itute1 %all-- 7#a7 cont9ue to exp& rese>* activities address+ sleep heal? disp>ities2 & 7#b7 cont9ue implem5tation ( ! ,,nih ,sleep ,disord]s ,rese>* ,plan across all in/itutes & c5t]s ( ! ,national ,in/itutes ( ,heal? to improve treatm5t & prev5tion ( sleep heal? disp>ities4 7b7 ,requir$ rese>* activities ,9 conduct+ or support+ rese>* relat+ to sleep & circadian rhy?m1 ! ,director ( ! ,national ,he>t1 ,lung1 & ,blood ,in/itute %all-- 7#a7 advance epidemiology & cl9ical rese>* to a*ieve a m complete und]/&+ ( disp>ities 9 doma9s ( sleep heal? & across population subgr\ps = :i* c>diovascul> & metabolic heal? disp>ities exi/1 includ+-- 7,a7 preval5ce & sev]ity ( sleep apnea2 7,b7 habitual sleep duration2 7,c7 sleep tim+ & regul>ity2 & 7,d7 insomnia2 7#b7 develop /udy designs & analytical approa*es to expla9 & pr$ict multilevel & life-c\rse det]m9ants ( sleep heal? & to elucidate ! sleep-relat$ causes ( c>diovascul> & metabolic heal? disp>ities across ! age spectrum1 includ+ su* det]m9ants & causes t are-- 7,a7 environm5tal2 7,b7 biological or g5etic2 7,c7 psy*osocial2 7,d7 societal2 7,e7 political2 or 7,f7 economic2 7#c7 det]m9e ! contribution ( sleep impairm5ts su* z sleep apnea1 insuffici5t sleep duration1 irregul> sleep s*$ules1 & insomnia to unexpla9$ disp>ities 9 c>diovascul> & metabolic risk & disease outcomes2 7#d7 develop /udy designs1 data sampl+ & collection tools1 & analytical approa*es to optimize und]/&+ ( m$iat+ & mod]at+ factors1 & fe$back me*anisms c\pl+ sleep to c>diovascul> & metabolic heal? disp>ities2 7#e7 advance rese>* to und]/& cultural & l+ui/ic b>ri]s 7on ! p]son1 provid]1 or sy/em level7 to access to c>e1 m$ical diagnosis1 & treatm5t ( sleep disord]s 9 div]se population gr\ps2 7#f7 develop & te/ multilevel int]v5tions 7includ+ sleep heal? education 9 div]se communities7 to r$uce disp>ities 9 sleep heal? t w impact ability to improve disp>ities 9 c>diovascul> & metabolic risk or disease2 7#g7 create opportunities to integrate sleep & heal? disp>ity sci5ce by /rategically utiliz+ res\rces 7exi/+ or anticipat$ cohorts71 ex*ang+ sci5tific data & ideas 7cross-ov] into sci5tific meet+s71 & develop multidiscipl9>y inve/igator-initiat$ grant applications2 & 7#h7 enhance ! div]sity & fo/] c>e] developm5t ( "y inve/igators involv$ 9 sleep & heal? disp>ities sci5ce4 7c7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y = fiscal ye> #bjba & ea* subsequ5t fiscal ye>4 #gic4 ,sleep & circadian rhy?m heal? disp>ities-relat$ activities ( ! ,c5t]s = ,disease ,control & ,prev5tion 7a7 ,9 g5]al ,! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion %all conduct1 support1 & exp& public heal? /rategies & prev5tion1 diagnosis1 surveillance1 & public & pr(essional aw>5ess activities reg>d+ sleep & circadian rhy?m disord]s4 7b7 ,f9d+s ,congress f9ds z foll[s3 7#a7 ,sleep disord]s & sleep defici5cy unrelat$ to a prim>y sleep disord] are und]diagnos$ & are increas+ly detrim5tal to heal? /atus4 7#b7 ,! consequ5ces to society include additional diseases1 motor vehicle accid5ts1 decreas$ longevity1 elevat$ direct m$ical co/s1 & indirect co/s relat$ to "w abs5teeism & prop]ty damage4 7c7 ,requir$ surveillance & education aw>5ess activities ,9 conduct+ or support+ rese>* relat+ to sleep & circadian rhy?m disord]s surveillance & education aw>5ess activities1 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion %all-- 7#a7 ensure t su* activities are culturally & l+ui/ically appropriate to m9ority pati5ts1 t>get+ sleep & circadian rhy?m heal? promotion & prev5tion programs ( ea* major e?nic gr\p1 includ+-- 7,a7 ,native ,am]icans & ,alaska ,natives2 7,b7 ,asian ,am]icans2 7,c7 ,african ,am]icans & ,blacks2 7,d7 ,hispanic & ,lat9o-,am]icans2 & 7,e7 ,native ,hawaiians & ,pacific ,isl&]s2 7#b7 collect & compile national & ,/ate surveillance data on sleep disord]s heal? disp>ities2 7#c7 cont9ue to develop & implem5t new sleep que/ions 9 public heal? surveillance sy/ems to increase public aw>5ess ( sleep heal? & sleep disord]s & _! impact on heal?2 7#d7 publi% mon?ly reports highlight+ geographic1 racial1 & e?nic disp>ities 9 sleep heal?1 z well z relation%ips betwe5 insuffici5t sleep & *ronic disease1 heal? risk behaviors1 & o!r outcomes z det]m9$ necess>y by ! ,director2 & 7#e7 include public aw>5ess campaigns t in=m pati5t populations f major e?nic gr\ps ab\t ! preval5ce ( sleep & circadian rhy?m disord]s & emphasize ! importance ( sleep heal?4 7d7 ,au?orization ( ,appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y = fiscal ye> #bjba & ea* subsequ5t fiscal ye>4 #gid4 ,grants = compreh5sive sleep & circadian heal? education )9 heal? pr(essions s*ools 7a7 ,program au?oriz$ ,! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is section z ! ,secret>y71 9 coord9ation ) ! ,secret>y ( ,education1 %all aw>d grants1 on a competitive basis1 to academic heal? sci5ce c5t]s1 heal? pr(essions s*ools1 & in/itutions ( high] education to enable su* c5t]s1 s*ools1 & in/itutions to provide p ) compreh5sive education on sleep & circadian heal?1 p>ticul>ly-- 7#a7 poor sleep heal?2 7#b7 sleep disord]s2 7#c7 sleep heal? disp>ities2 & 7#d7 ! relation%ip betwe5 sleep & circadian heal? on metabolic activity1 neurological activity1 comorbidities1 & o!r diseases4 7b7 ,duration ,grants aw>d$ "u ?is section %all be = a p]iod ( #e ye>s4 7c7 ,applications ,an academic heal? sci5ce c5t]1 heal? pr(essions s*ool1 or in/itution ( high] education seek+ a grant "u ?is section %all submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7d7 ,priority ,9 aw>d+ grants "u ?is section1 ! ,secret>y %all give priority to an in/itution ( high] education t-- 7#a7 has an enrollm5t ( ne$y /ud5ts1 z def9$ 9 section #cah7;b7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajei;e7b772 7#b7 is a ,hispanic-s]v+ in/itution1 z def9$ 9 section #ejb7;a7 ( su* ,act 7#bj ,u4,s4,c4 #aaja;a7a772 7#c7 is a ,tribal ,college or ,univ]sity1 z def9$ 9 section #caf7;b7 ( su* ,act 7#bj ,u4,s4,c4 #ajei;c7b772 7#d7 is an ,alaska ,native-s]v+ in/itution1 z def9$ 9 section #cag7;b7 ( su* ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7#e7 is a ,native ,hawaiian-s]v+ in/itution1 z def9$ 9 section #cag7;b7 ( su* ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7#f7 is a ,pr$om9ately ,black ,in/itution1 z def9$ 9 section #cah7;b7 ( su* ,act 7#bj ,u4,s4,c4 #ajei;e7b772 7#g7 is a ,native ,am]ican-s]v+1 nontribal in/itution1 z def9$ 9 section #cai7;b7 ( su* ,act 7#bj ,u4,s4,c4 #ajei;f7b772 7#h7 is an ,asian ,am]ican & ,native ,am]ican ,pacific ,isl&]-s]v+ in/itution1 z def9$ 9 section #cbj7;b7 ( su* ,act 7#bj ,u4,s4,c4 #ajei;g7b772 or 7#i7 is a m9ority in/itution1 z def9$ 9 section #cfe ( su* ,act 7#bj ,u4,s4,c4 #ajfgk71 ) an enrollm5t ( ne$y /ud5ts1 z def9$ 9 section #cab ( su* ,act 7#bj ,u4,s4,c4 #ajeh74 7e7 ,uses ( funds ,an academic heal? sci5ce c5t]1 heal? pr(essions s*ool1 or in/itution ( high] education receiv+ a grant "u ?is section may use ! grant funds to integrate issues relat+ to compreh5sive sleep & circadian heal? into ! academic or support sectors ( ! c5t]1 s*ool1 or in/itution1 9 ord] to rea* a l>ge numb] ( /ud5ts1 by c>ry+ out #a or m ( ! foll[+ activities3 7#a7 ,develop+ educational cont5t = issues relat+ to compreh5sive sleep & circadian heal? education t w be incorporat$ into fir/-ye> ori5tation or core c\rses4 7#b7 ,creat+ innovative te*nology-bas$ approa*es to deliv] sleep heal? education to /ud5ts1 faculty1 & /aff4 7#c7 ,develop+ & employ+ pe]-outrea* & education programs to g5]ate discussion1 educate1 & raise aw>5ess among /ud5ts ab\t issues relat+ to poor quality sleep1 sleep & circadian disord]s1 & ! role sleep heal? plays 9 o!r diseases & comorbidities4 7f7 ,report to congress 7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 & annually !reaft] = a p]iod ( #e ye>s1 ! ,secret>y %all prep>e & submit to ! appropriate committees ( ,congress a report on ! activities to provide heal? pr(essions /ud5ts ) compreh5sive sleep & circadian heal? education fund$ "u ?is section4 7#b7 ,report elem5ts ,! report describ$ 9 p>agraph 7#a7 %all include in=mation ab\t-- 7,a7 ! numb] ( entities t are receiv+ grant funds2 7,b7 ! specific activities support$ by grant funds2 7,c7 ! numb] ( /ud5ts s]v$ by grant programs2 & 7,d7 ! /atus ( program evaluations4 7g7 ,def9ition ( in/itution ( high] education ,9 ?is section1 ! t]m in/itution ( high] education has ! mean+ giv5 su* t]m 9 section #aja7;b7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajja7;b774 #gie4 ,report on impact ( sleep & circadian heal? disord]s 9 vuln]able & racial_/e?nic populations 7a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all submit to ,congress & ! ,presid5t a report on ! impact ( sleep & circadian heal? disord]s = racial & e?nic m9ority communities & o!r vuln]able populations4 7b7 ,cont5ts ,! report "u subsection 7a7 %all include in=mation on !-- 7#a7 progress t has be5 made 9 r$uc+ ! impact ( sleep & circadian heal? disord]s 9 su* communities & populations2 7#b7 opportunities t exi/ to make additional progress 9 r$uc+ ! impact ( sleep & circadian heal? disord]s 9 su* communities & populations2 7#c7 *all5ges t may imp$e su* additional progress2 & 7#d7 ,f$]al fund+ necess>y to a*ieve sub/antial r$uctions 9 sleep & circadian heal? disord]s 9 racial & e?nic m9ority communities4 ,k ,kidney ,disease ,rese>*1 ,surveillance1 ,prev5tion1 & ,treatm5t #gig4 ,kidney disease1 rese>*1 surveillance1 prev5tion1 & treatm5t 7a7 ,%ort title ,?is section may be cit$ z ! ,kidney ,disease ,rese>*1 ,surveillance1 ,prev5tion & ,treatm5t ,improvem5t ,act ( #bjbj4 7b7 ,f9d+s ,congress makes ! foll[+ f9d+s3 7#a7 ,kidney diseases impact #cg1jjj1jjj individuals 9 ! ,unit$ ,/ates4 7#b7 ,african ,am]icans comprise j #ac p]c5t ( ! ,unit$ ,/ates population1 b #cc p]c5t ( ! ,unit$ ,/ates dialysis pati5t population4 ,comp>$ to ,caucasians1 kidney failure preval5ce is ab\t #c4g times great] 9 ,african ,am]icans1 #a4d times great] 9 ,native ,am]icans1 & #a4e times great] 9 ,asian ,am]icans4 7#c7 ,p]itoneal dialysis & home hemodialysis use is #dj-ej p]c5t l[] among ,african ,am]icans & ,hispanics4 7#d7 ,e racial & e?nic m9ority gr\p 9 ! ,unit$ ,/ates is significantly less likely to be treat$ ) home dialysis ?an ,:ites1 & demographic & cl9ical *>act]i/ics are insuffici5t to expla9 ?is diff]5tial use4 7#e7 ,african ,am]icans on dialysis1 irrespective ( dialysis modality1 & ,hispanics und]go+ ,,pd or 9-c5t] ,,hd1 are significantly less likely ?an _! ,:ite c\nt]p>ts to receive a kidney transplant4 7#f7 ,african ,am]icans1 ,hispanics1 & ,asian ,am]icans are less likely to receive liv+ donor kidney transplants ?an ,:ites4 ,ef=ts to r$uce disp>ities 9 live donor kidney transplantation = ,african-,am]ican1 ,hispanic1 & ,asian pati5ts ) kidney failure h be5 unsuccessful4 7#g7 ,m$ic>e & ,m$icaid pati5ts are less likely to receive a preemptive transplant f a deceas$ donor comp>$ to private insurance pati5ts 7#e p]c5t & #aa p]c5t v]sus #bd p]c5t71 & ,black & ,hispanic pati5ts are less likely to receive a preemptive transplant f a deceas$ donor comp>$ ) ,:ite pati5ts ev5 aft] *anges to ! kidney allocation sy/em 7#e p]c5t ( ,black pati5ts & #e p]c5t ( ,hispanic pati5ts comp>$ ) #ah p]c5t ( ,:ite pati5ts74 7#h7 ,l[-income populations are significantly m likely to progress to kidney failure4 7#i7 ,l[ socioeconomic /atus is associat$ ) increas$ incid5ce ( *ronic kidney disease1 progression to kidney failure1 inadequate dialysis treatm5t1 & r$uc$ access to kidney transplantation4 7#aj7 ,! #c goals ( ,executive ,ord] #achgi ( ,july #aj1 #bjai 7#hd ,f$4 ,reg4 #cchag2 relat+ to ,advanc+ ,am]ican ,kidney ,heal?71 recognizes ! ne$ = m transplants1 bett] prev5tion & education1 & improv$ access to treatm5t modalities4 #gih4 ,kidney disease rese>* 9 m9ority populations 7a7 ,9 g5]al ,! ,director ( ! ,national ,in/itutes ( ,heal? %all exp&1 int5sify1 & support ongo+ rese>* & o!r activities ) respect to kidney disease 9 m9ority populations4 7b7 ,rese>* 7#a7 ,description ,rese>* "u subsection 7a7 %all include inve/igation into-- 7,a7 ! causes ( kidney disease1 includ+ socioeconomic1 geographic1 cl9ical1 environm5tal1 g5etic1 & o!r factors t may contribute to increas$ rates ( kidney disease 9 m9ority populations2 & 7,b7 ! causes ( increas$ incid5ce ( kidney disease complications 9 m9ority populations1 & possible int]v5tions to decrease su* incid5ce4 7#b7 ,inclusion ( m9ority p>ticipants ,9 conduct+ & support+ rese>* describ$ 9 subsection 7a71 ! ,director ( ! ,national ,in/itutes ( ,heal? %all seek to include m9ority p>ticipants z /udy subjects 9 cl9ical trials4 7c7 ,report2 compreh5sive plan 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices %all-- 7,a7 prep>e & submit to ! ,congress1 n lat] ?an #f mon?s aft] ! date ( enactm5t ( ?is section1 a report on ,f$]al rese>* & public heal? activities ) respect to kidney disease 9 m9ority populations2 & 7,b7 develop & submit to ,congress1 n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is section1 an effective & compreh5sive ,f$]al plan 7includ+ all appropriate ,f$]al heal? programs7 to address kidney disease 9 m9ority populations4 7#b7 ,cont5ts ,! report "u p>agraph 7#a77;,a7 %all at m9imum address ea* ( ! foll[+3 7,a7 ,rese>* on kidney disease 9 m9ority populations1 includ+ su* rese>* on-- 7i7 g5etic1 behavioral1 & environm5tal factors2 & 7ii7 prev5tion & complications among individuals )9 ^! populations :o h already develop$ kidney disease4 7,b7 ,surveillance & data collection on kidney disease 9 m9ority populations1 includ+ ) respect to-- 7i7 ef=ts to bett] det]m9e ! preval5ce ( kidney disease among ,asian-,am]ican & ,pacific ,isl&] subgr\ps2 & 7ii7 ef=ts to coord9ate data collection on ! ,am]ican ,indian population4 7,c7 ,community-bas$ int]v5tions to address kidney disease t>get+ m9ority populations1 includ+-- 7i7 ! evid5ce base = su* int]v5tions2 7ii7 ! cultural appropriat5ess ( su* int]v5tions2 & 7iii7 ef=ts to educate ! public on ! causes & consequ5ces ( kidney disease4 7,d7 ,education & tra9+ programs = heal? pr(essionals 7includ+ community heal? work]s7 on ! prev5tion & managem5t ( kidney disease & its relat$ complications t are support$ by ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 includ+ su* programs support$ by ! ,bureau ( ,heal? ,work=ce1 ! ,bureau ( ,prim>y ,heal? ,c>e1 & ! ,heal?c>e ,sy/ems ,bureau4 #gii4 ,kidney disease action plan 7a7 ,9 g5]al ,! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion %all conduct1 support1 & exp& public heal? /rategies1 prev5tion1 diagnosis1 surveillance1 & public & pr(essional aw>5ess activities reg>d+ kidney disease4 7b7 ,national action plan 7#a7 ,developm5t ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,director ( ! ,national ,in/itute ( ,diabetes & ,dige/ive & ,kidney ,diseases1 9 consultation ) ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all develop a national action plan to address kidney disease 9 ! ,unit$ ,/ates ) p>ticipation f pati5ts1 c>egiv]s1 heal? pr(essionals1 pati5t advocacy organizations1 rese>*]s1 provid]s1 public heal? pr(essionals1 & o!r /akehold]s4 7#b7 ,cont5ts ,at a m9imum1 su* plan %all include recomm5dations =-- 7,a7 public heal? int]v5tions = ! purpose ( implem5tation ( ! national plan2 7,b7 biom$ical1 heal? s]vices1 & public heal? rese>* on kidney disease2 & 7,c7 inclusion ( kidney disease 9 ! heal? data collections ( all ,f$]al ag5cies4 7c7 ,kidney disease prev5tion programs ,! ,director ( ! ,national ,in/itute ( ,diabetes & ,dige/ive & ,kidney ,diseases %all c>ry out ! foll[+3 7#a7 ,conduct public education & aw>5ess activities ) pati5t & pr(essional organizations to /imulate e>li] diagnosis & improve pati5t outcomes f treatm5t ( kidney disease4 ,to ! ext5t kn[n & relevant1 su* public education & aw>5ess activities %all reflect diff]5ces 9 kidney disease by cause 7su* z hyp]t5sion1 diabetes1 & polycy/ic kidney disease7 & include a focus on outrea* to undiagnos$ &1 z appropriate1 m9ority populations4 7#b7 ,supplem5t & exp& ^u ! activities ( ! ,national ,in/itute ( ,diabetes & ,dige/ive & ,kidney ,diseases by mak+ grants to nonpr(it organizations1 ,/ate & local jurisdictions1 & ,indian tribes = ! purpose ( r$uc+ ! burd5 ( kidney disease1 especially 9 disproportionately impact$ communities1 ?r\gh public heal? int]v5tions & relat$ activities4 7#c7 ,coord9ate ) ! ,c5t]s = ,disease ,control & ,prev5tion1 ! ,indian ,heal? ,s]vice1 ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 & ! ,dep>tm5t ( ,vet]ans ,affairs to develop pilot programs to demon/rate be/ practices = ! diagnosis & managem5t ( kidney disease4 7#d7 ,develop improv$ te*niques & id5tify be/ practices1 9 coord9ation ) ! ,secret>y ( ,vet]ans ,affairs1 = assi/+ kidney disease pati5ts4 7d7 ,data collection ,n lat] ?an #ahj days aft] ! date ( enactm5t ( ?is ,act1 ! ,director ( ! ,national ,in/itute ( ,diabetes & ,dige/ive & ,kidney ,diseases & ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 act+ jo9tly1 %all assess ! dep? & quality ( in=mation on kidney disease t is collect$ 9 surveys & population /udies conduct$ by ! ,c5t]s = ,disease ,control & ,prev5tion1 includ+ :e!r !re are additional opportunities = in=mation to be collect$ 9 ! ,national ,heal? & ,nutrition ,exam9ation ,survey1 ! ,national ,heal? ,int]view ,survey1 & ! ,behavioral ,risk ,factor ,surveillance ,sy/em surveys4 ,! ,director ( ! ,national ,in/itute ( ,diabetes & ,dige/ive & ,kidney ,diseases %all include ! results ( su* assessm5t 9 ! national action plan "u subsection 7b74 7e7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section #a1jjj1jjj = fiscal ye> #bjba1 #a1jjj1jjj = fiscal ye> #bjbb1 #a1jjj1jjj = fiscal ye> #bjbc1 #a1jjj1jjj = fiscal ye> #bjbd1 & #a1jjj1jjj = fiscal ye> #bjbe4 #gii;,a4 ,home dialysis & increas+ end-/age r5al disease treatm5t modalities 9 m9ority communities action plan 7a7 ,national action plan 7#a7 ,developm5t ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,director ( ! ,national ,in/itute ( ,diabetes & ,dige/ive & ,kidney ,diseases1 9 consultation ) ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all develop a national action plan to increase ! numb] ( home dialyz]s & *oice 9 dialysis treatm5t modality 9 ! ,unit$ ,/ates ) p>ticipation f pati5ts1 c>egiv]s1 heal? pr(essionals1 pati5t advocacy organizations1 rese>*]s1 provid]s1 public heal? pr(essionals1 & o!r /akehold]s 9 m9ority communities4 7#b7 ,cont5ts ,at a m9imum1 su* plan %all include recomm5dations =-- 7,a7 public heal? (ficials = ! purpose ( implem5tation ( ! national plan2 7,b7 biom$ical1 heal? s]vices1 & public heal? rese>* on home dialysis & modalities 9 m9ority communities2 & 7,c7 inclusion ( dialysis location & modality 9 ! heal? data collections ( all ,f$]al ag5cies4 7b7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section #a1jjj1jjj = fiscal ye> #bjba1 #a1jjj1jjj = fiscal ye> #bjbb1 #a1jjj1jjj = fiscal ye> #bjbc1 #a1jjj1jjj = fiscal ye> #bjbd1 & #a1jjj1jjj = fiscal ye> #bjbe4 #gii;,b4 ,increas+ kidney transplants 9 m9ority populations 7a7 ,9 g5]al ,! ,director ( ! ,national ,in/itutes ( ,heal? %all exp&1 int5sify1 & support ongo+ rese>* & o!r activities ) respect to kidney transplants 9 m9ority populations4 7b7 ,rese>* ,rese>* "u subsection 7a7 %all include inve/igation into-- 7#a7 ! causes ( l[] rates ( kidney transplants 9 m9ority populations1 includ+ socioeconomic1 geographic1 cl9ical1 environm5tal1 g5etic1 & o!r factors t may contribute to l[] rates ( kidney transplants 9 m9ority populations2 & 7#b7 possible int]v5tions to increase kidney transplants4 7c7 ,report2 compreh5sive plan 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices %all-- 7,a7 prep>e & submit to ! ,congress1 n lat] ?an #f mon?s aft] ! date ( enactm5t ( ?is section1 a report on ,f$]al rese>* & public heal? activities ) respect to kidney transplants z a treatm5t = end-/age r5al disease 9 m9ority populations2 & 7,b7 develop & submit to ! ,congress1 n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is section1 an effective & compreh5sive ,f$]al plan 7includ+ all appropriate ,f$]al heal? programs7 to increase ! numb] ( kidney transplants 9 m9ority populations4 7#b7 ,cont5ts ,! report "u p>agraph 7#a77;,a7 %all at a m9imum address ea* ( ! foll[+3 7,a7 ,rese>* on kidney transplants 9 m9ority populations1 includ+ su* rese>* on f9ancial1 insurance cov]age1 g5etic1 behavioral1 & environm5tal factors4 7,b7 ,surveillance & data collection on kidney transplants 9 m9ority populations1 includ+ ) respect to-- 7i7 ef=ts to increase kidney transplants among ,asian-,am]ican & ,pacific ,isl&] subgr\ps ) end-/age r5al disease2 & 7ii7 ef=ts to increase kidney transplants 9 ! ,am]ican ,indian population4 7,c7 ,community-bas$ ef=ts to increase kidney transplants t>get+ m9ority populations1 includ+-- 7i7 ! evid5ce base = su* increases2 7ii7 ! cultural appropriat5ess ( su* increases2 & 7iii7 ef=ts to educate ! public on kidney transplants4 7,d7 ,education & tra9+ programs = heal? pr(essionals 7includ+ community heal? work]s7 on ! kidney transplants t are support$ by ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 includ+ su* programs support$ by ! ,bureau ( ,heal? ,work=ce1 ! ,bureau ( ,prim>y ,heal? ,c>e1 & ! ,heal?c>e ,sy/ems ,bureau4 #gii;,c4 ,environm5tal & occupational heal? programs ,! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion %all-- 7#a7 support rese>* into ! environm5tal & occupational causes & biological me*anisms t contribute to kidney disease2 & 7#b7 develop & dissem9ate public heal? int]v5tions t w less5 ! impact ( environm5tal & occupational causes ( kidney disease4 #gii;,d4 ,und]/&+ ! treatm5t patt]ns associat$ ) provid+ c>e & treatm5t ( kidney failure 9 m9ority populations 7a7 ,/udy ,! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y7 %all conduct a /udy on treatm5t patt]ns associat$ ) provid+ c>e1 "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 ! ,m$icaid program "u title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq471 & ?r\gh private heal? insurance1 to m9ority populations t are disproportionately affect$ by kidney failure4 7b7 ,report ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ,congress a report on ! /udy conduct$ "u subsection 7a71 toge!r ) su* recomm5dations z ! ,secret>y det]m9es to be appropriate4 #gii;,e4 ,improv+ access 9 und]s]v$ areas 7a7 ,def9ition ( prim>y c>e s]vices ,section #cca7;a77#c77;,d7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;d7a77#c77;,d77 is am5d$ by ins]t+ r5al dialysis1 aft] d5ti/ry14 7b7 ,national heal? s]vice corps s*ol>%ip program ,section #cch;,a7a77#b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bedl7a77#b77 is am5d$ by ins]t+ 1 :i* may include nephrology heal? pr(essionals be=e ! p]iod at ! end4 7c7 ,national heal? s]vice corps loan repaym5t program ,section #cch;,b7a77#b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bedl-#a7;a77#b77 is am5d$ by ins]t+ 1 :i* may include nephrology heal? pr(essionals be=e ! p]iod at ! end4 ,,viii ,heal? ,in=mation ,te*nology #hjj4 ,def9itions ,9 ?is title3 7#a7 ,c]tifi$ electronic heal? record te*nology ,! t]m c]tifi$ ,,ehr te*nology has ! mean+ giv5 su* t]m 9 section #cjjj ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj74 7#b7 ,,ehr ,! t]m ,,ehr means an electronic heal? record4 7#c7 ,int]op]ability ,! t]m int]op]ability has ! mean+ giv5 su* t]m 9 section #cjjj ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj74 ,evaluation & measurem5t ( int]op]ability %all consid] ex*ange ( electronic heal? in=mation1 usability ( ex*ang$ electronic heal? in=mation1 effective application & use ( ! ex*ang$ electronic heal? in=mation1 & impact on outcomes ( int]op]ability4 7#d7 ,access ,! t]m access1 ) respect to heal? in=mation1 means access describ$ 9 section #afd4ebd ( title #de1 ,code ( ,f$]al ,regulations 7or any successor regulations74 7#e7 ,c]tifi$ electronic heal? record te*nology2 ,,ehr ,! t]ms c]tifi$ electronic heal? record te*nology & ,,ehr include ! heal? in=mation infra/ructure = int]op]ability1 access1 ex*ange1 & use ( electronic heal? in=mation requir$ "u title ,,xxx ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj et seq471 & are n limit$ to electronic heal? records ma9ta9$ by doctors4 ,a ,r$uc+ ,heal? ,disp>ities ,?r\gh ,heal? ,,x #hja4 ,,hrsa assi/ance to heal? c5t]s = promotion ( ,heal? ,,x ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all exp& & int5sify ! programs & activities ( ! ,adm9i/ration 7directly or ?r\gh grants or contracts7 to provide te*nical assi/ance & res\rces to heal? c5t]s 7z def9$ 9 section #ccj7;a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;b7a777 to adopt & mean+fully use c]tifi$ ,,ehr te*nology = ! managem5t ( *ronic diseases & heal? conditions & r$uction ( heal? disp>ities4 #hjb4 ,assessm5t ( impact ( ,heal? ,,x on racial & e?nic m9ority communities2 outrea* & adoption ( ,heal? ,,x 9 su* communities 7a7 ,national ,coord9ator = ,heal? ,in=mation ,te*nology 7#a7 ,9 g5]al ,n lat] ?an #ah mon?s aft] ! date ( enactm5t ( ?is ,act1 ! ,national ,coord9ator = ,heal? ,in=mation ,te*nology 7ref]r$ to 9 ?is section z ! ,national ,coord9ator7 %all-- 7,a7 conduct an evaluation ( ! level ( int]op]ability1 access1 use1 & accessibility ( electronic heal? records 9 racial & e?nic m9ority communities1 focus+ on :e!r pati5ts 9 su* communities h provid]s :o use electronic heal? records1 & ! degree to :i* pati5ts 9 su* communities c access1 ex*ange1 & use )\t special ef=t _! heal? in=mation 9 ^? electronic heal? records1 & indicat+ :e!r su* provid]s-- 7i7 are p>ticipat+ 9 ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 or a ,/ate plan "u title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq47 7or a waiv] ( su* plan72 7ii7 h receiv$ inc5tive paym5ts or inc5tive paym5t adju/m5ts "u ,m$ic>e & ,m$icaid ,electronic ,heal? ,records ,inc5tive ,programs 7z def9$ 9 subsection 7c77#b772 7iii7 are ,,mips eligible pr(essionals1 z def9$ 9 p>agraph 7#a77;,c7 ( section #ahdh7q7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q771 = purposes ( ! ,m]it-,bas$ ,inc5tive ,paym5t ,sy/em "u su* section2 or 7iv7 h be5 recruit$ by any ( ! ,heal? ,in=mation ,te*nology ,regional ,ext5sion ,c5t]s e/abli%$ "u section #cjab ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj-#cb72 & 7,b7 publi% ! results ( su* evaluation includ+ ! race & e?nicity ( su* provid]s & ! populations s]v$ by su* provid]s4 7#b7 ,c]tification crit]ion ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,national ,coord9ator %all-- 7,a7 promulgate a c]tification crit]ion & module ( c]tifi$ ,,ehr te*nology t /ratifies quality measures = purposes ( ! ,m]it-,bas$ ,inc5tive ,paym5t ,sy/em by disp>ity *>act]i/ics1 includ+ race1 e?nicity1 language1 g5d]1 g5d] id5tity1 sexual ori5tation1 socio-economic /atus1 & disability /atus1 z su* *>act]i/ics are def9$ = purposes ( c]tifi$ ,,ehr te*nology2 & 7,b7 report to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ! quality measures /ratifi$ by race & at lea/ #b o!r disp>ity *>act]i/ics4 7b7 ,national c5t] = heal? /ati/ics ,z soon z practicable aft] ! date ( enactm5t ( ?is ,act1 ! ,director ( ! ,national ,c5t] = ,heal? ,/ati/ics %all provide to ,congress a m detail$ analysis ( ! data pres5t$ 9 ,national ,c5t] = ,heal? ,/ati/ics data brief entitl$ ,adoption ( ,c]tifi$ ,electronic ,heal? ,record ,sy/ems & ,electronic ,in=mation ,%>+ 9 ,physician ,(fices3 ,unit$ ,/ates1 #bjac & #bjad 7,,n*s ,data ,brief ,no4 #bcf74 7c7 ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 7#a7 ,9 g5]al ,z "p ( ! process ( collect+ in=mation1 ) respect to a provid]1 at regi/ration & atte/ation = purposes ( ,m$ic>e & ,m$icaid ,electronic ,heal? ,records ,inc5tive ,programs 7z def9$ 9 p>agraph 7#b77 or ! ,m]it-,bas$ ,inc5tive ,paym5t ,sy/em "u section #ahdh7q7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q771 ! ,secret>y ( ,heal? & ,human ,s]vices %all collect ! race & e?nicity ( su* provid]4 7#b7 ,m$ic>e & ,m$icaid ,electronic ,heal? ,records ,inc5tive ,programs def9$ ,= purposes ( p>agraph 7#a71 ! t]m ,m$ic>e & ,m$icaid ,electronic ,heal? ,records ,inc5tive ,programs means ! inc5tive programs "u section #ahad7l77#c71 subsections 7a77#g7 & 7o7 ( section #ahdh1 subsections 7l7 & 7m7 ( section #ahec1 subsections 7b77#c77;,b77ix77,i7 & 7n7 ( section #ahhf1 & subsections 7a77#c77;,f7 & 7t7 ( section #aijc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7l77#c71 #aciew-#d1 #aciew-#bc1 #acieww1 & #acif;b74 7d7 ,national ,coord9ator's assessm5t ( impact ( ,,hit ,section #cjja7;c77#f77;,c7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj-#aa7;c77#f77;,c77 is am5d$-- 7#a7 9 ! head+ by ins]t+ 1 racial & e?nic m9ority communities1 aft] heal? disp>ities2 7#b7 by ins]t+ 1 9 communities ) a high proportion ( individuals f racial & e?nic m9ority gr\ps 7z def9$ 9 section #agjg7;g771 includ+ p ) disabilities 9 ^! gr\ps1 aft] communities ) heal? disp>ities2 7#c7 by /rik+ ,! ,national ,coord9ator & ins]t+ ! foll[+3 7i7 ,9 g5]al ,! ,national ,coord9ator 2 & 7#d7 by add+ at ! end ! foll[+3 7ii7 ,crit]ia ,9 any publication "u clause 7i71 ! ,national ,coord9ator %all include be/ practices = enc\rag+ p>tn]%ips betwe5 ! ,f$]al ,gov]nm5t1 ,/ates1 & private entities to exp& outrea* = & ! adoption ( c]tifi$ ,,ehr te*nology 9 communities ) a high proportion ( individuals f racial & e?nic m9ority gr\ps 7z s def9$71 :ile also ma9ta9+ ! accessibility requirem5ts ( section #ejh ( ! ,rehabilitation ,act ( #aigc to enc\rage pati5t involvem5t 9 pati5t heal? c>e4 ,! ,national ,coord9ator %all-- 7,i7 n lat] ?an #f mon?s aft] ! submission ( ! report requir$ "u section #hbb ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbj1 e/abli% crit]ia = evaluat+ ! impact ( heal? in=mation te*nology on communities ) a high proportion ( individuals f racial & e?nic m9ority gr\ps 7z s def9$7 tak+ into acc\nt ! f9d+s 9 su* report2 & 7,,ii7 n lat] ?an #a ye> aft] ! submission ( su* report1 conduct & publi% ! results ( an evaluation ( su* impact4 4 #hjc4 ,nondiscrim9ation & heal? equity 9 heal? in=mation te*nology 7a7 ,9 g5]al ,cov]$ entities %all ensure t electronic & in=mation te*nology 9 _! heal? programs or activities does n exclude individuals f p>ticipation 91 d5y individuals ! b5efits (1 or subject individuals to discrim9ation "u any heal? program or activity on ! basis ( race1 color1 national orig91 sex1 age1 or disability4 7b7 ,cov]$ entities ,9 ?is section1 ! t]m cov]$ entity means-- 7#a7 an entity t op]ates a heal? program or activity1 any "p ( :i* receives ,f$]al f9ancial assi/ance2 7#b7 an entity e/abli%$ "u title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aad-adh7 t adm9i/]s a heal? program or activity2 or 7#c7 ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 #hjd4 ,language access 9 heal? in=mation te*nology ,! ,national ,coord9ator %all-- 7#a7 n lat] ?an #ah mon?s aft] ! date ( enactm5t ( ?is ,act1 propose a rule = provid+ access to pati5ts1 ?r\gh c]tifi$ ,,ehr te*nology1 to _! p]sonal heal? in=mation 9 a computable =mat1 includ+ us+ pati5t portals or ?ird-p>ty applications 7z describ$ 9 section #cjji7;e7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj-#ai7;e7771 9 ! #aj mo/ common non-,engli% languages2 7#b7 hold a public he>+ to id5tify be/ practices = c>ry+ out p>agraph 7#a72 & 7#c7 n lat] ?an #f mon?s aft] ! public he>+ "u p>agraph 7#b71 promulgate a f9al regulation ) respect to p>agraph 7#a74 ,b ,modifications ,to ,a*ieve ,p>ity 9 ,exi/+ ,programs #haa4 ,ext5d+ fund+ to /r5g!n ! ,heal? ,,x infra/ructure 9 racial & e?nic m9ority communities ,section #cjaa ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj-#ca7 is am5d$-- 7#a7 9 subsection 7a71 9 ! matt] prec$+ p>agraph 7#a71 by ins]t+ 1 includ+ ) respect to communities ) a high proportion ( individuals f racial & e?nic m9ority gr\ps 7z def9$ 9 section #agjg7;g77 be=e ! colon2 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7e7 ,annual report on exp5ditures ,! ,national ,coord9ator %all report annually to ,congress on activities & exp5ditures "u ?is section4 4 #hab4 ,ext5d+ competitive grants = ! developm5t ( loan programs to facilitate adoption ( c]tifi$ ,,ehr te*nology by provid]s s]v+ racial & e?nic m9ority gr\ps ,section #cjad7;e7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj-#cd7;e77 is am5d$1 9 ! matt] prec$+ p>agraph 7#a71 by ins]t+ 1 includ+ ) respect to communities ) a high proportion ( individuals f racial & e?nic m9ority gr\ps 7z def9$ 9 section #agjg7;g77 aft] heal? c>e provid] to4 #hac4 ,au?orization ( appropriations ,section #cjah ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj-#ch7 is am5d$ by /rik+ fiscal ye>s #bjji ?r\gh #bjac & ins]t+ fiscal ye>s #bjba ?r\gh #bjbf4 ,c ,additional ,rese>* & ,/udies #hba4 ,data collection & assessm5ts conduct$ 9 coord9ation ) m9ority-s]v+ in/itutions ,section #cjja7;c77#f7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj-#aa7;c77#f77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,f7 ,data collection & assessm5ts conduct$ 9 coord9ation ) m9ority-s]v+ in/itutions 7i7 ,9 g5]al ,9 c>ry+ out subp>agraph 7,c7 ) respect to communities ) a high proportion ( individuals f racial & e?nic m9ority gr\ps 7z def9$ 9 section #agjg7;g771 ! ,national ,coord9ator %all1 to ! greate/ ext5t possible1 coord9ate ) an entity describ$ 9 clause 7ii74 7ii7 ,m9ority-s]v+ in/itutions ,= purposes ( clause 7i71 an entity describ$ 9 ?is clause is a hi/orically black college or univ]sity1 a ,hispanic-s]v+ in/itution1 a ,tribal ,college or ,univ]sity1 or an ,asian-,am]ican-1 ,native ,am]ican-1 or ,pacific ,isl&]-s]v+ in/itution ) an accr$it$ public heal?1 heal? policy1 or heal? s]vices rese>* program4 4 #hbb4 ,/udy ( heal? in=mation te*nology 9 m$ically und]s]v$ communities 7a7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all-- 7#a7 ent] into an agreem5t ) ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e to conduct a /udy on ! developm5t1 implem5tation1 & effectiv5ess ( heal? in=mation te*nology )9 m$ically und]s]v$ areas 7z describ$ 9 subsection 7c772 & 7#b7 submit a report to ,congress describ+ ! results ( su* /udy1 includ+ any recomm5dations = legislative or adm9i/rative action4 7b7 ,/udy ,! /udy describ$ 9 subsection 7a77#a7 %all-- 7#a7 id5tify b>ri]s to successful implem5tation ( heal? in=mation te*nology 9 m$ically und]s]v$ areas2 7#b7 survey a cross-section ( individuals 9 m$ically und]s]v$ areas & report _! op9ions ab\t ! v>i\s topics ( /udy2 7#c7 exam9e ! degree ( int]op]ability among heal? in=mation te*nology & us]s ( heal? in=mation te*nology 9 m$ically und]s]v$ areas1 includ+ pati5ts1 provid]s1 & community s]vices2 7#d7 exam9e ! impact ( heal? in=mation te*nology on provid+ quality c>e & r$uc+ ! co/ ( c>e to individuals 9 su* areas1 includ+ ! impact ( su* te*nology on improv$ heal? outcomes = individuals1 includ+ :i* te*nology work$ = :i* population & h[ x improv$ heal? outcomes = t population2 7#e7 exam9e ! impact ( heal? in=mation te*nology on improv+ heal? c>e-relat$ decisions by bo? pati5ts & provid]s 9 su* areas2 7#f7 id5tify specific be/ practices = us+ heal? in=mation te*nology to fo/] ! consi/5t provision ( physical accessibility & reasonable policy accommodations 9 heal? c>e to individuals ) disabilities 9 su* areas2 7#g7 assess ! feasibility & co/s associat$ ) ! use ( heal? in=mation te*nology 9 su* areas2 7#h7 evaluate :e!r ! adoption & use ( qualifi$ electronic heal? records 7z def9$ 9 section #cjjj ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj77 is effective 9 r$uc+ heal? disp>ities1 includ+ analysis ( cl9ical quality measures report$ by provid]s :o are p>ticipat+ 9 ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 or a ,/ate plan "u title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq47 7or a waiv] ( su* plan71 pursuant to programs to enc\rage ! adoption & use ( c]tifi$ ,,ehr te*nology2 7#i7 id5tify provid]s 9 m$ically und]s]v$ areas t are n elect+ to adopt & use electronic heal? records & det]m9e :at b>ri]s are prev5t+ ^? provid]s f adopt+ & us+ su* records2 & 7#aj7 exam9e urban & rural community heal? sy/ems & det]m9e ! impact t heal? in=mation te*nology may h on ! capacity ( prim>y heal? provid]s 9 ^? sy/ems4 7c7 ,m$ically und]s]v$ area ,! t]m m$ically und]s]v$ area means-- 7#a7 a population t has be5 designat$ z a m$ically und]s]v$ population "u section #ccj7;b77#c7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;b7b77#c772 7#b7 an area t has be5 designat$ z a heal? pr(essional %ortage area "u section #ccb ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;e72 7#c7 an area or population t has be5 designat$ z a m$ically und]s]v$ community "u section #gii;,b ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #biep72 or 7#d7 ano!r area or population t-- 7,a7 exp]i5ces significant b>ri]s to access+ quality heal? s]vices2 & 7,b7 has a high preval5ce ( diseases or conditions describ$ 9 title ,,vii1 ) su* diseases or conditions hav+ a disproportionate impact on racial & e?nic m9ority gr\ps 7z def9$ 9 section #agjg7;g7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f7;g777 or a subgr\p ( p ) disabilities :o h specific functional impairm5ts4 #hbc4 ,assessm5t ( use & misuse ( de-id5tifi$ heal? data 7a7 ,9 g5]al ,n lat] ?an #ah mon?s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all-- 7#a7 ent] into an agreem5t ) ! ,(fice ( ! ,national ,coord9ator to conduct a /udy1 9 consultation ) relevant /akehold]s1 on ! impact ( digital heal? te*nology on m$ically und]s]v$ areas 7z describ$ 9 section #hbb7;c772 & 7#b7 submit a report to ,congress describ+ ! results ( su* /udy1 includ+ any recomm5dations = legislative or adm9i/rative action4 7b7 ,/udy ,! /udy describ$ 9 subsection 7a77#a7 %all-- 7#a7 exam9e ! ov]all preval5ce1 & hi/orical & exi/+ practices & _! respective preval5ce1 ( use & misuse ( de-id5tifi$ protect$ heal? in=mation1 z def9$ 9 section #afj4ajc1 title #de1 ,code ( ,f$]al ,regulations 7or any successor regulations71 to discrim9ate aga9/ or b5efit m$ically und]s]v$ areas2 7#b7 id5tify be/ practices & tools to lev]age ! b5efits & prev5t misuse ( de-id5tifi$ protect$ heal? in=mation to discrim9ate aga9/ m$ically und]s]v$ areas2 7#c7 exam9e ! ov]all preval5ce1 & hi/orical & exi/+ practices & _! respective preval5ce1 ( use & misuse ( de-id5tifi$ p]sonal heal? in=mation o!r ?an protect$ heal? in=mation1 z def9$ 9 section #afj4ajc1 title #de1 ,code ( ,f$]al ,regulations 7or any successor regulations71 to discrim9ate aga9/ or b5efit m$ically und]s]v$ areas2 & 7#d7 id5tify be/ practices & tools to lev]age ! b5efits & prev5t misuse ( de-id5tifi$ p]sonal heal? in=mation o!r ?an protect$ heal? in=mation to discrim9ate aga9/ m$ically und]s]v$ areas4 ,d ,clos+ ,gaps 9 ,fund+ ,to ,adopt ,c]tifi$ ,e,h,rs #hca4 ,ext5d+ ,m$icaid ,,ehr inc5tive paym5ts to rehabilitation facilities1 long-t]m c>e facilities1 & home heal? ag5cies 7a7 ,9 g5]al ,section #aijc7t77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7t77#b77;,b77 is am5d$-- 7#a7 9 clause 7i71 by /rik+ 1 or & ins]t+ a semicolon2 7#b7 9 clause 7ii71 by /rik+ ! p]iod at ! end & ins]t+ a semicolon2 & 7#c7 by ins]t+ aft] clause 7ii7 ! foll[+ new clauses3 7iii7 a rehabilitation facility 7z def9$ 9 section #ahhf7;j77#a77 t furni%es acute or subacute rehabilitation s]vices2 7iv7 a long-t]m c>e hospital 7z def9$ 9 section #ahhf7;d77#a77;,b77iv772 or 7v7 a home heal? ag5cy 7z def9$ 9 section #ahfa7o774 4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all apply ) respect to am\nts exp5d$ "u section #aijc7;a77#c77;,f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#c77;,f77 = cal5d> qu>t]s beg9n+ on or aft] ! date ( ! enactm5t ( ?is ,act4 #hcb4 ,ext5d+ physician assi/ant eligibility = ,m$icaid electronic heal? record inc5tive paym5ts 7a7 ,9 g5]al ,section #aijc7t77#c77;,b77v7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7t77#c77;,b77v77 is am5d$ to read z foll[s3 7v7 physician assi/ant4 4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all apply ) respect to am\nts exp5d$ "u section #aijc7;a77#c77;,f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#c77;,f77 = cal5d> qu>t]s beg9n+ on or aft] ! date ( ! enactm5t ( ?is ,act4 ,,ix ,acc\ntability & ,evaluation #ija4 ,prohibition on discrim9ation 9 ,f$]al assi/$ heal? c>e s]vices & rese>* programs on ! basis ( sex 7includ+ sex ori5tation1 g5d] id5tity1 & pregnancy1 includ+ t]m9ation ( pregnancy71 race1 color1 national orig91 m>ital /atus1 familial /atus1 sexual ori5tation1 g5d] id5tity1 or disability /atus 7a7 ,9 g5]al ,no p]son 9 ! ,unit$ ,/ates %all1 on ! basis ( sex 7includ+ sex ori5tation1 g5d] id5tity1 & pregnancy1 includ+ t]m9ation ( pregnancy71 race1 color1 national orig91 m>ital /atus1 familial /atus1 sexual ori5tation1 g5d] id5tity1 or disability /atus1 be exclud$ f p>ticipation 91 be d5i$ ! b5efits (1 or be subject$ to discrim9ation "u any heal? program or activity1 includ+ any heal? rese>* program or activity1 receiv+ ,f$]al f9ancial assi/ance1 includ+ cr$its1 subsidies1 or contracts ( insurance or any heal? program or activity t is adm9i/]$ by an executive ag5cy4 7b7 ,def9ition ,9 ?is section1 ! t]m familial /atus means1 ) respect to "o or m individuals-- 7#a7 be+ domicil$ ) any individual relat$ by blood or aff9ity ^: close association ) ! individual is ! equival5t ( a family relation%ip2 7#b7 be+ 9 ! process ( secur+ legal cu/ody ( any individual2 or 7#c7 be+ pregnant4 #ijb4 ,treatm5t ( ,m$ic>e paym5ts "u title ,,vi ( ! ,civil ,rights ,act ( #aifd ,a paym5t to a provid] ( s]vices1 physician1 or o!r suppli] "u "p ,b1 ,c1 or ,d ( title ,,xviii ( ! ,social ,security ,act %all be deem$ a grant1 & n a contract ( insurance or gu>anty1 = ! purposes ( title ,,vi ( ! ,civil ,rights ,act ( #aifd4 #ijc4 ,acc\ntability & transp>5cy )9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices ,title ,,xxxiv ( ! ,public ,heal? ,s]vice ,act1 z am5d$ by titles ,i1 ,,ii1 & ,,iii ( ?is ,act1 is fur!r am5d$ by ins]t+ aft] subtitle ,c ! foll[+3 ,d ,/r5g!n+ acc\ntability #cdda4 ,elevation ( ! ,(fice ( ,civil ,rights 7a7 ,9 g5]al ,! ,secret>y %all e/abli% )9 ! ,(fice = ,civil ,rights an ,(fice ( ,heal? ,disp>ities1 :i* %all be head$ by a director to be appo9t$ by ! ,secret>y4 7b7 ,purpose ,! ,(fice ( ,heal? ,disp>ities %all ensure t ! heal? programs1 activities1 & op]ations ( heal? entities t receive ,f$]al f9ancial assi/ance are 9 compliance ) title ,,vi ( ! ,civil ,rights ,act1 includ+ ?r\gh ! foll[+ activities3 7#a7 ,! developm5t & implem5tation ( an action plan to address racial & e?nic heal? c>e disp>ities1 :i* %all address conc]ns relat+ to ! ,(fice = ,civil ,rights z releas$ by ! ,unit$ ,/ates ,commission on ,civil ,rights 9 ! report entitl$ ,heal? ,c>e ,*all5ge3 ,ackn[l$g+ ,disp>ity1 ,confront+ ,discrim9ation1 & ,ensur+ ,equity 7,septemb] #aiii7 9 conjunction ) ! reports by ! ,national ,academy ( ,sci5ces 7=m]ly kn[n z ! ,in/itute ( ,m$ic9e7 entitl$ ,unequal ,treatm5t3 ,confront+ ,racial & ,e?nic ,disp>ities 9 ,heal? ,c>e1 ,cross+ ! ,quality ,*asm3 ,a ,new ,heal? ,sy/em = ! #ba/ ,c5tury1 ,9 ! ,nation's ,compell+ ,int]e/3 ,ensur+ ,div]sity 9 ! ,heal? ,c>e ,work=ce1 ,! ,national ,p>tn]%ip = ,action to ,end ,heal? ,disp>ities1 & ,! ,heal? ( ,lesbian1 ,gay1 ,bisexual1 & ,transg5d] ,p1 & o!r relat$ reports by ! ,national ,academy ( ,sci5ces4 ,?is plan %all be publicly disclos$ = review & comm5t & ! f9al plan %all address any comm5ts or conc]ns t are receiv$ by ! ,(fice4 7#b7 ,inve/igative & en=cem5t actions aga9/ int5tional discrim9ation & policies & practices t h a disp>ate impact on m9orities4 7#c7 ,! review ( racial1 e?nic1 g5d] id5tity1 sexual ori5tation1 sex1 disability /atus1 socioeconomic /atus1 & prim>y language heal? data collect$ by ,f$]al heal? ag5cies to assess heal? c>e disp>ities relat$ to int5tional discrim9ation & policies & practices t h a disp>ate impact on m9orities4 ,su* review %all include an assessm5t ( heal? disp>ities 9 communities ) a comb9ation ( ^! classes4 7#d7 ,outrea* & education activities relat+ to compliance ) title ,,vi ( ! ,civil ,rights ,act4 7#e7 ,! provision ( te*nical assi/ance = heal? entities to facilitate compliance ) title ,,vi ( ! ,civil ,rights ,act4 7#f7 ,coord9ation & ov]sight ( activities ( ! civil rights compliance (fices e/abli%$ "u section #cddb4 7#g7 ,ensur+-- 7,a7 at a m9imum1 compliance ) ! mo/ rec5t v]sion ( ! ,(fice ( ,managem5t & ,budget /ati/ical policy directive entitl$ ,/&>ds = ,ma9ta9+1 ,collect+1 & ,pres5t+ ,f$]al ,data on ,race & ,e?nicity2 & 7,b7 consid]ation ( available data & language /&>ds su* z-- 7i7 ! /&>ds = collect+ & report+ data "u section #caja2 & 7ii7 ! ,national ,/&>ds on ,culturally & ,l+ui/ically ,appropriate ,s]vices ( ! ,(fice ( ,m9ority ,heal?4 7c7 ,fund+ & /aff ,! ,secret>y %all ensure ! effectiv5ess ( ! ,(fice ( ,heal? ,disp>ities by ensur+ t ! ,(fice is provid$ )-- 7#a7 adequate fund+ to enable ! ,(fice to c>ry out its duties "u ?is section2 & 7#b7 /aff ) exp]tise 9-- 7,a7 epidemiology2 7,b7 /ati/ics2 7,c7 heal? quality assurance2 7,d7 m9ority heal? & heal? disp>ities2 7,e7 cultural & l+ui/ic compet5cy2 7,f7 civil rights2 & 7,g7 social1 behavioral1 & economic det]m9ants ( heal?4 7d7 ,report ,n lat] ?an ,decemb] #ca1 #bjba1 & annually !reaft]1 ! ,secret>y1 9 collaboration ) ! ,director ( ! ,(fice = ,civil ,rights & ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 %all submit a report to ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate & ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives t includes-- 7#a7 ! numb] ( cases fil$1 brok5 d[n by category2 7#b7 ! numb] ( cases inve/igat$ & clos$ by ! (fice2 7#c7 ! outcomes ( cases inve/igat$2 7#d7 ! /aff+ levels ( ! (fice includ+ /aff cr$5tials2 7#e7 ! numb] ( o!r l+]+ & em]g+ cases 9 :i* civil rights inequities c be demon/rat$2 & 7#f7 ! numb] ( cases rema9+ op5 & an explanation = _! op5 /atus4 7e7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjba ?r\gh #bjbf4 #cddb4 ,e/abli%m5t ( ,heal? ,program (fices = ,civil ,rights )9 ,f$]al ,heal? & human s]vices ag5cies 7a7 ,9 g5]al ,! ,secret>y %all e/abli% civil rights compliance (fices 9 ea* ag5cy )9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices t adm9i/]s heal? programs4 7b7 ,purpose ( (fices ,ea* (fice e/abli%$ "u subsection 7a7 %all ensure t recipi5ts ( ,f$]al f9ancial assi/ance "u ,f$]al heal? programs adm9i/] programs1 s]vices1 & activities 9 a mann] t-- 7#a7 does n discrim9ate1 ei!r int5tionally or 9 effect1 on ! basis ( race1 national orig91 language1 e?nicity1 sex1 age1 disability1 sexual ori5tation1 & g5d] id5tity2 & 7#b7 promotes ! r$uction & elim9ation ( disp>ities 9 heal? & heal? c>e bas$ on race1 national orig91 language1 e?nicity1 sex1 age1 disability1 sexual ori5tation1 & g5d] id5tity4 7c7 ,p[]s & duties ,! (fices e/abli%$ 9 subsection 7a7 %all h ! foll[+ p[]s & duties3 7#a7 ,! e/abli%m5t ( compliance & program p>ticipation /&>ds = recipi5ts ( ,f$]al f9ancial assi/ance "u ea* program adm9i/]$ by ! applicable ag5cy1 includ+ ! e/abli%m5t ( disp>ity r$uction /&>ds to encompass disp>ities 9 heal? & heal? c>e relat$ to race1 national orig91 language1 e?nicity1 sex1 age1 disability1 sexual ori5tation1 & g5d] id5tity4 7#b7 ,! developm5t & implem5tation ( program-specific guidel9es t int]pret & apply ,dep>tm5t ( ,heal? & ,human ,s]vices guidance "u title ,,vi ( ! ,civil ,rights ,act ( #aifd & section #aeeg ( ! ,pati5t ,protection & ,af=dable ,c>e ,act to ea* ,f$]al heal? program adm9i/]$ by ! ag5cy4 7#c7 ,! developm5t ( a disp>ity-r$uction impact analysis me?odology t %all be appli$ to e rule issu$ by ! ag5cy & publi%$ z "p ( ! =mal rulemak+ process "u sections #eee1 #eef1 & #eeg ( title #e1 ,unit$ ,/ates ,code4 7#d7 ,ov]sight ( data collection1 analysis1 & publication requirem5ts = all recipi5ts ( ,f$]al f9ancial assi/ance "u ea* ,f$]al heal? program adm9i/]$ by ! ag5cy2 compliance )1 at a m9imum1 ! mo/ rec5t v]sion ( ! ,(fice ( ,managem5t & ,budget /ati/ical policy directive entitl$ ,/&>ds = ,ma9ta9+1 ,collect+1 & ,pres5t+ ,f$]al ,data on ,race & ,e?nicity2 & consid]ation ( available data & language /&>ds su* z-- 7,a7 ! /&>ds = collect+ & report+ data "u section #caja2 & 7,b7 ! ,national ,/&>ds on ,culturally & ,l+ui/ically ,appropriate ,s]vices ( ! ,(fice ( ,m9ority ,heal?4 7#e7 ,! conduct ( publicly available /udies reg>d+ discrim9ation )9 ,f$]al heal? programs adm9i/]$ by ! ag5cy z well z disp>ity r$uction initiatives by recipi5ts ( ,f$]al f9ancial assi/ance "u ,f$]al heal? programs4 7#f7 ,annual reports to ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions & ! ,committee on ,f9ance ( ! ,s5ate & ! ,committee on ,en]gy & ,comm]ce & ! ,committee on ,ways & ,means ( ! ,h\se ( ,repres5tatives on ! progress 9 r$uc+ disp>ities 9 heal? & heal? c>e ?r\gh ! ,f$]al programs adm9i/]$ by ! ag5cy4 7d7 ,relation%ip to ,(fice = ,civil ,rights 9 ! ,dep>tm5t ( ,ju/ice 7#a7 ,dep>tm5t ( ,heal? & ,human ,s]vices ,! ,(fice = ,civil ,rights ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices %all provide /&>d-sett+ & compliance review inve/igation support s]vices to ! ,civil ,rights ,compliance ,(fice = ea* ag5cy describ$ 9 subsection 7a71 subject to p>agraph 7#b74 7#b7 ,dep>tm5t ( ,ju/ice ,! ,(fice = ,civil ,rights ( ! ,dep>tm5t ( ,ju/ice may1 z appropriate1 in/itute =mal proce$+s :5 a civil rights compliance (fice e/abli%$ "u subsection 7a7 det]m9es t a recipi5t ( ,f$]al f9ancial assi/ance is n 9 compliance ) ! disp>ity r$uction /&>ds ( ! applicable ag5cy4 7e7 ,def9ition ,9 ?is section1 ! t]m ,f$]al heal? programs mean programs-- 7#a7 "u ! ,social ,security ,act 7#db ,u4,s4,c4 #cja et seq47 t pay = heal? c>e & s]vices2 & 7#b7 "u ?is ,act t provide ,f$]al f9ancial assi/ance = heal? c>e1 biom$ical rese>*1 heal? s]vices rese>*1 & programs design$ to improve ! public's heal?1 includ+ heal? s]vice programs4 4 #ijd4 ,unit$ ,/ates ,commission on ,civil ,rights 7a7 ,coord9ation )9 ,dep>tm5t ( ,ju/ice ( activities reg>d+ ,heal? disp>ities ,section #c7;a7 ( ! ,civil ,rights ,commission ,act ( #aihc 7#db ,u4,s4,c4 #aige;a7a77 is am5d$-- 7#a7 9 p>agraph 7#a71 by /rik+ & at ! end2 7#b7 9 p>agraph 7#b71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7#c7 by add+ at ! end ! foll[+3 7#c7 %all1 ) respect to activities c>ri$ out 9 heal? c>e & correctional facilities t[>d ! goal ( elim9at+ heal? disp>ities betwe5 ! g5]al population & memb]s ( m9ority gr\ps bas$ on race or color1 promote coord9ation ( su* activities (-- 7,a7 ! ,(fice = ,civil ,rights )9 ! ,(fice ( ,ju/ice ,programs ( ! ,dep>tm5t ( ,ju/ice2 7,b7 ! ,(fice ( ,ju/ice ,programs )9 ! ,dep>tm5t ( ,ju/ice2 7,c7 ! ,(fice = ,civil ,rights )9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices2 & 7,d7 ! ,(fice ( ,m9ority ,heal? )9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices 7head$ by ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?74 4 7b7 ,au?orization ( appropriations ,section #e ( ! ,civil ,rights ,commission ,act ( #aihc 7#db ,u4,s4,c4 #aige;c7 is am5d$ by /rik+ ! fir/ s5t5ce & ins]t+ ! foll[+3 ,= ! purpose ( c>ry+ out ?is ,act1 !re are au?oriz$ to be appropriat$ #cj1jjj1jjj = fiscal ye> #bjba1 & su* sums z may be necess>y = ea* ( ! fiscal ye>s #bjbb ?r\gh #bjbf44 #ije4 ,s5se ( ,congress conc]n+ full fund+ ( activities to elim9ate racial & e?nic heal? disp>ities 7a7 ,f9d+s ,congress makes ! foll[+ f9d+s3 7#a7 ,! heal? /atus ( ! population ( ! ,unit$ ,/ates is decl9+ & ! ,unit$ ,/ates curr5tly ranks bel[ mo/ indu/rializ$ nations 9 heal? /atus measur$ by longevity1 sickness1 & mortality4 7#b7 ,racial & e?nic m9ority populations t5d to h ! poore/ heal? /atus & face sub/antial cultural1 social1 & economic b>ri]s to obta9+ quality heal? c>e4 7#c7 ,lesbian1 gay1 bisexual1 transg5d]1 que]1 & que/ion+ populations exp]i5ce significant p]sonal & /ructural b>ri]s to obta9+ high-quality heal? c>e4 7#d7 ,ef=ts to improve m9ority heal? h be5 limit$ by inadequate res\rces 7fund+1 /aff+1 & /ew>d%ip7 & lack ( acc\ntability4 7b7 ,s5se ( ,congress ,x is ! s5se ( ,congress t-- 7#a7 heal? disp>ities negatively impact outcomes = heal? & human security ( ! ,nation2 7#b7 r$uc+ racial1 e?nic1 sexual1 & g5d] disp>ities 9 prev5tion & treatm5t are unique civil & human rights *all5ges &1 z su*1 ,f$]al ag5cies & heal? c>e entities & sy/ems receiv+ ,f$]al funds %\ld be acc\ntable = _! role 9 caus+ disp>ities & inequity2 7#c7 fund+ = ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities1 ! ,(fice ( ,civil ,rights 9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 ! ,national ,in/itute ( ,nurs+ ,rese>*1 & ! ,(fice ( ,m9ority ,heal? %\ld be d\bl$ by fiscal ye> #bjbb2 7#d7 adequate fund+ by fiscal ye> #bjbb1 & subsequ5t fund+ increases1 %\ld be provid$ = heal? & human s]vice pr(essions tra9+ programs1 ! ,racial & ,e?nic ,approa*es to ,community ,heal? ,initiative at ! ,c5t]s = ,disease ,control & ,prev5tion1 ! ,m9ority ,,hiv_/,,aids ,initiative1 & ! ,excell5ce ,c5t]s to ,elim9ate ,e?nic_/,racial ,disp>ities ,program at ! ,ag5cy = ,heal?c>e ,rese>* & ,quality2 7#e7 fund+ %\ld be fully re/or$ to ! ,racial & ,e?nic ,approa*es to ,community ,heal? ,initiative at ! ,c5t]s = ,disease ,control & ,prev5tion1 :i* has be5 a successful program at ! community heal? level1 & ef=ts %\ld cont9ue to place a /rong emphasis on build+ community capacity to secure f9ancial res\rces & te*nical assi/ance to elim9ate heal? disp>ities2 7#f7 adequate fund+ = fiscal ye> #bjbb & increas$ fund+ = future ye>s %\ld be provid$ = ! ,racial & ,e?nic ,approa*es to ,community ,heal? ,initiative's ,unit$ ,/ates ,risk ,factor ,survey to ensure adequate data collection to track heal? disp>ities1 & !re %\ld be appropriate av5ues provid$ to dissem9ate f9d+s to ! g5]al public2 7#g7 curr5t & newly creat$ heal? disp>ity elim9ation inc5tives1 programs1 ag5cies1 & dep>tm5ts "u ?is ,act 7& ! am5dm5ts made by ?is ,act7 %\ld receive adequate /aff+ & fund+ by fiscal ye> #bjbb2 & 7#h7 /ew>d%ip & acc\ntability %\ld be provid$ to ! ,congress & ! ,presid5t = measurable & su/a9able progress t[>d heal? disp>ity elim9ation4 #ijf4 ,,gao & ,,nih reports 7a7 ,,gao report on ,,nih grant racial & e?nic div]sity 7#a7 ,9 g5]al ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all conduct a /udy on ! racial & e?nic div]sity among ! foll[+ gr\ps3 7,a7 ,all applicants = grants1 contracts1 & coop]ative agreem5ts aw>d$ by ! ,national ,in/itutes ( ,heal? dur+ ! p]iod beg9n+ on ,janu>y #a1 #bjji1 & end+ ,decemb] #ca1 #bjai4 7,b7 ,all recipi5ts ( su* grants1 contracts1 & coop]ative agreem5ts dur+ su* p]iod4 7,c7 ,all memb]s ( ! pe] review panels ( su* applicants & recipi5ts1 respectively4 7#b7 ,report ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al %all complete ! /udy "u p>agraph 7#a7 & submit to ,congress a report conta9+ ! results ( su* /udy4 7b7 ,,nih report on c]ta9 au?ority ( ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is ,act1 & bi5nially !reaft]1 ! ,director ( ! ,national ,in/itutes ( ,heal?1 9 collaboration ) ! ,director ( ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities1 %all submit to ,congress a report t details & evaluates-- 7#a7 ! /eps tak5 dur+ ! applicable report p]iod by ! ,director ( ! ,national ,in/itutes ( ,heal? to en=ce ! exp&$ plann+1 coord9ation1 review1 & evaluation au?ority provid$ ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities "u section #dfdz-#c7;h7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhe7;h77 ov] all m9ority heal? & heal? disp>ity rese>* t is conduct$ or support$ by ! ,in/itutes & ,c5t]s at ! ,national ,in/itutes ( ,heal?2 & 7#b7 ! outcomes ( su* /eps4 7c7 ,,gao report relat$ to recipi5ts ( ,,ppaca fund+ ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act & bi5nially !reaft] until #bjbd1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report t id5tifies-- 7#a7 ! racial & e?nic div]sity ( community-bas$ organizations t appli$ = ,f$]al enrollm5t fund+ provid$ pursuant to ! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh7 7includ+ ! am5dm5ts made by su* ,act72 7#b7 ! p]c5tage ( su* organizations t 7 aw>d$ su* fund+2 & 7#c7 ! impact ( su* community-bas$ organizations' enrollm5t ef=ts on ! insurance /atus ( _! communities4 7d7 ,annual report on activities ( ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities ,! ,director ( ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities %all prep>e an annual report on ! activities c>ri$ out or to be c>ri$ out by su* in/itute1 & %all submit ea* su* report to ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate1 ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives1 ! ,secret>y ( ,heal? & ,human ,s]vices1 & ! ,director ( ! ,national ,in/itutes ( ,heal?4 ,) respect to ! fiscal ye> involv$1 ! report %all-- 7#a7 describe & evaluate ! progress made 9 heal? disp>ities rese>* conduct$ or support$ by in/itutes & c5t]s ( ! ,national ,in/itutes ( ,heal?2 7#b7 summ>ize & analyze exp5ditures made = activities ) respect to heal? disp>ities rese>* conduct$ or support$ by ! ,national ,in/itutes ( ,heal?2 7#c7 include a sep>ate /atem5t apply+ ! requirem5ts ( p>agraphs 7#a7 & 7#b7 specifically to m9ority heal? disp>ities rese>*2 & 7#d7 conta9 su* recomm5dations z ! ,director ( ! ,in/itute consid]s appropriate4 ,x ,address+ ,social ,det]m9ants & ,improv+ ,environm5tal ,ju/ice ,a ,9 ,g5]al #ajja4 ,def9itions ,9 ?is title3 7#a7 ,det]m9ants ( heal? ,! t]m det]m9ants ( heal?-- 7,a7 means ! range ( p]sonal1 social1 economic1 & environm5tal factors t influ5ce heal? /atus2 & 7,b7 includes social det]m9ants ( heal? 7:i* are sometimes ref]r$ to z social & economic det]m9ants ( heal?1 socioeconomic det]m9ants ( heal?1 environm5tal det]m9ants ( heal?1 social driv]s ( inequality1 or p]sonal det]m9ants ( heal?74 7#b7 ,environm5tal det]m9ants ( heal? ,! t]m environm5tal det]m9ants ( heal? means ! broad physical 7includ+ manmade & natural71 psy*ological1 social1 spiritual1 cultural1 & ae/hetic environm5t4 7#c7 ,built environm5t ,! t]m built environm5t means ! compon5ts ( ! environm5t1 & ! location ( ^! compon5ts 9 a geographically def9$ space1 t are creat$ or modifi$ by individuals to =m ! physical & social *>act]i/ics ( a community or enhance quality ( human life1 includ+-- 7,a7 homes1 s*ools1 & places ( "w & wor%ip2 7,b7 p>ks1 recreation areas1 & gre5ways2 7,c7 transportation sy/ems2 7,d7 bus9ess1 indu/ry1 & agriculture2 & 7,e7 l&-use plans1 projects1 & policies t impact ! physical or social *>act]i/ics ( a community1 includ+ access to s]vices & am5ities4 7#d7 ,p]sonal det]m9ants ( heal? ,! t]m p]sonal det]m9ants ( heal? means an individual's behavior1 biology1 & g5etics4 7#e7 ,social det]m9ants ( heal? ,! t]m social det]m9ants ( heal? means a subset ( det]m9ants ( ! heal? ( individuals & environm5ts 7su* z communities1 neighborhoods1 & societies7 t describe an individual's or gr\p ( p's social id5tity1 describe ! social & economic res\rces to :i* su* individual or gr\p has access1 & describe ! conditions 9 :i* an individual or gr\p ( p works1 lives1 & plays4 7#f7 ,economic det]m9ants ( heal? ,! t]m economic det]m9ants ( heal? ref]s to income & social /atus4 ,high] income & socioeconomic /atus are l9k$ to decreas$ rates ( morbidity & mortality1 ) high] socioeconomic /atus correlat$ ) bett] heal? & long] life1 & l[] socioeconomic /atus correlat$ ) an increas$ risk ( illness & dea?4 #ajjb4 ,f9d+s ,congress f9ds z foll[s3 7#a7 ,social det]m9ants ( heal? are ! greate/ pr$ictors ( heal? outcomes4 7#b7 ,social det]m9ants ( heal?1 includ+ heal?-relat$ behaviors1 social & economic factors1 & physical environm5t factors acc\nt = #hj p]c5t ( heal? outcomes1 :]eas cl9ical c>e acc\nts = #bj p]c5t ( improv$ heal? outcomes4 ,yet1 9 #bjag1 public heal? sp5d+ repres5t$ only #b4e p]c5t ( all heal? sp5d+ 9 ! ,unit$ ,/ates4 7#c7 ,!re are m opportunities to improve heal? = ev]yone :5 we und]/& t heal? />ts1 fir/1 n 9 a m$ical sett+1 b 9 our families1 9 our s*ools & workplaces1 9 our neighborhoods1 9 ! air we brea!1 & 9 ! wat] we dr9k4 7#d7 7,a7 ,heal?y ,p #bjbj id5tifies heal? & heal? c>e quality z a function ( n only access to heal? c>e1 b also ! social det]m9ants ( heal?1 categoriz$ into ! foll[+3 neighborhoods & ! built environm5t2 social & community context2 education2 & economic /ability4 7,b7 ,! foll[+ examples illu/rate ! nexus betwe5 ! unequal di/ribution ( ! social det]m9ants ( heal? & heal? disp>ities3 7i7 ,! built environm5t influ5ces resid5ts' level ( physical activity4 ,neighborhoods ) high levels ( pov]ty are significantly less likely to h places :]e *ildr5 c be physically active1 su* z p>ks1 gre5 spaces1 & bike pa?s & lanes4 ,neighborhoods & communities c provide opportunities = physical activity & support active life/yles ?r\gh accessible & safe p>ks & op5 spaces & ?r\gh l& use policy1 zon+1 & heal?y community design4 7ii7 ,emotional & physical heal? & well-be+ are directly impact$ by p]ceiv$ levels ( safety1 su* z unlit /reets at night4 ,community memb]s h express$ t safety is n only a b>ri] to access+ programs & s]vices t increase quality ( life b !y are also n able to access physical activity 9 _! community ?r\gh ! built environm5t4 7iii7 ,hi/orical & in/itutional racism 9 ! ,unit$ ,/ates has %ap$ ! way 9 :i* social & economic res\rces & exposure to heal? promot+ environm5ts are di/ribut$4 ,income1 education1 occupation1 neighborhood conditions1 s*ools1 workplaces1 ! use ( heal? & social s]vices1 & exp]i5ces ) ! crim9al ju/ice sy/em are all highly patt]n$ by race1 ) p ( color exp]i5c+ m t is heal? h>m+4 ,f9d+ ways to unc\ple ! l9k betwe5 race & access to res\rces & heal?y environm5ts is a pr9cipal means ( r$uc+ heal? disp>ities4 ,additionally1 ! anticipation ( racism itself causes high] psy*ological & c>diovascul> /ress levels t are l9k$ to poor heal? outcomes4 ,rem$y+ discrim9atory practices at ! individual & sy/emic levels w likely r$uce heal? disp>ities caus$ by ?is unequal di/ribution ( /ress4 7iv7 ,poor heal? among ,native ,am]icans has l>gely be5 driv5 by po/-colonial oppression & hi/orical trauma4 ,! expropriation ( native l&s & t]ritories to ! ,am]ican /ate _h sev]e consequ5ces on ,native ,am]ican heal?4 ,?is result$ 9 ! deprivation ( traditional food s\rces--& nutri5ts--= ,native ,am]icans & also ! de/ruction ( traditional economies & community organization4 ,today1 ,native ,am]icans h twice ! rate ( diabetes ( non-,hispanic ,:ites4 ,recognition ( ! orig9s ( ! diabetes z hav+ a social & community context1 r ?an j individual responsibility & g5etic pr$isposition1 w %ape bett] policy to provide food security4 7v7 ,9 ! context ( prisons1 ov]cr[d+ has l$ to ! det]ioration ( ! physical & m5tal heal? ( individuals aft] !y leave prison4 ,9 p>ticul>1 ! mass inc>c]ation ( ,african-,am]ican males z a result ( unequal contact ) & treatm5t 9 ! crim9al ju/ice sy/em has contribut$ to an ov]burd5+ ( c]ta9 infecti\s diseases )9 ! ,african-,am]ican community4 ,z a social in/itution1 inc>c]ation amplifies exi/+ adv]se heal? conditions by conc5trat+ diseases & h>mful heal? behaviors su* z tobacco use1 drug use1 & viol5ce4 7vi7 ,educational atta9m5t is ! /ronge/ pr$ictor ( adult mortality4 ,x is a basic compon5t ( socioeconomic /atus t %apes e>n+ pot5tial to access res\rces t promote heal?4 ,p ) m education are less likely to report t !y are 9 poor heal?1 & are also less likely to h diabetes & o!r *ronic diseases4 7vii7 ,individuals ) l[] levels ( educational atta9m5t are mu* m likely to report to be curr5t smok]s4 ,9 #bjag1 smok+ preval5ce 0 #cf4h p]c5t among adults ) a ,,g$ diploma1 #bc4a p]c5t ) less ?an a high s*ool diploma1 & #ah4g p]c5t ) a high s*ool diploma1 :ile dropp+ significantly to #g4a p]c5t among adults ) an und]graduate college degree & #d4a p]c5t ) a po/graduate college degree4 7viii7 ,income inequality diff]5ces acc\nt = a l>ge "p ( heal? disp>ities44 ,= example1 *ildr5 liv+ 9 pov]ty exp]i5ce poor] h\s+ conditions1 increas$ exposure to indoor all]g5s & tox9s 7su* z pe/icides1 lead1 m]cury1 radon1 air pollution1 & c>c9og5s71 increas$ food insecurity1 & m psy*ological /ress4 ,^! exp]i5ces culm9ate 9 worse adult heal? z comp>$ ) *ildr5 ) high] socioeconomic /atus4 ,specifically1 *ildr5 liv+ 9 l[] socioeconomic neighborhoods h high] rates ( a/hma due to high] rates ( psy*ological /ress result+ f high] rates ( viol5ce4 ,food insecurity is associat$ ) obesity & racial & e?nic m9orities h high] rates ( food insecurity4 7ix7 ,lesbian1 gay1 bisexual1 transg5d]1 que] or que/ion+1 int]sex1 & asexual or alli$ 7ref]r$ to 9 ?is section z ,,lgbtqia7 individuals face heal? disp>ities l9k$ to societal /igma1 discrim9ation1 & d5ial ( _! civil & human rights4 ,discrim9ation aga9/ ,,lgbtqia individuals has be5 associat$ ) high rates ( psy*iatric disord]s1 sub/ance abuse1 & suicide4 ,exp]i5ces ( viol5ce & victimization are frequ5t = ,,lgbtqia individuals1 & h long-la/+ effects on ! individual & ! community4 ,p]sonal1 family1 & social acceptance ( sexual ori5tation & g5d] id5tity affects ! m5tal heal? & p]sonal safety ( ,,lgbtqia individuals4 7x7 ,individuals 9 old] & *eap] h\s+ are at high] risks to be expos$ to lead1 p>ticul>ly 9 h\s+ built prior to #aifj4 ,! ?reat ( lead poison+ disproportionally affects vuln]able populations1 ) *ildr5 liv+ 9 pov]ty 7#e4f p]c5t7 & ,black *ildr5 7#e4f7 exp]i5c+ ! highe/ rates4 ,accord+ to ! ,dep>tm5t ( ,h\s+ & ,urban ,developm5t1 ab\t #c1fjj1jjj homes nationwide t h\se "y *ildr5 h lead haz>ds su* z contam9at$ dr9k+ wat]1 peel+ pa9t1 contam9at$ du/1 or toxic soil4 ,! comb9$ co/ ( m$ical treatm5t & special education = lead poison$ *ildr5 av]ages ab\t #e1fjj p] *ild p] ye>1 & lead poison+ co/s ! ,unit$ ,/ates an e/imat$ #ej1jjj1jjj1jjj annually4 7xi7 ,accord+ to ! report ,heal?y ,p #bjbj1 individuals ) disabilities1 z a gr\p1 exp]i5ce heal? disp>ities 9 r\t9e public heal? ar5as su* z heal? behaviors1 cl9ical prev5tive s]vices1 & *ronic conditions4 ,comp>$ ) individuals )\t disabilities1 individuals ) disabilities are-- 7,i7 less likely to receive recomm5d$ prev5tive heal? c>e s]vices1 su* z r\t9e tee? clean+s & canc] scre5+s2 7,,ii7 at a high risk = poor heal? outcomes su* z obesity1 hyp]t5sion1 falls-relat$ injuries1 & mood disord]s su* z depression2 & 7,,iii7 m likely to engage 9 unheal?y behaviors t put _! heal? at risk1 su* z cig>ette smok+ & inadequate physical activity4 7#e7 ,laws & regulations t improve opportunities to live 9 safe neighborhoods ) m social cohesion1 atta9 high] education1 su/a9 /able employm5t1 & bridge class diff]5ces help fo/] ! heal? & safety ( individuals4 7#f7 ,! global public heal? community has rea*$ cons5sus ?r\gh ! ,rio ,political ,decl>ation ( ,social ,det]m9ants ( ,heal? adopt$ by ! ,_w ,heal? ,organization 9 ,octob] #bjaa t collaboration 9 coord9at$ & int]sectoral policy actions has prov5 to be effective4 ,heal? 9 ,all ,policies1 an initiative ( ! ,am]ican ,public ,heal? ,association1 toge!r ) int]sectoral coop]ation & action1 is "o promis+ approa* to enhance acc\ntability 9 o!r sectors ( heal?1 z well z ! promotion ( heal? equity & m inclusive & productive societies44 #ajjc4 ,heal? impact assessm5ts 7a7 ,f9d+s ,congress makes ! foll[+ f9d+s3 7#a7 ,heal? ,impact ,assessm5t is a tool to help plann]s1 heal? (ficials1 decision mak]s1 & ! public make m in=m$ decisions ab\t ! pot5tial heal? effects ( propos$ plans1 policies1 programs1 & projects 9 ord] to maximize heal? b5efits & m9imize h>ms4 7#b7 ,heal? ,impact ,assessm5ts fo/]s community lead]%ip1 own]%ip & p>ticipation 9 decision-mak+ processes4 7#c7 ,heal? ,impact ,assessm5ts c build community support & r$uce opposition to a project or policy1 !reby facilitat+ economic gr[? by aid+ ! developm5t ( cons5sus reg>d+ new developm5t proposals4 7#d7 ,heal? ,impact ,assessm5ts facilitate collaboration across sectors4 7b7 ,purposes ,x is ! purpose ( ?is section to-- 7#a7 provide m in=mation ab\t ! pot5tial human heal? effects ( policy decisions & ! di/ribution ( ^? effects2 7#b7 improve h[ heal? is consid]$ 9 plann+ & decision-mak+ processes2 & 7#c7 build /rong]1 heal?i] communities ?r\gh ! use ( ,heal? ,impact ,assessm5ts4 7c7 ,heal? impact assessm5ts ,"p ,p ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhj;g et seq471 z am5d$ by section #gdd1 is fur!r am5d$ by add+ at ! end ! foll[+3 #cii,v-#ab4 ,heal? impact assessm5ts 7a7 ,def9itions ,9 ?is section3 7#a7 ,adm9i/rator ,! t]m ,adm9i/rator means ! ,adm9i/rator ( ! ,environm5tal ,protection ,ag5cy4 7#b7 ,director ,! t]m ,director means ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion4 7#c7 ,heal? impact assessm5t ,! t]m heal? impact assessm5t means a sy/ematic process t uses an array ( data s\rces & analytic me?ods & consid]s input f /akehold]s to det]m9e ! pot5tial effects ( a propos$ policy1 plan1 program1 or project on ! heal? ( a population & ! di/ribution ( ^? effects )9 ! population4 ,su* t]m includes id5tify+ & recomm5d+ appropriate actions on monitor+ & maximiz+ pot5tial b5efits & m9imiz+ ! pot5tial h>ms4 7#d7 ,heal? disp>ity ,! t]m heal? disp>ity means a p>ticul> type ( heal? diff]5ce t is closely l9k$ ) social1 economic1 or environm5tal disadvantage & t adv]sely affects gr\ps ( p :o h sy/ematically exp]i5c$ great] ob/acles to heal? bas$ on _! racial or e?nic gr\p2 religion2 socioeconomic /atus2 g5d]2 age2 m5tal heal?2 cognitive1 s5sory1 or physical disability2 sexual ori5tation or g5d] id5tity2 geographic location2 citiz5%ip /atus2 or o!r *>act]i/ics hi/orically l9k$ to discrim9ation or exclusion4 7b7 ,e/abli%m5t ,! ,secret>y1 act+ ?r\gh ! ,director & 9 collaboration ) ! ,adm9i/rator1 %all-- 7#a7 9 consultation ) ! ,director ( ! ,national ,c5t] = ,*ronic ,disease ,prev5tion & ,heal? ,promotion & relevant (fices )9 ! ,dep>tm5t ( ,h\s+ & ,urban ,developm5t1 ! ,dep>tm5t ( ,transportation1 & ! ,dep>tm5t ( ,agriculture1 e/abli% a program at ! ,national ,c5t] = ,environm5tal ,heal? at ! ,c5t]s = ,disease ,control & ,prev5tion focus$ on advanc+ ! field ( heal? impact assessm5t t includes-- 7,a7 collect+ & dissem9at+ be/ practices2 7,b7 adm9i/]+ capacity build+ grants to ,/ates to support grantees 9 initiat+ heal? impact assessm5ts1 9 accordance ) subsection 7d72 7,c7 provid+ te*nical assi/ance2 7,d7 develop+ tra9+ tools & provid+ tra9+ on conduct+ heal? impact assessm5t & ! implem5tation ( built environm5t & heal? indicators2 7,e7 mak+ in=mation available1 z appropriate1 reg>d+ ! exi/5ce ( o!r community heal?y liv+ tools1 *eckli/s1 & indices t help connect public heal? to o!r sectors1 & tools to help exam9e ! effect ( ! indoor built environm5t & build+ codes on population heal?2 7,f7 conduct+ rese>* & evaluations ( heal? impact assessm5ts2 & 7,g7 aw>d+ competitive extramural rese>* grants2 7#b7 develop guidance & guidel9es to conduct heal? impact assessm5ts 9 accordance ) subsection 7c72 & 7#c7 e/abli% a grant program to all[ ,/ates to fund eligible entities to conduct heal? impact assessm5ts4 7c7 ,guidance 7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbj1 ! ,secret>y1 act+ ?r\gh ! ,director1 %all issue f9al guidance = conduct+ ! heal? impact assessm5ts4 ,9 develop+ su* guidance ! ,secret>y %all-- 7,a7 consult ) ! ,director ( ! ,national ,c5t] = ,environm5tal ,heal? &1 ! ,director ( ! ,national ,c5t] = ,*ronic ,disease ,prev5tion & ,heal? ,promotion1 & relevant (fices )9 ! ,dep>tm5t ( ,h\s+ & ,urban ,developm5t1 ! ,dep>tm5t ( ,transportation1 & ! ,dep>tm5t ( ,agriculture2 & 7,b7 consid] available int]national heal? impact assessm5t guidance1 ,nor? ,am]ican heal? impact assessm5t practice /&>ds1 & recomm5dations f ! ,national ,academy ( ,sci5ce4 7#b7 ,cont5t ,! guidance "u ?is subsection %all include-- 7,a7 backgr\nd on national & int]national ef=ts to bridge urban plann+1 climate =eca/+1 & public heal? in/itutions & discipl9es1 includ+ a review ( heal? impact assessm5t be/ practices int]nationally2 7,b7 evid5ce-bas$ direct & indirect pa?ways t l9k l&-use plann+1 transportation1 & h\s+ policy & objectives to human heal? outcomes2 7,c7 data res\rces & quantitative & qualitative =eca/+ me?ods to evaluate bo? ! /atus ( heal? det]m9ants & heal? effects1 includ+ id5tification ( exi/+ programs t c dissem9ate ^! res\rces2 7,d7 be/ practices = inclusive public involvem5t 9 conduct+ heal? impact assessm5ts2 & 7,e7 te*nical assi/ance = o!r ag5cies seek+ to develop _! own guidel9es & proc$ures = heal? impact assessm5t4 7d7 ,grant program 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director & 9 collaboration ) ! ,adm9i/rator1 %all-- 7,a7 aw>d grants to ,/ates to fund eligible entities = capacity build+ or to prep>e heal? impact assessm5ts2 & 7,b7 ensure t ,/ates receiv+ a grant "u ?is subsection fur!r support tra9+ & te*nical assi/ance = grantees "u ! program by fund+ & ov]see+ appropriate local1 ,/ate1 ,tribal1 ,f$]al1 in/itution ( high] education1 or nonpr(it heal? impact assessm5t exp]ts to provide su* te*nical assi/ance4 7#b7 ,applications 7,a7 ,9 g5]al ,to be eligible to receive a grant "u ?is section1 an eligible entity %all-- 7i7 be a ,/ate1 ,indian tribe1 or tribal organization t includes individuals or populations ! heal? ( :i* are1 or w be1 affect$ by an activity or a propos$ activity2 & 7ii7 submit to ! ,secret>y an application 9 accordance ) ?is subsection1 at su* "t1 9 su* mann]1 & conta9+ su* additional in=mation z ! ,secret>y may require4 7,b7 ,inclusion ,an application "u ?is subsection %all include a li/ ( propos$ activities t require or w\ld b5efit f conduct+ a heal? impact assessm5t )9 six mon?s ( aw>d+ funds4 ,! li/ %\ld be accompani$ by support+ docum5tation1 includ+ lett]s ( support1 f pot5tial conductors ( heal? impact assessm5ts = ! li/$ propos$ activities4 ,ea* application %\ld also include an assessm5t by ! eligible entity ( ! heal? ( ! population ( its jurisdiction & describe pot5tial adv]se or positive effects on heal? t ! propos$ activities may create4 7,c7 ,pref]5ce ,pref]5ce 9 aw>d+ funds "u ?is section may be giv5 to eligible entities t demon/rate ! pot5tial to significantly improve population heal? or l[] heal? c>e co/s z a result ( pot5tial heal? impact assessm5t "w4 7#c7 ,use ( funds 7,a7 ,9 g5]al ,an entity receiv+ a grant "u ?is section %all use su* grant funds to conduct heal? impact assessm5t capacity build+ or to fund subgrantees 9 conduct+ a heal? impact assessm5t = a propos$ activity 9 accordance ) ?is subsection4 7,b7 ,purposes ,! purposes ( a heal? impact assessm5t "u ?is subsection are-- 7i7 to facilitate ! involvem5t ( tribal1 ,/ate1 & local public heal? (ficials 9 community plann+1 transportation1 h\s+1 & l& use decisions & o!r decisions affect+ ! built environm5t to id5tify any pot5tial heal? conc]n or heal? b5efit relat+ to an activity or propos$ activity2 7ii7 to provide = an inve/igation ( any heal?-relat$ issue ( conc]n rais$ 9 a plann+ process1 an environm5tal impact assessm5t process1 or policy appraisal relat+ to a propos$ activity2 7iii7 to describe & comp>e alt]natives 7includ+ no-action alt]natives7 to a propos$ activity to provide cl>ification ) respect to ! pot5tial heal? outcomes associat$ ) ! propos$ activity &1 :]e appropriate1 to ! relat$ b5efit-co/ or co/-effectiv5ess ( ! propos$ activity & alt]natives2 7iv7 to contribute1 :5 applicable1 to ! f9d+s ( a plann+ process1 policy appraisal1 or an environm5tal impact /atem5t ) respect to ! t]ms & conditions ( implem5t+ a propos$ activity or relat$ mitigation recomm5dations1 z necess>y2 7v7 to ensure t ! disproportionate di/ribution ( negative impacts among vuln]able populations is m9imiz$ z mu* z possible2 7vi7 to engage affect$ community memb]s & ensure adequate opportunity = public comm5t on all /ages ( ! heal? impact assessm5t2 7vii7 :]e appropriate1 to consult ) local & c\nty heal? dep>tm5ts & appropriate organizations1 includ+ plann+1 transportation1 & h\s+ organizations & provid+ !m ) in=mation & tools reg>d+ h[ to conduct & integrate heal? impact assessm5t into _! "w2 & 7viii7 to inspect homes1 wat] sy/ems1 & o!r elem5ts t pose risks to lead exposure1 ) an emphasis on areas t pose a high] risk to *ildr54 7#d7 ,assessm5ts ,heal? impact assessm5ts c>ri$ out us+ grant funds "u ?is section %all-- 7,a7 take appropriate heal? factors into consid]ation z e>ly z practicable dur+ ! plann+1 review1 or decision-mak+ processes2 7,b7 assess ! effect on ! heal? ( individuals & populations ( propos$ policies1 projects1 or plans t result 9 modifications to ! built environm5t2 & 7,c7 assess ! di/ribution ( heal? effects across v>i\s factors1 su* z race1 income1 e?nicity1 age1 disability /atus1 g5d]1 & geography4 7#e7 ,eligible activities 7,a7 ,9 g5]al ,eligible entities fund$ "u ?is subsection %all conduct an evaluation ( any propos$ activity to det]m9e :e!r x w h a significant adv]se or positive effect on ! heal? ( ! affect$ population 9 ! jurisdiction ( ! eligible entity1 bas$ on ! crit]ia describ$ 9 subp>agraph 7,b74 7,b7 ,crit]ia ,! crit]ia describ$ 9 ?is subp>agraph include1 z applicable to ! propos$ activity1 ! foll[+3 7i7 ,any sub/antial adv]se effect or significant heal? b5efit on heal? outcomes or factors kn[n to influ5ce heal?1 includ+ ! foll[+3 7,i7 ,physical activity4 7,,ii7 ,injury4 7,,iii7 ,m5tal heal?4 7,,iv7 ,accessibility to heal?-promot+ goods & s]vices4 7,v7 ,respiratory heal?4 7,,vi7 ,*ronic disease4 7,,vii7 ,nutrition4 7,,viii7 ,l& use *anges t promote local1 su/a9able food s\rces4 7,,ix7 ,infecti\s disease4 7,x7 ,heal? disp>ities4 7,,xi7 ,exi/+ air quality1 gr\nd or surface wat] quality or quantity1 or noise levels4 7,,xii7 ,lead exposure4 7,,xiii7 ,dr9k+ wat] quality & accessibility4 7ii7 ,o!r factors t may be consid]$1 includ+-- 7,i7 ! pot5tial = a propos$ activity to result 9 sy/ems failure t leads to a public heal? em]g5cy2 7,,ii7 ! probability t ! propos$ activity w result 9 a significant increase 9 t\rism1 economic developm5t1 or employm5t 9 ! jurisdiction ( ! eligible entity2 7,,iii7 any o!r significant pot5tial haz>d or enhancem5t to human heal?1 z det]m9$ by ! eligible entity2 or 7,,iv7 :e!r ! evaluation ( a propos$ activity w\ld duplicate ano!r analysis or /udy be+ und]tak5 9 conjunction ) ! propos$ activity4 7,c7 ,factors = consid]ation ,9 evaluat+ a propos$ activity "u subp>agraph 7,a71 an eligible entity may take into consid]ation any reasonable1 direct1 indirect1 or cumulative effect t c be cle>ly relat$ to pot5tial heal? effects & t is relat$ to ! propos$ activity1 includ+ ! effect ( any action t is-- 7i7 includ$ 9 ! long-range plan relat+ to ! propos$ activity2 7ii7 likely to be c>ri$ out 9 coord9ation ) ! propos$ activity2 7iii7 dep5d5t on ! occurr5ce ( ! propos$ activity2 or 7iv7 likely to h a disproportionate impact on high-risk or vuln]able populations4 7#f7 ,requirem5ts ,a heal? impact assessm5t prep>$ ) funds aw>d$ "u ?is subsection %all incorporate ! foll[+1 aft] conduct+ ! scre5+ phase 7id5tify+ projects or policies = :i* a heal? impact assessm5t w\ld be valuable & feasible7 ?r\gh ! application process3 7,a7 ,scop+ ,id5tify+ :i* heal? effects to consid] & ! rese>* me?ods to be utiliz$4 7,b7 ,assess+ risks & b5efits ,assess+ ! basel9e heal? /atus & factors kn[n to influ5ce ! heal? /atus 9 ! affect$ community1 :i* may include aggregat+ & syn!siz+ exi/+ heal? assessm5t evid5ce & data f ! community4 7,c7 ,develop+ recomm5dations ,sugge/+ *anges to proposals to promote positive or mitigate adv]se heal? effects4 7,d7 ,report+ ,syn!siz+ ! assessm5t & recomm5dations & communicat+ ! results to decision mak]s4 7,e7 ,monitor+ & evaluat+ ,track+ ! decision & implem5tation effect on heal? det]m9ants & heal? /atus4 7#g7 ,plan ,an eligible entity t is aw>d$ a grant "u ?is section %all develop & implem5t a plan1 to be approv$ by ! ,director1 = mean+ful & inclusive /akehold] involvem5t 9 all phases ( ! heal? impact assessm5t4 ,/akehold]s may include community lead]s1 community-bas$ organizations1 y\?-s]v+ organizations1 plann]s1 public heal? exp]ts1 ,/ate & local public heal? dep>tm5ts & (ficials1 heal? c>e exp]ts or (ficials1 h\s+ exp]ts or (ficials1 & transportation exp]ts or (ficials4 7#h7 ,submission ( f9d+s ,an eligible entity t is aw>d$ a grant "u ?is section %all submit ! f9d+s ( any fund$ heal? impact assessm5t activities to ! ,secret>y & make ^! f9d+s publicly available4 7#i7 ,assessm5t ( impacts ,an eligible entity t is aw>d$ a grant "u ?is section %all ensure ! assessm5t ( ! di/ribution ( heal? impacts 7relat$ to ! propos$ activity7 across race1 e?nicity1 income1 age1 g5d]1 disability /atus1 & geography4 7#aj7 ,conduct ( assessm5t ,to ! greate/ ext5t feasible1 a heal? impact assessm5t %all be conduct$ "u ?is section 9 a mann] t respects ! ne$s & tim+ ( ! decision-mak+ process x evaluates4 7#aa7 ,me?odology ,9 prep>+ a heal? impact assessm5t "u ?is subsection1 an eligible entity or p>tn] %all foll[ ! guidance publi%$ "u subsection 7c74 7e7 ,heal? impact assessm5t database ,! ,secret>y1 act+ ?r\gh ! ,director & 9 collaboration ) ! ,adm9i/rator1 %all e/abli%1 ma9ta91 & make publicly available a heal? impact assessm5t database1 includ+-- 7#a7 a catalog ( heal? impact assessm5ts receiv$ "u ?is section2 7#b7 an inv5tory ( tools us$ by eligible entities to conduct heal? impact assessm5ts2 & 7#c7 guidance = eligible entities ) respect to ! selection ( appropriate tools describ$ 9 p>agraph 7#b74 7f7 ,evaluation ( grantee activities ,! ,secret>y %all aw>d competitive grants to ,prev5tion ,rese>* ,c5t]s1 or nonpr(it organizations or academic in/itutions ) exp]tise 9 heal? impact assessm5ts to-- 7#a7 assi/ grantees ) ! provision ( tra9+ & te*nical assi/ance 9 ! conduct+ ( heal? impact assessm5ts2 7#b7 evaluate ! activities c>ri$ out ) grants "u subsection 7d72 & 7#c7 assi/ ! ,secret>y 9 dissem9at+ evid5ce1 be/ practices1 & lessons le>n$ f grantees4 7g7 ,report to ,congress ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbj1 ! ,secret>y %all submit to ,congress a report conc]n+ ! evaluation ( ! programs "u ?is section1 includ+ recomm5dations z to h[ lessons le>n$ f su* programs c be incorporat$ into future guidance docum5ts develop$ & provid$ by ! ,secret>y & o!r ,f$]al ag5cies1 z appropriate4 7h7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y4 #cii,v-#ac4 ,implem5tation ( rese>* f9d+s to improve heal? outcomes ?r\gh ! built environm5t 7a7 ,rese>* grant program ,! ,secret>y1 9 collaboration ) ! ,adm9i/rator ( ! ,environm5tal ,protection ,ag5cy 7ref]r$ to 9 ?is section z ! ,adm9i/rator71 %all aw>d grants to public ag5cies or private nonpr(it in/itutions to implem5t evid5ce-bas$ programm+ to improve human heal? ?r\gh improvem5ts to ! built environm5t & subsequ5tly human heal?1 by address+-- 7#a7 levels ( physical activity2 7#b7 consumption ( nutritional foods2 7#c7 rates ( crime2 7#d7 air1 wat]1 & soil quality2 7#e7 risk or rate ( injury2 7#f7 accessibility to heal?-promot+ goods & s]vices2 7#g7 *ronic disease rates2 7#h7 community design2 7#i7 h\s+2 7#aj7 transportation options2 & 7#aa7 o!r factors1 z ! ,secret>y det]m9es appropriate4 7b7 ,applications ,a public ag5cy or private nonpr(it in/itution desir+ a grant "u ?is section %all submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* agreem5ts1 assurances1 & in=mation z ! ,secret>y1 9 consultation ) ! ,adm9i/rator1 may require4 7c7 ,rese>* ,! ,secret>y1 9 consultation ) ! ,adm9i/rator1 %all support1 ?r\gh grants aw>d$ "u ?is section1 rese>* t-- 7#a7 uses evid5ce-bas$ rese>* to improve ! built environm5t & human heal?2 7#b7 exam9es-- 7,a7 ! scope & int5sity ( ! impact t ! built environm5t 7includ+ ! v>i\s *>act]i/ics ( ! built environm5t7 has on ! human heal?2 or 7,b7 ! di/ribution ( su* impacts by-- 7i7 location2 & 7ii7 population subgr\p2 7#c7 is us$ to develop-- 7,a7 measures & indicators to address heal? impacts & ! connection ( heal? to ! built environm5t2 7,b7 ef=ts to l9k ! measures to transportation1 l& use1 & heal? databases2 & 7,c7 ef=ts to enhance ! collection ( built environm5t surveillance data2 7#d7 di/+ui%es c>efully betwe5 p]sonal attitudes & *oices & ext]nal influ5ces on behavior to det]m9e h[ mu* ! association betwe5 ! built environm5t & ! heal? ( resid5ts1 v]sus ! life/yle pref]5ces ( ! p t *oose to live 9 ! neighborhood1 reflects ! physical *>act]i/ics ( ! neighborhood2 & 7#e7 7,a7 id5tifies or develops effective int]v5tion /rategies focus+ on enhancem5ts to ! built environm5t t promote increas$ use physical activity1 access to nutriti\s foods1 or o!r heal?-promot+ activities by resid5ts2 & 7,b7 9 develop+ ! int]v5tion /rategies "u subp>agraph 7,a71 ensures t ! int]v5tion /rategies w rea* out to high-risk or vuln]able populations1 includ+ l[-income urban & rural communities & ag+ populations1 9 addition to ! g5]al population4 7d7 ,surveys ,! ,secret>y may all[ recipi5ts ( grants "u ?is section to use su* grant funds to support ! expansion ( national surveys & data track+ sy/ems to provide m detail$ in=mation ab\t ! connection betwe5 ! built environm5t & heal?4 7e7 ,priority ,9 aw>d+ grants "u ?is section1 ! ,secret>y & ! ,adm9i/rator %all give priority to entities ) programm+ t incorporates-- 7#a7 int]discipl9>y approa*es2 or 7#b7 ! exp]tise ( ! public heal?1 physical activity1 urban plann+1 l& use1 & transportation rese>* communities 9 ! ,unit$ ,/ates & abroad4 7f7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ su* sums z may be necess>y to c>ry out ?is section4 ,! ,secret>y may allocate n m ?an #bj p]c5t ( ! am\nt s appropriat$ = a fiscal ye> = purposes ( conduct+ rese>* "u subsection 7c74 4 #ajjd4 ,implem5tation ( recomm5dations by ,environm5tal ,protection ,ag5cy 7a7 ,inspector g5]al recomm5dations ,! ,adm9i/rator ( ! ,environm5tal ,protection ,ag5cy 7ref]r$ to 9 ?is section z ! ,adm9i/rator7 %all1 z promptly z practicable1 c>ry out ea* ( ! foll[+ recomm5dations ( ! ,inspector ,g5]al ( ! ,environm5tal ,protection ,ag5cy z describ$ 9 ! report entitl$ ,,epa ,ne$s to ,conduct ,environm5tal ,ju/ice ,reviews ( ,its ,programs1 ,policies & ,activities 7,report ,no4 #bjjf-,p-#jjjcd73 7#a7 ,! recomm5dation t ! program & regional (fices ( ! ,environm5tal ,protection ,ag5cy id5tify :i* programs1 policies1 & activities ne$ environm5tal ju/ice reviews & ! ,adm9i/rator require ^? (fices to e/abli% a plan to complete ! necess>y reviews4 7#b7 ,! recomm5dation t ! ,adm9i/rator ensure t ! reviews describ$ 9 p>agraph 7#a7 det]m9e :e!r ! programs1 policies1 & activities may h a disproportionately high & adv]se heal? or environm5tal impact on m9ority & l[-income populations4 7#c7 ,! recomm5dation t ea* program & regional (fice ( ! ,environm5tal ,protection ,ag5cy develop specific environm5tal ju/ice review guidance = conduct+ environm5tal ju/ice reviews4 7#d7 ,! recomm5dation t ! ,adm9i/rator designate a responsible (fice to compile results ( environm5tal ju/ice reviews & recomm5d appropriate actions4 7b7 ,,gao recomm5dations ,9 promulgat+ regulations ( ! ,environm5tal ,protection ,ag5cy1 ! ,adm9i/rator %all1 z promptly z practicable1 c>ry out ea* ( ! foll[+ recomm5dations ( ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates z describ$ 9 ! report entitl$ ,,epa ,%\ld ,devote ,m ,att5tion to ,environm5tal ,ju/ice :5 ,develop+ ,clean ,air ,rules 7,,gao-#je-bhi73 7#a7 ,! recomm5dation t ! ,adm9i/rator ensure t workgr\ps involv$ 9 develop+ a rule devote att5tion to environm5tal ju/ice :ile draft+ & f9aliz+ ! rule4 7#b7 ,! recomm5dation t ! ,adm9i/rator enhance ! ability ( ! workgr\ps describ$ 9 p>agraph 7#a7 to id5tify pot5tial environm5tal ju/ice issues ?r\gh /eps su* z-- 7,a7 provid+ workgr\p memb]s ) guidance & tra9+ to help ^? memb]s id5tify pot5tial environm5tal ju/ice problems2 & 7,b7 involv+ environm5tal ju/ice coord9ators 9 ! workgr\ps if appropriate4 7#c7 ,! recomm5dation t ! ,adm9i/rator improve assessm5ts ( pot5tial environm5tal ju/ice impacts 9 economic reviews by id5tify+ ! data & develop+ ! model+ te*niques ne$$ to assess ^? impacts4 7#d7 ,! recomm5dation t ! ,adm9i/rator direct appropriate (fic]s & employees ( ! ,environm5tal ,protection ,ag5cy1 if feasible1 to respond fully to public comm5ts on environm5tal ju/ice1 includ+ by-- 7,a7 improv+ ! explanation by ! ,adm9i/rator ( ! basis = any conclusions relat+ to environm5tal ju/ice2 & 7,b7 includ+ 9 an explanation "u subp>agraph 7,a7 support+ data4 7c7 #bjjd ,inspector ,g5]al report 7#a7 ,9 g5]al ,! ,adm9i/rator %all1 z promptly z practicable1 c>ry out ea* ( ! foll[+ recomm5dations ( ! ,inspector ,g5]al ( ! ,environm5tal ,protection ,ag5cy z describ$ 9 ! report entitl$ ,,epa ,ne$s to ,consi/5tly ,implem5t ! ,int5t ( ! ,executive ,ord] on ,environm5tal ,ju/ice 7,report ,no4 #bjjd-,p-#jjjjg73 7,a7 ,! recomm5dation t ! ,adm9i/rator cle>ly def9e ! mission ( ! ,(fice ( ,environm5tal ,ju/ice & provide ,environm5tal ,protection ,ag5cy /aff ) an und]/&+ ( ! roles & responsibilities ( t ,(fice4 7,b7 ,! recomm5dation t ! ,adm9i/rator-- 7i7 e/abli%1 ?r\gh ! issuance ( guidance or a policy /atem5t1 specific timeframes = ! developm5t ( def9itions1 goals1 & measurem5ts reg>d+ environm5tal ju/ice2 & 7ii7 provide ! regions & program (fices a /&>d & consi/5t def9ition = a m9ority & l[-income community1 ) in/ructions on h[ ! ,environm5tal ,protection ,ag5cy w implem5t & put into op]ation environm5tal ju/ice 9 ! daily activities ( ! ,environm5tal ,protection ,ag5cy4 7,c7 ,! recomm5dation t ! ,adm9i/rator ensure t ! compreh5sive tra9+ program t 0 "u developm5t 7z ( ! date ( ! report7 includes /&>d & consi/5t def9itions ( ! key environm5tal ju/ice concepts1 su* z l[-income1 m9ority1 & disproportionately impact$1 & in/ructions = implem5tation ( ^? concepts4 7#b7 ,reports 7,a7 ,initial report ,n lat] ?an #ahj days aft] ! date ( enactm5t ( ?is ,act1 ! ,adm9i/rator %all submit to ,congress an initial report on ! /rategy ( ! ,adm9i/rator = implem5t+ ! recomm5dations describ$ 9 subp>agraphs 7,a71 7,b71 & 7,c7 ( p>agraph 7#a74 7,b7 ,subsequ5t reports ,aft] submitt+ ! initial report "u subp>agraph 7,a71 ! ,adm9i/rator %all submit to ,congress semiannual reports on ! progress ( ! ,adm9i/rator 9-- 7i7 implem5t+ ! recomm5dations ref]r$ to 9 subp>agraph 7,a72 & 7ii7 modify+ ! em]g5cy managem5t proc$ures ( ! ,adm9i/rator to incorporate environm5tal ju/ice 9 ! ,incid5t ,comm& ,/ructure ( ! ,environm5tal ,protection ,ag5cy1 9 accordance ) ! ,decemb] #ah1 #bjjf1 lett] f ! ,deputy ,adm9i/rator to ! ,act+ ,inspector ,g5]al ( ! ,environm5tal ,protection ,ag5cy4 7d7 ,f$]al action plan = sav+ lives1 protect+ p & _! families f radon 7#a7 ,f9d+s ,congress f9ds t radon is a naturally occurr+ radioactive gas t is-- 7,a7 recogniz$ z ! lead+ cause ( lung canc] among nonsmok]s2 & 7,b7 a p>ticul> environm5tal ?reat = l[-income & m9ority individuals because ( ! lack ( in=mation ab\t radon levels 9 ! homes ( ^? individuals4 7#b7 ,implem5tation ,n lat] ?an #ahj days aft] ! date ( enactm5t ( ?is ,act1 ! ,adm9i/rator %all implem5t ! action plan entitl$ ,protect+ ,p & ,families f ,radon3 ,a ,f$]al ,action ,plan = ,sav+ ,lives 7,june #bj1 #bjaa71 9 consultation ) ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion & any o!r ,f$]al ag5cies ref]r$ to 9 ! action plan4 7#c7 ,specific /eps ,9 c>ry+ out p>agraph 7#b71 ! ,adm9i/rator %all ensure t-- 7,a7 ! workgr\p compris$ ( ! ,f$]al ag5cies p>ticipat+ 9 ! developm5t ( ! action plan ref]r$ to 9 p>agraph 7#b7 implem5ts specific /eps )9 ! exi/+ au?ority & activities ( ea* ,f$]al ag5cy to r$uce exposure to radon2 & 7,b7 n lat] ?an ! date t is #a ye> aft] ! date on :i* ! ,adm9i/rator beg9s implem5tation ( ! action plan describ$ 9 p>agraph 7#b71 ! workgr\p describ$ 9 subp>agraph 7,a7 meets to assess & recognize a*ievem5ts ( ! plan4 7#d7 ,report ,aft] ! progress meet+ ( ! workgr\p "u p>agraph 7#c77;,b71 ! ,adm9i/rator %all submit to ,congress a report on ! implem5tation ( ! action plan describ$ 9 p>agraph 7#b71 includ+ ! *all5ges rema9+ & ! progress 9 r$uc+ radon exposure1 p>ticul>ly = l[-income & m9ority families4 7e7 ,f$]al action plan = prev5t+ *ildhood lead poison+ 7#a7 ,f9d+s ,congress f9ds t-- 7,a7 ! effects ( lead poison+ are irrev]sible & co/ ! ,unit$ ,/ates millions annually 9 m$ical & education co/s2 7,b7 ! cognitive effects suff]$ by *ildr5 expos$ to lead result 9 a lifetime ( heal? & behavioral problems1 :i* makes prev5tion ef=ts m critical2 & 7,c7 ! risk is especially high = vuln]able m9ority populations :o are m likely to live 9 old] homes1 :]e lead-bas$ pa9t is m likely to be pres5t4 7#b7 ,action plan ,n lat] ?an #ahj days aft] ! date ( enactm5t ( ?is ,act1 ! ,adm9i/rator1 9 consultation ) ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion & o!r relevant ,f$]al ag5cies1 %all develop an action plan to r$uce exposure to lead4 7#c7 ,specific /eps ,9 c>ry+ out p>agraph 7#b71 ! ,adm9i/rator %all-- 7,a7 e/abli% a work+ gr\p1 compris$ ( repres5tatives ( ! ,f$]al ag5cies p>ticipat+ 9 ! developm5t ( ! action plan describ$ 9 p>agraph 7#b71 to make recomm5dations = ! implem5tation ( specific /eps )9 ! exi/+ au?ority & activities ( ea* ,f$]al ag5cy to r$uce exposure to lead2 & 7,b7 assi/ o!r ,f$]al ag5cies 9 ! developm5t ( mat]ials on ! haz>ds ( lead-bas$ pa9t = ! purpose ( educat+ t5ants & l&lords1 h[ to recognize pot5tial s\rces ( exposure1 & h[ to rem$iate ^? s\rces4 #ajje4 ,grant program to conduct environm5tal heal? improvem5t activities & to improve social det]m9ants ( heal? 7a7 ,def9itions ,9 ?is section3 7#a7 ,director ,! t]m ,director means ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 act+ 9 collaboration ) ! ,adm9i/rator ( ! ,environm5tal ,protection ,ag5cy & ! ,director ( ! ,national ,in/itute ( ,environm5tal ,heal? ,sci5ces4 7#b7 ,eligible entity ,! t]m eligible entity means a ,/ate or local community t-- 7,a7 be>s a disproportionate burd5 ( exposure to environm5tal heal? haz>ds2 7,b7 be>s a disproportionate burd5 ( exposure to unheal?y liv+ conditions1 l[ /&>d h\s+ conditions1 l[ socioeconomic /atus1 poor nutrition1 less opportunity = educational atta9m5t1 disproportionately high unemploym5t rates1 or l[] lit]acy levels & access to in=mation2 7,c7 has e/abli%$ a coalition-- 7i7 ) n less ?an #a community-bas$ organization or demon/ration program2 & 7ii7 ) n less ?an #a-- 7,i7 public heal? entity2 7,,ii7 heal? c>e provid] organization2 7,,iii7 academic in/itution1 includ+ any m9ority-s]v+ in/itution 7includ+ a ,hispanic-s]v+ in/itution1 a hi/orically ,black college or univ]sity1 or a ,tribal ,college or ,univ]sity72 7,,iv7 *ild-s]v+ in/itution2 or 7,v7 l&lord or h\s+ provid] work+ on lead rem$iation2 7,d7 ensures plann$ activities & fund+ /reams are coord9at$ to improve community heal?2 & 7,e7 submits an application 9 accordance ) subsection 7c74 7b7 ,e/abli%m5t ,! ,director %all e/abli% a grant program "u :i* eligible entities %all receive grants to conduct environm5tal heal? improvem5t activities & to improve social det]m9ants ( heal?4 7c7 ,application ,to receive a grant "u ?is section1 an eligible entity %all submit an application to ! ,director at su* "t1 9 su* mann]1 & accompani$ by su* in=mation z ! ,director may require4 7d7 ,use ( grant funds ,an eligible entity may use a grant "u ?is section-- 7#a7 to promote environm5tal heal?2 7#b7 to address environm5tal heal? disp>ities among all populations1 includ+ *ildr52 & 7#c7 to address racial & e?nic disp>ities 9 social det]m9ants ( heal?4 7e7 ,am\nt ( coop]ative agreem5t ,! ,director %all aw>d grants to eligible entities at ! foll[+ #c fund+ levels3 7#a7 ,level #a coop]ative agreem5ts 7,a7 ,9 g5]al ,an eligible entity aw>d$ a grant "u ?is p>agraph %all use ! funds to id5tify environm5tal heal? problems & solutions by-- 7i7 e/abli%+ a plann+ & prioritiz+ c\ncil 9 accordance ) subp>agraph 7,b72 & 7ii7 conduct+ an environm5tal heal? assessm5t 9 accordance ) subp>agraph 7,c74 7,b7 ,plann+ & prioritiz+ c\ncil 7i7 ,9 g5]al ,a prioritiz+ & plann+ c\ncil e/abli%$ "u subp>agraph 7,a77i7 7ref]r$ to 9 ?is p>agraph z a ,,ppc7 %all assi/ ! environm5tal heal? assessm5t process & environm5tal heal? promotion activities ( ! eligible entity4 7ii7 ,memb]%ip ,memb]%ip ( a ,,ppc %all consi/ ( repres5tatives f v>i\s organizations )9 public heal?1 plann+1 developm5t1 & environm5tal s]vices & %all include /akehold]s f vuln]able gr\ps su* z *ildr51 ! eld]ly1 disabl$1 & m9ority e?nic gr\ps t are (t5 n actively involv$ 9 democratic or decision-mak+ processes4 7iii7 ,duties ,a ,,ppc %all-- 7,i7 id5tify key /akehold]s & engage & coord9ate pot5tial p>tn]s 9 ! plann+ process2 7,,ii7 e/abli% a =mal advisory gr\p to plan = ! e/abli%m5t ( s]vices2 7,,iii7 conduct an 9-dep? review ( ! nature & ext5t ( ! ne$ = an environm5tal heal? assessm5t1 includ+ a local epidemiological pr(ile1 an evaluation ( ! s]vice provid] capacity ( ! community1 & a pr(ile ( any t>get populations2 & 7,,iv7 def9e ! compon5ts ( c>e & =m ess5tial programmatic l9kages ) relat$ provid]s 9 ! community4 7,c7 ,environm5tal heal? assessm5t 7i7 ,9 g5]al ,a ,,ppc %all c>ry out an environm5tal heal? assessm5t to id5tify environm5tal heal? conc]ns4 7ii7 ,assessm5t process ,! ,,ppc %all-- 7,i7 def9e ! goals ( ! assessm5t2 7,,ii7 g5]ate ! environm5tal heal? issue li/2 7,,iii7 analyze issues ) a sy/ems framework2 7,,iv7 develop appropriate community environm5tal heal? indicators2 7,v7 rank ! environm5tal heal? issues2 7,,vi7 set priorities = action2 7,,vii7 develop an action plan2 7,,viii7 implem5t ! plan2 & 7,,ix7 evaluate progress & plann+ = ! future4 7,d7 ,evaluation ,ea* eligible entity t receives a grant "u ?is p>agraph %all evaluate1 report1 & dissem9ate program f9d+s & outcomes4 7,e7 ,te*nical assi/ance ,! ,director may provide su* te*nical & o!r non-f9ancial assi/ance to eligible entities z ! ,director det]m9es to be necess>y4 7#b7 ,level #b coop]ative agreem5ts 7,a7 ,eligibility 7i7 ,9 g5]al ,! ,director %all aw>d grants "u ?is p>agraph to eligible entities t h already-- 7,i7 e/abli%$ broad-bas$ collaborative p>tn]%ips2 & 7,,ii7 complet$ environm5tal assessm5ts4 7ii7 ,no level #a requirem5t ,to be eligible to receive a grant "u ?is p>agraph1 an eligible entity is n requir$ to h successfully complet$ a ,level #a ,coop]ative ,agreem5t 7z describ$ 9 p>agraph 7#a774 7,b7 ,use ( grant funds ,an eligible entity aw>d$ a grant "u ?is p>agraph %all use ! funds to fur!r activities to c>ry out environm5tal heal? improvem5t activities1 includ+-- 7i7 address+ community environm5tal heal? priorities 9 accordance ) p>agraph 7#a77;,c77ii71 includ+-- 7,i7 geography2 7,,ii7 ! built environm5t2 7,,iii7 air quality2 7,,iv7 wat] quality2 7,v7 l& use2 7,,vi7 solid wa/e2 7,,vii7 h\s+2 7,,viii7 viol5ce2 7,,ix7 socioeconomic /atus2 7,x7 e?nicity1 social con/ruct & language pref]5ce2 7,,xi7 educational atta9m5t2 7,,xii7 employm5t2 7,,xiii7 food safety1 accessibility1 & af=dability2 7,,xiv7 nutrition2 7,,xv7 heal? c>e s]vices2 & 7,,xvi7 injuries2 7ii7 build+ p>tn]%ips betwe5 plann+1 public heal?1 & o!r sectors1 includ+ *ild-s]v+ in/itutions1 to address h[ ! built environm5t impacts food availability & access & physical activity to promote heal?y behaviors & life/yles & r$uce ov]weight & obesity1 musculoskeletal diseases1 respiratory conditions1 d5tal1 oral & m5tal heal? conditions1 pov]ty1 & relat$ co-morbidities2 7iii7 e/abli%+ programs to address-- 7,i7 h[ environm5tal & social conditions ( "w & liv+ *oices influ5ce physical activity & diet>y intake2 or 7,,ii7 h[ ! conditions describ$ 9 subclause 7,i7 influ5ce ! conc]ns & ne$s ( p :o h impair$ mobility & use assi/ance devices1 includ+ :eel*airs1 l[] limb pro/heses1 & hip1 knee1 & o!r jo9t replacem5ts2 & 7iv7 conv5+ int]v5tion & demon/ration programs t exam9e ! role ( ! social environm5t 9 connection ) ! physical & *emical environm5t 9-- 7,i7 det]m9+ access to nutritional food2 7,,ii7 improv+ physical activity to r$uce ov]weight1 obesity1 & co-morbidities & increase quality ( life2 & 7,,iii7 location & access to m$ical facilities4 7#c7 ,level #c coop]ative agreem5ts 7,a7 ,9 g5]al ,an eligible entity aw>d$ a grant "u ?is p>agraph %all use ! funds to id5tify & address racial & e?nic disp>ities 9 social det]m9ants ( heal? by creat+ demon/ration programs t assess ! feasibility ( e/abli%+ a f$]ally fund$ compreh5sive program & describe key outcomes t address racial & e?nic disp>ities 9 social det]m9ants ( heal?4 7,b7 ,program ,design 7i7 ,evaluation ,no lat] ?an #a ye> aft] enactm5t ( ?is ,act1 ! ,director %all evaluate ! be/ practices ( exi/+ programs f ! private1 public1 community bas$1 & academically support$ initiatives focus$ on r$uc+ disp>ities 9 ! social det]m9ants ( heal? = racial & e?nic populations4 7ii7 ,demon/ration projects ,n lat] ?an two ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,director %all implem5t at lea/ t5 demon/ration projects includ+ at lea/ "o project = ea* major racial & e?nic m9ority gr\p1 ea* ( :i* is unique to ! cultural & l+ui/ic ne$s ( ea* ( ! foll[+ gr\ps3 7,i7 ,native ,am]icans & ,alaska ,natives4 7,,ii7 ,asian ,am]icans4 7,,iii7 ,african ,am]icans_/,blacks4 7,,iv7 ,hispanic_/,lat9o-,am]icans4 7,v7 ,native ,hawaiians & ,pacific ,isl&]s4 7iii7 ,report to ,congress ,no lat] ?an #b ye>s aft] ! implem5tation ( ! initial demon/ration projects1 ! ,director %all submit to ,congress a report :i* includes-- 7,i7 a description ( ea* demon/ration project & design2 7,,ii7 an evaluation ( ! co/-effectiv5ess ( ea* project's prev5tion & treatm5t ef=ts2 7,,iii7 an evaluation ( ! cultural & l+ui/ic appropriat5ess ( ea* project by racial & e?nic gr\p2 & 7,,iv7 an evaluation ( ! b5efici>y's heal? /atus improvem5t "u ! demon/ration project4 7iv7 ,any o!r in=mation deem$ appropriate by ! ,director ,! ,director %all require eligible entities aw>d$ a grant "u ?is p>agraph to report any o!r in=mation ! ,director det]m9es appropriate to be %>$ by or develop$ by su* entity1 includ+ ! foll[+3 7,i7 ,develop+ models & evaluat+ me?ods t improve ! cultural & l+ui/ically appropriate s]vices provid$ ?r\gh ! ,c5t]s = ,disease ,control & ,prev5tion to t>get individuals impact$ by heal? disp>ities bas$ on _! race1 e?nicity1 & g5d]4 7,,ii7 ,promot+ ! collaboration betwe5 prim>y & specialty c>e heal? c>e provid]s & pati5ts1 to ensure pati5ts impact$ by heal? disp>ities bas$ on race1 e?nicity1 & g5d] are receiv+ compreh5sive & organiz$ treatm5t & c>e4 7,,iii7 ,educat+ heal? c>e pr(essionals on ! causes & effects ( disp>ities 9 ! social det]m9ants ( heal? z x relates to m9ority & racial & e?nic communities & ! ne$ = culturally & l+ui/ically appropriate c>e 9 ! prev5tion & treatm5t ( high-impact diseases4 7,,iv7 ,enc\rag+ collaboration among community & pati5t-bas$ organizations :i* "w to address disp>ities 9 ! social det]m9ants ( heal? z x relates to high-impact diseases 9 m9ority & racial & e?nic populations4 7f7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section-- 7#a7 #be1jjj1jjj = fiscal ye> #bjba2 & 7#b7 su* sums z may be necess>y = fiscal ye>s #bjbb ?r\gh #bjbd4 #ajjf4 ,additional rese>* on ! relation%ip betwe5 ! built environm5t & ! heal? ( community resid5ts 7a7 ,def9ition ( eligible in/itution ,9 ?is section1 ! t]m eligible in/itution means a public or private nonpr(it in/itution t submits to ! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y7 & ! ,adm9i/rator ( ! ,environm5tal ,protection ,ag5cy 79 ?is section ref]r$ to z ! ,adm9i/rator7 an application = a grant "u ! grant program au?oriz$ "u subsection 7b77#b7 at su* "t1 9 su* mann]1 & conta9+ su* agreem5ts1 assurances1 & in=mation z ! ,secret>y & ,adm9i/rator may require4 7b7 ,rese>* grant program 7#a7 ,def9ition ( heal? ,9 ?is section1 ! t]m heal? includes-- 7,a7 levels ( physical activity2 7,b7 degree ( mobility due to factors su* z musculoskeletal diseases1 ar?ritis1 & obesity2 7,c7 consumption ( nutritional foods2 7,d7 rates ( crime2 7,e7 air1 wat]1 & soil quality2 7,f7 risk ( injury2 7,g7 accessibility to heal? c>e s]vices2 7,h7 levels ( educational atta9m5t2 & 7,i7 o!r indicators z det]m9$ appropriate by ! ,secret>y4 7#b7 ,grants ,! ,secret>y1 9 collaboration ) ! ,adm9i/rator1 %all provide grants to eligible in/itutions to conduct & coord9ate rese>* on ! built environm5t & its influ5ce on individual & population-bas$ heal?4 7#c7 ,rese>* ,! ,secret>y %all support rese>* t-- 7,a7 inve/igates & def9es ! causal l9ks betwe5 all aspects ( ! built environm5t & ! heal? ( resid5ts2 7,b7 exam9es-- 7i7 ! ext5t ( ! impact ( ! built environm5t 7includ+ ! v>i\s *>act]i/ics ( ! built environm5t7 on ! heal? ( resid5ts2 7ii7 ! v>iance 9 ! heal? ( resid5ts by-- 7,i7 location 7su* z inn] cities1 inn] suburbs1 & out] suburbs72 & 7,,ii7 population subgr\p 7includ+ *ildr51 ! eld]ly1 ! disadvantag$72 or 7iii7 ! importance ( ! built environm5t to ! total heal? ( resid5ts1 :i* is ! prim>y v>iable ( int]e/ f a public heal? p]spective2 7,c7 is us$ to develop-- 7i7 measures to address heal? & ! connection ( heal? to ! built environm5t2 & 7ii7 ef=ts to l9k ! measures to travel & heal? databases2 7,d7 di/+ui%es c>efully betwe5 p]sonal attitudes & *oices & ext]nal influ5ces on obs]v$ behavior to det]m9e h[ mu* an obs]v$ association betwe5 ! built environm5t & ! heal? ( resid5ts1 v]sus ! life/yle pref]5ces ( ! p t *oose to live 9 ! neighborhood1 reflects ! physical *>act]i/ics ( ! neighborhood2 & 7,e7 7i7 id5tifies or develops effective int]v5tion /rategies to promote bett] heal? among resid5ts ) a focus on behavioral int]v5tions & enhancem5ts ( ! built environm5t t promote increas$ use by resid5ts2 & 7ii7 9 develop+ ! int]v5tion /rategies "u clause 7i71 ensures t ! int]v5tion /rategies w rea* out to high-risk populations1 includ+ racial & e?nic m9orities1 l[-income urban & rural communities1 & *ildr54 7#d7 ,priority ,9 provid+ assi/ance "u ! grant program au?oriz$ "u p>agraph 7#b71 ! ,secret>y & ! ,adm9i/rator %all give priority to rese>* t incorporates-- 7,a7 m9ority-s]v+ in/itutions z grantees2 7,b7 int]discipl9>y approa*es2 or 7,c7 ! exp]tise ( ! public heal?1 physical activity1 nutrition & heal? c>e 7includ+ *ild heal?71 urban plann+1 & transportation rese>* communities 9 ! ,unit$ ,/ates & abroad4 #ajjg4 ,environm5t & public heal? re/oration 7a7 ,f9d+s ,congress f9ds t-- 7#a7 humans %>e an environm5t ) a wide v>iety ( habitats & ecosy/ems t nurture & su/a9 a div]sity ( species2 7#b7 ! abundance ( natural res\rces 9 ! environm5t =ms ! basis = ! economy & has greatly contribut$ to human developm5t ?r\gh\t hi/ory2 7#c7 ! accel]at$ pace ( human developm5t ov] ! la/ sev]al hundr$ ye>s has significantly impact$-- 7,a7 ! natural environm5t & its res\rces2 7,b7 ! heal? & div]sity ( plant & animal life2 7,c7 ! availability ( critical habitats2 7,d7 ! quality ( ! air & wat]2 & 7,e7 ! global climate2 7#d7 ! int]v5tion ( ! ,f$]al ,gov]nm5t is necess>y to m9imize & mitigate human impact on ! environm5t-- 7,a7 = ! b5efit ( public heal?2 7,b7 to ma9ta9 air quality & wat] quality2 7,c7 to su/a9 ! div]sity ( plants & animals2 7,d7 to combat global climate *ange2 & 7,e7 to protect ! environm5t2 7#e7 laws & regulations 9 ! ,unit$ ,/ates h be5 enact$ & promulgat$ to m9imize & mitigate human impact on ! environm5t = ! b5efit ( public heal?1 to ma9ta9 air quality & wat] quality1 to su/a9 wildlife1 & to protect ! environm5t2 & 7#f7 attempts to repeal or weak5 key environm5tal safegu>ds pose dang]s to ! public heal?1 air quality1 wat] quality1 wildlife1 & ! environm5t4 7b7 ,/atem5t ( policy ,x is ! policy ( ! ,f$]al ,gov]nm5t to "w 9 conjunction ) ,/ates1 t]ritories1 ,tribal gov]nm5ts1 int]national organizations1 & =eign gov]nm5ts z a /ew>d ( ! environm5t = ! b5efit ( public heal?1 to ma9ta9 air quality & wat] quality1 to su/a9 ! div]sity ( plant & animal species1 to combat global climate *ange1 & to protect ! environm5t = future g5]ations4 7c7 ,/udy & report on public heal? or environm5tal impact ( revis$ rules1 regulations1 laws1 or o!r ag5cy decisions 7#a7 ,/udy ,n lat] ?an #cj days aft] ! date ( enactm5t ( ?is ,act1 ! ,presid5t %all seek to ent] into an arrangem5t "u :i* ! ,national ,academy ( ,sci5ces %all conduct a /udy to det]m9e ! impact on public heal?1 air quality1 wat] quality1 wildlife1 & ! environm5t ( ! foll[+ regulations1 laws1 & o!r ag5cy decisions3 7,a7 ,clean wat] 7i7 ,! f9al rule ( ! ,environm5tal ,protection ,ag5cy & ! ,corps ( ,eng9e]s entitl$ ,f9al ,revisions to ! ,clean ,wat] ,act ,regulatory ,def9itions ( ,fill ,mat]ial & ,dis*>ge ( ,fill ,mat]ial 7#fg ,f$4 ,reg4 #caabi 7,may #i1 #bjjb774 7ii7 ,! f9al rule ( ! ,environm5tal ,protection ,ag5cy entitl$ ,national ,pollutant ,dis*>ge ,elim9ation ,sy/em ,p]mit ,regulation = ,conc5trat$ ,animal ,fe$+ ,op]ations3 ,removal ( ,vacat$ ,elem5ts 9 ,response to #bjaa ,c\rt ,decision 7#gg ,f$4 ,reg4 #dddid 7,july #cj1 #bjab774 7iii7 ,! f9al rule entitl$ ,)drawal ( ,revisions to ! ,wat] ,quality ,plann+ & ,managem5t ,regulation & ,revisions to ! ,national ,pollutant ,dis*>ge ,elim9ation ,sy/em ,program 9 ,support ( ,revisions to ! ,wat] ,quality ,plann+ & ,managem5t ,regulation 7#fh ,f$4 ,reg4 #acfjh 7,m>* #ai1 #bjjc774 7iv7 ,! f9al rule ( ! ,environm5tal ,protection ,ag5cy entitl$ ,consolidat$ ,p]mit ,regulations3 ,,rcra ,haz>d\s ,wa/e2 ,,sdwa ,und]gr\nd ,injection ,control2 ,,cwa ,national ,pollutant ,dis*>ge ,elim9ation ,sy/em2 ,,cwa ,section #djd ,dr$ge or ,fill ,programs2 & ,,caa ,prev5tion ( ,significant ,det]ioration 7#de ,f$4 ,reg4 #ccbij 7,may #ai1 #aihj771 ) respect to ! def9ition ( ! wat]s ( ! ,unit$ ,/ates4 7v7 ,! f9al rule ( ! ,corps ( ,eng9e]s & ! ,environm5tal ,protection ,ag5cy entitl$ ,def9ition ( ,wat]s ( ! ,unit$ ,/ates--,recodification ( ,pre-,exi/+ ,rules 7#hd ,f$4 ,reg4 #effbf 7,octob] #bb1 #bjai774 7vi7 ,! f9al rule ( ! ,corps ( ,eng9e]s & ! ,environm5tal ,protection ,ag5cy entitl$ ,! ,navigable ,wat]s ,protection ,rule3 ,def9ition ( ,wat]s ( ! ,unit$ ,/ates 7#he ,f$4 ,reg4 #bbbej 7,april #ba1 #bjbj774 7,b7 ,=e/s & l& managem5t 7i7 ,! ,heal?y ,=e/s ,re/oration ,act ( #bjjc 7#af ,u4,s4,c4 #feja et seq474 7ii7 ,! application ( section #eec7;e7 ( title #e1 ,unit$ ,/ates ,code1 su* t a ,/ate may petition = a special rule = ! ,national ,=e/ ,sy/em inv5tori$ roadless areas )9 ! ,/ate4 7iii7 ,! f9al rules entitl$ ,national ,=e/ ,sy/em ,l& ,managem5t ,plann+ 7#gg ,f$4 ,reg4 #baafb 7,april #i1 #bjab77 & ,national ,=e/ ,sy/em ,l& ,managem5t ,plann+ 7#ha ,f$4 ,reg4 #ijgbc 7,decemb] #ae1 #bjaf774 7iv7 ,! f9al rule entitl$ ,oil ,%ale ,managem5t--,g5]al 7#gc ,f$4 ,reg4 #fidad 7,novemb] #ah1 #bjjh774 7v7 ,! record ( decision describ$ 9 ! notice ( availability entitl$ ,notice ( ,availability ( ,approv$ ,l& ,use ,plan ,am5dm5ts_/,record ( ,decision = ,allocation ( ,oil ,%ale & ,t> ,s&s ,res\rces on ,l&s ,adm9i/]$ by ! ,bureau ( ,l& ,managem5t 9 ,colorado1 ,utah1 & ,wyom+ & ,f9al ,programmatic ,environm5tal ,impact ,/atem5t 7#gh ,f$4 ,reg4 #aieah 7,april #a1 #bjac774 7,c7 ,sci5tific review ,! f9al rule entitl$ ,int]ag5cy ,coop]ation ,"u ! ,endang]$ ,species ,act 7#gc ,f$4 ,reg4 #gfbgb 7,decemb] #af1 #bjjh771 z am5d$ by ! f9al rule entitl$ ,endang]$ & ,?reat5$ ,wildlife & ,plants2 ,regulations = ,int]ag5cy ,coop]ation 7#hd ,f$4 ,reg4 #ddigf 7,augu/ #bg1 #bjai774 7#b7 ,me?od ,9 conduct+ ! /udy "u p>agraph 7#a71 ! ,national ,academy ( ,sci5ces may use & comp>e exi/+ sci5tific /udies reg>d+ ! regulations1 laws1 & o!r ag5cy decisions describ$ 9 p>agraph 7#a74 7#c7 ,report ,n lat] ?an #bgj days aft] ! date on :i* ! ,presid5t ent]s into ! arrangem5t "u p>agraph 7#a71 ! ,national ,academy ( ,sci5ces %all make publicly available & %all submit to ,congress & to ! head ( ea* dep>tm5t & ag5cy ( ! ,f$]al ,gov]nm5t t issu$1 implem5ts1 or w\ld implem5t a regulation1 law1 or o!r ag5cy decision describ$ 9 p>agraph 7#a71 a report t includes-- 7,a7 a description ( ! impact ( ea* regulation1 law1 or o!r ag5cy decision describ$ 9 p>agraph 7#a7 on public heal?1 air quality1 wat] quality1 wildlife1 & ! environm5t1 comp>$ to ! impact ( preexi/+ regulations1 laws1 or o!r ag5cy decisions 9 effect1 z applicable1 includ+-- 7i7 any negative impacts to air quality or wat] quality2 7ii7 any negative impacts to wildlife2 7iii7 any delays 9 haz>d\s wa/e cleanup t are project$ to be haz>d\s to public heal?2 & 7iv7 any o!r negative impact on public heal? or ! environm5t2 & 7,b7 any recomm5dations t ! ,national ,academy ( ,sci5ces consid]s appropriate to ma9ta91 re/ore1 or improve 9 :ole or 9 "p protections = public heal?1 air quality1 wat] quality1 wildlife1 & ! environm5t = ea* ( ! regulations1 laws1 & o!r ag5cy decisions describ$ 9 p>agraph 7#a71 :i* may include recomm5dations = ! adoption ( any regulation or law 9 place or propos$ prior to ,janu>y #a1 #bjja4 7d7 ,dep>tm5t & ag5cy revision ( exi/+ rules1 regulations1 or laws ,n lat] ?an #ahj days aft] ! date on :i* ! report is submitt$ pursuant to subsection 7c77#c71 ! head ( ea* dep>tm5t or ag5cy t has issu$ or implem5t$ a regulation1 law1 or o!r ag5cy decision describ$ 9 subsection 7c77#a7 %all submit to ,congress a plan describ+ ! /eps ! dep>tm5t or ag5cy w take1 or has tak51 to re/ore or improve protections = public heal? & ! environm5t 9 :ole or 9 "p t 7 9 exi/5ce prior to ! issuance ( ! applicable regulation1 law1 or o!r ag5cy decision4 #ajjh4 ,,gao report on heal? effects ( ,deepwat] ,horizon oil rig explosion 9 ! ,gulf ,coa/ 7a7 ,/udy ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all conduct a /udy on ! type & scope ( heal? c>e s]vices adm9i/]$ ?r\gh ! ,dep>tm5t ( ,heal? & ,human ,s]vices address+ ! provision ( heal? c>e to racial & e?nic m9orities1 includ+ resid5ts1 cleanup work]s1 & volunte]s1 affect$ by ! bl[\t & explosion ( ! mobile (f%ore drill+ unit ,deepwat] ,horizon t occurr$ on ,april #bj1 #bjaj1 & result+ hydroc>bon releases into ! environm5t4 7b7 ,specific compon5ts ,9 c>ry+ out subsection 7a71 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all-- 7#a7 assess ! type1 size1 & scope ( programs adm9i/]$ by ! ,secret>y ( ,heal? & ,human ,s]vices t focus on ! provision ( heal? c>e to communities on ! ,gulf ,coa/2 7#b7 id5tify ! m]its & disadvantages associat$ ) ea* ( ! programs2 7#c7 p]=m an analysis ( ! co/s & b5efits ( ! programs2 & 7#d7 det]m9e :e!r !re is any duplication ( programs4 7c7 ,report ,n lat] ?an #ahj days aft] ! date ( enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report t includes-- 7#a7 ! f9d+s ( ! /udy conduct$ "u subsection 7a72 & 7#b7 recomm5dations = improv+ access to heal? c>e = racial & e?nic m9orities4 #ajji4 ,e/abli% an int]ag5cy c\nsel & grant programs on social det]m9ants ( heal? 7a7 ,%ort title ,?is section may be cit$ z ! ,social ,det]m9ants ,accel]ator ,act ( #bjbj4 7b7 ,f9d+s2 purposes 7#a7 ,f9d+s ,congress f9ds ! foll[+3 7,a7 ,!re is a significant body ( evid5ce %[+ t economic & social conditions h a p[]ful impact on individual & population heal? outcomes & well-be+1 z well z m$ical co/s4 7,b7 ,/ate1 local1 & ,tribal gov]nm5ts & ! s]vice deliv]y p>tn]s ( su* gov]nm5ts face significant *all5ges 9 coord9at+ b5efits & s]vices deliv]$ ?r\gh ! ,m$icaid program & o!r social s]vices programs because ( ! fragm5t$ & complex nature ( ,f$]al & ,/ate fund+ & adm9i/rative requirem5ts4 7,c7 ,! ,f$]al ,gov]nm5t %\ld prioritize & proactively assi/ ,/ate & local gov]nm5ts to /r5g!n ! capacity ( ,/ate & local gov]nm5ts to improve heal? & social outcomes = individuals1 !reby improv+ co/-effectiv5ess & return on inve/m5t4 7#b7 ,purposes ,! purposes ( ?is section are z foll[s3 7,a7 ,to e/abli% effective1 coord9at$ ,f$]al te*nical assi/ance to help ,/ate & local gov]nm5ts to improve outcomes & co/-effectiv5ess (1 & return on inve/m5t f1 heal? & social s]vices programs4 7,b7 ,to build a pipel9e ( ,/ate & locally design$1 cross-sector int]v5tions & /rategies t g5]ate rigor\s evid5ce ab\t h[ to improve heal? & social outcomes1 & increase ! co/-effectiv5ess (1 & return on inve/m5t f1 ,f$]al1 ,/ate1 local1 & ,tribal heal? & social s]vices programs4 7,c7 ,to enli/ ,/ate & local gov]nm5ts & ! s]vice provid]s ( su* gov]nm5ts z p>tn]s 9 id5tify+ ,f$]al /atutory1 regulatory1 & adm9i/rative *all5ges 9 improv+ ! heal? & social outcomes (1 co/-effectiv5ess (1 & return on inve/m5t f1 ,f$]al sp5d+ on individuals enroll$ 9 ,m$icaid4 7,d7 ,to develop /rategies to improve heal? & social outcomes )\t d5y+ s]vices to1 or re/rict+ ! eligibility (1 vuln]able populations4 7c7 ,social det]m9ants accel]ator c\ncil 7#a7 ,e/abli%m5t ,! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is section z ! ,secret>y71 9 coord9ation ) ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 7ref]r$ to 9 ?is section z ! ,adm9i/rator71 %all e/abli% an int]ag5cy c\ncil1 to be kn[n z ! ,social ,det]m9ants ,accel]ator ,int]ag5cy ,c\ncil 7ref]r$ to 9 ?is section z ! ,c\ncil7 to a*ieve ! purposes li/$ 9 subsection 7b77#b74 7#b7 ,memb]%ip 7,a7 ,f$]al composition ,! ,c\ncil %all be compos$ ( at lea/ "o designee f ea* ( ! foll[+ ,f$]al ag5cies3 7i7 ,! ,(fice ( ,managem5t & ,budget4 7ii7 ,! ,dep>tm5t ( ,agriculture4 7iii7 ,! ,dep>tm5t ( ,education4 7iv7 ,! ,indian ,heal? ,s]vice4 7v7 ,! ,dep>tm5t ( ,h\s+ & ,urban ,developm5t4 7vi7 ,! ,dep>tm5t ( ,labor4 7vii7 ,! ,dep>tm5t ( ,transportation4 7viii7 ,any o!r ,f$]al ag5cy ! ,*air ( ! ,c\ncil det]m9es necess>y4 7,b7 ,designation 7i7 ,9 g5]al ,! head ( ea* ag5cy specifi$ 9 subp>agraph 7,a7 %all designate at lea/ "o employee to s]ve z a memb] ( ! ,c\ncil4 7ii7 ,responsibilities ,an employee describ$ 9 ?is clause %all be a s5ior employee ( ! ag5cy-- 7,i7 ^: responsibilities relate to au?orities1 policies1 & proc$ures ) respect to ! heal? & well-be+ ( individuals receiv+ m$ical assi/ance "u a ,/ate plan 7or a waiv] ( su* plan7 "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq472 or 7,,ii7 :o has au?ority to implem5t & evaluate trans=mative initiatives t h>ness data or conducts rigor\s evaluation to improve ! impact & co/-effectiv5ess ( f$]ally fund$ s]vices & b5efits4 7,c7 ,,hhs repres5tation ,9 addition to ! designees "u subp>agraph 7,a71 ! ,c\ncil %all include designees f at lea/ #c ag5cies )9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 includ+ ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 at lea/ "o ( :om %all meet ! crit]ia "u ?is section4 7,d7 ,,omb role ,! ,director ( ! ,(fice ( ,managem5t & ,budget %all facilitate ! timely resolution ( ,f$]al ,gov]nm5t-wide & multiag5cy issues to help ! ,c\ncil a*ieve cons5sus recomm5dations describ$ "u ?is section4 7,e7 ,non-,f$]al composition ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates may designate up to #f ,c\ncil designees-- 7i7 :o h relevant subject matt] exp]tise1 includ+ exp]tise implem5t+ & evaluat+ trans=mative initiatives t h>ness data & conduct evaluations to improve ! impact & co/-effectiv5ess ( ,f$]al ,gov]nm5t s]vices2 & 7ii7 t ea* repres5t-- 7,i7 ,/ate1 local1 & ,tribal heal? & human s]vices ag5cies2 7,,ii7 public h\s+ au?orities or ,/ate h\s+ f9ance ag5cies2 7,,iii7 ,/ate & local gov]nm5t budget (fices2 7,,iv7 ,/ate ,m$icaid ag5cies2 or 7,v7 national consum] advocacy organizations4 7,f7 ,*air 7i7 ,9 g5]al ,! ,secret>y %all select ! ,*air ( ! ,c\ncil f among ! memb]s ( ! ,c\ncil4 7ii7 ,initiat+ guidance ,! ,*air1 on behalf ( ! ,c\ncil1 %all id5tify & invite individuals f div]se entities to provide ! ,c\ncil ) advice & in=mation p]ta9+ to address+ social det]m9ants ( heal?1 includ+-- 7,i7 individuals f ,/ate & local gov]nm5t heal? & human s]vices ag5cies2 7,,ii7 individuals f ,/ate ,m$icaid ag5cies2 7,,iii7 individuals f ,/ate & local gov]nm5t budget (fices2 7,,iv7 individuals f public h\s+ au?orities or ,/ate h\s+ f9ance ag5cies2 7,v7 individuals f nonpr(it organizations1 small bus9esses1 & philan?ropic organizations2 7,,vi7 advocates2 7,,vii7 rese>*]s2 & 7,,viii7 any o!r individuals ! ,*air det]m9es to be appropriate4 7#c7 ,duties ,! duties ( ! ,c\ncil are-- 7,a7 to make recomm5dations to ! ,secret>y & ! ,adm9i/rator reg>d+ ! crit]ia = mak+ aw>ds "u ?is section2 7,b7 to id5tify ,f$]al au?orities & opportunities = use by ,/ates or local gov]nm5ts to improve coord9ation ( fund+ & adm9i/ration ( ,f$]al programs1 ! b5efici>ies ( :om include individuals1 & :i* may be unkn[n or und]utiliz$ & to make in=mation on su* au?orities & opportunities publicly available2 7,c7 to provide t>get$ te*nical assi/ance to ,/ates develop+ a social det]m9ants accel]ator plan "u ?is section1 includ+ id5tify+ pot5tial /atutory or regulatory pa?ways = implem5tation ( ! plan & assi/+ 9 id5tify+ pot5tial s\rces ( fund+ to implem5t ! plan2 7,d7 to report to ,congress annually on ! subjects set =? 9 ?is section2 7,e7 to develop & dissem9ate evaluation guidel9es & /&>ds t c be us$ to reliably assess ! impact ( an int]v5tion or approa* t may be implem5t$ pursuant to ?is section on outcomes1 co/-effectiv5ess (1 & return on inve/m5t f ,f$]al1 ,/ate1 local1 & ,tribal gov]nm5ts1 & to facilitate te*nical assi/ance1 :]e ne$$1 to help to improve ,/ate & local evaluation designs & implem5tation2 7,f7 to seek fe$back f ,/ate1 local1 & ,tribal gov]nm5ts1 includ+ ?r\gh an annual survey by an indep5d5t ?ird p>ty1 on h[ to improve ! te*nical assi/ance ! ,c\ncil provides to bett] equip ,/ate1 local1 & ,tribal gov]nm5ts to coord9ate heal? & social s]vice programs2 7,g7 to solicit applications = grants "u ?is section2 & 7,h7 to coord9ate ) o!r cross-ag5cy initiatives focus$ on improv+ ! heal? & well-be+ ( l[-income & at-risk populations 9 ord] to prev5t unnecess>y duplication betwe5 ag5cy initiatives4 7#d7 ,s*$ule ,n lat] ?an #fj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,c\ncil %all conv5e to develop a s*$ule & plan = c>ry+ out ! duties describ$ 9 ?is section1 includ+ solicitation ( applications = ! grants "u ?is section4 7#e7 ,report to ,congress ,! ,c\ncil %all submit an annual report to ,congress1 :i* %all include-- 7,a7 a li/ ( ! ,c\ncil memb]s2 7,b7 activities & exp5ditures ( ! ,c\ncil2 7,c7 summ>ies ( ! int]v5tions & approa*es t w be support$ by ,/ate1 local1 & ,tribal gov]nm5ts t receiv$ a grant "u ?is section1 includ+-- 7i7 ! be/ practices & evid5ce-bas$ approa*es su* gov]nm5ts plan to employ to a*ieve ! purposes li/$ 9 ?is section2 & 7ii7 a description ( h[ ! practices & approa*es w impact ! outcomes1 co/-effectiv5ess (1 & return on inve/m5t f1 ,f$]al1 ,/ate1 local1 & ,tribal gov]nm5ts ) respect to su* purposes2 7,d7 ! fe$back receiv$ f ,/ate & local gov]nm5ts on ways to improve ! te*nical assi/ance ( ! ,c\ncil1 includ+ f9d+s f a ?ird-p>ty survey & actions ! ,c\ncil plans to take 9 response to su* fe$back2 & 7,e7 ! major /atutory1 regulatory1 & adm9i/rative *all5ges id5tifi$ by ,/ate1 local1 & ,tribal gov]nm5ts t receiv$ a grant "u subsection 7d71 & ! actions t ,f$]al ag5cies are tak+ to address su* *all5ges4 7#f7 ,,faca applicability ,! ,f$]al ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 %all n apply to ! ,c\ncil4 7#g7 ,c\ncil proc$ures ,! ,secret>y1 9 consultation ) ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates & ! ,director ( ! ,(fice ( ,managem5t & ,budget1 %all e/abli% proc$ures = ! ,c\ncil to-- 7,a7 ensure t adequate res\rces are available to effectively execute ! responsibilities ( ! ,c\ncil2 7,b7 effectively coord9ate ) o!r relevant advisory bodies & work+ gr\ps to avoid unnecess>y duplication2 7,c7 create transp>5cy to ! public & ,congress ) reg>d to ,c\ncil memb]%ip1 co/s1 & activities1 includ+ ?r\gh use ( mod]n te*nology & social m$ia to dissem9ate in=mation2 & 7,d7 avoid conflicts ( int]e/ t w\ld jeop>dize ! ability ( ! ,c\ncil to make decisions & provide recomm5dations4 7d7 ,social det]m9ants accel]ator grants to ,/ates or local gov]nm5ts 7#a7 ,grants to ,/ates1 local gov]nm5ts1 & tribes ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,adm9i/rator1 9 consultation ) ! ,secret>y & ! ,c\ncil1 %all aw>d on a competitive basis n m ?an #be grants to eligible applicants describ$ 9 ?is subsection1 = ! developm5t ( social det]m9ants accel]ator plans1 z describ$ 9 ?is subsection4 7#b7 ,eligible applicant ,an eligible applicant describ$ 9 ?is subsection is a ,/ate1 local1 or ,tribal heal? or human s]vices ag5cy t-- 7,a7 demon/rates ! support ( relevant p>ties across relevant ,/ate1 local1 or ,tribal jurisdictions2 & 7,b7 9 ! case ( an applicant t is a local gov]nm5t ag5cy1 provides to ! ,secret>y a lett] ( support f ! lead ,/ate heal? or human s]vices ag5cy = ! ,/ate 9 :i* ! local gov]nm5t is locat$4 7#c7 ,am\nt ( grant ,! ,adm9i/rator1 9 coord9ation ) ! ,c\ncil1 %all det]m9e ! total am\nt t ! ,adm9i/rator w make available to ea* grantee "u ?is subsection4 7#d7 ,application ,an eligible applicant seek+ a grant "u ?is subsection %all include 9 ! application ! foll[+ in=mation3 7,a7 ,! t>get population 7or populations7 t w\ld b5efit f implem5tation ( ! social det]m9ants accel]ator plan propos$ to be develop$ by ! applicant4 7,b7 ,a description ( ! objective or objectives & outcome goals ( su* propos$ plan1 :i* %all include at lea/ "o heal? outcome & at lea/ "o o!r important social outcome4 7,c7 ,! s\rces & scope ( ineffici5cies t1 if address$ by ! plan1 c\ld result 9 improv$ co/-effectiv5ess ( or return on inve/m5t f ,f$]al1 ,/ate1 local1 & ,tribal gov]nm5ts4 7,d7 ,a description ( pot5tial int]v5tions t c\ld be design$ or enabl$ us+ su* propos$ plan4 7,e7 ,! ,/ate1 local1 ,tribal1 academic1 nonpr(it1 community-bas$ organizations1 & o!r private sector p>tn]s t w\ld p>ticipate 9 ! developm5t ( ! propos$ plan & subsequ5t implem5tation ( programs or initiatives includ$ 9 su* propos$ plan4 7,f7 ,su* o!r in=mation z ! ,adm9i/rator1 9 consultation ) ! ,secret>y & ! ,c\ncil1 det]m9es necess>y to a*ieve ! purposes ( ?is section4 7#e7 ,use ( funds ,a recipi5t ( a grant "u ?is subsection may use funds receiv$ ?r\gh ! grant = ! foll[+ purposes3 7,a7 ,to conv5e & coord9ate ) relevant gov]nm5t entities & o!r /akehold]s across sectors to assi/ 9 ! developm5t ( a social det]m9ant accel]ator plan4 7,b7 ,to id5tify populations ( individuals receiv+ m$ical assi/ance "u a ,/ate plan 7or a waiv] ( su* plan7 "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 :o may b5efit f ! propos$ approa*es to improv+ ! heal? & well-be+ ( su* individuals ?r\gh ! implem5tation ( ! propos$ social det]m9ants accel]ator plan4 7,c7 ,to engage qualifi$ rese>* exp]ts to advise on relevant rese>* & to design a propos$ evaluation plan1 9 accordance ) ! /&>ds & guidel9es issu$ by ! ,adm9i/rator4 7,d7 ,to collaborate ) ! ,c\ncil to support ! developm5t ( social det]m9ants accel]ator plans4 7,e7 ,to prep>e & submit a f9al social det]m9ants accel]ator plan to ! ,c\ncil4 7#f7 ,cont5ts ( plans ,a social det]m9ant accel]ator plan develop$ "u ?is subsection %all include ! foll[+3 7,a7 ,a description ( ! t>get population 7or populations7 t w\ld b5efit f implem5tation ( ! social det]m9ants accel]ator plan1 includ+ an analysis describ+ ! project$ impact on ! well-be+ ( individuals describ$ 9 p>agraph 7#e77;,b74 7,b7 ,a description ( ! int]v5tions or approa*es design$ "u ! social det]m9ants accel]ator plan & ! evid5ce = select+ su* int]v5tions or approa*es4 7,c7 ,! objectives & outcome goals ( su* int]v5tions or approa*es1 includ+ at lea/ "o heal? outcome & at lea/ "o o!r important social outcome4 7,d7 ,a plan = access+ & l9k+ relevant data to enable coord9at$ b5efits & s]vices = ! jurisdictions describ$ 9 ?is section & an evaluation ( ! propos$ int]v5tions & approa*es4 7,e7 ,a description ( ! ,/ate1 local1 ,tribal1 academic1 nonpr(it1 or community-bas$ organizations1 or any o!r private sector organizations t w\ld p>ticipate 9 implem5t+ ! propos$ int]v5tions or approa*es1 & ! role ea* w\ld play to contribute to ! success ( ! propos$ int]v5tions or approa*es4 7,f7 ,! id5tification ( ! fund+ s\rces t w\ld be us$ to f9ance ! propos$ int]v5tions or approa*es4 7,g7 ,a description ( any f9ancial inc5tives t may be provid$1 includ+ outcome-focus$ contract+ approa*es to enc\rage s]vice provid]s & o!r p>tn]s to improve outcomes (1 co/-effectiv5ess (1 & return on inve/m5t f1 ,f$]al1 ,/ate1 local1 or ,tribal gov]nm5t sp5d+4 7,h7 ,! id5tification ( ! applicable ,f$]al1 ,/ate1 local1 or ,tribal /atutory & regulatory au?orities1 includ+ waiv] au?orities1 to be lev]ag$ to implem5t ! propos$ int]v5tions or approa*es4 7,i7 ,a description ( pot5tial consid]ations t w\ld enhance ! impact1 scalability1 or su/a9ability ( ! propos$ int]v5tions or approa*es & ! actions ! grant aw>dee w\ld take to address su* consid]ations4 7,j7 ,a propos$ evaluation plan1 to be c>ri$ out by an indep5d5t evaluator1 to measure ! impact ( ! propos$ int]v5tions or approa*es on ! outcomes (1 co/-effectiv5ess (1 & return on inve/m5t f1 ,f$]al1 ,/ate1 local1 & ,tribal gov]nm5ts4 7,k7 ,precautions = ensur+ t vuln]able populations w n be d5i$ access to ,m$icaid or o!r ess5tial s]vices z a result ( implem5t+ ! propos$ plan4 7e7 ,fund+ 7#a7 ,9 g5]al ,out ( any money 9 ! ,treasury n o!rwise appropriat$1 !re is appropriat$ to c>ry out ?is section #be1jjj1jjj to rema9 available = obligation until ! date t is #e ye>s aft] ! date ( enactm5t ( ?is section4 7#b7 ,res]vation ( funds 7,a7 ,9 g5]al ,( ! funds made available "u p>agraph 7#a71 ! ,secret>y %all res]ve n less ?an #bj p]c5t to aw>d grants to eligible applicants = ! developm5t ( social det]m9ants accel]ator plans "u ?is section int5d$ to s]ve rural populations4 7,b7 ,exception ,9 ! case ( a fiscal ye> = :i* ! ,secret>y det]m9es t !re are n suffici5t eligible applicants to aw>d up to #be grants "u subsection 7d7 t are int5d$ to s]ve rural populations & ! ,secret>y _c satisfy ! #bj-p]c5t requirem5t1 ! ,secret>y may res]ve an am\nt t is less ?an #bj p]c5t ( am\nts made available "u p>agraph 7#a7 to aw>d grants = su* purpose4 7#c7 ,rule ( con/ruction ,no?+ 9 ?is section %all prev5t ,f$]al ag5cies repres5t$ on ! ,c\ncil f contribut+ additional fund+ f o!r s\rces to support activities to improve ! effectiv5ess ( ! ,c\ncil4 #ajaj4 ,correct+ hurtful & ali5at+ names 9 gov]nm5t expression 7,,*ange7 7a7 ,%ort title ,?is section may be cit$ z ! ,correct+ ,hurtful & ,ali5at+ ,names 9 ,gov]nm5t ,expression 7,,*ange7 ,act4 7b7 ,def9itions ,9 ?is section3 7#a7 ,employee ,! t]m employee has ! mean+ giv5 ! t]m 9 section #baje ( title #e1 ,unit$ ,/ates ,code4 7#b7 ,executive ag5cy ,! t]m ,executive ag5cy has ! mean+ giv5 ! t]m 9 section #aje ( title #e1 ,unit$ ,/ates ,code4 7#c7 ,(fic] ,! t]m (fic] has ! mean+ giv5 ! t]m 9 section #bajd ( title #e1 ,unit$ ,/ates ,code4 7#d7 ,prohibit$ t]m ,! t]m prohibit$ t]m means-- 7,a7 ! t]m ali51 :5 us$ to ref] to an individual :o is n a citiz5 or national ( ! ,unit$ ,/ates2 & 7,b7 ! t]m illegal ali51 :5 us$ to ref] to an individual :o-- 7i7 is unlawfully pres5t 9 ! ,unit$ ,/ates2 or 7ii7 lacks a lawful immigration /atus 9 ! ,unit$ ,/ates4 7c7 ,mod]nization ( language ref]r+ to individuals :o are n citiz5s or nationals ( ! ,unit$ ,/ates 7#a7 ,9 g5]al ,except z provid$ 9 p>agraph 7#b71 on & aft] ! date ( enactm5t ( ?is ,act1 an ,executive ag5cy may n use a prohibit$ t]m 9 any propos$ or f9al rule1 regulation1 int]pretation1 publication1 o!r docum5t1 display1 or sign issu$ by ! ,executive ag5cy4 7#b7 ,exception ,an ,executive ag5cy may use a prohibit$ t]m "u p>agraph 7#a7 if ! ,executive ag5cy uses ! prohibit$ t]m :ile quot+ or reproduc+ text writt5 by a s\rce t is n an (fic] or employee ( ! ,executive ag5cy4 7d7 ,uni=m def9ition 7#a7 ,9 g5]al ,*apt] #a ( title #a1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+3 #i4 ,def9ition ( =eign national ,9 det]m9+ ! mean+ ( any ,act ( ,congress or any rul+1 regulation1 or int]pretation ( an adm9i/rative bureau or ag5cy ( ! ,unit$ ,/ates1 ! t]m =eign national means any individual t is n an individual :o-- 7#a7 is a citiz5 ( ! ,unit$ ,/ates2 or 7#b7 ?\gh n a citiz5 ( ! ,unit$ ,/ates1 owes p]man5t allegiance to ! ,unit$ ,/ates4 4 7#b7 ,te*nical am5dm5t ,! table ( sections = *apt] #a ( title #a1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+3 #i4 ,def9ition ( =eign national4 4 7e7 ,ref]5ces 7#a7 ,9 g5]al ,any ref]5ce 9 any ,f$]al /atute1 rule1 regulation1 ,executive ord]1 publication1 or o!r docum5t ( ! ,unit$ ,/ates-- 7,a7 to ! t]m ali51 :5 us$ to ref] to an individual :o is n a citiz5 or national ( ! ,unit$ ,/ates1 is deem$ to ref] to ! t]m =eign national2 & 7,b7 to ! t]m illegal ali5 is deem$ to ref] to ! t]m undocum5t$ =eign national1 :5 us$ to ref] to an individual :o-- 7i7 is unlawfully pres5t 9 ! ,unit$ ,/ates2 or 7ii7 lacks a lawful immigration /atus 9 ! ,unit$ ,/ates4 7#b7 ,con=m+ am5dm5ts 7,a7 ,section #dba7e77;,a77ii77,,ii7 ( ! ,congressional ,budget & ,imp\ndm5t ,control ,act ( #aigd 7#b ,u4,s4,c4 #feh7e77;,a77ii77,,ii77 is am5d$-- 7i7 by /rik+ illegal1 deportable1 & excludable ali5s & ins]t+ undocum5t$ =eign nationals & deportable & excludable =eign nationals2 & 7ii7 by /rik+ illegal ali5s ea* place x appe>s & ins]t+ undocum5t$ =eign nationals4 7,b7 ,section #dcb7;e7 ( ! ,homel& ,security ,act ( #bjjb 7#f ,u4,s4,c4 #bdj7;e77 is am5d$ by /rik+ illegal ali5 & ins]t+ undocum5t$ =eign national4 7,c7 ,section #dci ( ! ,antit]rorism & ,effective ,dea? ,p5alty ,act ( #aiif 7#h ,u4,s4,c4 #abeb;c7 is am5d$ 9 ! section head+ by /rik+ illegal ali5s & ins]t+ undocum5t$ =eign nationals4 7,d7 ,section #bhj7;b77#c77;,a77iii7 ( ! ,immigration & ,nationality ,act 7#h ,u4,s4,c4 #accj7;b77#c77;,a77iii77 is am5d$ by /rik+ illegal ali5s & ins]t+ undocum5t$ =eign nationals4 7,e7 ,section #bhf7r77#c77;ii7 ( ! ,immigration & ,nationality ,act 7#h ,u4,s4,c4 #acef7r77#c77;ii77 is am5d$ by /rik+ illegal ali5s & ins]t+ undocum5t$ =eign nationals4 7,f7 ,title ,v ( ! ,immigration ,re=m & ,control ,act ( #aihf 7,public ,law #ii-fjc2 #ajj ,/at4 #cddc7 is am5d$-- 7i7 9 ! title head+1 by /rik+ illegal ali5s & ins]t+ undocum5t$ =eign nationals2 & 7ii7 9 section #eja 7#h ,u4,s4,c4 #acfe7-- 7,i7 9 ! section head+1 by /rik+ illegal ali5s & ins]t+ undocum5t$ =eign nationals2 7,,ii7 9 subsection 7b71 9 ! subsection head+1 by /rik+ ,illegal ali5s & ins]t+ ,undocum5t$ =eign nationals2 & 7,,iii7 by /rik+ illegal ali5 ea* place su* t]m appe>s & ins]t+ undocum5t$ =eign national4 7,g7 ,section #ccb ( ! ,omnibus ,consolidat$ ,appropriations ,act1 #aiig 7#h ,u4,s4,c4 #acff7 is am5d$ by /rik+ illegal ali5s ea* place x appe>s & ins]t+ undocum5t$ =eign nationals4 7,h7 ,section #daa7;d7 ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#h ,u4,s4,c4 #afba7;d77 is am5d$ 9 ! subsection head+ by /rik+ illegal ali5s & ins]t+ undocum5t$ =eign nationals4 7,i7 ,section #djabe7;a77#b7 ( title #di1 ,unit$ ,/ates ,code1 is am5d$ by /rik+ illegal ali5s & ins]t+ undocum5t$ =eign nationals4 ,b ,gun ,viol5ce #ajaa4 ,f9d+s ,congress f9ds z foll[s3 7#a7 ,on av]age1 #hf ,am]icans are kill$ by guns ea* day4 7#b7 ,an e/imat$ #ci1ggc p 7 kill$ by guns 9 #bjag1 ( :i* two-?irds committ$ suicide4 7#c7 ,gun viol5ce disproportionately affects communities ( color1 especially ,african ,am]icans 7:o comprise ar\nd #ad p]c5t ( ! ,unit$ ,/ates population b acc\nt = m ?an half ! c\ntry's gun homicide victims74 7#d7 ,on av]age1 !re is m ?an "o mass %oot+ ea* day 9 ! ,unit$ ,/ates4 #ajab4 ,reaffirm+ rese>* au?ority ( ! ,c5t]s = ,disease ,control & ,prev5tion 7a7 ,9 g5]al ,section #cia ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhj;b7 is am5d$-- 7#a7 9 subsection 7a77#a71 by /rik+ rese>* relat+ to ! causes1 me*anisms1 prev5tion1 diagnosis1 treatm5t ( injuries1 & rehabilitation f injuries2 & ins]t+ ! foll[+3 rese>*1 includ+ data collection1 relat+ to-- 7,a7 ! causes1 me*anisms1 prev5tion1 diagnosis1 & treatm5t ( injuries1 includ+ ) respect to gun viol5ce2 & 7,b7 rehabilitation f su* injuries2 2 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7c7 ,no advocacy or promotion ( gun control ,no?+ 9 ?is section %all be con/ru$ to-- 7#a7 au?orize ! ,secret>y to give assi/ance1 make grants1 or ent] into coop]ative agreem5ts or contracts = ! purpose ( advocat+ or promot+ gun control2 or 7#b7 p]mit a recipi5t ( any assi/ance1 grant1 coop]ative agreem5t1 or contract "u ?is section to use su* assi/ance1 grant1 agreem5t1 or contract = ! purpose ( advocat+ or promot+ gun control4 4 #ajac4 ,national ,viol5t ,dea? ,report+ ,sy/em ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all improve1 p>ticul>ly ?r\gh ! inclusion ( additional ,/ates1 ! ,national ,viol5t ,dea? ,report+ ,sy/em1 z au?oriz$ by sections #cja7;a7 & #cia7;a7 ( ! ,public ,s]vice ,heal? ,act 7#db ,u4,s4,c4 #bda7;a71 #bhj7;b774 ,p>ticipation 9 ! sy/em by ! ,/ates %all be volunt>y4 #ajad4 ,report on effects ( gun viol5ce on public heal? ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 & annually !reaft]1 ! ,surgeon ,g5]al %all submit to ,congress a report on ! effects on public heal?1 includ+ m5tal heal?1 ( gun viol5ce 9 ! ,unit$ ,/ates dur+ ! prec$+ ye>1 & ! /atus ( actions tak5 to address su* effects4 #ajae4 ,report on effects ( gun viol5ce on m5tal heal? 9 m9ority communities ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal? 9 ! ,(fice ( ! ,secret>y ( ,heal? & ,human ,s]vices %all submit to ! ,congress a report on ! effects ( gun viol5ce on public heal?1 includ+ m5tal heal?1 9 m9ority communities 9 ! ,unit$ ,/ates1 & ! /atus ( actions tak5 to address su* effects4